bluuebunny/crossref_metadata_2025 huggingface dataset:
1170 Outcome of Various Fixation Techniques for Talo-Navicular Arthrodesis
Authors: Khattak M , Sharoff L , Thomas-Fernandez K , Rahman N
Published: October 2021

Aim

The talonavicular (TN) forms part of the medial joint complex, which is involved in maintaining stability during the gait cycle Arthrodesis can be used to manage a range of deformities and to treat degenerative and inflammatory changes of the joint. The most significant complication is non-union, but chronic pain due to complex regional pain syndrome, or progressive arthritic changes can also occur. The aim was to evaluate the outcome of different methods of fixation used for TN arthrodesis in adults within the trust.

Method

This was a quality improvement project, looking retrospectively at inpatient surgeries over a 6-year period. Inpatient notes, operative notes, clinic letters and imaging were analysed. Treatment methods included IOFIX devices, cannulated screws, staples, plates and screws, and combined staples and screws. The sample included a total of 57 patients (42 females and 15 males).

Results

IOFIX had a 93% fusion rate, and a 27% complication rate. Cannulated screws had a 79% fusion rate, and a 46% complication rate. Screws and staples had a 75% union rate, and a 13% complication rate. Only one sample used plates and screws, which resulted in union and no complications. Using staples alone had a 78% union rate and a 11% complication rate.

Conclusions

The greatest union rate was achieved with IOFIX devices, followed by cannulated screws. Greatest complication rate was with cannulated screws, and lowest with the combined use of staples and screws. Highest rate of revision surgery was with cannulated screws. Recommendations included a switch to IOFIX devices for TN arthrodesis.
1200 Management of Supracondylar Fractures at a District General Hospital
Authors: Erotocritou M , Antar M , Abdulkarim A
Published: October 2021

Aim

The aims of the study were to identify supracondylar fracture cases, identify any differences in management between the pre- and post-COVID period, as well as compare local management to BOAST guidelines.

Method

Cases were retrospectively identified using electronic patient records, imaging, theatre records and clinic letters. Cases were identified between 1st of December 2019 – 30th December 2020. The Pre-COVID period was defined as before 15th of March 2020. The Post-COVID period was defined as after 15th of March 2020. Inclusion criteria: any paediatric supracondylar fracture requiring conservative or surgical management. Exclusion criteria: any adult cases. Data analysis and graphics were produced on Microsoft Excel.

Results

A total of 22 cases were identified. Time to operation Pre-COVID: 1 day vs Post-COVID 2 days (p < 0.05). Only 30% of cases had good neurovascular status documentation. Using the Gartland Classficiation – Type I:2, Type II:10, Type III:9, Type IV:1. Type of Fixation – MUA: 3, K-wires: 18, Plate and screws: 1. All Type I fractures were treated with K-wires. Cast duration for MUA 4 weeks vs K-wire 5 weeks (p-value< 0.05). Only 2/22 cases were referred to physiotherapy, whilst only 1 case required revision surgery.

Conclusions

MUA was not the treatment of choice for Type I fractures against BOAST guidelines. MUA offered a shorter duration in cast compared to K-wires. There was a statistically significant increase in time to operation between the Pre-COVID to Post-COVID Period. There is a need for better documentation for neurovascular status.
1220 Dual Mobility Cups in Primary and Revision Thas – A Single UK Centre Outcome Study
Authors: Yiu A C F , Thambipillai R , Toteja M B , Unnithan A
Published: October 2021

Aim

Total Hip Arthroplasty has been challenged with instability and dislocation (5%) and restricted movements. Risks are further increased in trauma and revision cases (7-14%). Dual Mobility (DM) prosthesis is one solution to these issues and has shown to reduce the rate of dislocation in multiple USA and France studies. Its uses remain limited in the UK due to unfamiliarity. DM implants contain a small femoral head mobile within a polyethylene liner which articulates with a supra-hemispheric metallic acetabular shell. Increased coverage of the shell reduces intra-prosthetic dislocation. The highly crosslinked polyethylene helps to reduce wear while the extra arc of motion improved range of movement. Our centre started using DM prosthesis since 2018 and this study demonstrates our outcomes.

Method

Retrospective study of all DM replacement from January 2018 – May 2020. Allowing a minimum follow up of 6 months. Data was collected from an electronic database.

Results

54 cases were identified (35 elective cases and 19 trauma cases). 34 cases were revision surgery, and 21 cases were primary arthroplasty. The average age was 75, average length of surgery was 3 hours and average stay in hospital was 9 days. No dislocation was noted in this study. All patients reported good range of movement in follow ups with no complaints of instability.

Conclusions

DM prosthesis provides excellent outcomes with no dislocation and good patient reported satisfaction at our center. This result is supported by various systematic reviews. The reduction of complications is also economically advantageous. Use of Dual Mobility prosthesis should be encouraged in UK.
1235 A Multi-Site Review of Second Hip Fractures Across 6 Dublin Teaching Hospitals
Authors: Murphy B , Downey C , Flannery S , Daly T , Conway S , Gaffar M , Dawson P , Collins D , Kenny P , McCarthy T , Cashman J , Hurson C , O'Daly B , Quinlan J
Published: October 2021

Introduction

Hip fractures are a common presentation to Irish hospitals with 3,701 hip fractures recorded by 16 hospitals in the Irish Hip Fracture Database (IHFD) in 2019. Second hip fractures (HF2) make up a significant proportion of hip fractures and represent an opportunity to prevent subsequent fragility fracture.

