bluuebunny/crossref_metadata_2025 huggingface dataset:
603 Evaluation the First Ray Instability Using the Double Dorsiflexion Test: A Prospective Observational Case-Controlled Study
Authors: Solomou G , Pasapula C , Al-Sukaini A , Liew I , Goetz J , Cutts S
Published: November 2022

First-Ray (FR) stability allows for foot propulsion in-stance, taking 60% weight. First-ray instability (FRI) is associated with middle column overload, synovitis, deformity, and osteoarthritis. Clinical detection can still be challenging. We propose to develop a clinical test that helps identify FRI using two simple manual manoeuvres.

10 patients with unilateral FRI were recruited. Stringent exclusion criteria were applied including hallux MTP pain, laxity, inflammatory arthropathy. A Klauemeter directly measured the sagittal plane dorsal first metatarsal head translation of affected vs unaffected feet. Maximum passive proximal phalanx 1st MTP joint dorsiflexion was measured using Tracker motion software analysis with and without applying a dorsal force at the 1st metatarsal head using a Newton meter. P-value of <0.05 was considered significant.

FRI feet had dorsal translation greater than 8mm (median, 11.94; interquartile range [IQR], 10.23–13.81) vs 1.77 for unaffected control feet was (median, 1.77; interquartile range [IQR], 1.23–2.96) using the Klauemeter. The percentage reduction in 1st MTP joint dorsiflexion ROM when applying the double dorsiflexion test FRI (mean reduction of 67.98%) when compared to control feet (mean reduction of 28.44%)(P<0.01). Receiver operating characteristic (ROC) analysis showed that a 50% reduction in dorsiflexion ROM of 1st MTPJ when performing the double dorsiflexion test achieved a specificity of 100% and sensitivity of 90% (AUC =0.990, 95%CI [0.958–1.000], P>0.0001).

The double dorsiflexion (DDF) is easy to perform with manual manoeuvres that avoid complex instrumented and radiation-based assessment. A greater than 50% decrease in proximal phalanx motion has an over 90% sensitivity in identifying feet with FRI.
631 A Comparison of the Microbiology Profile for Two-Stage Revision Surgery in Periprosthetic Joint Infection (PJI) of Primary Knee Arthroplasty and Lower Limb Endoprostheses for Tumour Surgery
Authors: McCulloch RA , Adlan A , Jenkins N , Parry M , Stevenson J , Jeys L
Published: November 2022

Aim

To compare the microbiology organisms responsible for PJI in patients who underwent two-stage revision of infected primary knee replacement with two-stage revision of infected oncological endoprostheses of the lower limb in a single institution.

Method

118 patients were treated with 2-stage revision surgery for infected knee arthroplasty and lower limb endoprostheses between 1999 and 2019. 74 patients had two-stage revision for PJI of knee arthroplasty and 44 had two-stage revision to eradicate infection of lower limb endoprostheses for tumour resection. All microbiological data from the first stage sampling was collected and analysed retrospectively. Patient host and extremity criteria were categorised according to the MSIS Host and Extremity Staging System.

Results

According to the MSIS Staging System, the host and extremity grade of the knee arthroplasty PJI cohort were significantly better than endoprostheses PJI(p<0.05). The incidence of multi-drug resistance (MDR) was higher, 36% in the endoprosthetic group compared to 17% in the infected primary knee replacement group (p=0.001). MDR was most common in coagulase-negative staphylococcus. Gram-positive organisms were isolated in more than 80% of cultures from both cohorts. Coagulase-negative staphylococcus (CoNs) was the commonest gram-positive organism and E Coli was the commonest Gram-negative organism in both groups.

Conclusion

Patients presenting with PJI after lower limb endoprostheses have a higher incidence of MDR organisms compared to an arthroplasty cohort. Pre-operative microbiological sampling and meticulous sampling methods intra-operatively are extremely important in these patients.
720 Dynamic Hip Screw vs Short Intra Medullary Nail - Which Is Safer for the Surgeon: A Retrospective Comparison of Radiation Exposure
Authors: Noton T , Khanom S , Kazzazi F , Magill H , Bagouri E , Abd Wahab EH , Vasireddy A
Published: November 2022

Aim

Dynamic hip screws (DHS) and short intra medullary (IM) nails are fixation methods used for neck of femur (NOF) fractures. Both require fluoroscopic assistance within the operating theatre, therefore exposing the surgeon and patient to ionising radiation. There is minimal literature investigating radiation exposure. Aims of this study are to compare the radiation doses in each procedure and to estimate a normalised dose.

Method

Retrospective data analysis was carried out for patients who underwent fluoroscopically assisted surgical management of NOF fractures using DHS and short IM nail over a 3-year-period. Data was sourced using electronic operative records and Sectra PACS imaging software. Radiation dose parameters collected were the cumulative dose in milligrays (mGy), cumulative dose area product (DAP) (Gy.cm2) and time of exposure in minutes and seconds. Statistical analysis was performed using SPSS statistical software.

Results

A total of 56 patients were treated with a DHS, and 46 with short IM nails (Short TFNA - Synthes). 79% of DHS cases were for extra capsular neck of femur fractures versus 100% of short IM nails. Cumulative radiation dose for the DHS group demonstrated a mean of 6.007mGy, compared to 1.153mGy for the short IM nail. Mean exposure times were 1:39 for the DHS group compared to 1:32 for the IM nail.

