bluuebunny/crossref_metadata_2025 huggingface dataset:
295 Education and Training to Improve Compliance to the BOAST Guidelines on Assessing and Documenting Peripheral Nerve Status and Injury
Authors: Khirsheh O , Yusuf K , Dutta A , Serino C , Rafiq I
Published: August 2023

Introduction

Peripheral nerve injuries affect 2-3% of trauma patients, with potentially high morbidity, and associations with litigation. BOAST guidelines were introduced in December 2021 outlining standards in assessing and documenting neurovascular status in trauma patients. Key elements included nerve-specific documentation and assessments pre- and post-interventions such as manipulation.

Aim

This project assessed departmental performance against the BOAST standards, then presented the results to both orthopaedic and emergency departments, as well as setting up teaching sessions to orthopaedic junior doctors in the assessment of neurovascular status and updating awareness on the guidelines.

Method

50 patient records were analysed retrospectively for the first arm, and 50 records prospectively for the second arm. Acute trauma presentations with a risk of peripheral nerve injury met the inclusion criteria. Intervention included practical senior-led teaching on clinically assessing neurovascular status, and the importance of detailed documentation, as well as when to repeat the examination.

Results

Results were improved drastically from initial audit against standards to post-intervention audit; documentation improved from 70% to 95% (n = 50 for both arms), with appropriate detail in documentation improving from 11% to 49%.

Conclusions

Neurovascular status is critical to be documented in detail, both pre and post-interventions. By using BOAST guidance as a standard, the initial inadequacies of the departmental practice were highlighted, and significantly improved through active teaching, distribution of the guidelines, raising the standards, clinical assessment, and documentation, thus improving patient care, and robustness of legal documentation.
302 A Systematic Review and Meta-Analysis of Intra-Articular Injections for Base of Thumb Osteoarthritis
Authors: Thakker A , Hau M , Ramchandani J , Johnson N , Dias J
Published: August 2023

Aim

Current literature is equivocal surrounding intra-articular injections for the treatment of thumb base osteoarthritis (TBOA), which is reflected in national and international guidelines. This systematic review assesses the effectiveness of different intra-articular injections for TBOA on pain and functional outcomes.

Method

MEDLINE, EMBASE, Cochrane Central Register of Control Trials and CINAHL databases were searched from inception to April 2022. Randomised controlled trials and comparative case series which investigated an injection-based intervention with any comparator/s were included. The protocol was registered to PROSPERO (CRD42022337265).

Results

Fifteen studies were included in the descriptive analysis of this review, with 4 included in the meta-analysis. From the intra-articular injection therapies, hyaluronic acid (HA) in 11 studies, corticosteroid (CS) CS in 10 studies, platelet-rich plasma (PRP) in 2 studies, dextrose (DX) in 1, HA mixed with NSAID in 1 study and placebo (saline) in 3 studies. Meta-analysis of visual analogue scale (VAS) showed that there was no statistically significant improvement in pain in the short-, medium- or long-term time points between HA vs CS injection therapies. Meta-analysis of functional outcomes showed an improvement in function with HA vs CS ((standardised mean difference (SMD) −1.05, 95% CI −1.43 to −0.68)) at the long-term time point. No significant adverse effects were reported.

Conclusions

There is no superior type of intra-articular injection for improving pain and limited evidence for HA for improving function. The choice of injection should be based on availability, guidelines and cost-benefit analysis until further methodologically robust trials can be completed.
429 Service Evaluation of the Royal Orthopaedic Hospital Bone Infection Service in Patients with Spinal Infections, Both Native and Following Surgery - Five Years of Experience
Authors: Nam R , Gardner A , Hughes S , Jenkins N
Published: August 2023

Aim

The Royal Orthopaedic Hospital Bone Infection Service (ROH BIS) is one of the four formal bone infection services in the United Kingdom, providing multidisciplinary care and community support for patients with bone infection. This service evaluation is to document burden, pattern of infection and subsequent treatment by the ROH BIS in treating those with spinal infection, both native and following spinal surgery.

Method

This is a retrospective analysis of spinal infections treated from 2017-2022 at the ROH BIS. Clinical, MDT and investigation notes were reviewed for demographics, comorbidities and details of identification and management of the infection.

Results

39 patients (median age = 63, IQR = 34, male = 46.2%) were identified. 23 patients had previous metal implanted, 16 did not. The infection rate in ROH spinal surgery is 3%, 15 infections were native, and 24 were iatrogenic. Cardiovascular-related disease (38.5%) is the most common comorbidity. The mean time taken to identify a bone infection and infectious organism was 1.5 days and 4.0 days. Enterobacteriaceae (33.3%) and Staphylococcus Aureus (20.5%) were most commonly identified. Recurrent infection rate was 5.1%, and 5 (21.7%) cases required removal of implant. The mean number of MDT meetings for each patient is 1.7 meetings, and the mean extra hospital stay is 20 days.