Method

Hip fracture datasheets from 2019 in six Dublin hospitals were analysed.

Results

1,284 hip fractures in total were recorded in 2019 in these six hospitals. 112 of these were second hip fractures (8.72%). 24.1% of patients had a HF2 in year 1 post their first hip fracture (HF1). 14.3% of patients had a HF2 in Year 2, 8% in Year 3, 8.9% in Year 4 and 6.3% in Year 5. 17.9% of patients had an HF2 at an unknown time in relation to their HF1. 57.6% of all patients with any hip fracture were started on bone protection medications (BPMs) during their admission. 18.9% continued a pre-admission prescription. 7% of all patients were previously assessed and determined not to require BPM. 6.9% of patients were awaiting outpatient department (OPD) assessment for bone protection. 8.6% had no assessment for bone protection conducted. Of all patients with an HF2, 48.2% were started on BPMs on admission with their HF2. 33% continued BPMs started pre-admission.

Discussion

In 2019, approximately 1 in 10 hip fractures were second hip fractures. Evidence suggests that fracture liaison services represent a viable, economic means of preventing second hip fractures to improve patient outcomes and reduce healthcare expenditure.
1238 Surgical Management of Chronic Osteomyelitis of the Femur and Tibia: A Scoping Review
Authors: Arshad Z , Lau E J S , Aslam A , Thahir A , Krkovic M
Published: October 2021

Aim

This scoping review aims to map and summarise the literature on treatment of chronic femoral and tibial osteomyelitis, in order to enhance the reader’s understanding of potential treatment options, whilst also identifying areas of future research

Method

This scoping review was guided by the methodological framework of the Joanna Briggs institute. A computer-based search was conducted in PubMed, EMBASE, MEDLINE, Emcare and CINAHL, for articles reporting treatment of chronic tibial/femoral osteomyelitis. Title/abstract and full text screening was performed independently by two reviewers according to pre-defined criteria.

Results

A total of 1223 articles were identified, with 40 studies, involving 2,489 patients being finally included. A range of treatments are reported, with the key reported principles being removal of infected tissue, dead-space management and antibiotic therapy. The majority (76.2%) of patients presented with stage III or IV disease according to the Cierny-Mader classification and the most commonly cultured pathogen was Staphylococcus aureus. The proportion of patients achieving remission with no recurrence during follow up varies from 72.0% - 100.0%.

Conclusions

The majority of studies report excellent outcomes in terms of infection remission and lack of recurrence. However, using the current literature to identify specific patient and treatment related factors which may affect treatment results is challenging due to a number of potential confounding factors. Further high-level research such as randomized control trials and comparative studies are required to achieve this.
1295 Virtual Fracture Clinic: An Audit of Referral Quality and Service Effectiveness
Authors: Beoku-Betts C , Prodromidis A , Nazar A , Sharma D , Barton S
Published: October 2021

Aim

Assessment of referral quality to the virtual fracture clinic (VFC) at the Liverpool University Hospital foundation trust compared to the standards set out by the Glasgow virtual fracture clinic pathway. As a secondary aim the effectiveness of the VFC in diverting patients not requiring further clinical management away from face-to-face specialist physical fracture clinics (PFC) was assessed.

Method

Outcomes of 1st attendances were collected for standard PFC's before the implementation of the VFC at our centre. This data was comparatively analysed to the outcomes of 1st ‘attendances' of VFCs post-service implementation. To assess VFC referral quality fracture type was recorded and compared to the standard set out by the Glasgow virtual fracture pathway which states that a selection of simple stable fractures should be discharged from ED directly with patient advice and telephone support.

Results

We analysed 529 PFC first attendances and 402 VFC first attendances. We saw a variety of simples stable fractures (21%) in the VCF including: Distal radial, Fifth metatarsal, Minor radial head, Fifth metacarpal, Mallet finger, which could have been managed with direct ED discharge and telephone support. 19.4% of PFC attendance resulted in discharge without a change in management as compared to 22.1% of 1st attendances for the VFC.

Conclusions

The VFC clinic has shown itself as an effective service in re-directing patients from face-to-face appointments, evidenced by the comparative rates of patient discharge on first attendance. This study has laid the foundation for improving referral quality to the VFC. Collaborative efforts between Orthopaedics and ED could improve VFC clinic efficiency further.
1298 Could Antiangiogenic Drugs Be the Solution to Tendon Injury? A Literature Review on The Use of Antiangiogenic Drugs for Tendon Regeneration
Authors: Kirchhoff C
Published: October 2021

Aim

Tendinopathy accounts for more than half of reported cases of musculoskeletal injuries worldwide. The subsequent healing process results in a disorganised tendon structure secondary to increased neovascularisation, forming a bulky tendon with overall reduced strength. Current treatment options remain controversial as re-rupture rates following surgical interventions are high. It has been proposed that the use of anti-vascular endothelial growth factors could improve tendon healing.

Method

This literature review employed a systematic approach. The search strategy incorporated an adjusted PICO format and PRISMA flow diagram. Search findings were critically appraised using the CASP tool checklist. Identified studies investigated the effects of injectable anti-angiogenic drugs following tendon injury.