Conclusions

Our study showed the difference in cumulative radiation exposure was significantly less when using the short IM nail compared to the DHS. Additional radiation should be considered a safety hazard for the surgeon, theatre staff and patients.
748 A Comparison Between Arthroscopic Capsular Release and Hydrodilatation in the Treatment of Frozen Shoulder
Authors: Hunter J , Adam JR , Howell G
Published: November 2022

Aim

Frozen shoulder (FS) is a common but poorly understood condition with no gold standard identified, two options include arthroscopic capsular release (ACR) and hydrodilatation (HD). Recently, the use of HD has become increasingly popular, and this study aims to compare the outcomes of patients undergoing ACR and HD.

Method

A retrospective analysis of 171 patients diagnosed with FS and treated with either ACR or HD. Data was collected on demographics, range of motion (pre and post procedure), diabetic or trauma status and outcome. The primary outcome measure was whether the patient required further treatment. The secondary outcome measure was the range of motion. Subgroup analyses were also performed on diabetic and post-traumatic groups with frozen shoulder.

Results

A total of 71 patients had an ACR and 100 patients had HD, with 73.2% and 70% of patients being discharged respectively. The average age was 54.5 years in the ACR cohort and 54.1 years in the HD cohort. There was a significant improvement in range of motion for both cohorts and no difference in the efficacy of the treatments. The same result was found for diabetic and trauma patient subgroups. However, diabetics were 2.41 times more likely to require further treatment than non-diabetics.

Conclusion

ACR and HD are effective treatments, however, no significant difference in outcome between the two was found. HD has a lower cost and less risk attached compared to ACR, making it preferable. Where HD isn't successful, ACR provides another reliable option.
775 Role of Inversion Imaging in the Diagnoses of Neck of Femur Fractures
Authors: Ahmed M , Saad A , Bani-Khalid A , Kho J , Sonsale P , Iyengar K , Botchu R
Published: November 2022

Aim

The objective of this study was to assess whether inversion of grey scale radiograph images has any impact on the diagnostic sensitivity and inter-observer reliability in diagnosing neck of femur fractures.

Method

We performed a retrospective, single centre study, using 50 randomly selected AP pelvis radiographs. The images included a combination of normal, intracapsular and extracapsular neck of femur fractures, which had been confirmed on CT, MRI and/or subsequent surgery.

Four independent observers (two orthopaedic specialists, one registrar and one SHO in orthopaedics) reviewed the images and graded each radiograph image using the Likert scale in response to the statement “there is a fracture”. Following this, the same radiographs were inverted to grey scale images and sent for a second review using the same method. RAND correlation was used for statistical analysis.

Results

Overall, observers appeared to have similar accuracy and equivocal rates with normal and inversion radiographic imaging.

One of the T&O Consultant's had much higher equivocal rate when analysing inverted radiographs compared to conventional digital radiographs but had slightly higher accuracy with inversion (95.35% compared to 93.88%) as well as the Registrar (83.33% compared to 81.63%). The second Trauma and Orthopaedics Consultant had slightly more accuracy with conventional digital radiographs (89.58% compared with 87.50%).

Conclusions

Inversion of digital radiographs did not affect the diagnostic sensitivity of neck of femur fractures in our study, and similarly did to not have a statistically significant impact in clinician confidence in diagnosing neck of femur fractures.
796 Post Operative Drop in Haemoglobin Is Associated with Increased Morbidity and Mortality in Fracture Neck of Femurs
Authors: Ayesha R , Gravett E , Craig J , Anto J
Published: November 2022

Aim

Post-operative anaemia in hip fracture patients is associated with increased risk of blood transfusion, poorer outcomes, increased morbidity, and mortality. Our aim is measure the drop in haemoglobin(Hb) post-operatively in hip fracture surgery and its impact on length of stay, morbidity and 30-day mortality.

Method

A retrospective study of neck-of-femur patients looking at pre-op and discharge haemoglobin levels, taking into consideration conditions that could affect Hb, and adverse effects peri-operatively.Data collected from Medway, Clinic letters, ICE and NHFD database.

Results

257 patients were included in the study. Mean age was 82(range 43–100). Pre-operatively 60(23%) had normal Hb, 34(13%) had borderline, and 163(64%) had severe anaemia. 131(51%) had hemi-arthroplasty, 61(24%) had DHS, 45(18%) had IM nail and 20(7%) had THR.Normal Hb found in 62 patients (24%), 33(13%) had borderline and 162(63%) had severe anaemia at discharge.30 patients (11.7%) had post-op transfusions and 7 were prescribed oral iron. Readmission rate was 4.3%(11 patents) of which 8(73%) had severe anaemia.Average length of stay in patients with severe anaemia was 21 days.Overall 30-day mortality was 17%(43 patients); in patients with severe anaemia, mortality was 50%(21 patients).

