bluuebunny/crossref_metadata_2025 huggingface dataset:
836 Aetiology and Management Outcomes of Adult Mechanical Bowel Obstruction in Nigeria: A Systematic Review and Meta-analysis
Authors: Falola A , Dada O , Ndong A , Akande D
Published: August 2023

Aim

Adult mechanical bowel obstruction (AMBO) has been previously reported to be majorly caused by hernias in developing countries. In Nigeria, however, there has been a recent change in pattern with adhesions now being the leading cause. The changing pattern of the causes, clinical features, mode of management and factors influencing the outcome of adult patients managed for bowel obstruction in Nigeria necessitated this review.

Method

Relevant keywords relating to AMBO were used to conduct a search on PubMed, Google Scholar and AJOL. The search returned 452 articles which were subjected to title, abstract and full text screening, according to the inclusion and exclusion criteria. 10 articles met the inclusion criteria and were included in the final qualitative synthesis.

Results

The total sample size across the 10 studies was 1033. Adhesions, hernias and intra-abdominal tumours, which are responsible for 46.25%, 26.31% and 12.23% of cases respectively, were the major causes of AMBO. 65.6% of cases were managed operatively and 34.4% were managed conservatively. The meta-analysis revealed high morbidity and mortality rates of 31% (95% CI:17, 44) and 11% (95% CI: 6, 15), respectively, among adult patients managed for mechanical bowel obstruction in Nigeria.

Conclusions

Adhesion, which results majorly from appendicectomy is the most common cause of AMBO in Nigeria. This is unlike former reports where hernia was the most common cause. Morbidity results majorly from wound infection, recurrent adhesions and post-operative enterocutaneous fistula. The mortality rate is similar to reports from various West African studies, and it is significantly influenced by surgical intervention time.
984 Comparing Modalities for the Detection of Lymph Node Metastasis in Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis
Authors: Lastoria D Ab
Published: August 2023

Aim

Papillary thyroid carcinoma (PTC) is the most common cancer of the thyroid gland (Lin, 2007). Cancer cells can metastasise to the cervical lymph nodes (LNs), including the central and lateral group of LNs (Yu et al, 2020). Lymph node metastasis is an important indicator of PTC prognosis, leading to a high recurrence rate and low survival (Yu et al, 2020). Identification of LN metastasis is key for improving surgical outcomes in patients with PTC. The aim of this systematic review and meta-analysis was to compare imaging modalities for the detection of LN metastasis in PTC.

Method

A total of 2756 records were identified and screened following database, conference proceedings and currently registered studies search. Data from 15 case series was extracted. A random-effects meta-analysis of sensitivity and specificity of ultrasound (US), CT and MRI for the detection of LN metastasis in PTC was performed. A sub-group analysis of central and lateral LNs was also performed.

Results

Sensitivity for the detection of LN metastasis was the highest for MRI (69.7%, 95% CI: 45.1%-89.9%), followed by CT (63.3%, 95% CI: 44.1%-80.7%), and US (57.1%, 95% CI: 44.1%-69.7%). Specificity was highest for MRI (85.5%, 95% CI: 78.6%-91.3%), followed by US (81.2%, 95% CI: 74.7%-87.9%), and CT (80.2%, 95% CI: 67.2%-90.8%).

Conclusions

This meta-analysis suggests MRI should be used for the detection of LN metastasis in PTC, given it demonstrated the highest sensitivity and specificity. Accurate identification can lead to the implementation of tailored surgical and chemoradiotherapeutic treatment approaches, improving patient outcomes.
1101 Patient Experiences of Teleconsultations Follow-Up After Cancer Surgery Within the National Health Service. a Qualitative Systematic Review
Authors: Klaud Francheska B , Lee R , Oni G , Wilson E
Published: August 2023

Background

Teleconsultations were introduced for cancer surgery follow-up to ease pressure on hospital services and facilitate patients’ access to those services. Currently, there is limited evidence of patients’ perception of the swift shift in service provision.

Aim

This qualitative systematic review aimed to explore patient experiences of teleconsultations within UK-based NHS cancer surgery follow-up services; to better understand patient perception, satisfaction, and acceptability of the teleconsultation approach.

Method

MEDLINE, EMBASE, PUBMED, and Google scholar were searched up to the 1st of January 2022. Articles were screened by two independent reviewers and qualitative studies were synthesized using the Braun and Clarke framework. Concepts identified were summed up into relevant themes and subthemes.

Results

A total of 1226 articles were screened, of which six were retained after full-text screening and quality assessment. The main findings revealed three overarching themes: accessibility, patient experience, and consultation. Most patients reported a positive experience with remote consultation, although others had uncertainties about its effectiveness due to the inability to build rapport with clinicians and the lack of emotional support.

Conclusions

Teleconsultations were widely accepted among cancer surgical patients. More research is needed to explore clinicians’ views of teleconsultations in cancer surgery and audits should be carried out to evaluate the system currently in place.
462 Is Donor Renal Arterial Anastomosis to the External Iliac Artery Comparable to the Internal Iliac Artery in Living Donor Renal Transplantation?
Authors: Chacko A , Mukherjee P , George S J A , Mukha R , J C
Published: August 2023

Background

In renal transplantation, the donor artery may be anastomosed to the external iliac artery (EIA) or the internal iliac artery (IIA). Few retrospective studies have not observed any difference in outcomes between these techniques. We aimed to compare these two techniques in a series of living donor renal transplants from a single institution.