Results

Three final studies were identified. Tempfer et al. showed a reduction in cross sectional tendon area in the intervention group (5.6mm² +1.8), comparatively to the control group (9.1mm² +2.0), and increased tensile tendon strength in the intervention group (47.7N+6.41) comparatively to the control group(32.41N+9.23). Dallaudiere (2014) et al. showed a reduced cross-sectional area in the intervention group (0.95mm²+0.01) compared with the control group (0.75mm²+0.01). Dallaudiere (2013) et al. also showed a reduced cross-sectional area in the intervention group (1.10mm²+0.01) compared with the control group (1.11mm²+0.03).

Conclusions

All studies supported the use of anti-angiogenic drugs to support tendon healing. The use of injectable anti-angiogenic drugs may potentially serve in conjunction with surgical interventions or as an alternative minimally invasive intervention to improve tendon rehabilitation. This review recommends that further randomised control studies could be used to strengthen the current promising evidence base.
1301 Early MRI in the Diagnosis of Suspected Scaphoid Fractures – An Audit of a Redesigned Diagnostic Pathway
Authors: Cullen J , Donovan R , Vipulendran K , Lostis E , Blewitt N , Kelly M , Bott A
Published: October 2021

Introduction

MRI is the gold standard for investigation of suspected scaphoid fractures, which can be missed on initial x-rays. This full cycle audit reports the impact of our new patient pathway, which changes repeat x-rays at 2 weeks to urgent limited sequence scaphoid MRI for those with normal initial x-rays, but clinical suspicion of fracture at initial clinic visit.

Method

A second cycle audited MRI requests for suspected scaphoid fractures at Southmead hospital following implementation of the new pathway in October 2020. We collected wait times from request to scan, and radiologist reports. Results were compared to our first cycle, 6-month time period.

Results

he results for 24 limited sequence MRIs via our new pathway were compared to 134 full wrist MRIs of the first cycle. Two scans (9.1%) were positive for scaphoid fracture versus 12% in the first cycle. 19 scans (86%) identified alternate pathology including sprain (6), bone bruise (5), non-scaphoid fractures (4) and degenerative change (3). 1 scan (4.5%) was reported as normal. 73% of MRIs were performed within 14 days, compared to 63% in previous cohort.

Conclusions

Our new pathway using limited sequence MRI identified similar rates of scaphoid fractures. Reduced time to MRI was observed compared to the previous cohort due to shorter scan durations and resulted in earlier diagnosis and fewer outpatient follow-up appointments. Our new pathway has benefits to patient experience and also reduces footfall in hospital, during a time of global Covid-19 pandemic, with no increase in costs.
1343 Post-Operative Outcomes of Circular External Fixation in The Treatment of Tibial Plafond Fractures: A Systematic Review
Authors: Legg P , Ibrahim Y , Malik-Tabassum K
Published: October 2021

Introduction

Tibial plafond fractures (TPF) are uncommon but potentially devastating injuries to the ankle. Meticulous care of the associated soft tissue injury is imperative in managing these fractures. The reported benefits of circular external fixation (CEF) include the ability to affect fracture reduction and create stable fixation, while limiting further soft tissue insult. This article provides the systematic review of the clinical and functional outcomes of TPF treated definitively with CEF.

Method

A literature search from inception to 13th November 2020 was performed. Quality and risk of bias was assessed using standardised scoring tools.

Results

16 studies were included. 303 patients were analysed. Mean follow-up was 35 months. The mean time in CEF was 18 weeks and mean time to union was 21 weeks. Non-union and malunion occurred in 3.2% and 12.4% respectively. The overall complication rate was 12.3%. The rate of deep infection was 4.8%. No amputations were reported. Minor soft tissue infection (including pin site infections) accounted for 56.7% of complications. Almost two-thirds achieved good-to-anatomic reduction radiologically. Mean range of motion assessments were 11.8 and 24.8 degrees in dorsiflexion and plantarflexion, respectively. Approximately one-third reported excellent functional outcome scores. Quality of the studies was deemed satisfactory. A moderate risk of bias was acknowledged.

Conclusions

This systematic review provides an evidence-based summary, which highlights CEF as an acceptable treatment option with comparable complication rate and outcome scores to that of internal fixation. However, we acknowledge that high quality evidence is still lacking.
1357 Ankle Blocks: Improving Day Case Efficiency
Authors: Doherty C , McKenna R , Kang H W , Gibson D , Hanratty B , Wong-Chung J
Published: October 2021

Introduction

The COVID pandemic has exerted unprecedented pressure on hospital resources. Resulting in cancellation of elective operative services, increased patient waiting lists, limited surgical training opportunities along with reduced availability of staff, theatre, and in-patient bed capacity. A novel approach for day case forefoot surgery under ankle block, to mitigate the pandemic service limitations without compromising care, was developed.

Method

This is a 3-month, multi-centre, prospective cohort study evaluating the novel ankle block day case forefoot surgery pathway. Patients had a minimum of three months clinical follow up with outcome scores. They were matched to a cohort undergoing similar surgery prior to the COVID pandemic.

Results

The utilisation of an ankle block pathway resulted in an average reduction of inpatient stay by 2 days per patient. Over the study period conservative savings of £26,659 were calculated. Anecdotally we observed a reduction in morbidity (wound complications, SSI’s) although not statistically significant.