Conclusions

Most patients (63%) had severe anaemia at discharge. There was a significant drop of Hb post-operatively especially THR and hemi-arthroplasty. Our study demonstrates pre-surgical anaemia in hip fracture patients is associated with increased hospital morbidity and mortality.Identification of anaemia at admission and discharge provides an opportunity for treatment to avoid transfusions and improve patient outcomes.
807 The Association between Blood Transfusion and Outcome in Hip Fracture Patients
Authors: Brasnic L , Martin C , Ward K , Adam K , MacLullich A , Farrow L
Published: November 2022

Aim

Hip Fractures are endemic in older adults across Europe, with potential increases in incidence expected as the population ages. Management of blood loss and anaemia is a mainstay of care for these patients, but there is still significant debate regarding balance between benefit and risk of liberal versus restrictive transfusion policies. Understanding the association between providing blood products and adverse healthcare outcomes in hip fracture patients is a key component in the transfusion decision-making process.

Method

This retrospective cohort study uses national audit data from the Scottish Hip Fracture Audit (SHFA) and the Scottish National Blood Transfusion Service (SNBTS) to examine the association between blood transfusion and important hip fracture process of care measures and healthcare outcomes.

Results

A total of 28 461 patient records were included for assessment across 19 acute hospitals. Blood transfusion during admission was associated with a small but statistically significant decrease in survival at both 30 and 60 days. Those receiving blood transfusion during admission were less likely to be mobilised by the end of the 1st post-operative day, less likely to have a length of stay below the average and had far lower probability of discharge.

Conclusion

This study found that blood transfusion is associated with poor healthcare outcomes following hip fracture, even when adjusted for potential confounding factors. This likely reflects the potential harm of perioperative anaemia rather than any direct impact from transfusion. Further work to reduce perioperative blood loss is therefore key to improving important hip fracture outcomes.
848 Cannulated Screws vs DHS Fixation for Undisplaced Intracapsular Neck of Femur Fractures
Authors: Fitzpatrick N , Lynch-Wong M
Published: November 2022

Introduction

The FAITH RCT (Lancet 2017) described the results of cannulated screws (CS) vs dynamic hip screw (DHS) fixation for undisplaced intracapsular NOF fractures in 1108 patients. Data compared reoperation rates, 24-month mortality and progression to avascular necrosis (AVN). Via retrospective analysis of data from 2018–2020 NHFD, we aimed to compare local outcomes over a 3-year period.

Method

Data was collected from NHFD, retrospectively analysed from the past 3 years. 93 patients were included, having undergone CS or DHS fixation for an undisplaced intracapsular NOF fracture. Data comparing length of hospital stay, reoperation rate and progression to AVN were compared.

Results

FAITH described reoperation rates of 20% for DHS fixation vs 22% for CS fixation. Data from the last 3 years suggests a reoperation rate of 0% in the DHS cohort vs 6.89% with CS. Locally, there was a 24-month mortality of 21% vs 14% in the study population. Those undergoing CS fixation had an acute inpatient stay of just 8.72 days vs 10.55 days in DHS patients, likely reflecting the less invasive nature of the former. No reports of avascular necrosis were reported locally, compared to 7% in the FAITH trial.

Conclusions

Cannulated screw fixation leads to shorter inpatient stays and had no higher incidence on AVN in those included in the study. Whilst it had a higher 24-month mortality, the study did not adjust for confounding variables such as concomitant injury. Locally, reoperation rates were lower than the FAITH trial suggested, as were rates of AVN.
859 A Single Center Retrospective Study Comparing Retrograde TibioTaloCalcaneal Nailing vs Open Reduction Internal Fixation of Ankle Fractures in a Comorbid Elderly Population
Authors: Oochit KK , Imran A , Brown MJC , Hrycaiczuk A , Jamal B
Published: November 2022

Aim

The aim of this paper is to compare the functional outcomes and complication rates of ankle fractures treated with retrograde tibiotalocalcaneal nail (TTC) and open reduction internal fixation (ORIF).

Method

Matched cohorts according to age and Charlson Comorbidities Index (CCI) (mean=6) were established by performing a retrospective search of a prospectively collated Bluespier® database for patients within our unit who underwent TTC nailing and open reduction internal fixation (ORIF) for acute trauma from 2015 to 2021.

Results

32 patients (8 males/ 24 females) were identified in both the TTC and ORIF groups with mean ages of 78.4 (55–96) and 78.3 (52–93) respectively. Mean follow-up length was 6 months in both groups. All fractures were classified according to AO classification. 3.1% of fractures were 44A, 71.9% 44B, 25% 44C in the TTC group compared to 3.1% 44A, 59.4% 44B and 37.5% 44C fractures in the ORIF group. Surgical site infection rate was 9.4% in the TTC group compared to 6.3% in the ORIF group. Both groups had a similar implant failure rate of 9.4%. 2/32 (6.3%) suffered from periprosthetic fractures in the TTC group and 1 of them required re-operation. 45% of patients in the TTC group returned to their pre-injury level of mobility compared to 40.6% in the ORIF group at their last follow up.

Conclusions

Our study showed that retrograde TTC nailing can be a useful treatment option for ankle fractures in the comorbid elderly, restoring function and enabling return to full weight bearing immediately after surgery.
866 Improving the Quality of Clinical Coding and Documentation to Record Accurate Outcomes in Non-Operatively Managed Hip Fractures
Authors: Shrestha S , Khatir MAA , Iyengar KP , Sangani C
Published: November 2022

Background

Our 2019 Clinical Audit for non-operatively managed hip fractures at our Trust was 9.76% against the national standard of 5% at The National Hip Fracture Database (NHFD) annual report 2017. A re-audit was conducted to review reasons for higher incidence as recommended by NICE and improve outcomes.

