Aims

The COVID-19 pandemic has had a significant impact on the provision of orthopaedic care across the UK. During the pandemic orthopaedic specialist registrars were redeployed to “frontline” specialties occupying non-surgical roles. The impact of the COVID-19 pandemic on orthopaedic training in the UK is unknown. This paper sought to examine the role of orthopaedic trainees during the COVID-19 and the impact of COVID-19 pandemic on postgraduate orthopaedic education.

Aims

Elective operating was halted during the COVID-19 pandemic to increase the capacity to provide care to an unprecedented volume of critically unwell patients. During the pandemic, the orthopaedic department at the Aneurin Bevan University Health Board restructured the trauma service, relocating semi-urgent ambulatory trauma operating to the isolated clean elective centre (St. Woolos’ Hospital) from the main hospital receiving COVID-19 patients (Royal Gwent Hospital). This study presents our experience of providing semi-urgent trauma care in a COVID-19-free surgical unit as a safe way to treat trauma patients during the pandemic and a potential model for restarting an elective orthopaedic service.

Anatomical variation of Lisfranc mortise has been implicated in the susceptibility of Lisfranc fracture-dislocation. We investigated whether the variations in the dimensions of second metatarsal base makes the joint vulnerable to fracture dislocation.

Patients and Methods: 31 normal (group A) and 23 injured (group B) foot x-rays were compared. The average age of patients was 33(range 16–64) years. Routine AP and 45 degree oblique foot x-rays were used to measure second metatarsal parameters such as L (length of second metatarsal) were measured on x-rays in both groups. Additionally D (height of base of second metatarsal in sagittal plane of foot) was measured in CT scans. Statistical analysis was performed to test the viability of the null hypothesis that states that the relationship of second metatarsal length and height at the base does not correlate with increased susceptibility of Lisfranc injury. Similar analyses of the relevant parameters at the second metatarsal mortice were also calculated.

Results: Mean values of D, L and D/L were obtained in both groups. Statistically the value of D/L was found to be significantly different between injured group and normal group, with a P value of 0.03, while the values of length of second metatarsal itself was not significantly different between two groups (P=0.15). However, no significant correlation was noticed using other parameters of the second metatarsal mortice.

Conclusion: Previously shallowness of the second metatarsal mortice was shown to be significantly correlated with increased risk of Lisfranc injury. However, this study suggests that dimensions of second metatarsal such as, depth/length of the second metatarsal significantly increase the risk of Lisfranc injury. In other words more slender metatarsal dimensions at its base carry increased risk to Lisfranc injury. Thus, anatomical variation at the base of the second metatarsal makes the Lisfranc joint susceptible to injury.

Purpose: In the modern political climate our practice is increasingly being compared with that of our peers. Outcome measures will form the basis of this. Good outcome measures have two essential requirements; they should be valid and reliable. Outcome measures are not easy to construct. Traditionally subjective walking distances have formed a portion of the assessment. This has never been validated.

Method: Null hypothesis - patients can accurately estimate their actual walking distance.

After gaining COREC approval we compared the objective to subjective walking distance of patients who had sustained a fractured Os Calcis over the past two years and were allowed to full weight bear. Patients were assessed by a senior physiotherapist and Doctor. Both the American Orthopaedic Foot and Ankle Score and Maryland Score were performed. Patients were asked to estimate their maximum walking distance prior to objective treadmill assessment.

Results: 20 patients, 6 female and 14 male were assessed. Average age was 67yrs (range 46–83yrs). One patient was excluded as they were breathless at rest. Good correlation was found between the subjective walking assessments of the two scores. All patients’ uniformly over estimated their walking ability. This was a highly significant difference, p-value 0.002. Therefore the null hypothesis has been disproved; patients’ subjective walking distance is inaccurate.

Significance: Walking distance assessment is used is as a measure in many fields of orthopaedics namely foot and ankle outcome measures and lower limb arthroplasty. This study has shown it to be an inaccurate method. It also highlights the need to validate all outcome measures.

Introduction: With the rising popularity of biological fixation, “Less invasive skeletal stabilisation system” (L.I.S.S.) has emerged as a valid option to treat complex fractures around the knee. Published reports have shown good results with shorter healing time and lesser re-operation rates. However as with any close procedure, restoring correct alignment of the limb could be difficult with this system and has not been reported previously. We report the results of CT alignment study in 20 cases of LISS fixation.

Methods: In a combined retrospective-prospective study, 20 patients, who were treated with LISS system for stabilizing either femoral or tibial fractures were enrolled. Patents with only unilateral fractures with a normal contra-lateral lower limb were included. All patients had CT scannograms and limited axial CT cuts of both lower limbs. Axial and rotational alignments were measured and assessed by one consultant radiologist.

Result: There were 9 cases of femoral and 11 cases of tibial LISS . The mean total malrotation was found to be 11.97 degrees (2.0–34.5). All femora were found to be malrotated externally with a mean of 11.71 degrees where as for the tibiae the mean internal and external malrotaions were found to be12.53 and 11.74 respectively. Mean coronal malalignment was found to be 3.76 degrees. If acceptable alignment was taken as 5 degrees in any plane, then the degree of malrotation in our study was found to be statistically significant.

Discussion and conclusion: Malalignment, mainly in the rotational plane has been reported in other closed techniques such as femoral and tibial nailing. As LISS is also minimally invasive and done through indirect reduction techniques, restoration of correct alignment could be difficult to achieve. This study is reassuring as we have found that generally, alignment of limb in our study was satisfactory and no corrective surgery was needed.