Conclusions

Our novel surgical pathway has enabled continued elective operating for procedures that previously required hospital admission during a period of severe restrictions within the NHS. We observed significant reductions in cost, surgical inpatient bed utilisation and total operative time with staff, resource, and time savings. We hypothesise that prehabilitation with physiotherapy, ankle instead of thigh tourniquets and early mobilisation may have contributed to improved morbidity scores. The findings of this project have implications for training, upper limb services and are transferrable as a template to improve service efficiency while maintaining high quality care.
1414 The Impact Of COVID-19 On Individuals with Neck of Femur Fracture in The United Kingdom: A Systematic Review and Meta-analysis
Authors: Andritsos L , Thomas O , Pallikadavath S , Sambhwani S , Kirmani S
Published: October 2021

Aim

All Neck of Femur fracture patients have a significant 30 – day mortality despite efforts to improve their outcomes. Incidence of NOF cases remained high during the pandemic in the UK and as a result numerus cases were complicated with SARS-CoV-2 infection. We performed a systematic review and meta-analysis of all UK published studies related to NOF fractures and 30-day mortality outcomes during the COVID 19 pandemic.

Method

A systematic review and meta-analysis was performed and reported as per the PRISMA checklist. Two reviewers independently searched on Medline for UK studies that were published between 1stof March 2020 and 1stof November 2020. Outcomes compared were 30-day mortality, time to surgery and anaesthetic risk.

Results

A total of 5 articles were included in our study. These studies were all case series with evidence level 3 or 4. A total of 286 patients complicated with COVID infection with a range of 30-day mortality 30.5%-50%. OR 6.02(95CI: 4.10-8.85), Chi24.82, I2 58%. Increased time to surgery due to Coronavirus related delays was also noted for the majority of studies. Mortality scores (Charlson Comorbidity Index, Nottingham Hip fracture score) failed to accurately predict the mortality risk.

Conclusions

Concurrent infection of COVID -19 in patients with NOF fractures increases the 30-day mortality 6 times compared to the negative group. Efforts should be made to optimise time to surgery as well as postoperative care via higher dependency units. Updates in mortality predicting scores is deemed necessary to include the SARS-CoV-2 infection as a factor.
1419 Targeted Use of Physiotherapy Resources in The COVID Era: How Does Face to Face Physiotherapy Compare with Simple Advice Sheets After Manipulation Under Anaesthetic for Frozen Shoulder?
Authors: Castelhano R , Woods J , Akehurst H , Mitra A , James M , Tasker A , Woods D
Published: October 2021

Introduction

This study compares two pathways for patients undergoing MUA for FS, one where physiotherapy advice is only given to the patient (Group 1), and the other where supervised hydrotherapy and physiotherapy occur post operatively (Group 2).

Method

A descriptive analysis of pre- and post-operative Oxford Shoulder Scores and change scores were performed. Analysis of covariance (ANCOVA) was used to measure the effect of physiotherapy on post-operative OSS, with pre-operative OSS as the only covariate.

Results

The results for post-operative OSS were significantly greater for Group 2 than for Group 1 (40.7 for NHS and 44.7 for private, improvement of 17.32 for NHS and 18.23 for Private). The effect of physiotherapy was significant (p < 0.001). The estimated effect of physiotherapy on postoperative OSS was an increase of 3.2 (95% confidence interval 1.5 – 4.8).

Conclusions

We detected a statistically significant increase in post-operative OSS in patients treated for frozen shoulder with MUA + physiotherapy compared with patients receiving MUA plus advice alone. These results suggest that physiotherapy does confer a real benefit, however the increased OSS is below the clinically significant level. Therefore, in a resource poor environment, such as may exist during and after COVID in many health care systems, MUA plus physio advice alone gives an excellent outcome for the treatment of FS.
1450 Relationship between Spinopelvic Parameters and Symptomatic Femoroacetabular Impingment: A Scoping Review
Authors: Khokher Z , Rai A , Karoda Y , Saito M , Kumar K H S , Khanduja V
Published: October 2021

Aim

Reports have shown that spinopelvic mobility influences the outcome following total hip arthroplasty. The aim of this scoping review was to investigate the relationship between spinopelvic parameters (SPP) and symptomatic femoroacetabluar impingement (FAI).

Method

A systematic computer search of EMBASE, PubMed and Cochrane for literature related to SPPs and FAI was undertaken as per PRISMA guidelines. Clinical outcome studies and prospective/retrospective studies that investigated the role of SPPs in symptomatic FAI were included. Review articles, case reports and book chapters were excluded. Information extracted pertained to symptomatic cam deformities, pelvic tilt, deviations in acetabular version, decreases in pain-free hip range of motion (ROM) on dynamic hip movements and radiological signs of FAI.

Results

The literature search identified 46 papers out of 1168 investigating the link between SPPs and pathological processes characteristic of FAI. Anteior pelvic tilt was associated with radiographic over-coverage parameters of FAI. Three studies associated FAI pathology with a greater pelvic incidence (PI), while four associated it with a smaller PI. In dynamic movements, decreased posterior pelvic tilt and reduced saggital pelvic ROM was found in symptomatic FAI patients during hip flexion.