Method

We retrospectively included 345 patients undergoing living donor renal transplantation who were divided into two groups: Group A (153 patients): anastomosis to IIA; and Group B (192 patients): anastomosis to EIA. The recipient characteristics, post-operative complications, Resistivity Index (RI) measured by colour Doppler on day 5 and at last follow-up and renal function were compared between the two groups.

Results

The demographic characteristics were similar. Mean operative time was longer in Group B compared to Group A (284 versus 244 minutes; p<0.001). Post-operative complication rates were similar. Mean follow-up was 27 months. Renal artery peak systolic velocities were higher in Group B compared to Group A (192 versus 135 cm/sec, p<0.01) while mean RI values were similar (0.73 and 0.61, p = 0.28) at last follow-up. There was no difference in mean creatinine (A: 1.23 mg% vs B: 1.36 mg/dL) at last follow-up.

Conclusions

The operative time was longer in EIA compared to IIA anastomosis. However, there was no difference in complications, vascular and renal function between the two groups. Therefore, the two techniques are comparable.
658 Adolescent-Targeted Organ Donation Education to Improve the Impact of Opt-Out Legislation
Authors: Song K , Duck E , Convill J , Byrne M , Symington M , Battle J , Green M , Brathwaite-Shirley C , Whitter L , Whitby J ,   We Are Donors Collaborative
Published: August 2023

Aim

Opt-out organ donation legislation in the UK has not led to sustained improvements in donation rates. Given poor familial authorisation rates (66% in 2021-2022) in the soft opt-out model, altering public perceptions of organ donation, through means including engaging young people and promoting family discussion, are prerequisites for successful legislation changes. We explore the impact of an educational intervention on organ donation, family discussions and knowledge of the opt-out law.

Method

We delivered a 15-minute educational presentation, along with an optional questionnaire, to UK secondary schools across five counties between Jan-May 2022.

Results

616 students aged 11-18 years (mean 14.6±1.9) completed the survey. Following the intervention, the proportion of individuals on/planning to join the ODR increased from 9% to 31%. Of the remaining students, 48% said they would consider joining.

Pre-intervention, 58% of adolescents agreed they had knowledge of organ donation, which increased to 85% post-intervention. Originally, 28% knew about the opt-out law, this increased to 77% post-intervention. The proportion of students that expressed knowledge of issues relating to organ donation in Black, Asian and ethnic minority communities, increased from 27% to 72% post-intervention. 28% had previously discussed organ donation with family, whilst 70% intended to do so post-intervention. 91% of responders would or would consider recommending the presentation to their peers.

Conclusions

Educational intervention increased adolescent understanding of organ donation, opt-out legislation, and intention to join the ODR and discuss donation with family. Through promoting wider public discussions, adolescent educational interventions can positively impact public perceptions of organ donation.
107 OPEN to Change: Can District General Hospitals Deal with Open Fractures Too?
Authors: Solomon D J , Niggher J , Magil P
Published: August 2023

Introduction

Fractures compromising soft tissues puts patients at risk of significant morbidity, therefore require timely multidisciplinary management. The British Orthopaedic Association Standard for Trauma (BOAST) Guidelines, updated December 2017, state “Patients with open fractures of long bones, hind foot or midfoot should be taken directly or transferred to a specialist centre that can provide Orthoplastic care.” Northern Ireland’s population is estimated at 1.8 million, within this there are between 370 and 500 cases of major trauma each year.

Method

This review looks at patients presenting to Craigavon Area Hospital in Northern Ireland, between October 2021 to October 2022, with open fractures.

Results

Over the study period, 41 Open fractures presented, 12 meeting criteria for transfer to a major trauma centre with orthopastic’s present as per BOAST Guidelines point 1. However, 11 patients were managed in Craigavon Area Hospital and 1 patient required transfer to a site with plastics available.

Conclusions

Can we learn from this same subgroup of patients? There is an ever-growing demand to major trauma centres in Northern Ireland some of the burden on which can be dealt with by DGH’s. This data should help contribute to any future updates of BOAST’s guidelines.
134 Simultaneous Bilateral Patella Tendon Rupture: A Systematic Review
Authors: Fernandes A , Rufino M , Hamal D , Sousa A , Fossett E , Cheema K
Published: August 2023

Aim

A single patella tendon rupture is relatively uncommon, but a simultaneous bilateral event is a rare occurrence and has been scarcely reviewed in the literature. This review was carried out to analyse the existing literature on this event, with the aim of proposing a standardised approach to the diagnosis and management of this injury.

Method

A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three independent reviewers conducted searches in PubMed, OvidSP for Medline and Embase, as well as Cochrane Library using the same search strategy. From a total of 183 studies, 45 were included, i.e., 90 patellas.

Results

46 patellas had a Type 1 Rupture equating to 51%, with Type 3 being the least common, with only 7 patellas sustaining this injury. The mean Insall-Salvio ratio for each knee was 1.62 (R) and 1.60 (L). Direct Primary Repair was the most common surgical technique compared to Tendon Reconstruction, with End to End and Transosseous techniques split almost equally. Brace immobilisation was preferred overcast, with a mean start to weight-bearing of 3.23 weeks post-op.