Method

Hip fracture patients admitted between 1st April 2019 and 31st August 2020 to Southport and Ormskirk NHS Trust were reviewed clinico-radiologically. Data was collected from NHFD, EVOLVE patient records, and PACS imaging systems. Following appropriate “Primary Diagnosis” of hip fracture, confirmation of operative or non-operative management was undertaken following a joint assessment by the Orthopaedic staff and the Clinical Coding department evaluating reasons behind the decision. Secondary outcome measures compared 30-day and one-year mortality with the previous cohort.

Results

In the re-audit, 512 cases were reviewed, 50 patients excluded following correct Clinical Coding, 440 hips were operated and 22 (4.8%) managed non-operatively. However, 30-day mortality rose from 30.5% during the audit to 54.50% possibly due to the effect of COVID-19.

Conclusions

The newly introduced “Neck of Femur Proforma” has remarkably improved the quality and organization of clinical documentation of diagnosis. Appropriate Clinical Coding allows correct information for the NHFD Trust figures.
877 Improving Daily Inpatient Neck of Femur Fracture (NOFF) Patient Care Using a Focused Review Proforma
Authors: Sambhwani S , Rayan F , Hirschowitz D , Shrestha S , Madhavan B , Shyamsundar S
Published: November 2022

Aim

The National Hip Fracture Database (NHFD) encompasses key parameters to reduce mortality and improve care in NOFF patients. Current practice across the NHS incorporates several different inpatient orthogeriatric models. Our quality improvement project sought to improve inpatient care delivered by orthopaedic staff with a geriatric targeted focus.

Method

An initial audit on 50 patients was conducted and key areas of concern were highlighted. A focussed proforma for daily reviews was implemented which encompassed local and national (NHFD) recommendations and this was re audited for a further 50 patients.

Results

Documentation of demographics, comoribidites and pre-operative social parameters improved from 70 to 100%. Examination of general health systems improved from 80 to 100%. Identification of nutritional abnormalities improved from 66 to 95%. Documentation of skin condition including wound care and pressure ulcers improved from 55 to 90%. Management of perioperative indwelling urinary catheters improved from 55 to 90%. Identification of unwell patients and thromboembolic risk assessments improved from 65 and 70 to 90 and 95% respectively.

Conclusions

Our targeted focused proforma facilitated an easy and comprehensive daily review for vulnernable geriatric patients. Additionally, it formed a basis for daily handover amongst juniors changing wards and was adopted formally and adapted for other geriatric services.
923 Exploring the Impact of Interhospital Transfers on Patients Who Are Managed Conservatively Following Traumatic Spinal Injury: A Scoping Review
Authors: Nedham M
Published: November 2022

Introduction

Traumatic spinal injury (TSI) is a devastating event that could lead to serious permanent disability to patients. Therefore, a multidisciplinary team is needed to manage such cases. In the UK, patients with a TSI score a minimum of 16 on the Injury Severity Score (ISS) and are transported to a Major Trauma Centre (MTC). In cases where patients initially present to a none MTC, patients are stabilised and transferred to MTC prominently. Specialised Spinal Cord Units (SCIU) are centres specialised in the definitive management of TSI patients and it is advised that patients get referred to SCIU in a timely manner as studies demonstrate improved patient outcomes. Early transfers are recommended due to the positive impact of early surgical decompression of the injury, which relieves the pressure on the neural tissue. Nevertheless, is this impact still positive if patients are managed conservatively?

Aim

To explore the impact of intermediate interhospital transfers on TSI patients when no surgical intervention is taking place.

Method

A scoping review is utilised to explore the research question. CINAHL, MEDLINE, Pubmed, Cochrane library and ASSIA were the search engines utilised.

Results

The search resulted in 4,595 papers. 15 met the inclusion and exclusion criteria and included in the review.

Conclusions

There are no studies that directly explored the impact of transfer on conservatively managed patients, and most of the studies were of low-quality evidence. Age, length of stay, mechanism of injury and cost were all explored as factors related to patients transfer status.
926 Peri-Operative Antibiotic Prophylaxis in K-Wire Fixation: Systematic Review and Meta-Analysis
Authors: Abul A , Karam M , Alshammari S , Alashqar M , Nisar S
Published: November 2022

Aim

There are presently no established standards on whether antibiotic prophylaxis is necessary during Kirschner wire (K-wire) fixation in order to reduce infection rates. The outcomes of antibiotic prophylaxis vs no antibiotic prophylaxis in K-wire fixation, were compared.

Method

A systematic review and meta-analysis were carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines, and an electronic search was carried out to identify all Randomised Controlled Trials (RCTs) and non-randomised studies comparing the outcomes of antibiotic prophylaxis groups versus those without antibiotic in patients undergoing K-wire fixation. The primary outcome was the rate of infection. The depth of infection was used as a supplementary outcome measure. The analysis employed fixed effects modelling.

Results

Four retrospective cohort studies and one randomised controlled trial with a total of 2316 patients were found. In terms of infection rate, there was no significant difference between the preventive antibiotic and no antibiotic groups (Odds Ratio [OR] = 0.72, P = 0.18). In terms of secondary outcomes, antibiotic prophylaxis had the same depth of infection rates as no antibiotics.

