1. Two cases of post-traumatic osteolysis of the outer end of the clavicle are reported. 2. The essential features of the lesion are summarised. 3. The possible
1. A measuring instrument is described which enables the surgeon to determine the anteroposterior diameter of the vertebral canal during operation. 2. Developmental narrowness of the lumbar vertebral canal is shown to exist and to be caused by an abnormally short antero-posterior diameter. 3. In patients with a narrow, although not abnormally narrow, lumbar vertebral canal, slight deformities such as posterior spur formation or small disc protrusions may produce particular symptoms, which are interesting from a clinical as well as from a
The results of treatment of Lisfranc injuries are often unsatisfactory. This retrospective study investigated 46 patients with isolated Lisfranc injuries at a minimum of two years after surgery. Thirteen patients had a poor outcome and had to change employment, or were unable to find work as a result of this injury. The presence of a compensation claim (p = 0.02) and a delay in diagnosis of more than six months were associated with a poor outcome (p = 0.01). There was no association between poor functional outcome and age, gender, mechanism of injury or previous occupation. This study may have
The cost of clinical negligence in the UK has continued to rise despite no increase in claims numbers from 2016 to 2019. In the US, medical malpractice claim rates have fallen each year since 2001 and the payout rate has stabilized. In Germany, malpractice claim rates for spinal surgery fell yearly from 2012 to 2017, despite the number of spinal operations increasing. In Australia, public healthcare claim rates were largely static from 2008 to 2013, but private claims rose marginally. The cost of claims rose during the period. UK and Australian trends are therefore out of alignment with other international comparisons. Many of the claims in orthopaedics occur as a result of “failure to warn”, i.e. lack of adequately documented and appropriate consent. The UK and USA have similar rates (26% and 24% respectively), but in Germany the rate is 14% and in Australia only 2%. This paper considers the drivers for the increased cost of clinical negligence claims in the UK compared to the USA, Germany and Australia, from a spinal and orthopaedic point of view, with a focus on “failure to warn” and lack of compliance with the principles established in February 2015 in the Supreme Court in the case of Montgomery v Lanarkshire Health Board. The article provides a description of the prevailing medicolegal situation in the UK and also calculates, from publicly available data, the cost to the public purse of the failure to comply with the principles established. It shows that compliance with the Montgomery principles would have an immediate and lasting positive impact on the sums paid by NHS Resolution to settle negligence cases in a way that has already been established in the USA. Cite this article:
Informed patient consent is a legal prerequisite endorsed by
multiple regulatory institutions including the Royal College of
Surgeons and the General Medical Council. It is also recommended
that the provision of written information is available and may take
the form of a Patient Information Leaflet (PIL) with multiple PILs
available from leading orthopaedic institutions. PILs may empower
the patient, improve compliance, and improve the patient experience.
The national reading age in the United Kingdom is less than 12 years
and therefore PILs should be written at a readability level not
exceeding 12 years old. We aim to assess the readability of PILs
currently provided by United Kingdom orthopaedic institutions. The readability of PILs on 58 common conditions provided by seven
leading orthopaedic associations in January 2017, including the
British Orthopaedic Association, British Hip Society, and the British
Association of Spinal Surgeons, was assessed. All text in each PIL
was analyzed using readability scores including the Flesch–Kincaid Grade
Level (FKGL) and the Simple Measure of Gobbledygook (SMOG) test.Aims
Patients and Methods
To determine whether the findings from a landmark Canadian trial
assessing the optimal management of acute rupture of the Achilles
tendon influenced the practice patterns of orthopaedic surgeons
in Ontario, Canada. Health administrative databases were used to identify Ontario
residents ≥ 18 years of age with an Achilles tendon rupture from
April 2002 to March 2014. The rate of surgical repair (per 100 cases)
was calculated for each calendar quarter. A time-series analysis
was used to determine whether changes in the rate were chronologically
related to the dissemination of results from a landmark trial published
in February 2009. Non-linear spline regression was then used independently
to identify critical time-points of change in the surgical repair
rate to confirm the findings.Aims
Materials and Methods
In the time since Letournel popularised the surgical
treatment of acetabular fractures, more than 25 years ago, there
have been many changes within the field, related to patients, surgical
technique, implants and post-operative care. However, the long-term
outcomes appear largely unchanged. Does this represent stasis or
have the advances been mitigated by other negative factors? In this
article we have attempted to document the recent changes within
the surgery of patients with a fracture involving the acetabulum,
outline contemporary management, and identify the major problem
areas where further research is most needed. Cite this article:
Identifying cervical spine injuries in confused or comatose patients
with multiple injuries provides a diagnostic challenge. Our aim
was to investigate the protocols which are used for the clearance
of the cervical spine in these patients in English hospitals. All hospitals in England with an Emergency Department were asked
about the protocols which they use for assessing the cervical spine.
All 22 Major Trauma Centres (MTCs) and 141 of 156 non-MTCs responded
(response rate 91.5%).Aim
Patients and Methods
Fractures of the hip are common, often occurring
in frail elderly patients, but also in younger fit healthy patients following
trauma. They have a significant associated mortality and major social
and financial implications to patients and health care providers.
Many guidelines are available for the management of these patients,
mostly recommending early surgery for the best outcomes. As a result,
healthcare authorities now put pressure on surgical teams to ‘fast
track’ patients with a fracture of the hip, often misquoting the
available literature, which in itself can be confusing and even
conflicting. This paper has been written following an extensive review of
the available literature. An attempt is made to clarify what is
meant by early surgery (expeditious Cite this article:
Clinicians are often asked by patients, “When
can I drive again?” after lower limb injury or surgery. This question
is difficult to answer in the absence of any guidelines. This review
aims to collate the currently available evidence and discuss the
factors that influence the decision to allow a patient to return
to driving. There is currently insufficient evidence for any authoritative
body to determine fitness to drive. The lack of guidance could result
in patients being withheld from driving for longer than is necessary,
or returning to driving while still unsafe. Cite this article:
This paper offers a summary of the ethical guide
for the European orthopaedic community; the full report will be
published in the EFORT Journal. Cite this article:
Restoration of leg length and offset is an important
goal in total hip replacement. This paper reports a calliper-based technique
to help achieve these goals by restoring the location of the centre
of the femoral head. This was validated first by using a co-ordinate
measuring machine to see how closely the calliper technique could
record and restore the centre of the femoral head when simulating
hip replacement on Sawbone femur, and secondly by using CT in patients
undergoing hip replacement. Results from the co-ordinate measuring machine showed that the
centre of the femoral head was predicted by the calliper to within
4.3 mm for offset (mean 1.6 (95% confidence interval (CI) 0.4 to
2.8)) and 2.4 mm for vertical height (mean -0.6 (95% CI -1.4 to
0.2)).
The CT scans showed that offset and vertical height were restored
to within 8 mm
(mean -1 (95% CI -2.1 to 0.6)) and -14 mm (mean 4 (95% CI 1.8 to
4.3)), respectively. Accurate assessment and restoration of the centre of the femoral
head is feasible with a calliper. It is quick, inexpensive, simple
to use and can be applied to any design of femoral component.