Conclusions

Bilateral patellar tendon rupture is a rare injury that should be considered in patients with knee extensor mechanism disruption. The key limitation of this study was the low number of patients encompassed by the eligible literature. There is space for a higher level of evidence study, specifically regarding surgical treatment choice and methods, as well as post-operative management, which could potentially improve the outcomes in the management of this injury.
173 Performance of PERSARC as Prognostic Tool of Extremity Soft Tissue Sarcoma
Authors: So C P , Jayasankar V , Mahendra A
Published: August 2023

Aim

To review extremity soft tissue sarcoma (ESTS) in MSK sarcoma unit in Glasgow Royal Infirmary. To assess reliability of PERSARC nomogram in estimating outcomes of FNCLCC Grade II and III ESTS.

Method

A retrospective study of 72 patients with primary ESTS, treated surgically at GRI from 2010-2015 was performed. Patients were followed up as per local sarcoma protocol up to 10 years. Overall survival (OS), Local recurrence (LR) and Distant metastasis (DM) at 3 years and 5 years post-op were calculated and PERSARC nomogram was used to estimate predicted OS, LR and DM at 3 years and 5 years post-op. The reliability of PERSARC to estimate ESTS outcomes was assessed using discrimination and calibration. Concordance index was used to assess discrimination. Calibration plot was used to assess calibration.

Results

Observed 5-year OS, LR and DM were 77.78%, 12.5% and 27.77% respectively. Concordance indices for 3-year OS, LR and DM were 0.82, 0.68 and 0.70 respectively. Concordance indices for 5-year OS, LR and DM were 0.77, 0.69 and 0.66 respectively. Calibration plot showed PERSARC underestimated 3-year and 5-year OS. Calibration plot showed good calibration for 3-year and 5-year LR and DM.

Conclusions

PERSARC nomogram showed good discriminative ability for 3-year OS, 3-year DM, and 5-year OS as the concordance indices were >0.7 and good calibration for 3-year and 5-year LR and DM. PERSARC could be beneficial to guide shared decision making between patients and healthcare professionals, leading to focused and personalised care for patients with ESTS.
264 Observational Study of Clinical Impact of E-Scooter Injuries at Major Trauma Centre
Authors: Metry A , Lui D , Arnander M
Published: August 2023

Aim

Is to focus on frequency E-scooter associated injuries especially open fractures and to see its burden on health system.

Method

Data of E-scooter injuries was extracted from trauma database from November 2017 to July 2022. Outcome measures were type of injuries: site of bony fractures, closed Vs open fracture, number of operations, complications and Length of Hospital Stay.

Results

Number of patients enrolled was 104. The mean age was 34.3 years and 78.8% were males. The main mechanism of injury was riding 91%. Patients with bony injuries were 65.4% with 22.1% of them were open fractures. Most common bony injuries were lower limb only fractures 45.6%, then upper limb only injuries 39.7%. Head and neck injuries composed 23.1% of the reported injuries including: intracranial haemorrhages (9.6%), extensive traumatic brain injury (3.8%), hematoma/lacerations (3.8%), cervical spine fractures (1.9%) and skull fractures (1.9%). Mean duration of hospital stay was 8.6 days and 9.6% patients needed ITU admission. Number of patients presented as trauma calls were 55.8%. Patients that needed surgical intervention either under Orthopaedics or other specialities were 52.9% and 21.2% of total patients had complications either due to surgical intervention or long hospital stay.

Conclusions

E-scooter riding can lead to serious injuries that can end with limb or life-threatening conditions. There should be more emphasis on wearing protective gear like wrist and elbow guards in addition to helmets. Future prospective studies with larger cohorts across multiple regions and hospitals are necessary to truly characterize the nature and cost of e-scooter injuries.
358 What Is the Caregiver Experience of Soft-Cast Removal at Home Following Paediatric Upper Limb Trauma? a Qualitative Analysis
Authors: Wang J , Hughes K , Wickramasinghe N , Baird E
Published: August 2023

Aim

At-home soft-cast removal has shown to be safe and effective following paediatric orthopaedic trauma. It minimises clinician contact time, reducing costs for hospitals and families. Limited qualitative evidence on caregiver experience exists. This study explores the caregiver experience of at-home soft-cast removal.

Method

Retrospective analysis of fractures (<16yrs) requiring application of circumferential soft-cast, later removed at home, between July–August 2022. Demographic data collected included age, fracture type and angulation, need for manipulation and complications or unplanned re-attendance.

A caregiver telephone Likert questionnaire, friends and family satisfaction score and qualitative descriptors were used to assess the caregiver experience.

Results

30 families were contacted at mean 110 days post-injury. Mean age 8 years. 25 successfully removed their soft cast at home with no further orthopaedic follow-up. 36% distal radius and 36% both-bone forearm. 64% of injuries required manipulation under procedural sedation with mean fracture angulation 26 degrees. Two patients re-attended due to parental concern regarding the appearance of the limb after soft-cast removal. 64% of families were ‘extremely’ or ‘somewhat’ satisfied, and 56% were ‘extremely’ or ‘somewhat’ likely to recommend at-home soft-cast removal. Qualitative descriptors indicated a range of experiences, from ‘easy’ and ‘convenient’, to ‘difficult’ and ‘traumatic’.