Conclusions

Infections following spinal surgery are well managed by the multidisciplinary ROH BIS model. Rapid referral acceptance, strict diagnostic sampling criteria and specialised nursing care enabled precise management and lessened the burden of reoperation or metal implant removal on patients
535 A Case Report of a Rare Post Traumatic Infected Regenerate Following Corticotomy for Lengthening Following a Frame Ankle Fusion
Authors: Haq L , Thomson L , Wright S , Bose D
Published: August 2023

Introduction

We present a case of a 49-year-old patient who initially presented in May 2020 with an open pilon fracture. Managed with initial debridement, fixation, and flap - who subsequently underwent circular frame application for failure of fixation, requiring a transport to fusion frame who developed beta-haemolytic streptococcus A within the site of the proximal corticotomy.

Method

A systematic review of the literature was conducted searching EMBASE, MEDLINE and Cochrane library for all articles discussing infected bone regenerate- a paucity of information was found. Abstracts were independently reviewed by 2 authors (LH and LT). In total, there were 16 papers, and then subsequently analysed we identified two case reports regarding infected regenerate.

Results

Developing an infection in a regenerate is highly rare with very few reported cases within the published literature. The literature identified risk factors for an infected regenerate, with open fracture and smoking being the two consistent factors. The open fracture deep infection rate is cited at 10% in most publications, this is at the site of the open fracture and not within the regenerate.

Conclusions

Infection within the regenerate during distraction osteogenesis is highly unusual, with only two other published papers in the literature to the best of our knowledge. This should be borne in mind when managing patients with infection of unknown sources in cases of distraction osteogenesis.
577 Risk Factors Associated with the Reported Scores on Symptoms Severity and Functional Limitations Scales of the Boston Carpal Tunnel Questionnaire: A Cross-Sectional Study
Authors: Al-Jasim A , Sarhan F , Al-Abbasi G , Ali A B , Alaraj R S N , Yasin D , Macciacchera M , Bouchard M , Ibrahim I K
Published: August 2023

Aim

We aim to identify risk factors associated with higher scores of CTS symptoms severity and functional limitations on the BCTQ.

Method

This cross-sectional study was conducted among 366 female participants. The data was mainly collected using the BCTQ. Demographics and risk factors of CTS were added to the study's complete questionnaire; Risk factors included: Rheumatoid Arthritis (RA), Diabetes Mellitus (DM), hypothyroidism, number of pregnancies, usage of Oral Contraceptive Pills (OCPs), use of smartphones and keyboards. A P-value of < 0.05 was considered statistically significant.

Results

Most participants were in their thirties (44%) and housewives. RA, DM, hypothyroidism, and pregnancy were associated with reporting symptoms and functional limitations on BCTQ. OCPs and smartphone use were associated with functional limitations only.

Conclusions

Different risk factors are associated with reporting symptoms and functional limitations of CTS on the BCTQ. For example, RA, DM, hypothyroidism, pregnancy, OCPs and smartphone use have all been found statistically affect the outcome of the BCTQ in this study. Clinical confirmation of CTS diagnosis is required in future studies to make sure that these symptoms and functional limitations are associated with CTS pathology itself rather than other risk factors pathologies for proper targeted treatment plans and outcomes.
653 Evaluating the Effectiveness of Osseointegration for Traumatic Lower Limb Amputations: A Narrative Review
Authors: Adebayo O , Ahmed Z
Published: August 2023

Aim

Major trauma to the limbs often results in amputation and can have a debilitating effect on an individual’s physical and psychological health. Currently, the conventional management to remediate the consequences of limb amputation is a Traditional Socket-mounted Prosthesis (TSP) for the affected limbs. However, its use is associated with various complications, such as skin ulcers, increased fracture risk, nerve pain, and heterotopic ossification. To address this, a novel approach known as osseointegration; a procedure in which an artificial implant is surgically integrated and anchored into residual bone, has been developed.

This narrative review aims to primarily evaluate the efficacy and functional outcomes of lower limb osseointegration compared to TSP.

Method

A literature review was performed to identify and analyse studies addressing the efficacy, functional outcomes, and complications of lower limb osseointegration prosthesis compared to TSP. Studies were summarised according to type of osseointegration prosthesis, number of surgeries required, and amputation location.

Data on efficacy, functional outcomes, and complications of patients with osseointegrated prosthesis was extracted.

Results

Six studies were chosen for critical analysis of the primary and secondary aims. All studies reported osseointegration conferred significant improvements in mobility, walking capability, walking speed, quality of life, prosthesis comfortability, prosthetic control, and prosthetic use. Complications reported were mild infection, phantom limb pain and periprosthetic fractures although incidences were rare.

Conclusions

Osseointegration has been shown to increase prosthetic use, improve confidence, walking ability, and mobility. Complications are mild and easily treated. Overall, there is sufficient evidence to suggest osseointegration could become standard management for lower-limb amputations.
684 Lateral Extra-Articular Tenodesis Versus Anterolateral Ligament Reconstruction Lateral Augmentation for Primary Anterior Cruciate Ligament Reconstruction with Minimum 2- Year Follow-Up: A Systematic Review and Meta-Analysis
Authors: Abdelmoneim A , Shannon F
Published: August 2023

Background

Lateral augmentation (LA) of anterior cruciate ligament reconstruction (ACLR) aims to improve the anterolateral stability of the knee and patient functional outcomes while reducing complication rates. Despite growing evidence and popularity, there have been no studies directly comparing the main two methods of LA; Lateral extra-articular tenodesis (LEAT) and Anterolateral ligament reconstruction (ALLR).