Conclusions

Giving antibiotics peri-operatively showed no significant difference in managing infection rates. However, more clinical trials are required to ascertain this evidence.
956 Patient-Reported Outcomes After Platelet Rich Plasma Injections for Elbow Tendinopathies
Authors: Haruna M , Stevens R , Macinnes S
Published: November 2022

Introduction

Elbow tendinopathies affect 1–3% of the population, with 35–50 years old most commonly being affected. It is work-related as such can lead to significant morbidity, time off work, and affect the income of patients as well as daily activities. Non-operative management is the recommended first step however, success is influenced by patient compliance. Autologous platelet-rich plasma injections are a novel approach to managing tendinopathies however, evidence of efficacy was determined by NICE to be inadequate as such recommended more research into its use.

Aim

Assess patient-reported outcomes after PRP injections for management of elbow tendinopathies.

Method

Retrospective study of 28 patients with chronic elbow tendinopathies treated with PRP injections between 2018–2020. Pre-and Post-procedure outcomes were measured using the Oxford Elbow Score questionnaire. Average f/u duration-234 days.

Results

27 patients answered the questionnaire out of 28 total patients that underwent the procedure. Of the 27 patients, 20 patients (74%) reported improvement in symptoms and were satisfied with their outcomes after one injection.

Conclusions

This study shows PRP injections are reasonable and efficient management for elbow tendinopathies in patients not managed medically. This helps strengthen arguments for PRP injections over steroids for tendinopathies as studies have shown that steroids have potential side effects, usually requires more than 1 injection for symptomatic relief and despite being beneficial in short term, is worse than other treatment options in the intermediate and long term for patients with tendinopathies.

Our numbers also coincide with previous larger studies that showed ∼70% of patients reported symptoms improving after 1 injection.
974 Fragility Fractures of the Hip: A Matched Cohort Study of Acetabular Fractures and Neck of Femur Fractures
Authors: Ali F , Musbahi O , Petohazi A , Sindhar J , Akilapa S , Bailey D , Harnett P
Published: November 2022

Aim

Due to an ageing population, acetabular fractures in the elderly are on the rise. Management of this group of patients remains controversial, especially as it is associated with high morbidity and mortality. With an ageing population, there will be an increasing trend in low energy associated acetabular fractures. We present the largest cohort of operatively treated acetabular geriatric patients in the UK, comparing complications and mortality, and also comparing them to patients with neck of femur fractures.

Method

A review of a prospectively collected acetabular database was conducted. All patients over the age of 60 that had an operative fixation for an acetabular fracture from 2015 to 2020 were identified. Demographic data, operative details and complications were recorded. We cohort-matched these patients with neck of femur fractures during the same period to compare patient outcomes and cohort demographics.

Results

204 patients were included in the study. The mean age was 76. The most common mechanism of injury was a fall from less than 1 metre (64%). The mean length of stay for acetabular fractures was 25 days. In-hospital mortality was 3% and 10% for acetabular fractures and neck of femur fractures respectively.

Conclusion

There is little difference in demographic information between geriatric acetabular fractures and neck of femur fractures. Operatively treated geriatric acetabular fractures are associated with greater length of stay than neck of femur fractures.
1015 Reducing Waiting Time to Surgery for Patients with Femoral Peri-Prosthetic Fractures (FPP#s): A Quality Improvement Project
Authors: Ayathamattam J , Kumar V , Shah N
Published: November 2022

Introduction

Research has shown that early fixation and return to mobility in femoral fragility fractures improves post-operative outcomes. Based on this, in patients with neck of femur fractures (NOF#), NICE guidelines advise fixation ‘on the day of or the day after admission’. However, no guidelines exist in the case of femoral periprosthetic fractures (FPP#) despite emerging evidence showing improved outcomes in this cohort of patients also.

Method

We retrospectively analysed the waiting times from admission to surgery for NOF#s and FPP#s admitted between 1/9/20 to 1/4/21 at St. Richard's and Worthing Hospitals that required surgery. 30 FPP# and 503 NOF# patients were admitted during this period. Data was collected on all FPP# patients and a randomly selected cohort of 30 patients from the NOF# group.

Results

There was an average waiting time of 1.3 days for NOF#s and 3.7 days for FPP#s from admission to surgery.

Conclusions

This initial data demonstrates the longer waiting times for FPP# patients. We identified key areas where improvements could be sought decreasing time until CT scanning for evaluation of fracture pattern and decreasing time until a specialist opinion from a hip surgeon to decide between operative fixation or conservative management. By addressing these and educating team members about the positive outcomes by reducing delays to surgery in FPP# patients we hope to decrease their waiting times. We are currently re-auditing to identify any improvements and any further facets for advances in the future.
1034 Radiological Outcomes Following Surgery for Developmental Dysplasia of the Hip
Authors: Czyzykowska K , Baird E
Published: November 2022

Aim

Developmental dysplasia of the hip (DDH) is a condition affecting newborns, in which abnormal acetabulum development can result in femoral head subluxation or dislocation. This study aims to retrospectively evaluate radiological outcomes of patients with DDH, treated by either closed reduction, open reduction, or open reduction with osteotomy.