Conclusions

Our tertiary centre experience confirms that at-home soft-cast removal with no further orthopaedic follow-up is safe and feasible, even after displaced upper limb fractures requiring manipulation under sedation. The majority of families report at-home soft-cast removal to be a positive experience, however this is not universal. Developing patient information resources is likely to improve caregivers’ experiences.
457 Tourniquet Pressures in Orthopaedic Surgery - Is the Standard 250mmHg Safe?
Authors: Barclay A , Turner T
Published: August 2023

Aim

To determine safe levels of tourniquet inflation pressures in trauma and orthopaedic surgery.

Method

Data was collected on 150 patients retrospectively from the intraoperative and anaesthetic records of patients undergoing trauma and elective orthopaedic surgery at a single site. Data collected included demographic data, tourniquet inflation pressures and maximum intraoperative systolic blood pressures. British Orthopaedic Association (BOA) standards for safe intraoperative tourniquet use were used to determine safe tourniquet inflation pressures.

Results

The average maximum intraoperative systolic blood pressure was 125mmHg. In 134 cases (91%) the tourniquet pressure used was 250mmHg. Of the cases studied 54% of upper limb and 33% of lower limb tourniquets were overinflated when compared with BOA standards. Given the average maximum intraoperative systolic blood pressure, standard tourniquet inflation pressures of 200mmHg for upper limbs and 225mmHg for lower limbs should be used in preference to the more commonly used standard used pressure of 250mmHg.

Conclusions

All patients should ideally have an individual tourniquet pressure set based on their systolic blood pressure. However, if a standard pressure is to be used, values of 200mmHg for upper limbs and 225mmHg for lower limbs should be used in preference to 250mmHg as appears to commonly used currently.
509 Diagnosing Paediatric Compartment Syndrome and Its Challenges
Authors: Siddiqui R S
Published: August 2023

Aim

to conduct a critical analysis of current published evidence and key papers in relation to diagnosing paediatric compartment syndrome.

Method

A thorough literature search was conducted using databases including Pubmed, Cochrane central register, Medline and google scholar. Specific eligibility criteria was applied to studies within the last 20 years to incorporate post neonatal paediatric patients till the age of 16 with a high clinical suspicion of limb compartment syndrome presenting acutely.

Results

There is an overall good literature overview in diagnosing paediatric compartment syndrome and a general consensus in assessing agitation, anxiety and increasing use of analgesia as the 3A's for clinical diagnosis. Several studies recommend measuring delta P by subtracting compartment pressure from diastolic blood pressure. The majority of evidence is level IV and level V as pressure monitoring in children is challenging and user dependent. Literature fails to agree on a cut off for emergency fasciotomy using pressure monitoring and there is limited evidence to validate normal paediatric compartment pressures. Non-invasive compartment pressure monitoring such as near infrared spectroscopy, pulse phase locked loop ultrasound and mechanical myotonometry is currently being researched.

Conclusions

Compartment syndrome is an orthopaedic emergency requiring emergency fasciotomy in theatre. It is primarily a clinical diagnosis however there is lack of a validated diagnostic test in paediatric patients due to limitations of using needle manometry in an upset child. There is a need for an evidence-based database with further research to determine the extent of pressure monitoring in children identifying normal versus abnormal compartment pressures.
560 Evaluating the Utility of Plain Radiograph and Computerised Tomography Scanning in Identifying Concomitant Foot Fractures in Patients with Unstable Lisfranc Injuries
Authors: Aamir J , Caldwell R , Karthikappallil D , Tanaka H , Elbannan M , Mason L
Published: August 2023

Aim

Lisfranc fracture dislocations are uncommon injuries. There is varying evidence on the utility of plain radiographs (XR) and CT in identifying Lisfranc injuries and concomitant fractures. Our aim was to identify the utility of XR as compared to CT, with the nul hypothesis that there was no difference in fracture identification.

Method

A retrospective assessment of patients who had sustained a Lisfranc injury between 2013 and 2022 across two trauma centres within the United Kingdom who underwent surgery. Pre-operative images were reviewed independently by 2 reviewers to identify the presence of injuries.

Results

A total of 175 patients were included. We found that XR images significantly under-diagnosed metatarsal and midfoot fractures. The largest discrepancies between XR and CT in their rates of detection were in fractures of the cuboid (5.7% vs 28%, p<0.001), medial cuneiform (20% vs 51%, p = 0.008), lateral cuneiform (4% vs 36%, p = 0.113), second metatarsal (57% vs 82%, p<0.001), third metatarsal (37% vs 61%, p<0.001) and fourth metatarsal (26% vs 43%, p<0.001).

As compared to CT, the sensitivity of XR was low. The lowest sensitivity for identification however was lateral foot injuries, specifically fractures of the lateral cuneiform (sensitivity 7.94%, specificity 97.3%), cuboid (sensitivity 18.37%, specificity 99.21%), fourth (sensitivity 46.7%, specificity 89.80%) and fifth metatarsal (sensitivity 45.00%, specificity 96.10%).