Aim

To establish level I evidence by assessing studies with minimum two-years follow-up investigating LEAT and ALLR patient-reported outcome measures (PROM) and post-operative complications.

Method

This is a systematic review and meta-analysis conducted in accordance with the PRISMA guidelines. The primary investigators (AA/FS) on August 1st, 2022 undertook a comprehensive systematic review of electronic databases. Studies that met our inclusion criteria were selected.

Results

14 studies were included in our study with a total of 2374 patients. 1273 patients were included in the LEAT studies (666 male, 607 female) and 1101 in the ALLR studies (818 male, 283 female). Statistically significant improved PROM were found in the LEAT group for postoperative International Knee Documentation Committee Scores (MD 2.31; 95% CI: 0.54 – 4.09, P = 0.01), Tegner Activity score (MD 0.79, 95% CI: 0.58 – 0.99, P<0.01), and for both the ALLR (MD 1.43, 95% CI: 0.33 – 2.52, P = 0.01) and LEAT (MD 4.07, 95% CI: 2.67 – 5.47, P<0.01) groups for Lysholm scores. LEAT and ALLR are associated with reduced graft re-rupture risk and improved postoperative knee stability.

Conclusions

LA is associated with improved PROM, knee stability, and functional outcomes when compared to iACLR. No differences were found between LEAT to ALLR.
892 Dual Platform 4th Generation Shoulder Replacement System-Medium Term Results
Authors: Komperla S , Giles W , Flatt E , Eyre-Brook A , Jones V , Papanna M , Eves T , Thyagarajan D
Published: August 2023

Aim

To report medium term outcomes following 4th generation VAIOS® shoulder replacement.

Method

We retrospectively analysed prospectively collected data following VAIOS® shoulder arthroplasty performed by the senior author between 2014-2020. This included anatomical (TSR), reverse(rTSR), revision and trauma shoulder replacements. The primary outcome was implant survival (Kaplan-Meier analysis). Secondary outcomes were Oxford Shoulder Scores (OSS), radiological outcomes and complications.

Results

152 patients met our inclusion criteria with 114 rTSR and 38 anatomical TSR

Reverse TSR

Reverse TSR- 55 primary, 31 revisions, 28 for trauma.

Primary rTSR- 0 revisions, average 3.35-year follow-up.

Revision rTSR-1 revision (4.17%), average 3.52-year follow-up.

Trauma rTSR- 1 revision (3.57%), average 4.56-year follow-up

OSS: Average OSS improved from 15.39 to 33.8 (Primary rTSR) and from 15.11 to 29.1 (Revision rTSR). Trauma rTSR-Average post-operative OSS was 31.4.

Anatomical TSR

38 patients underwent primary anatomical TSR. In 16/38 patients, glenoid bone loss was addressed by bone grafting before implantation of the metal back glenoid component. Mean age at time of surgery was 68.3 years (53 – 81 years). Mean follow-up was 34 months (12 – 62 months). The average Oxford shoulder score improved from 14 (7-30) to 30 (9-48).

There were 3 revisions (7.8%); two following subscapularis failure requiring revision conversion to reverse shoulder replacement and one for glenoid graft failure.

Conclusions

The medium-term results of the VAIOS® system suggest much lower revision rates across multiple configurations of the system than previously reported, as well as a low incidence of scapular notching. This system allows conversion to rTSR during primary and revision surgery.
909 Current Challenges and Future Prospects of Osseointegration Limb Reconstruction for Amputees
Authors: Akhtar M A , Low C , Blacklock C , Tiemessen C , Hoellwarth J S , Al Muderis M , Tetsworth K
Published: August 2023

Aim

The field of osseointegration has existed for almost 30 years and now appears to be on the verge of greater acceptance and widespread implementation. We reviewed the current challenges and future prospects of osseointegration limb reconstruction.

Method

A scoping review of the literature was conducted by researchers with an interest in Osseoinegration and key papers were identified and summarized.

Results

The 3 biggest challenges identified included Risk of Infection, High Cost and lack of outcome measures.

The solutions identified for the advances in Infection prevention and control included; Smart Implant Coating, Mechanical inactivation of Staphylococcus aureus and Pseudomonas aeruginosa, Biofilm erradication, Simultaneous Monitoring of Loosening and Temperature in Orthopaedic Implants, Realtime information on implant infection, Adjuvant therapeutic agents-Delivery Options, Nanotechnology and Nanomaterials, Nanobiotechnology- Prevention and Treatment of Orthopaedic Implant Associated Infection.

In order to cut the cost, we noted the following Advances in Production and Biomaterials; Three-dimensional (3D) Printing, Customised Implants, Natural Medicinal Compounds in Bone Tissue Engineering, Cost Effectiveness of 3D Printing implants, Meta-biomaterials, Functionalization of 3D-printed titanium alloy orthopedic implants.

We noted the following advances in Designs and feedback of Prosthetics; SMART (sensing, measuring, and advanced reporting technology) Implants, Technological Advances in Prosthesis Design and Rehabilitation, Biofeedback to Improve the Performance of Myoelectric Pattern Recognition, Neurophysiological Evaluation of Haptic Feedback for Myoelectric Prostheses.