Method

This study included 59 hips of 54 patients with a median age of 19.6 months at the time of surgery. Radiographs were assessed for the International Hip Dysplasia Institute (IHDI) grade of dislocation, acetabular index (AI), centre-edge angle (CEA), Severin classification and avascular necrosis (AVN).

Results

Median duration of follow up between primary operation and latest available radiograph was 4.9 years. Pre-operatively, 41 hips were IHDI Grade IV, 16 hips were Grade III and two hips were Grade II. Mean pre-operative AI was 37.9°, which decreased to 22.7° at the latest follow up. Mean CEA was 22.9°. 25 hips were found to be Severin class I, eight hips were class II and three hips were class III. Four hips developed Group II AVN and one hip developed Group III. Nine hips required further surgery.

Conclusions

The study found overall favourable radiological outcomes of treatment of DDH, with minimal differences between each operation. Longer follow up is needed to evaluate time-dependent outcomes such as Severin class and AVN. A patient-reported outcome questionnaire is necessary to provide information on the correlation of radiological outcomes and physical function.
1048 In Vitro Evaluation of the Response of Human Tendon-Derived Stromal Cells to a Novel Electrospun Suture
Authors: Nezhentsev A , Abhari R , Baldwin M , Mimpen J , Augustyniak E , Isaacs M , Mouthuy PA , Carr A , Snelling S
Published: November 2022

Aim

Recurrent tears after surgical tendon repair remain common, with 40% of rotator cuff repairs failing within one year. Repair failures can be partly attributed to the use of sutures not designed for the tendon cellular niche. Synthetic electrospun materials can mechanically support the tendon while providing topographical cues that modulate the immune response to promote wound healing. Here, a novel electrospun suture made from twisted polydioxanone (PDO) polymer filaments is compared to PDS II, a PDO suture clinically utilised in tendon repair.

Method

We evaluated the ability of electrospun suture and PDS II to support the attachment and proliferation of human tendon-derived stromal cells using PrestoBlue cell viability assays and scanning electron microscopy. Suture surface chemistry was analysed using X-ray photoelectron spectroscopy (XPS). Bulk RNA-Seq interrogated the transcriptional response of primary tendon-derived stromal cells to sutures after 14 days.

Results

The electrospun suture showed increased initial cell attachment compared to PDS II. XPS revealed that both sutures had similar local surface chemistry, indicating that the tendon-like architecture of electrospun suture was responsible for the greater cell attachment. Furthermore, electrospun suture elicited a stronger transcriptional response compared with PDS II, with relative enrichment of pathways including mTorc1 signalling and depletion of epithelial-to-mesenchymal transition and extracellular matrix gene sets. Neither suture induced transcriptional upregulation of inflammatory pathways.

Conclusion

Twisted electrospun sutures show promise in improving outcomes in surgical tendon repair by allowing increased cell attachment while maintaining a tissue response indicative of cell proliferation and wound healing, without significant fibrosis.
17 Is Group and Saving Before the Modern Transurethral Resection of the Prostate Still Necessary?
Authors: Kretzmer L , Damola A , Libotte C , Apakama I
Published: November 2022

A group and save (G&S) sample is routinely taken preoperatively for patients undergoing a transurethral resection of the prostate (TURP). This procedure has become a key endo-urological procedure; however, it can be associated with complications such as bleeding, potentially requiring blood transfusion. The aim of our study was to assess the need for preoperative G&S sampling in all patients undergoing TURP.

This study was a retrospective review of all patients who underwent a TURP from January 2009 until December 2019 in one centre. A total of 687 patients were identified during this period. Data was collected on G&S samples, blood products and post-operative complications such as clot retention or if patients required a blood transfusion.

All patients had G&S samples taken prior to their operation, of these, only six (0.87%) patients required a blood transfusion. Half were transfused intra-operatively and half post-operatively. Remarkably, none of the transfused patients were below the National Institute for Health and Care Excellence (NICE) threshold to transfuse of <70g/dl(8). Six patients were also noted to develop clot retention following removal of catheter.

This study has determined that patients undergoing a TURP rarely require blood transfusions. We propose that the practice of routinely taking G&S samples prior to this procedure should be reviewed. This would give a financial benefit and relieve patients of an unnecessary test. We would recommend thorough optimisation of patients prior to surgery including review of anticoagulation and correction of any pre-operative anaemia.
75 A Single Centre Study Evaluating the Effectiveness of Shock Wave Lithotripsy for Ureteric Stones at a Tertiary Centre in the United Kingdom
Authors: Kumar A , Gada R , Sali G , Subramonian K
Published: November 2022

Aim

Extracorporeal shock wave lithotripsy (ESWL) is recommended as first-line management of acute presentation or readmission for ureteric stones, in accordance with NICE guidelines (1). This large-scale retrospective study aims to evaluate the effectiveness of ESWL via the Storz Modulith SLX-F2 Machine, identifying patients who may experience greatest benefit in our tertiary centre.

Method

The medical records and CT scans of all patients who underwent ESWL for ureteric stones between 2012–2021 were analysed (n=277) using SPSS software. Data demonstrated normal distribution, hence means and standard deviation were used for analysis. Logistical regression was used to identify factors independently associated with stone clearance.