Conclusions

From our analysis, we can determine that XR significantly under-diagnoses associated injuries in patient sustaining an unstable Lisfranc injury, with lateral foot injuries being the worst identified. We advised the use of CT imaging in all cases for appropriate surgical planning.
561 A Morphological Review of Medial Malleolar Fractures – a Large Single Centre Series
Authors: Aamir J , Caldwell R , Long S , Sreenivasan S , Mavrotas J , Panesa A , Jeevaresan S , Lampridis V , Mason L
Published: August 2023

Background

Medial Malleolus Fractures (MMF) are frequently managed by orthopaedic surgeons and are one of the most treated fractures of the ankle. Many approaches to management are described in the literature however, their morphology is under investigated.

Method

Patients who had surgical fixation of their MMF were identified from 2012 to 2022. Analysis of their pre-operative, intra-operative and post-operative radiographs was performed. Lauge-Hansen classification was used to characterise ankle fracture morphology and Herscovici classification to characterise MMF morphology.

Results

A total of 647 patients were identified across a 10-year period who had sustained a medial malleolar fracture. The most common Herscovici fracture in Supination Adduction injuries was a Herscovici D (43.9%, 17/39), in supination external rotation injuries was Herscovici C (52.75%, 259/491), in pronation external rotation injuries was Herscovici C (48.81%, 41/84) and in pronation abduction injuries was Herscovici B (45.45%, 12/33). Medial wall blowout occurred in 19.23%, occurring in supination adduction injuries most commonly (51.28%, 20/39). Herscovici A fractures were significantly more malreduced at time of surgery compared to other fracture types (21.88%, 7/32, p = .003). There was no significant difference in union rates across the classification groups (range 11.67% Herscovici D to 22.86% for Herscovici B).

Conclusions

Knowledge of the medial malleolar morphology allows greater assessment and planning in their surgical treatment. There was a high rate of medial wall blowout even in the non-adduction fracture types, and this should be assessed to prevent over compression during surgical treatment. Herscovici A fracture malunions may need further investigation and different methods of fixation.
564 Pelvic Fracture Incidence in EU15+ Countries: Trends Over a 30-Year Period
Authors: Hagroo A G , Ali R , Goodall R , Sugand K , Borsky K , Salciccioli J , Marshall D , Shalhoub J
Published: August 2023

Aim

Pelvic fractures (PF) are relatively uncommon but significant injuries accounting for approximately 3% of all skeletal injuries. We aimed to assess the burden of PFs across high health expenditure countries by describing the trends in PF incidence rates over the last three decades.

Method

Using the Global Burden of Disease (GBD) Study database, we extracted sex specific PF age-standardised incidence rates (ASIRs) from 1990-2019 for each of the 19 European Union (EU) 15+ countries. We performed Joinpoint regression analysis to further characterise the trends.

Results

Over the 30-year period of study, 89% of countries experienced a decline in ASIRs for males, with a median percentage change of -11.8%, in comparison to females where 53% of countries experienced an increase in ASIR (median percentage increase of +3.1%). For females, the largest increases in PF incidence were observed in the Netherlands and Belgium; these were also the only two counties with increased overall PF incidence in males over the study period observed. The countries with the greatest decrease in ASIRs were Italy and Denmark for females and Portugal and Spain for males. Joinpoint regression identified that over the time periods covered by the most recent trends, PF incidence rates had increased in 58% of countries for females and 52% of countries for males.

Conclusions

We found overall decreased incidences of PFs amongst males over the last 3 decades, compared with increased incidence in females. However, joinpoint regression analysis demonstrated a trend towards rising incidence of PFs amongst both males and females in recent years.
688 Burden of Trauma from Electric Scooter Related Accidents in Central Birmingham: A Retrospective Observational Study
Authors: Begum S , Tahir M , Ponnuru R , Prakash D
Published: August 2023

Aim

The Department of Transport deployed an e-scooter rental trial in multiple cities across the UK in 2020. Despite its environmental incentive, this trial has sparked safety concerns as national statistics have shown >1,900 casualties in e-scooter collisions since 2020, including 15 fatalities. This study aims to assess the volume and type of e-scooter related injuries presenting to an inner-city Trauma and Orthopaedic (T&O) department.

Method

A retrospective study was conducted to identify all patients referred to the T&O department at a large trauma unit with e-scooter related injuries over the 2 years prior and 2 years after introduction of the Birmingham e-scooter rental scheme in October 2020.

Results

A total of 72 patients were identified with e-scooter related injuries, 4 of whom were pedestrians, median age 22 (range 2-86) years and 74% (n = 53) were male. Majority (74%, n = 53) had sustained limb fractures, of which 49% (n = 26) were long bone fractures and 11% (n = 6) were open fractures. The remaining 26% consisted of soft tissue trauma (18%), head injuries (0.07%), and spinal injuries (0.01%). Surgical management was undertaken in 78% (n = 56) of all patients. Majority of injuries (87.5%) occurred after the rental scheme was introduced.

Conclusions

The incidence of significant injuries to riders and pedestrians has increased since the introduction of the rental e-scooter scheme, which may result in further financial strain on the health service nationally. A review of e-scooter safety measures and their enforcement should be undertaken before any future legislation of this scheme.
863 Management of Paediatric Forearm Fractures Presenting to the Whittington Hospital Emergency Department: An Audit of Current Practice
Authors: Dighero I , Haider Z , Prinja A , Haddo O
Published: August 2023

Aim

The most common site of fractures in children is the forearm. According to BOAST standards, early closed reduction by manipulation, avoiding the need for admission and general anaesthesia, is the treatment of choice for most forearm fractures. Further, management should include a documented assessment of neurovascular status and formal consent. Our aim was to audit management of forearm fractures in our emergency department against these standards.