Conclusions

Our study shows that spinopelvic parameters can influence radiological and clinical manifestations of FAI, with pelvic incidence, acetabular version and muscular imbalances being aetiologically implicated. Individual spinopelvic mobility may predispose to the development of FAI, which may be amenable to non-surgical management. If FAI pathoanatomy already exists however, sagittal pelvic parameters can influence whether FAI symptoms develop, and the extent to which they do so.
1484 Tranexamic Acid Use to Decrease Blood Loss in Primary Shoulder and Elbow Replacement: A Systematic Review and Meta-Analysis
Authors: Varma J , Donovan R , Whitehouse M , Kunutsor S , Blom A
Published: October 2021

Tranexamic acid (TXA) is an inexpensive, commonly used antifibrinolytic agent that has been shown to significantly reduce perioperative blood loss and transfusion requirements after total hip and knee replacement. We conducted a systematic review and meta-analysis to synthesise the latest evidence regarding the effects of TXA on blood loss in total shoulder replacement (TSR) and total elbow replacement (TER).

We systematically searched MEDLINE, EMBASE and CENTRAL from inception to 03 September 2020 for randomised controlled trial (RCTs) and observational studies. Our primary outcome was blood loss, and secondary outcomes included the need for blood transfusion and venous thromboembolic (VTE) complications.

Four RCTs and five retrospective cohort studies (RCS) met eligibility criteria for TSRs, but none for TERs. RCT data determined that TXA administration significantly decreased estimated total blood loss, postoperative blood loss, change in haemoglobin (Hb) and total Hb loss when compared to placebo. RCS data demonstrated significant association between TXA administration and decreased in postoperative blood loss, change in Hb, change in Hct and length of stay.

This meta-analysis demonstrates that TXA administration in primary TSR significantly decreases blood loss compared with placebo and is associated with lower blood loss and shorter length of stay compared with no treatment with no increase in VTE complications. TXA administration should be part of a wider blood management strategy to minimise perioperative blood loss and blood transfusion requirements in patients undergoing TSR. Further research is needed to demonstrate if a similar treatment benefit exists in patients undergoing TER.
1499 The Statistical Value of Different Clinical Characteristics in Evaluation of Suspected Cauda Equina Syndrome
Authors: Levitt W , Kamalakannan B , Leung Y
Published: October 2021

Introduction

Cauda Equina Syndrome(CES) is a potentially disabling condition caused by compression of the thecal sac in the lumbar spine. Traditional teaching suggests red flags include back pain, sciatica, saddle anaesthesia and bladder disturbance. Current guidelines from the British Association of Spinal Surgeons recommend prompt investigation with MRI should these symptoms be present.

Method

A retrospective electronic case note review was undertaken from a one-year period to identify patients referred to the on call orthopaedic team with suspected CES and were investigated with MRI. Notes were reviewed for the presence of each clinical characteristic and correlated with MRI findings.

Results

334 referrals underwent urgent MRI with 25 scans showing CES. Poor statistical association was observed with unilateral leg pain (sensitivity 0.28, specificity 0.48), back pain (sensitivity 0.92, specificity 0.13) and bladder dysfunction (sensitivity 0.72, specificity 0.36). Much closer statistical association was seen with bilateral leg pain (sensitivity 0.6, specificity 0.7, OR 5.03, 95% CI 2.16-11.68, p0.0002), leg weakness (sensitivity 0.68, specificity of 0.72, OR 5.35, 95% CI 2.23-12.85, p0.0002), leg sensory deficit (sensitivity 0.72, specificity 0.60, OR 3.79, 95% CI 1.54-9.36, p0.004) and altered perianal sensation (sensitivity 0.6, specificity 0.67, OR 3.03, 95% CI 1.31-6.99, p 0.009)

Conclusions

The diagnostic accuracy for some conventional red flag characteristics in CES is low. In our series back pain, unilateral sciatica and bladder disturbance showed low predictive value while bilateral sciatica, saddle anesthesia and lower limb sensorimotor deficits showed closer association and therefore should be closely evaluated for when reviewing such patients.
1514 Higher Mortality in Pelvic Acetabular Fractures Is Associated with Lower Body Mass Index
Authors: Waseem S , Lenihan J , Davies B , Rawal J , Hull P , Carrothers A , Chou D
Published: October 2021

Aim

Fractures of the pelvis and acetabulum can be life-threatening or life changing injuries. Multiple factors can contribute to outcome including age, frailty, and baseline nutritional status. The aim of this study was to identify if low BMI (<18.5) was a predictor of outcome for patients with such injuries in terms of morbidity and mortality.

Method

We retrospectively analysed 1033 patients with pelvic or acetabular fractures referred to a single level 1 major trauma centre over a 4.5-year period (August 2015 - January 2020). Of these patients, 569 were admitted to the centre and included in our analysis. Data was collected on demographics, injury pattern, operative intervention, and complications. Comparison was made between patients that were underweight (BMI<18.5) and patients that were not, for in-hospital and post discharge complications including pulmonary embolus (PE), deep venous thrombosis (DVT), ileus, infection, loss of reduction and mortality at 6 months.

Results

Underweight patients had a statistically significant increase in mortality both in-hospital (p = 0.019) and at 6 months post injury (p = 0.039) when compared to other BMI groups. No statistical significance was found between these BMI groups comparing morbidity: DVT (p = 0.712), PE (p = 0.736) nor ileus (p = 0.149). Covariate analysis showed that a low BMI was associated with 3 times increased in-hospital mortality after correction for age and energy of injury (adjusted OR 3.028, 95% CI 1.059-8.659).

