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Bone & Joint 360
Vol. 4, Issue 3 | Pages 31 - 32
1 Jun 2015
York P Mauffrey C

Bone & Joint 360
Vol. 3, Issue 6 | Pages 2 - 7
1 Dec 2014
Lewis C Mauffrey C Lewis AC Whiting F

There are significant differences in the methods and styles of orthopaedic surgical training between continents, all with the aim to produce competent consultant surgeons, but the differences in training content and pathway are vast. We review and contrast the key differences between three continents.

The Bone & Joint Journal
Vol. 96-B, Issue 9 | Pages 1143 - 1154
1 Sep 2014
Mauffrey C Cuellar III DO Pieracci F Hak DJ Hammerberg EM Stahel PF Burlew CC Moore EE

Exsanguination is the second most common cause of death in patients who suffer severe trauma. The management of haemodynamically unstable high-energy pelvic injuries remains controversial, as there are no universally accepted guidelines to direct surgeons on the ideal use of pelvic packing or early angio-embolisation. Additionally, the optimal resuscitation strategy, which prevents or halts the progression of the trauma-induced coagulopathy, remains unknown. Although early and aggressive use of blood products in these patients appears to improve survival, over-enthusiastic resuscitative measures may not be the safest strategy.

This paper provides an overview of the classification of pelvic injuries and the current evidence on best-practice management of high-energy pelvic fractures, including resuscitation, transfusion of blood components, monitoring of coagulopathy, and procedural interventions including pre-peritoneal pelvic packing, external fixation and angiographic embolisation.

Cite this article: Bone Joint J 2014; 96-B:1143–54.

The Bone & Joint Journal
Vol. 96-B, Issue 8 | Pages 997 - 999
1 Aug 2014
Stahel PF Mauffrey C

We explore the limitations of complete reliance on evidence-based medicine which can be diminished by confounding issues and sampling bias. Other strategies which may be reasonably invoked are discussed.

Cite this article: Bone Joint J 2014; 96-B:997–9.

Bone & Joint 360
Vol. 3, Issue 2 | Pages 1 - 1
1 Apr 2014
Mauffrey C

Bone & Joint 360
Vol. 2, Issue 4 | Pages 36 - 36
1 Aug 2013
Herbert B Hao J Mauffrey C

The Journal of Bone & Joint Surgery British Volume
Vol. 94-B, Issue 5 | Pages 704 - 708
1 May 2012
Mauffrey C McGuinness K Parsons N Achten J Costa ML

The ideal form of fixation for displaced, extra-articular fractures of the distal tibia remains controversial. In the UK, open reduction and internal fixation with locking-plates and intramedullary nailing are the two most common forms of treatment. Both techniques provide reliable fixation but both are associated with specific complications. There is little information regarding the functional recovery following either procedure.

We performed a randomised pilot trial to determine the functional outcome of 24 adult patients treated with either a locking-plate (n = 12) or an intramedullary nailing (n = 12). At six months, there was an adjusted difference of 13 points in the Disability Rating Index in favour of the intramedullary nail. However, this was not statistically significant in this pilot trial (p = 0.498). A total of seven patients required further surgery in the locking-plate group and one in the intramedullary nail group.

This study suggests that there may be clinically relevant, functional differences in patients treated with nail versus locking-plate fixation for fractures of the distal tibia and differences in related complications. Further trials are required to confirm the findings of this pilot investigation.