Circular external fixators are fundamental to lower limb reconstruction, primarily in situations with a high risk of infection such as open fractures. During the Covid-19 pandemic, use of circular frames in our unit decreased, following departmental approval, due to resource management and in keeping with BOA guidelines as we opted to “consider alternative techniques for patients who require soft tissue reconstruction to avoid multiple operations”. These alternatives included the use of internal fixation (plate osteosynthesis and intramedullary nailing) as a measure to reduce the number of hospital attendances for patients and to conserve resources. This change in practice has continued in part following the pandemic with the increased use of internal fixation in cases previously deemed unsuitable for such techniques. We present our experience of this treatment strategy in the management of complex lower limb injuries, focusing on outcomes and consider the lessons learnt. Data of patients with complex lower limb injuries treated before, during and after the pandemic were collected from our in-house trauma database, theatre records and follow up clinics. The rationale for choosing other techniques over a circular frame, the type of alternative technique used, the cost of such alternatives, the need for soft tissue reconstruction, time to recovery, complications and amputation rates were compared among groups.Introduction
Materials & Methods
Over 10% of total hip arthroplasty (THA) surgeries performed in England and Wales are revision procedures1. Malorientation of the acetabular component in THA may contribute to premature failure. Yet with increasingly younger populations receiving THA surgery (through higher incidences of obesity) and longer life expectancy in general, the lifetime of an implant needs to increase to avoid a rapid increase in revision surgery in the future. The Evaluation of X-ray, Acetabular Guides and Computerised Tomography in THA (EXACT) trial is assessing the pelvic tilt of a patient by capturing x-rays from the patient in sitting, standing and step-up positions. It uses this information, along with a CT scan image, to deliver a personalised dynamic simulation that outputs an optimised position for the hip replacement. A clinical trial is currently in place to investigate how the new procedure improves patient outcomes2. Our aim in this project was to assess whether accurate functional assessment of pelvic tilt could be further obtained using inertial measurement units (IMUs). This would provide a rapid, non-invasive triaging method such that only patients with high levels of tilt measured by the sensors would then receive the full assessment with x-rays. Recruited patients were fitted with a bespoke device consisting of a 3D-printed clamp which housed the IMU and fitted around the sacrum area. A wide elastic belt was fitted around the patient's waist to keep the device in place. Pelvic tilt is measured in a standing, flexed seated and step-up position while undergoing X-rays with the IMU capturing the data in parallel. Patients further completed another five repetitions of the movements with the IMU but without the x-ray to test repeatability of the measurements. Statistical analysis included measures of correlation between the X-ray and IMU measurements.Background
Methods
Bioresorbable materials offer the potential of developing fracture fixation plates with similar mechanical properties to bone thereby minimizing stress shielding and obviating the need for implant removal. To determine the in vivo degradation profile of a novel phosphate glass fibre composite bioresorbable plate and effects on the underlying bone.Background
Aim
Approximately one-fifth of patients are not satisfied with total knee arthroplasty (TKA). Preoperative variables associated with poorer outcomes are severity and chronicity of pain and psychological disease, which may present as anxiety and depression. It is unclear whether this is constitutional or the result of knee pain. To address this, we explored the association of anxiety and depression with knee disability before and after TKA. Forty patients undergoing TKA completed Hospital Anxiety and Depression Scale (HADS) and Oxford Knee Scores (OKS) preoperatively and at three and six months postoperatively. Both were elevated preoperatively and improved significantly post-operatively (P<0.001). The severity of preoperative anxiety and depression was associated with worse knee disability (coefficient −0.409, p=0.009). Postoperatively reduction in anxiety and depression was associated with improvement in knee disability after three (coefficient −0.459, p=0.003) and six months (coefficient −0.428, p=0.006). The difficulty in interpreting preoperative anxiety and depression and the outcome of TKA is establishing whether they are the cause or effect of pain in the knee. As anxiety and depression improves with knee pain and function, this study suggests that knee pain contributes to the psychological symptoms and that a successful TKA offers an excellent chance of improving both.