Results

The overall success rate of ESWL was 62.64% (n=265; 12 lost to follow-up). Average time to success was 50.48 days (n=146). Elective ESWL accounted for 84.48% of procedures. Analysis of factors affecting ESWL success showed that stone size (p=0.004), stone density (p=0.01), and BMI (p=0.033) significantly favoured positive outcome. Success rate was subsequently stratified based on these factors. The highest success rate was found in patients with stones <5mm, density <984 HU, and BMI <30kg/m2. Complication rates in the study group were low, with only 7.5% of patients requiring emergency re-admission. Of these, one patient was admitted with urosepsis requiring drainage, the remainder related to pain.

Conclusions

ESWL is very effective in treating patients presenting with ureteric stones, with minimal complications. Our study helps in predicting the success rate of treatment and therefore counselling patients prior to treatment.
120 Standardizing Consent Forms for Outpatient Urology Procedures
Authors: Shrestha S , Jiang E , Sandhu A , Pinnamaraju P , Swallow T , Pai A
Published: November 2022

Introduction

British Association of Urological Surgeons (BAUS) guidelines have provided comprehensive and standardized guidelines for urological procedures, including indications, benefits, risks involved, and alternatives. At our institution, currently, consent forms are handwritten resulting in generalized or incomplete information given to patients.

Aim

To improve patient understanding of the procedures they are undergoing by providing standardized consent form stickers for procedures as per BAUS guidelines.

Method

Single institution data were collected retrospectively for flexible cystoscopy, stent removal, transrectal ultrasonography (TRUS), and transurethral laser ablation (TULA). Consent forms compared to BAUS guidelines. A standardized consent form sticker for each procedure was developed in accordance with BAUS guidelines and reviewed via the trust's clinical governance process. Clinicians were educated in their use for future consenting.

Results

Consent forms of consecutive patients over a two-month period were analyzed. The initial audit showed that the proportion of patients who had all risks included was 0% for flexible cystoscopy, 0% for TRUS, and 100% for stent removal. Common and rare, but serious risks were not mentioned in all cases. 100% of patients had all risks mentioned for TULA. After education on the consent process and the introduction of consent form stickers, all risks (100%) were mentioned for all procedures.

Conclusions

It is imperative that patients are fully informed about the risks, indications, and alternatives of their treatment. Failure to provide this information in full may lead to unnecessary angst, morbidity, and litigation. Simple quality improvement projects can lead to measurable improvement in patient information.
176 A Retrospective Analysis of Non-Muscle Invasive Bladder Cancer (NMIBC) Follow-Up Using Flexible Cystoscopy and the Role of the Charlson Co-Morbidity Index (CCI) in Improving Follow Up
Authors: Dickson S , Jones J , Clark R
Published: November 2022

Aim

1. A retrospective analysis of NMIBC follow-up using flexible cystoscopy during COVID-19.

2. Charlson Co-Morbidity Index (CCI) as a method of improving follow up.

Method

Online patient records were reviewed for 153 patients who attended Ayr University Hospital between 01/02/2020 and 01/05/ 2020 for check cystoscopy. We recorded the patients risk category and the number of months lapsed since their previous scope. Follow up schedules were compared with current NICE guidelines. CCI for each patient was calculated.

Results

The majority of the patients sampled had follow up adherent to NICE guidelines. Deviations were secondary to ‘allocation to an incorrect follow up schedule’, ‘late follow up’ and ‘non-compliance’. Incorrect allocation was due to both human error and clinical judgement. Clinical judgement included frail patients thought not to benefit from their current intensive schedule and patients with areas of suspicion warranting an earlier check. CCI scores ranged from 2–11. 25% of had a Charlson score of >6 - this predicts a 0% 10-year survival.

Conclusions

We hypothesise that patients with a CCI > 6 should be considered for less intensive follow up. Their co-morbid status makes them likely unsuitable for intervention if reoccurrence was identified.We are pleased with our current adherence to NICE guidelines. We recognise areas for improvement and have raised these at local meetings. We hope that the CCI can be used to ensure we practice realistic medicine and act in the best of the patient when deciding to follow up.
181 Service Evaluation of the Utilisation and Impact of PredictProstate on Clinical Decision-Making in a Prostate Cancer Specialist Multidisciplinary Service
Authors: Pandiaraja M , Pryle I , West L , Gardner L , Shallcross O , Tay J , Shah N , Gnanapragasam V , Lamb BW
Published: November 2022

Aim

Patients with low and intermediate risk prostate cancer must decide whether to undergo radical treatment. The PredictProstate tool uses patient characteristics to quantify the relative benefit of radical treatment. It has been introduced in our prostate cancer specialist multidisciplinary team meeting (pcSMDT) and in subsequent communication with patients to facilitate informed decision-making. The aim of this study was to assess the utilisation and utility of PredictProstate in informing treatment decisions for men referred to Cambridge University Hospitals (CUH) for consideration of radical prostatectomy (RARP).

Method

A retrospective chart review was conducted of patients referred to the CUH pcSMDT and robotic prostatectomy clinic (ROPD) between Sep 2019 and Aug 2021 for consideration of RARP. Data on patient characteristics, use of PredictProstate, and management decisions was collected from the EPIC EMR. A total of 841 patients were included in the analysis.