Conclusions

We believe that the future of amputee rehabilitation is bright with the advances in implant manufacturing, biofeedback, and infection prevention.
1012 Evaluation of the ‘Clicky’ Hip in the Diagnosis of Developmental Dysplasia of the Hip (DDH)
Authors: Ross M , Poacher A , Froud J , Morgan E , Carpenter E , Ramage G
Published: August 2023

Aim

Early detection of developmental dysplasia of the hip (DDH) is associated with improved outcomes of conservative treatment. Therefore, we aimed to evaluate the use of a ‘clicky’ hip as an indication for secondary assessment as per the British Society for Children's Orthopaedic Surgery (BSCOS) consensus statement.

Method

Prospective cohort study of all patients born within the catchment area of a single tertiary centre (n = 27,731) all of whom underwent a new-born and 6–8-week examination and ultrasonographic screening of the hip. Multivariate odds ratios, cumulative risk difference, were calculated in relation to DDH (Graf type IIb-IV that required treatment) for those with ‘clicky’ hip as the only abnormality on examination.

Results

The prevalence of pathological DDH that required treatment within our population was 5.1/1000 live births (n = 148). An abnormal examination defined only by the presence of ‘clicky’ hip had a sensitivity of 11.5% [(95%CI6.84 to 14.75) 17/148)] and a positive predictive value of 4.39% (95%CI2.82 to 6.77%) for DDH. The increase in risk of having DDH from having a clicky hip during the 6-8-week examination was 10.1% and odds ratio 3.84 (95%CI2.33 to 6.32) demonstrated a significant association (p<0.001).

Conclusions

This study has evaluated the role of the ‘clicky’ hip in neonatal hip screening. Clearly demonstrating a statistical association with pathological DDH and also providing important information relating to the risk and predicative value of a clicky hip, addressing the principal research need by the BSCOS consensus statement.
1062 Opioid Requirements During Rehabilitation After Pelvic Fracture
Authors: Zhang J , Stevenson A , Lu V , Zhou A , Bradshaw F , Duchniewicz M , Krkovic M
Published: August 2023

Aim

Pelvic fractures are highly traumatic and debilitating injuries for patients, with an arduous rehabilitation process. Our study analyses the predictors for opioid requirements in pelvic fractures.

Method

Data was collected from all pelvic fractures treated at a Major Trauma Centre from 2015-2021, including fracture location, demographics, and comorbidities. Opioid prescriptions in the first post-injury year were calculated every month up to 6 months, and then from the 7th-12th month period. We calculated the total strength in Morphine Milligram Equivalents (MME), and days with at least one opioid prescribed (“coverage”). Multivariate regression was performed on the outcomes.

Results

A total of 3137 patients with pelvic fractures were included, with mean 954 MME (95%, CI = 899-999) in the first year. Acetabulum fractures showed lower strength in the 1st, and 7–12-month periods, with lower coverage in the 1st- 3rd months (p<0.05). Pubis fractures needed higher strength opioids for more days across all time intervals (p<0.01). On multivariate comorbidity analysis, in every subinterval after 1st month and overall, higher BMI and age, pulmonary disease, and drug abuse were associated with higher strength. In every subinterval after 4th month and overall, liver disease was associated with higher strength (p<0.05). Higher age and BMI were associated with increased coverage overall and every individual month (p<0.01), with chronic kidney disease and rheumatological conditions associated with increased coverage after the 2nd month (p<0.05).

Conclusions

Our study highlights the various injury, demographic and comorbidity factors that predispose patients to requiring higher strength and coverage of opioids during their rehabilitation from pelvic fractures.
1075 Community Outpatient Orthopaedic Clinics; a Post Pandemic Model of Care
Authors: Clowes R , Kohli S , Vincent J , Davis S , Smith J
Published: August 2023

Aim

In response to the elective orthopaedic backlog created by the Covid19 pandemic, we developed a secondary care community clinic service outside of the main hospital site. The facility provides a holistic, multidisciplinary alternative to the standard outpatient clinic model for Orthopaedic patients, in order to improve the quality and efficiency of the experience. This study describes patient satisfaction and experience of using the new temporary facility to inform the development of a permanent outpatient centre utilising the same model of care.

Method

Two surveys were created to evaluate the environment, design, flow, and experience of patients and staff who attended the community clinic. Data was collected from 05/01/2022 to 28/02/2022 and 01/08/2022 to 31/08/2022.

Results

A total of 296 responses were collected. The significant majority (82-96%) of patients and staff rated the overall environment as good or very good and would recommend the service to family or friends. Key atmospheric themes include positive remarks on a collaborative feel, welcoming and a spacious environment.

Conclusions

The community outpatients centre has had a significant impact on the care we deliver patients. The large open space with clinical hubs provides flexibility to develop new patient pathways and services. Patient and staff feedback from the experience has been very positive, with a high-cost efficiency.
1118 Epidemiology of Tibial Fractures, a UK Major Trauma Centre Perspective
Authors: Zhang J , Stevenson A , Zhou A , Lu V , Josipović M , Bradshaw F , Zhu J , Krkovic M
Published: August 2023

Aim

There is no recent large UK-based study on the epidemiology of tibial fractures. In our study, we report incidence and factors associated with tibial fractures treated at a Level I Trauma Centre over a 7-year period.