Method

Patients presenting to our emergency department with isolated and neurovascularly intact forearm fractures were retrospectively identified from Nov 2021 to April 2022. Initial case management was assessed against BOAST standards and, where early manipulation in the emergency department was not performed, cases were reviewed by an orthopaedic consultant to determine if this could have occurred.

Results

24 patients were identified. The mean age at time of injury was 10 years. 62.5% of patients underwent manipulation within the emergency department of which 47% (7/15) were unsuitable to continue non-operative treatment. 37.5% of patient did not undergo manipulation, of these 44.4% (4/9) were deemed as could have been suitable for manipulation. This led to 67% (16/24) of patients requiring a procedure under general anaesthesia. Neurovascular assessment was documented for 29% and formal consent for manipulation for 0% of patients.

Conclusions

There is scope for more forearm fractures to undergo early closed reduction by manipulation in our emergency department, potential avoiding intervention under general anaesthesia. Documentation of neurovascular assessment and formal consent requires significant improvement. A hospital protocol is currently being produced to help standardise care of such injuries.
873 Fixation and Graft Augmentation of Tibial Plateau Fractures: A Systematic Review and Meta-Analysis
Authors: Clarke A , Robinson M
Published: August 2023

Aim

Modern techniques have challenged the consensus of open reduction and internal fixation (ORIF) with autologous graft augmentation as the gold standard management of tibial plateau fractures. The objective of this review was to assess the outcomes of surgical techniques and graft materials for managing tibial plateau fractures.

Method

MEDLINE, Embase and CENTRAL searches were conducted alongside trial registers, conference abstracts and OpenGrey from their inception to July 2022. Randomized and quasi-randomized controlled trials comparing fixation techniques or graft materials were included. Bias was assessed using the Risk of Bias 2 (ROB2) framework, and certainty of evidence using the GRADE approach. Primary outcomes included functional and radiographic outcome scores, with secondary outcomes of complications, radiographic parameters, and time to union.

Results

Eleven studies were included, five assessing surgical techniques and 6 graft materials. ROB2 assessments highlighted some concerns in nine papers and high risk in one. Improved functional outcomes were reported in minimally invasive techniques (mean difference = 3.25, 95% CI -0.17, 6.67) trending towards significance (p = 0.20). Trends towards significantly reduced complications were observed in both minimally invasive (risk ratio 0.58, 95% CI 0.26, 1.30, p = 0.19) and synthetic graft (risk ratio 0.66, 95% CI 0.37, 1.15, p = 0.14) groups.

sd definite conclusions regarding the best fixation and graft approach. However, greater efficacy and non-inferiority were demonstrated with minimally invasive techniques and synthetic grafts respectively. It is our judgement that the fixation approach is the most important prognostic factor in these injuries thus future research should be focused accordingly.
912 An Evaluation of Outcomes in G7 Dual Mobility Cup Arthroplasty for Primary Total Hip Arthroplasty: A Single Centre Retrospective Study
Authors: Aldridge W , Braimah F , Ahmed H , Jehan S , Ng A
Published: August 2023

Background

Hip instability is one of the commonest complications of total hip replacement (THR) and remains a leading indication for revision surgery. The G7 Dual Mobility Cup (G7-DMC) was designed to improve hip stability and increase range of movement. Our study aims to look at the use of G7-DMC in patients with varying risk of dislocation, to observe rates of hip instability, as well as their short and long term post-operative outcomes.

Method

Between 2017 and 2021, 177 patients received a G7-DMC for primary hip arthroplasty. These patients were divided into three groups: elective surgery with low risk for dislocation, elective surgery with high risk of dislocation or THR for trauma. Outcome measures included dislocation rate, Oxford Hip Score (OHS), short- and long-term complications and revision surgery.

Results

One traumatic dislocation (1.9%) was seen in the high-risk group following a fall in the post-operative period, no dislocations were seen in the low-risk or trauma groups. No patients required revision surgery for dislocation or hip instability.

OHS was significantly lower in the high-risk group (39.4 +/- 8.9) compared with low-risk (43.5 +/- 6.5) (P = 0.012), however no significant difference was seen against the trauma group (41.5 +/- 7.8). Long-term complications were similar in all three groups.

Conclusions

Despite higher rates of short-term complications and poorer OHS seen in the high-risk group of patients, no spontaneous dislocation or revision surgery for hip instability has been seen in any of the three groups. We therefore support its use in primary THR, particularly in those with high risk of dislocation.
924 The Epidemiology of Severe Obesity in Patients Undergoing Total Knee Replacement in the Kingdom of Fife Over the Last 20 Years
Authors: Akhtar M A , Thomson J , Blacklock C , Walmsley P , Ballantyne A
Published: August 2023

Aim

Obesity is associated with increased risk of postoperative complications such as wound infection and venous thromboembolism. The aim of our study was to assess changes in the epidemiology of severe obesity (WHO classification, BMI ≥ 40) in NHS Fife, Scotland, from 2001-2021 in patients undergoing Total Knee Replacement (TKR).