Results

The usage of PredictProstate in the pcSMDT increased in the second half of the study period (34.5% vs 23.8%, p<0.001). The use of PredictProstate for men with low and intermediate risk prostate cancer was associated with an increased likelihood of attending ROPD (75% vs 61%, p<0.001), but a reduced likelihood of RARP (41% vs 55%, p<0.01). These effects were most pronounced for men of favourable intermediate risk (80% vs 63%, p<0.004 and 34% vs 54%, p<0.07 respectively).

Conclusions

PredictProstate provides personalised prognostic data for patients. Its increased use for men with low and intermediate risk prostate cancer is associated with increased attendance at specialist surgical clinic and a reduced chance of undergoing RARP.
202 Review of the Uro-Oncology MDT Performance Comparing Pre-Operative Radiological Staging with Surgical Outcomes for Localised Prostate Cancer
Authors: Oo KK , Cox A
Published: November 2022

Aim

Treatment decisions for prostate cancer (CaP) depend on accurate clinical parameters (PSA, DRE and Gleason grade). The ideal imaging utilisation is the topic of much controversy and is constantly evolving. Following an Ombudsman investigation where CaP staging and MDT processes were questioned, the performance of an MDT was appraised by comparing pathological outcomes with pre-operative staging.

Method

All radical prostatectomies (RP) (n=159) undertaken in ABUHB between June-2018 and January-2021 were retrospectively reviewed. Data were collected for preoperative risk stratification, MRI score (LIKERT/PIRADS) and pathological reports.

Results

Among 159 patients, 25 had upgraded ISUP scores in post-RP histology (15.7%). A threefold increase in MRI usage was observed over the last decade [852(2012–14) vs 2469(2018–20)]. 60% of low-risk and intermediate-risk patients were found to have higher pathological staging postoperatively compared to preoperative MRI. pT≥3 was observed in 68% of LIKERT/PIRADS V, 58% of DRE T2 and 67% of DRE T3.

Conclusions

Pathological upgrading was comparably lower than the national average supporting existing diagnostic pathways. Staging comparison of radiological with surgical outcomes remains challenging but MDT performance and recording were modified to reflect changes in usage of pre-op staging and reporting. Findings have led to new prospective audits to be updated annually.
263 Minimally Invasive Non-Radical Nephrectomy for Benign Renal Disease: A Single Centre Experience Comparing Two Surgical Approaches
Authors: Thomas A , Lokman U , Phan Y
Published: November 2022

In our high-volume tertiary centre for renal disease, we perform in excess of 150 nephrectomies for benign or malignant disease per annum. In this study we compare outcomes between laparoscopic and retroperitoneoscopic minimally invasive (MI) approaches.

We retrospectively reviewed our database of all patients who underwent MI non-radical nephrectomy over a 3-year period. Indication for surgery, conversion rate, operative time, blood loss, length of stay and post-operative complications were examined.

A total of 61 MI nephrectomies were performed by three experienced minimal access surgeons. Indications for surgery included chronic infection, stone disease, tuberculosis, and obstruction associated with pain. Mean age was 51 years (range 22–89), 72% were female. The approach was laparoscopic in 62% and retroperitoneoscopic in 38%. Median operative time 137 minutes. The overall conversion rate was 3% (2 patients). Median blood loss 50ml's with 1.5% transfusion rate. Median length of stay was 2 days (1–69). There was no significant change in the renal function (P=0.32). Four patients developed Clavien-Dindo grade 3 complication. There was no recorded mortality in our series.

We acknowledge this is a retrospective study that may be subject to selection bias, however our experience of this procedure in high volume centre with experienced operators shows that both laparoscopic and retroperitoneoscopic approaches are safe in performing MI non-radical nephrectomy with very low conversion rate.
425 Extra-Anatomical Detour Ureteric Stents: Our District General Hospital Experience of 50 Patients with a Minimum Follow Up of 6 Months
Authors: Rahman A , Quraishi MK , Mackie S , Watson G
Published: November 2022

Aim

Extra-Anatomical Detour Stents offer a viable modality of decompression particularly in the context of malignancies; with the absent need for changes of stents, cosmetically better than nephrostomies and fewer admissions associated with blockages/infections. Our aim was to assess the safety and feasibility of performing detour stents in a district general hospital.

Method

A review of prospectively collected data on all patients undergoing detour stents between 2016 and 2021 was undertaken. This enabled a possible follow up period of 6 months, provided the patients remained alive. A statistical package was utilised for the analysis of the collected data.

Results

Fifty patients were identified to have undergone detour stent insertion with malignancy being the indication in 90% of cases. Seven patients required a further eleven procedures with the most common being due to repositioning of the stent (36%) or change of stent due to infection (27%). Four patients passed away within 60 days of their procedure. Four patients had their stents eventually replaced with nephrostomies and a patient no longer required the detour stent due to resolution of their obstructive pathology. Nine patients are currently being followed up and thirty-six patients from the original cohort passed away with functional detour stents. Their median survival time post-procedure was 164 days.

Conclusions

Extra-Anatomical Detour Stents offers patients with obstructing renal tract secondary to malignancy a better quality of life when compared with nephrostomy. Continued caseload and refinement of surgical technique would lead to further optimised surgical outcomes.