Method

We gathered data on fracture locations, age, gender, BMI, Charlson Comorbidity Index (CCI), and treatment options of all tibial fractures treated at a major trauma centre during the seven years from January 2015 to January 2022. The incidence of fracture types was calculated, as well as associations different fracture locations had with demographics, and their surgical managements.

Results

2018 patients suffered 2103 tibial fractures during the 7 years. This is composed of 735 proximal (plateau), 775 diaphyseal, and 593 distal (Pilon and tibial ankle component) fractures occurring, with overall incidence per 100,000 patients per year being 18.4, 19.1 and 14.6, respectively.

Of all fractures, the mean age, CCI score, and BMI was 46.9 years, 1.54, and 26.6, respectively. 56% were male, 26.3% were open fractures, and 52.4% were treated operatively.

Proximal and distal fracture patients had higher (50.9) and lower (43.2) ages, respectively (p<0.01). Proximal and shaft fractures had lower (48.9%) and higher (61.4%) percentages of male patients. Distal (64.4%) and open (79.0%) fractures had higher rates of operative treatment, respectively.

Conclusions

This study describes the epidemiology and incidence of tibial fractures in the UK major trauma centre setting, and analyses the association between demographic factors, fracture location and management. This adds to the literature and allows for future comparisons between regions.
1127 Prophylactic PPIs in NOF Fractures- Can It Be a Lifesaving Intervention?
Authors: Jamal Z , Khawaja Z , Zafar N , Haider I , Siddiqui A
Published: August 2023

Aim

Assess the incidence of UGI bleed in patients with NOF fractures. Develop trust-based guidelines to include PPIs in the management of such patients.

Method

A total of 119 patients who were admitted with NOF fractures between January and March 2022 were included. All the patients admitted to RAEI with NOF fractures were included in the study. All the patients with a previous diagnosis of GORD, peptic ulcers, or perforated peptic ulcers and those who were already taking PPIs before admission were excluded from the study. Information was collected about the hospital number, age, gender and if there was any gastrointestinal bleeding was noticed in such patients during the hospital admission.

Results

Our results showed that most of the patients who were admitted with NOF fractures were elderly. A total of 5/119 patients had major gastrointestinal bleeding during their hospital admission thus warranting further procedures such as endoscopy, transfusions, and prolonged hospital stay.

Conclusions

Elderly patients with NOF fractures are at an increased risk of stress-related mucosal damage and subsequent UGIB. Due to the devastating and potentially threatening complications of mucosal damage, preventative measures are mandatory. Therefore, PPIs should a routine part of drug prescription in patients admitted with NOF fractures. This can not only help prevent this potential bleeding but can also be cost-effective in terms of preventing prolonged stays and readmissions. A reaudit is planned to be done in 1 months’ time after the implementation of the changes.
1130 Does Fracture Location and Patient Comorbidity Influence Opioid Requirements in Tibial and Ankle Fractures?
Authors: Zhang J , Stevenson A , Lu V , Zhou A , Josipović M , Bradshaw F , Krkovic M
Published: August 2023

Aim

Opioid requirement in post-operative rehabilitation is an important area in orthopaedic surgery, with no large UK-based studies. Guidelines should reflect anticipated patient requirements. Our study explores the characteristics predisposing surgically managed tibial fracture patients to increased opioid requirements.

Method

All tibial fractures from 2015-2022 at a Major Trauma Centre were evaluated. 1890 patients were included. Post-operative opioid prescriptions in the 1st post-operative year were calculated every month up to 6 months and then from the 7th-12th month. Overall prescribed Morphine Milligram Equivalents (MME) “strength” and days with at least one opioid prescription (“coverage”) were calculated. Demographic, fracture location and various comorbidities were included in the multivariate modelling.

Results

Compared to the tibial average, plateau and Pilon fractures had x1.51 and x1.20 times the strength in the first year, with significance at every sub-interval (p<0.01) and ankle fractures had x0.756, significance at every individual time-interval (p<0.05).

For relative strength and coverage, for all time intervals, obesity, pulmonary disease, and drug abuse were associated with higher opioid requirements (p<0.05). Age, Charleston Comorbidity Index (CCI) and BMI were each positively associated with coverage in each of the first 3 months, with age and CCI associated with strength in 1st month (p<0.05).

Conclusions

Our study begins to elucidate a range of patient factors that can predispose to increased opioid usage in total strength and overall coverage. This, begins to construct an evidence-based tool for clinicians to base opioid prescriptions, manage patients effectively, and guide opioid stewardship.
1161 The Financial Impact of Electric Scooter Orthopaedic Injuries at a Large District General Hospital in England
Authors: Antonik M , Sankar S , Hassan S
Published: August 2023

Aim

Electric scooters are becoming an increasingly popular method of transportation in major urban cities worldwide. As their popularity gains, there are concerns about safety and injuries sustained, of which significant proportion are orthopaedic injuries. The aim of this study was to see the financial impact of e-scooter related orthopaedic injuries.

Method

In a retrospective study, we investigated the overall burden and the financial impact of the orthopaedic injuries as a result of the use of e-scooter transportation in a large District General Hospital in England over a 16-month period between September 2020 and December 2021.