Conclusions

This study suggests increased mortality in patients with pelvic or acetabular fractures who are underweight. Surgeons should consider these findings in initiating appropriate peri-operative optimisation for these patients.
1518 The Use of OrthoPathway, Decision Support Software, To Reduce Variation in Practice, Optimise Patient Care and Reduce Face-To-Face Appointments in Trauma and Orthopaedics
Authors: Jones M , Griffiths-Jones W
Published: October 2021

Introduction

Musculoskeletal problems account for 3.5million Emergency Department attendances annually. Front-line staff are under pressure, faced with complex decisions with limited supportive tools. Without adequate support there is greater variation in practice, poor patient outcomes, longer Emergency Department stays and unnecessary follow-up. OrthoPathway is a web application that enables the production of editable decision support pathways. We have published over 50 Consultant designed, locally approved, interactive pathways. Patient-facing staff can use these to follow national guidelines, by answering questions to establish appropriate treatments.

Method

New and follow-up fracture clinic patients were audited over a one-week period. Clinic letters and clerking documents were analysed to identify the diagnosis and management plan. From information and radiographs available OrthoPathway was used to generate a management plan, used as the audit standard.

Results

78 new patients and 83 follow-up patients were seen in fracture clinic over a one-week period. Clinical pathways were available on OrthoPathway for 42% of new patients and 40% of follow-up patients. Variation in practice was seen in 42% of new patients and 59% of follow-up patients. The associated saving in appointments was 11 and 21 and in the new and follow-up patients, respectively.

Conclusions

We have shown that OrthoPathway has the potential to reduce face-to-face appointments by 20%, with its current utilisation. Through the deployment of a full set of pathways we anticipated a reduction of greater than 40%, which is particularly pertinent given the current COVID-19 pandemic. This highlights the benefits of Consultant approved decision support pathways published on OrthoPathway.
1533 The Effect of Hip Fracture Anatomy and The Modality of Surgery on Red Blood Cell Transfusion and Mortality: A Retrospective Analysis
Authors: Greenhalgh M , Gowers B , Iyengar K , Adam R
Published: October 2021

Introduction

Hip fractures are common, with most requiring surgical management. Blood loss occurs from the fracture and intraoperatively. Often, blood transfusions are required. Hip fractures can be classified by their anatomy: intracapsular, intertrochanteric or subtrochanteric fractures. This study assesses the effect of fracture pattern and operation performed on transfusion rates within our centre. We aim to identify the patients most likely to require transfusion early, to improve outcomes.

Method

A retrospective cohort study of 324 consecutive hip fracture patients presenting to a district general hospital over one year. Data was collected from electronic patient records, the local transfusion laboratory, and the national hip fracture database.

Results

324 hip fractures were divided into 188 (58%) intracapsular, 121 (37%) intertrochanteric and 15 (5%) subtrochanteric fractures. The most common operation performed was hemiarthroplasty (128), followed by dynamic hip screw fixation (75). 75 (23%) of all patients received a blood transfusion. 28 (15%) of intracapsular, 42 (35%) of intertrochanteric and 5 (33%) of subtrochanteric fractures received transfusions. 47% of long intramedullary nails, 45% of short intramedullary nails, 29% of dynamic hip screws, 18% of hemiarthroplasties and 9% of total hip arthroplasties resulted in blood transfusions. One-year mortality in the transfused cohort was 52% and 30.5% in non-transfused.

Conclusions

Almost a quarter of hip fracture patients received a blood transfusion, which was associated with an increased risk of mortality. Intertrochanteric fractures most commonly led to a transfusion. The operation most associated with transfusions were long intramedullary nailings, and total hip arthroplasties were the least.
1550 Experience from A Level-1 Major Trauma Centre in England of Trauma Epidemiology After Easing of Lockdown Restrictions
Authors: Waseem S , Romann R , Lenihan J , Rawal J , Carrothers A , Hull P , Chou D
Published: October 2021

Aim

The COVID-19 pandemic transformed trauma care. We examined the effect of lockdown easing on trauma presentation and management.

Method

Data was retrospectively analysed from Trauma Audit and Research Network (TARN) on patients presenting to one Major Trauma Centre in the East of England with trauma. The first 47 days of lockdown (23rd March-9th May 2020, period 1) were compared with the next (10th May- 26th June 2020, period 2) and last 47 (27th June- 13th August 2020, period 3). Data collected included demographics, mechanism and severity of injury, management, and length of stay.

Results

1,249 patients were included; 62.2% were male with a mean age of 57.73. Footfall declined in April 2020 compared with 2019 (56 vs 143) but rebounded by May (123 v 120 patients). Road traffic collisions increased over periods 1-3 (18.8% v 23% v 30.1%, p = 0.038); deliberate self-harm (DSH) increased in period 2 compared with 1 and 3 (6.3% v 3.4% v 1.4%, p = 0.03) respectively. The 2020 patient age was younger than 2019, with less trauma relating to alcohol (7.3% v 13.2%, p = 0.009). Compared with 2019 reductions in total length of stay (14.1 v 17.4 days, p = <0.001), critical care length of stay (2.3 v 2.9 days, p = 0.04) and consultant driven care (54.9% v 64.9%, p < 0.001) were noted in lockdown.

Conclusions

Our study suggests that after lockdown easing, trauma footfall rapidly rebounded to 2019 levels. This should be acknowledged in resource allocation decisions if future lockdowns are necessitated.
1567 Investigating the Effect Of COVID-19 On Internet Searches for Hip, Knee and Shoulder Pain in the UK
Authors: Williams C Y K , Townson A T , Pace A
Published: October 2021

Aim

In response to the COVID-19 pandemic, all non-urgent surgery was suspended, with orthopaedic surgery among the worst affected. We conducted an infodemiological study to explore changes in internet searches for joint pain at a population level since the start of the pandemic.

