Aim

To review the patients that have undergone correction of a symptomatic femoral malunion using osteotomy combined with decortication.

We reviewed patients that have undergone correction of a symptomatic femoral malunion using osteotomy combined with decortication by retrospective reviewing all patients who have undergone the procedure, looking at the pre-operative deformity, correction achieved, time to union and complications.

Seven patients underwent correction under the senior author from 2003 to today. Average age was 46 years (range 32–60 years). All had femoral shortening, average 2.7cm (range 2–4 cm). Each also had at least one other plane of deformity with rotation being the next most commonly encountered in 5 out of the 7 (average 33 degrees). 2 had tri-planar deformity with the 5 having bi-planar deformity. Average time to union was 18.4 months (range 7 to 39 months) with an average of 1.6 operations (range 1 to 3 operations) to union. Two patients are awaiting union, 1 has required repeat plating and one is a primary fixation and correction awaiting union.

Correction of multiplanar deformity of the femur is challenging. Osteotomy with decortication provides a technique to achieve correction of significant femoral deformity union achieving full multi-planar deformity correction in a single operation. This paper provides guidance and a technical description of the operative technique.

Background

There is increasing interest in the use of Total Hip Replacement (THR) for reconstruction in patients who have suffered displaced intracapsular hip fractures. Patient selection is important for good outcomes but criteria have only recently been clearly defined in the form of national guidelines. This study aims to investigate patient reported outcomes and satisfaction after Total Hip Replacement (THR) undertaken for displaced hip fractures and to compare these with a matched cohort of patients undergoing contemporaneous THR for osteoarthritis in order to assess the safety and effectiveness of national clinical guidelines.

Military patients have high functional requirements of the upper limb and may have lower pre-operative PROM scores than civilian patients i.e. their function is high when benchmarked, but still insufficient to perform their military role thereby mandating surgery.

Our aim was to compare the pre-operative Oxford Shoulder Instability Scores in military and civilian patients undergoing shoulder stabilisation surgery.

We undertook a prospective, blinded cohort-controlled study (OCEBM Level 3b). The null hypothesis was that there was no difference in the Oxford Shoulder Instability Scores between military and civilian groups. A power calculation showed that 40 patients were required in each group to give 95% power with 5% significance. A clinical database (iParrot, ByResults Ltd., Oxford, UK) was interrogated for consecutive patients undergoing shoulder stabilisation surgery at a single centre. The senior author - blinded to the outcome score - matched patients according to age, gender and diagnosis. Statistical analysis showed the data to be normally distributed so a paired samples t-test was used to compare the two groups.

110 patients were required to provide a matched cohort of 80 patients. There were 70 males and 10 females. Age at the time of surgery was 16–19 yrs (n=6); 20–24yrs (n=28); 25–29 (n=16); 30–34 (n=12); 35–39 (n=12); 40–44 (n=6). 72 patients (90%) had polar group one and 8 patients (10%) had polar group two instability. The mean Oxford Shoulder Instability Score in the civilian group was 17 and the in military group was 18. There was no statistical difference between the two groups (p=0.395).

This study supports the use the Oxford Shoulder Instability Score to assess military patients with shoulder instability.

Skills simulation is increasingly used as a training tool in postgraduate surgical training. Trainee's perception of the value of this experience has not previously been investigated.

Our aim was to investigate the value of surgical simulation training delivered by an arthroscopy skills course.

We constructed a subject-specific, self-assessment questionnaire based around the ISCP Peer Assessment Tool. The questionnaire was administered to candidates before and after attending the Plymouth Arthroscopy Skills Course. Participant demographic data was recorded. Questionnaire data was interrogated to give an overview of the course, as well as the benefit of site-specific skills stations. Statistical analysis showed the data to be normally distributed. The paired T-test was used to compare mean values.

Twelve surgical trainees attended the course – CT2 trainees (n=4); ST3 trainees (n=7); ST4 trainee (n=1). 11 candidates completed both administered questionnaires giving a 92% response rate. The global mean score at the beginning of the course was 2.39. The global mean score at the end of the course was 3.90. The mean improvement was 1.51 (p<0.01; 95% CI = 0.96–2.07). Skill station specific scores all showed improvement with the greatest effect in wrist arthroscopy.

CT trainees had a lower mean score compared to ST trainees. Both groups completed the course with similar mean scores.

This study shows that arthroscopy simulation improves trainee-reported ratings of surgical skill. It also shows that less experienced candidates derived the greatest benefit from the training. Further research is required to compare self-assessed performance against objective benchmarks using validated assessment tools.

Skills simulation is increasingly used as a training tool in postgraduate surgical training. Trainee's perception of the value of this experience has not previously been investigated. The aim of this investigation was to investigate the value of surgical simulation training delivered by an arthroscopy skills course.

We constructed a subject-specific, self-assessment questionnaire based around the ISCP Peer Assessment Tool. The questionnaire was administered to candidates before and after attending the Plymouth Arthroscopy Skills Course. Participant demographic data was recorded. Questionnaire data was interrogated to give an overview of the course, as well as the benefit of site-specific skills stations. Statistical analysis showed the data to be normally distributed. The paired T-test was used to compare mean values.

Twelve surgical trainees attended the course – CT2 trainees (n=4); ST3 trainees (n=7); ST4 trainee (n=1). 11 candidates completed both administered questionnaires giving a 92% response rate. The global mean score at the beginning of the course was 2.39. The global mean score at the end of the course was 3.90. The mean improvement was 1.51 (p<0.01; 95% CI= 0.96-2.07). Skill station specific scores all showed improvement with the greatest effect in wrist arthroscopy. CT trainees had a lower mean score compared to ST trainees. Both groups completed the course with similar mean scores.

This study shows that arthroscopy simulation improves trainee-reported ratings of surgical skill. It also shows that less experienced candidates derived the greatest benefit from the training. Further research is required to compare self-assessed performance against objective benchmarks using validated assessment tools.

Military patients have high functional requirements of the upper limb and may have lower pre-operative PROM scores than civilian patients i.e. their function is high when benchmarked, but still insufficient to perform their military role thereby mandating surgery. Our aim was to compare the pre-operative Oxford Shoulder Instability Scores in military and civilian patients undergoing shoulder stabilisation surgery.

We undertook a prospective, blinded cohort-controlled study (OCEBM Level 3b). The null hypothesis was that there was no difference in the Oxford Shoulder Instability Scores between military and civilian groups. A power calculation showed that 40 patients were required in each group to give 95% power with 5% significance. A clinical database (iParrot, ByResults Ltd., Oxford, UK) was interrogated for consecutive patients undergoing shoulder stabilisation surgery at a single centre. The senior author - blinded to the outcome score - matched patients according to age, gender and diagnosis. Statistical analysis showed the data to be normally distributed so a paired samples t-test was used to compare the two groups. 110 patients were required to provide a matched cohort of 80 patients.

There were 70 males and 10 females. Age at the time of surgery was 16-19yrs (n=6); 20-24yrs (n=28); 25-29 (n=16); 30-34(n=12); 35-49(n=12); 40-44(n=6). 72 patients (90%) had polar group one and 8 patients (10%) had polar group two instability. The mean Oxford Shoulder Instability Score in the civilian group was 17 and the in military group was 18. There was no statistical difference between the two groups (p=0.395).

This study supports the use the Oxford Shoulder Instability Score to assess military patients with shoulder instability.