Results

Seventy-nine patients were identified with a mean age of 30.1 years (SD 11.6). Sixty-two of these patients were males and seventeen were females. There were eighty-six orthopaedic injuries, with fractures being the most occurring type of injury. Twenty-three patients required twenty-eight different surgical procedures. The combined theatre and recovery time was 5500 minutes, while the surgical procedures operating time was 2088 minutes. The cost total cost of theatre running time for these patients was £77,000. Seventeen patients required hospital admission under Trauma and Orthopaedics, which accounted for total stay of ninety-nine days with a mean length of stay of 5.8 days per patient.

Conclusions

We have demonstrated that although there are environmental benefits to e-scooters; there have been a significant increase in healthcare system burden as demonstrated by additional emergency attendances, frequent outpatient clinic appointments, surgical procedures, and hospital inpatient admissions.
1167 Assessing Femoral Cementing Qualities in Total Hip Replacements
Authors: Cooper C , Tse S , Dick A
Published: August 2023

Aim

High quality cement mantles are important to the long-term survival of femoral stems in total hip replacements (THRs). There’s variability in the quality of cement mantles and positioning of cement restrictors. The audit aim was to assess current practice of cemented femoral stems in THRs against local standards.

Method

All patients who underwent THR with a cemented femoral stem between March 2021 and April 2022 were included in the study. TraumaCad software was used to retrospectively collect data on post-operative radiographs for overall cement mantle quality, coronal stem alignment, tip of stem to radio-opaque cement restrictor marker distance, and tip of stem to end of cement mantle distance (Gruen Zone 4).

We audited against the following standards:90% of stems have Barrack and Harrison Grade A ratingKhalily angle <5°Tip of stem to radio-opaque marker of 20-40mmGruen zone 4 of 10-30mm

Results

126 cemented femoral stems were included. Evaluation of Barrack grading showed 55% (N = 69) compliance with grade A, 45% (N = 57) of stems were grade B, with 0% grade C or D. Mean Khalily angle was 1.67° (98.4% compliance). Mean distance from tip of stem to cement restrictor was 36.5mm (60% compliance). Mean length of cement mantle in Gruen zone 4 was 18.9mm (71% compliance).

Conclusions

Overall, cement mantle quality and femoral stem coronal alignment were acceptable. There is variability of cement mantle thickness below the tip of the stem and with restrictor placement. We recommend re-auditing following junior surgeon cementing technique education.
1173 What Influences Taylor Spatial Frame Effectiveness in the Treatment of Tibial Osteomyelitis? A Major Trauma Centre Perspective
Authors: Zhang J , Zhu J , Krkovic M
Published: August 2023

Aim

Treatment of tibial osteomyelitis can be challenging, with numerous complications possible during rehabilitation. We report on the usage of the Taylor Spatial Frame (TSF) and analyse factors that affect outcomes.

Method

Between 2015-2020, 51 patients were treated with TSF for osteomyelitis at a Major Trauma Centre. Demographic, infection, and treatment factors were collected, with microbiology results, antibiotic treatment regimes, and time to partial weight-bear (PWB) and full weight-bear (FWB) prescriptions also noted. Outcomes of complications and time to union were obtained.

Results

Radiological union was achieved at mean 11.0 months. Mean follow up was 24.1 months. Six/three patients were further treated with fusion/amputation respectively. Mean treatment time with TSF was 12.1 months. 78% had some complications, with pin-site infection, malunion, and non-union being most prevalent.

Staphylococcus epidermidis in bone debridement microbiology was significantly negatively associated with pin-site infection (OR = 0.093, 95% CI [0.011-0.828] ) and malunion (OR = 0.698 95% CI[0.573-0.849]), and enterococcus with non-union (OR = 0.775, 95% CI [0.656-0.916] ), during the treatment period. Time to union was significantly positively associated with time from admission to debridement (p = 0.035), time TSF was in (p = 0.021), presence of any complications (p = 0.045), bone loss complication (p = 0.037), time to FWB prescription (p = 0.001).

Conclusions

We have analysed the effectiveness of TSF in the treatment of tibial osteomyelitis, and elucidated the most important injury, treatment and rehabilitation factors that affect outcome. The negative bacterial-complication cross associations could be due to successful eradication as culture specific antibiotics were used postoperatively. Earlier patient full weight bearing could enhance callous formation leading to faster union.
1200 Polytrauma Clinic in a Major Trauma Centre in the UK – a Novel Approach for Polytrauma Patients
Authors: Cornish E , Gamble C , Telford J , Shah N , Lyle V , Walton K
Published: August 2023

Introduction

The UK major trauma network was successfully implemented in 2012. However, rehabilitation has mainly been described in military veterans. In our unit a multidisciplinary polytrauma clinic attended by an Advanced Physiotherapist, Rehabilitation Medicine Consultant and a Trauma and Orthopaedic Consultant was established to manage these patients after discharge.

Method

This observational study assessed the polytrauma rehabilitation clinic at a single UK Major Trauma Centre. Eligible patients had 2 or more significant limb injuries +/- pelvic fracture. A retrospective review between 1st July 2016 to 31st July 2021 was performed. Electronic records were assessed for mechanism of injury, number of injuries requiring surgery, length of inpatient stay, number of clinic appointments, diagnosis of post-traumatic amnesia and re-admission.