Method

Bayesian structural time-series methods were employed to evaluate the impact of cancelled orthopaedic operations on Google search interest in Knee, Hip and Shoulder pain in the UK. Data were extracted from Google Trends from January 2016-2021. The bsts package was used to construct counterfactual time series, incorporating local linear trend and yearly seasonal components. Causal effects were determined using the CausalImpact package, with 95% CIs and posterior probabilities calculated. 17 March 2020 was used for pre-/post-period cut-off as non-urgent surgery was suspended on this date. P value < 0.05 was significant. R version 4.0.3 was used for analyses.

Results

Knee pain was the most popular search term, followed by Shoulder pain then Hip pain. The onset of the COVID-19 pandemic was associated with a significant increase in searches for Knee pain (Relative effect [95% CI] = 14% [-0.85%, 29%], p = 0.031). However, there was no significant effect on searches for Hip pain (Relative effect [95% CI] = -1.3% [-15%, 12%], p = 0.427) or Shoulder pain (Relative change [95% CI] = 6.5% [-7.9%, 21%], p = 0.195).

Conclusions

Our findings suggest a greater impact of COVID-19 on the prevalence of knee pain, compared to hip/shoulder pain. This has implications for planning future orthopaedic surgery delivery and deciding on the priority order for rescheduled operations.
1671 The Effect Of COVID-19 On the Management and Outcome of Neck of Femur Fractures in A District General Hospital - A Comparative Study
Authors: Linardatou Novak P , Davies B , Bacon A , MacDowell A
Published: October 2021

Aim

We wanted to see how the virus has impacted the management and outcome of our neck of femur fracture patients during Spring 2020.

Method

We performed a retrospective study of all neck of femur fracture patients presenting to our hospital from 23rd March 2020 (start of official lockdown in UK) until the end of May 2020 and compared them to patients presenting in the same time period in 2019. We recorded patient demographics, COVID-19 swab results, time to surgery, length of stay, transfers between wards, and 30-day mortality rates.

Results

We identified 75 patients in 2020 compared to 88 in 2019. Average length of stay was 11.4 days compared to 14.3 a year earlier. Mean time to surgery was 32.3 hours compared to 31.6 in 2019. The 30-day mortality increased significantly from 5.7% (5/88) in 2019 to 16% (12/75) in 2020 (p < 0.05) From 73 patients tested for COVID-19, 3 had a positive swab. Of these, 2 died. During their admission, 14 patients were transferred to 3 or more wards; in this group, 30-day mortality was 42.9% (6/14).

Conclusions

There has been a significant increase in 30-day mortality during COVID-19. Despite maintaining our time to surgery and reducing overall length of stay, we saw an increase in mortality, associated with multiple ward transfers rather than a high number of COVID-19 positive swab cases. Changes in pathways and wards configurations led to some patients requiring multiple transfers. This can cause difficulties in coordinated, multidisciplinary care for patients with NOF Fractures.
66 Significance of Percutaneous Biopsy in the Clinical Management of Renal Masses
Authors: Cheah W , Marques S D B , Bhuvanagiri A , Kailasa A , Thangavelu M , Alexandrou K , Kannan S
Published: October 2021

Aim

Percutaneous renal mass biopsy is increasingly used in the management of renal masses. The objective of our study was to determine the significance of percutaneous renal mass biopsy and its impact on clinical management.

Method

Retrospective study of all patients who had image guided percutaneous renal mass biopsy health-board wide from April 2011 to April 2019. Renal mass biopsies were performed for either a localised or metastatic renal mass. Results of the renal biopsies were compared to final diagnosis to determine diagnostic accuracy measured by sensitivity, specificity, negative predictive value and positive predictive value.

Results

Out of 429 patients who had a renal biopsy, 91 patients- 55 males (61%) and 36 females (39%) were included in the final analysis. The mean age of the study population was 66 years (range 46-87). Renal mass biopsies were performed using coaxial 18-gauge core needle technique. We categorised patients into two groups (metastatic renal masses and localised renal mass). Sixty-eight patients had biopsies for metastatic disease and 23 patients had biopsies for a localised renal mass. In the localised disease group, the sensitivity was 100%, positive predictive value was 82% (95% CI, 48.2-97.7%) and the negative predictive value was 100% (95% CI, 66.4-100%) (Clopper Pearson Method). For patients with metastatic renal mass the positive predictive value was 83%.

Conclusions

Percutaneous renal mass biopsy may have a role for metastatic renal cancers that require targeted therapy and localised masses that require curative treatment.
116 An Assessment of Current Practice for Suspected Paediatric Testicular Torsion
Authors: Gibb J , Babawale O , Hodgson D , Harrison R
Published: October 2021

Aim

British Paediatric surgery guidelines (2019) state ‘immediate surgery should be performed if testicular torsion is suspected’. However, imaging ‘may be considered for a small number of children under the guidance of a senior clinician in late presenters or in those with atypical features. This study reviewed current practice in our hospital.

Method

Boys aged 16 and under in 2017-2019 who underwent scrotal exploration for suspected testicular torsion were reviewed. Outcomes assessed were number having ultrasound prior to theatre, pathological findings, number who had an orchidectomy, and post-op complications. Additionally, all testicular ultrasounds in those aged under 16 were screened to establish how many were requested for possible or missed torsion.