Method

A retrospective analysis of prospectively collected data was performed for 7320 patients, who underwent TKR between 2001 and 2021. Obese patients with BMI ≥ 40 were studied and their demographic details, rates of severe obesity, and length of stay were studied from 3 discrete years (2001, 2011 and 2021) in order to examine changes over time.

Results

A total of 474 patients with BMI ≥ 40 underwent TKR between 2001 and 2021. In 2001, 2.73% of TKR’s performed were in severely obese patients; this rose to 9.25% in 2011 and 10.24% in 2021. This constitutes a significant increase of 7.51% over the 20-year period (p = 0.0186).

Male/Female ratio was 67/33% in 2001, 41/59% in 2011 and 35/65% in 2021. Mean age was unchanged, from 61(SD13.23) in 2001 to 63 (SD 8.89) in 2021 (p = 0.807). Mean length of stay decreased significantly from 7.33 (SD 1.53) to 2.50 (SD 1.33) over the same period (p = 0.024).

Conclusions

Rates of severe obesity have significantly increased in patients undergoing TKR over the last 20 years in our region. Careful patient selection and informed discussion about the high risk of complications is extremely important to manage patient expectations in the presence of severe obesity.
928 The Golden Patient: A Concept to Improve Trauma Theatre Efficiency
Authors: McGurk C , Brasnic L , Tong E , Gerrie E , Duff J , Lim J W , Gardner T , Mitchell M , Boddie D
Published: August 2023

Aim

Golden patient (GP) is a pre-selected first patient on the next day’s trauma theatre list, with suitable medical fitness and a clear surgical plan. This study aimed to evaluate whether the GP concept improved the start times of theatre lists and the operating efficiency of the Aberdeen trauma unit.

Method

This prospective study compared theatre starting times before and following an intervention to improve consideration of the GP concept among both trauma and theatre staff. Data was collected from pre-planned trauma theatre lists on Bluespier software the evening before and the morning of the list. The comparative mean of operation start times between the groups was established and a two-sided t-test was performed to evaluate the significance between the groups.

Results

Post-interventional analysis identified 32 GPs out of which 28 persisted as first patients on the lists. The remaining 4 patients were deferred either due to an overnight emergency that took priority or a change in medical status that required them to be moved down the list. The mean operation start time was 10:00 compared to 10:14 pre-intervention. Further, in the re-audit, the mean operation start time was reduced by 39 minutes (p<0.01) when the GP remained first on the list.

Conclusions

The concept of GP has improved the theatre start times which is further evident in the delay to the start of the list when the GP is not employed. Additional contributing factors that influence theatre efficiency and require further review include anaesthetic planning, patient transport and others.
952 The Use of Cell-Salvage in Periprosthetic Femur Fractures: A Cheaper and Safer Alternative?
Authors: Kapuge L , Brunt R , Crosswell S
Published: August 2023

Aim

Periprosthetic femur fractures (PFF) are becoming increasingly frequent due to an ageing population and growing number of arthroplasties. PFF revision surgery is associated with significant peri-operative blood loss and higher transfusion requirements. There are few strategies to reduce rates of transfusion. One of which is the use of cell-salvage. The aim of this study was to determine whether cell salvage should be routinely implemented during PFF revision surgeries.

Method

All admission with PFF were retrospectively reviewed over a period of 18 months. Data points including patient demographics, admission/operation dates, fracture site, anticoagulation status, pre/post-op Hb and number of transfusions were collected.

Results

There were a total of 38 PFF. Average age was 83.4 years with admission Hb 11.65g/dl. Mean time for operation was 2.9 days. 56% of total hip replacement PFF received a blood transfusion post-operatively with an average of 2.6 units per patient. 100% of total knee replacement PFF received a post-operative transfusion with an average of 1.6 units per patient. Of note there was no increased transfusion requirements for patient on anticoagulation (Warfarin/DOAC).

Conclusions

We identified that >50% of PFF required a post-op transfusion. The cost of 1 unit of RBC locally was found to be £145.99. The average cost of a cell salvage filter is £100 per patient. Considering the above and the well-known risk of allogenic red blood cell transfusion, it was concluded that the routine use of cell salvage could be a cheaper and safer alternative to allogenic red blood cell transfusion.
1052 Safety of Drain-Less Anterior Cervical Discectomy and Fusion (ACDF) and Effects on Length of Stay
Authors: Kuligowska A , Geddes J , Wong F , Fakouri B
Published: August 2023

Aim

The use of drain in ACDF surgery is to avoid post-operative catastrophic haematomas compressing the airway. However, studies associate drains with dysphagia, infection and longer inpatient stays. This study assesses whether drain-less ACDF could avoid drain-site morbidity and reduce length of stay (LoS) without increasing complications.

Method

All consecutive adult patients who had ACDF under a single surgeon over a 4-year period were identified, where routine post-operative care did not involve drain placement when meticulous intra-operative haemostasis was achieved. Data was collected using electronic patient records. From Autumn 2020, patients were pre-operatively counselled on potential same-day discharge. This group of patients (PC) was compared with those without counselling (Control) for assessing secondary outcomes, including LoS and GP or A&E attendance.