Results

Of a total of 87 patients, 68% sustained injuries following road traffic collisions. Mean number of injuries per patient was 5.9 SD+/- 2.6, mean operations performed per patient 4.3 SD+/- 4. Patients had a mean of 1.4 SD+/- 0.6 reviews per year in the clinic, with 1.5 +/- 0.6 years of follow-up. 14% of patients had post-traumatic amnesia. Re-admission was required for 24 patients, of which 21 (87.5%) were planned.

Conclusions

The polytrauma clinic introduced a multi-disciplinary approach to the aftercare of this patient population, whilst reducing their appointment burden. This study found patients required 1-2 appointments per year, demonstrating a cost-effective approach to follow up. The streamlining of required interventions in a timely manner is supported by the fact that over 70% of patients did not require further admissions for treatment.
1291 Is the Trauma Meeting a Thing of the Past?
Authors: Chow V , Butler K
Published: August 2023

Aim

This study explores the educational value of traditional trauma meetings and provides a unique solution to maximising the scholastic value for non-essential juniors.

In October 2022, surgical trainee-led small group teaching sessions were initiated twice a week in place of the traditional trauma meetings. For the other three days, trauma meetings were attended. The objective was to provide frequent teaching of orthopaedics for non-essential junior doctors via trauma meeting simulations but with smaller chunks of useful content and in a more relatable, slower paced, and approachable environment.

Method

A 6-item feedback form with Likert scales and free text responses was filled out after each teaching session from October to November 2022. Understanding of orthopaedic topics prior to these sessions and after were evaluated as well as confidence in their clinical roles.

Results

Twenty feedback responses were recorded and analysed. An improvement from 30% to 80% in their understanding of orthopaedic content was seen after teaching, along with an average rating of 80% for application of knowledge to their clinical work and an average rating of 75% was given to confidence and understanding of discussions in subsequent trauma meetings.

Conclusions

This study reveals the educational limitations gained in trauma meetings for non-essential juniors and aims to optimise learning by introducing a more approachable ‘alternative trauma meeting’. Making knowledge more accessible cultivates insight and interest and increases clinical confidence. This implementation also provides teaching experiences for registrars and core trainees as well as encourages team building between trainees and non-essential juniors.
1310 Association of Anterior Knee Pain in Suprapatellar vs Infrapatellar Tibial Nailing Techniques. a Retrospective Cohort Study
Authors: Waqas Ilyas M , Amer A Sh , Al-Kharouf K , Alaraj M , Vakil H , Zohaib S , Mitchell C
Published: August 2023

Aim

To assess whether there is a statistically significant difference between the incidence of anterior knee pain in supra-patellar vs infra-patellar tibial nailing techniques.

Method

Data were collected from a single major trauma Centre in the UK and included all patients with tibial fractures who underwent fixation using IM nail. Out of 312 patients identified, 206 were included in the final data set who fulfilled the inclusion criteria. Patients were divided into two cohorts: “Suprapatellar Nailing” and “Infrapatellar Nailing”, and clinical follow-up records were looked at thoroughly to identify the incidence of anterior knee pain. Statistical analysis was performed to test the null hypothesis, i.e., “Documented anterior knee pain is higher in infrapatellar nailing vs suprapatellar nailing”.

Results

Of 206 patients, 140 were males, and 66 were females, with a mean age of 43 years (Range 16-91). 60.2% (n = 124) were treated with infrapatellar nailing compared to suprapatellar nailing 39.8% (n = 82). Anterior knee pain was reported in 14.2% (n = 17) of the infrapatellar cohort compared to 14.6% (n = 12) in the suprapatellar cohort. The Chi-square statistic with yates’ correction is 0.0124, with a p-value of 0.91. The result is not significant (p > 0.05).

Conclusions

The mean incidence of anterior knee pain in both cohorts is 14.4 % on the literature's lower spectrum of reported results. We acknowledge that the sample size needed to attain statistical significance is enormous; our study results suggest no significant difference in the incidence of anterior knee pain in infrapatellar vs suprapatellar nailing techniques and can give uncertain outcomes in well-trained hands.
140 Five Year Single-Unit Experience and Outcomes of Renal Decompression for Ureteral Obstruction: A Retrospective Analysis of 102 Kidney Units
Authors: Rahman K , Abdulmajed M
Published: August 2023

Aim

Renal decompression following ureteral obstruction is a common urological emergency. Malignant obstruction patients often have poor life-expectancy, and the impact of decompression on survival is questionable [1]. We herein review outcomes of ureteral obstruction management in a single unit.

Method

Records of nephrostomy requests in Ysbyty Gwynedd between January 2017 and December 2021 were retrospectively reviewed. Information on patient demographics, primary pathology, performance status (PS), change in renal function and outcomes were recorded.

Results

Over 60 months, 102 nephrostomies were performed. Benign obstructions constituted 30.4% (n = 31) of cases. Of 71 cancer cases, 9 were re-insertions due to complications. Cancer group was associated with high and early deaths (11.3%, 64.5% and 85.5% at 3, 12 and 60 months, respectively) with only 1 in 5 kidney units illustrating improvement in renal function following decompression. All cancer patients were frail, with performance status of 2 (63%) and 3 (37%). Following nephrostomy insertion, 69.3% of kidney units developed urinary infection and/or sepsis requiring treatment. Only about 1 in 2 (53%) cancer patients received further oncological treatment (chemo- and /or radiotherapy). Though ante grade ureteric stenting was attempted in 23 kidney units following nephrostomy insertion for cancer, only 21 were successful and 2 of those blocked within 14 days.