Results

46 patients underwent surgical exploration of which 18 had a confirmed torsion. Six patients had imaging prior to surgery, of which five suggested torsions and four of these were confirmed in theatre. 202 boys under 16 had a testicular ultrasound; 26 of these were for late presentation or those with atypical features of torsion. Three underwent scrotal exploration two of whom had reports suggestive of torsion which was confirmed on exploration.

Conclusions

Most testicular torsions occur around the age of puberty with no torsion identified in patients under 10. Ultrasound is a useful tool for identification of vascularity or alternative pathology in late or atypical presentations of torsion; but does not replace clinical judgement. Imaging may have prevented unnecessary exploration in 23 cases, although negative imaging did not always preclude exploration.
878 Optimizing Follow Up for Melanoma Patients: Are We Meeting NICE Guidance?
Authors: Labib A , Massardi C , Salfity L , Powell B
Published: October 2021

Introduction

St. George’s University Hospitals NHS Foundation Trust is a designated tertiary referral Centre for all skin cancers serving a population of 3.5 million in and around South West London. It has an international reputation for its management of melanoma cases. All melanoma patients need frequent follow up visits for a long period of time which may extend to more than 10 years. Many aspects should be included when following up these patients including clinical assessment, laboratory, and radiological evaluation.

Aim

The aim of this project is to assess the quality of laboratory follow up of melanoma patients focusing on optimizing vitamin D level.

Method

We performed a retrospective review of cutaneous melanoma patients in 2019. Laboratory standards for follow up of vitamin D level was identified from NICE guidance 2015. After introduction of a condensed guide, a second review was performed in 2020.

Results

In the first cycle, 63 patients were included. Only 47% of them had their Vitamin D levels checked at time of diagnosis. Follow up check for vitamin D level was only done in 36%. Following introduction of guidance, 36 patients have been included. Significant improvement in both parameters with rate of 65% and 96% respectively.

Conclusions

Although we managed to improve our adherence to NICE guidance, more effort is still needed to improve all patients' care. We are willing to conduct a qualitative survey asking staff to explore their obstacles.
219 Have New National Guidelines Changed Practice in Referrals with Suspected Ureteric Colic?
Authors: Boyle C , Young J
Published: October 2021

Aim

To assess how many patients had a non-contrast CT as first-line investigation for suspected renal colic, and how this was affected by the release of the 2019 NICE guidelines. A secondary aim was to assess the proportion of patients who had CT KUBs that demonstrated a ureteric calculus.

Method

CT KUB scans performed over two separate 3 month periods were identified. These reflected periods of time before and after the new NICE guidelines. Electronic records were used to assess if the patients had an ultrasound performed as the initial diagnostic investigation, instead of a CT scan. The results of the scans were reviewed to identify if a ureteric or renal calculus had been positively identified.

Results

In the period before the new guidelines, 61 patients were scanned. 4 had an ultrasound to assess for a stone prior to a CT. All of these patients were medical inpatients. None of the ultrasounds diagnosed a stone. 22/61 patients had CT-proven stones (36%) In the period after the new guidelines, 79 patients were scanned. 12 had an ultrasound to assess for a stone prior to a CT. 8 were medical patients, 3 were surgical and 1 was gynaecological. 1 ultrasound diagnosed a stone. 28/79 patients had CT-proven stones (35.4%)

Conclusions

The release of new guidelines did not improved compliance with suggested imaging pathways. This clearly demonstrates an area for improvement. It is also worth noting that only 1/3 of referrals with suspected renal colic did actually have a stone, which has implications for specialty referral pathways.
323 Association of Increased Body Mass Index and Waist to Hip Ratio with Kidney Stone Disease: a Prospective Analysis of 493,410 UK Biobank participants
Authors: Lovegrove C , Littlejohns T , Allen N , Howles S , Turney B
Published: October 2021

Aim

To investigate the relationship between measures of adiposity and risk of incident kidney stone disease.

Method

The UK Biobank is a prospective cohort study of ∼500,000 participants whose height, weight, BMI, waist circumference, hip circumference, waist:hip ratio (WHR), total fat mass, fat-free mass, body-fat percentage, and percentage truncal fat were measured at enrolment with linkage to medical records. ICD-10 and OPCS codes identified individuals with a new diagnosis of nephrolithiasis from 2006-2010. Individuals with a history of kidney stones or incomplete data were excluded. Multivariate Cox-proportional hazard models were used to assess associations between anthropometric measures and incident kidney stones.

Results

From the UK Biobank, 493,410 individuals were identified for inclusion; 3,466 developed a kidney stone during the study period. Increasing weight, BMI, waist, and hip circumferences, WHR, and body and truncal fat were all associated with increased risk of incident kidney stone disease. However, after adjustment for BMI, only waist circumference and WHR remained significantly associated with risk of nephrolithiasis. In overweight patients, high (men 94-102cm, women 80-88cm) waist circumference or WHR (men >0.9, women >0.85) conferred >40% increased risk of stone formation.

Conclusions

This study indicates that android fat distribution is independently associated with increased risk of developing nephrolithiasis. Kidney stone disease is known to be associated with hypertension, cardiovascular disease, and diabetes, all of which have been linked to android body shape. Our findings provide insight into anthropometric risk factors for stone disease, will facilitate identification of patients at greatest risk of stone recurrence, and will inform prevention strategies.