Results

Seventy-four patients were included in this study. None had post-operative drain placement and there were no reports of post-operative haematoma or return to theatre. There were 12 and 15 patients for PC and Control groups respectively. For same-day discharge, there were two patients in the PC group and none in Control group. Median LoS was also shorter in PC (1.0 day; IQR:1-1.3) compared to Control (2.0 days; IQR:1-3.5). Three patients from each group had persistent mild radicular symptoms, but none required GP or A&E attendance within 6 weeks post-operatively.

Conclusions

Our results support that routine drain placement may not be required for safe ACDF surgery. Additionally, with appropriate counselling, shorter LoS can be achieved. This could help develop safe daycase surgery pathways, easing bed demands while improving access to treatment.
1061 Improving the Emergency Management of Unstable Ankle Fractures in a District General Hospital: A Quality Improvement Project
Authors: Frank A , King A , Cunnington R , Bradman H
Published: August 2023

Aim

To assess and improve initial casting techniques in the emergency management of unstable ankle fractures.

Method

All patients who underwent operative management of ankle fractures over two consecutive 3-month periods were selected, before and after an intervention. Following the first cycle, an intervention included presentation of results and teaching delivery to the Emergency Department, with agreement to advocate for backslab as preferred casting technique.

Results

A total of fifty-two patients were identified, with an age range of 8 to 96 years. The majority were female (63%). Initial results demonstrated 61% were managed in below ankle backslabs, 33% in full casts and 1 patient in a moonboot. Subsequent loss of reduction was demonstrated in 27% of patients. Rates were higher with full casts (45.4%) compared to backslabs (20%). Following intervention, results demonstrated a 28% increase in use of backslab casting method (89%). Only 5% were managed with a full cast (28% decrease) and 1 inappropriately discharged without immobilisation. There was a 7% decrease in overall loss of reduction (21%). There was no loss of reduction within the full cast group and 22% with backslab management.

Conclusions

The use of backslab immobilisation in the management of unstable ankle fractures is preferred. Following a brief intervention, rates of backslab immobilisation increased and loss of reduction decreased. Results show an improvement in casting techniques in the management of these patients in an NHS Trust.
1070 Epidemiology and Incidence of Pelvic Fractures
Authors: Zhang J , Stevenson A , Zhou A , Lu V , Bradshaw F , Duchniewicz M , Zhu J , Krkovic M
Published: August 2023

Aim

There is a lack of recent UK based literature reporting on the incidence of pelvic fractures, and the demographic associations with fracture locations. Our study reports the incidence and factors associated with pelvic fractures at a major trauma centre over a 7-year period.

Method

Data from pelvic fractures treated at a Level 1 Trauma Centre was collected from January 2015 to January 2022. Fracture location, patient demographics, and operative status were collected and analysed.

Results

A total of 3137 patients with pelvic fractures were included, with an incidence of 78.6/100,000 patients per year. The mean age was 63.0, 53% of patients were female and the mean BMI was 25.3. The mean length of hospital admission was 20.5 days.

Patients with Pubis fractures had the highest mean age (65.55), whilst those with ilium fractures had the lowest (51.14), both significantly different from the mean (p<0.001). Female patients were more likely to have pubis (60.1%) fractures but less likely to have acetabulum (30.0%) fractures (p<0.01). Patients with acetabular fractures had a higher BMI (p<0.01) and the highest rate of operative fixation (48.5%).

Conclusions

Our study provides insight into the incidence and epidemiology of pelvic fractures in a UK major trauma centre setting, the first study in over 15 years in this context. This contributes to the literature, and allows inter-country comparisons to be conducted, and guidelines and policies to be more informed.
1151 The Accuracy and Diagnostic Value of Gram Staining from Joint Aspirates in Suspected Joint Infection
Authors: Zhang J , Stevenson A , Zhou A , Krkovic M
Published: August 2023

Aim

Septic arthritis is a debilitating pathology. Joint aspirate gram stain is often performed followed by definitive culture. We review the accuracy of gram staining for suspected septic arthritis, and investigate factors associated with aspirate cultures positive for bacterial growth.

Method

We reviewed all theatre performed joint aspirates at a Major Trauma Centre from 2015-2021 for suspected septic arthritis. Information collected included aspirate-site, gram stain and culture results delay, patient demographics, orthopaedic/rheumatological history of affected joint, and various comorbidities.

Outcomes included sensitivity and specificity of the gram stain. Factors that predisposed patients to positive cultures and false-negative gram stains results were calculated via multivariate binary logistic regression.

Results

A total of 408 joint aspirates were included, of which 37 did not receive initial gram staining. Gram staining and culture results’ delay were on average 1.1 and 5.4 days respectively. Logistic regression revealed that prosthetic joint (p = 0.007), past joint infections (p = 0.006), arthritis (p<0.001), hypertension (p = 0.007), currently smoking (p = 0.019) were positively associated with positive cultures, and past joint infections (p = 0.004) were significantly positively associated with false negative gram stain results. Patients on antibiotics at time of aspirate were at higher risk of false-negative gram stain results (OR = 5.538, 95% CI [2.802-10.948], p<0.001).

Conclusions

Whilst the initial gram stain is fast, it has poor sensitivity. We recommend caution when lending any weight to a negative result. Moreover, if the comorbidities highlighted are present or the patient is on antibiotics at time of aspirate, hyper-vigilance should be exercised to risk stratifying patients with any clinical hallmarks of joint infection.