Conclusions

Decompression of malignant ureteral obstruction may not improve survival and can involve multiple interventions with quality-of-life implication. Hence, the decision to decompress should not be the default and would therefore need to be individualized, adopting a multidisciplinary approach.
324 The Learning Curves of Major Laparoscopic and Robotic Procedures in Urology: A Systematic Review
Authors: Chahal B , Aydin A , Amin M S A , Khan A , Khan M S , Ahmed K , Dasgupta P
Published: August 2023

Aim

Urology has been at the forefront of adopting laparoscopic and robot-assisted techniques to improve patient outcomes. Defining the learning curves for these procedures enables assessment of trainee performances relative to expected progress and has important implications in research. This systematic review aimed to examine the literature relating to the learning curves of major urological robotic and laparoscopic procedures.

Method

In accordance with PRISMA guidelines, a systematic literature search strategy was employed across PubMed, EMBASE, and the Cochrane Library from inception to December 2021 for eligible studies alongside a search of the grey literature. Two independent reviewers completed the article screening and data extraction stages, using the Newcastle-Ottawa Scale (NOS) to then undertake quality assessment of the included articles. The review was reported in accordance with AMSTAR guidelines.

Results

Of 3702 records identified, 97 eligible studies were included for narrative synthesis. 39 studies evaluated robot-assisted laparoscopic prostatectomy (RALP) with the learning curve identified as 10-250 cases for operative time and 250-300 for potency. The shortest learning curve was reported for hand-assisted laparoscopic nephrectomy, involving 4-10 cases. There was considerable variation in the study designs, outcome measures and prior experience of surgeons, with all studies scoring either 5 or 6 on the NOS.

Conclusions

Standardised reporting of outcomes and performance measures is required to reduce heterogeneity and enable the undertaking of a meta-analysis. Future studies should use multiple surgeons and large sample sizes of cases to identify the currently undefined learning curves for laparoscopic radical cystectomy and for robotic and laparoscopic retroperitoneal lymph node dissection.
325 Antegrade Sclerotherapy: A Viable Option for the Treatment of Varicocele in the United Kingdom? a Single Centre Perspective
Authors: Chuah C T , Jones R , Patel C , Seipp C
Published: August 2023

Aim

Antegrade sclerotherapy has been used for the treatment of varicoceles since the 1970s. Despite its efficacy, minimally invasive technique, and short learning curve it is not routinely used in the United Kingdom. With the prospect of an increase in varicocele operations, with the European and American Associations of Urology now advocating for treatment in sub-fertile men with clinical varicoceles, we aim to look at the experiences of this procedure in a UK urology unit.

Method

A retrospective review of antegrade sclerotherapy for varicoceles within a single centre in North Wales. The primary outcome being clinical recurrence and secondary outcomes of fertility and radiation exposure.

Results

37 patients with a median age of 28 (range 14-65) were included. 35 out of 37 patients had a reported pre-operative scrotal ultrasound showing a left sided varicocele. The most common indication for procedure was pain (70.3%) followed by subfertility (21.6%). 45.9% were exposed to only 1 shot of radiation during the procedure. The median follow up was 3 months and only 2 patients had clinical recurrence and there were no significant complications (Clavien-Dindo > 3). 3 of 8 patients with subfertility had successful paternity. Another 4 patients had semen analysis, all of them had improved sperm count, motility, morphology postoperatively.

Conclusions

Antegrade sclerotherapy shows favourable outcome of only 5.4% recurrence accompanied with low dose of radiation. 37.5% of sub fertile patient managed to achieve paternity. This is another viable treatment option for consideration in the treatment of varicoceles.
371 A Single-Centre Impact Assessment of Delayed Imaging in Suspected Ureteric Colic
Authors: Beder D , Hassan M , Khan T , Ragge N , Abioye A , Pushkaran A
Published: August 2023

Introduction

Ureteric colic accounts for a quarter of emergency Urology presentations (Talreja et al, 2015). The British Association of Urological Surgeons (BAUS) recommends a CT of the urinary tract within 14 hours of presentation. However, District General Hospitals frequently lack access to cross-sectional imaging overnight for the purpose of investigating suspected ureteric colic. With the ever-increasing pressure on bed spaces, we report on the delay in discharge of appropriate patients with suspected ureteric colic due to delayed access to imaging.

Method

We performed a retrospective review of admissions for ureteric colic from October 2021 to March 2022. We determined the time from presentaon to performance of CT. Assessment of suitability for discharge was based on the BAUS consensus document. Factors contributing to delayed discharge were determined through case note review.

Results and Conclusions

Of 140 patients included, almost half (47%) were admitted overnight. 64% of admissions were avoidable by adherence to the BAUS guidelines on safe discharge. 54 patients were not discharged the same day: 57% due to delay in obtaining CT imaging, 17% due to sepsis, 13% due to AKI, and 13% due to reasons not specified. The mean discharge delay due to imaging was 1 day (0-3). Notably, only 60% of referrals with suspected ureteric colic had a ureteric stone present. We therefore conclude that imaging at the point of presentation of suspected ureteric colic can prevent unnecessary admission and direct safe patient discharge. These results have led to local introduction of a patient pathway to improve management.