bluuebunny/crossref_metadata_2025 huggingface dataset:
The factors affecting the survivability of malignant cancer patients with deep vein thrombosis among subjects with gynecologic and non-gynecologic cancer: An ambispective cohort study
Authors: Rachman Andhika , Christine Griskalia , Betsy Rachelle , Juanputra Samuel , Pratiwi Widya
Published: July 2023

Background: Gynecologic cancer is a significant public health concern worldwide, with three of the top ten most common cancers affecting women. The increasing incidence of deep vein thrombosis (DVT) and the disproportionately poor outcomes in cancer patients necessitates urgent intervention. This study aimed to analyze the factors affecting the survivability of cancer patients with DVT, especially among gynecologic and non-gynecologic cancers.

Methods: An ambispective cohort study was conducted among gynecologic and non-gynecologic cancer patients with DVT, from January 2011 until August 2013.

Results: Among 223 cancer subjects with DVT, 61.4% of the subjects developed short-term mortality. In the overall group, the survival time was significantly lower in subjects who developed immobilization status (p-value <0.001), advanced cancer stages (p-value <0.045), and infection status (p-value <0.001). In the gynecologic cancer group, the survival time was significantly lower in subjects who developed immobilization (p-value 0.007) and infection status (p-value 0.021). In the non-gynecologic cancer group, the survival time was significantly lower in subjects who developed immobilization (p-value 0.008), infection (p-value 0.002), undergo cancer surgery (p-value 0.024), and received high-risk systemic therapy (p-value 0.048). Additionally, the most common infection was pneumonia (29.6%).

Conclusions: Both gynecologic and non-gynecologic cancer patients who experienced DVT developed a high short-term mortality. Our finding of immobility, infection, advanced cancer stages, systemic therapy, and cancer surgery as risk factor that affect the survivability highlights the necessity of administering secondary prophylaxis as a standard procedure in clinical practice.
Europe and Turkey: identities in evolution. An analytical literature review
Authors: Gulmez Seckin Baris , Topal Alp Eren , Rumelili Bahar
Published: July 2023

This research aims to offer a valid answer to the question of how Turks and Europeans perceived each other in cultural and identity terms throughout history. With this purpose, it makes a thorough analytical review of the extant scholarly literature on identity relations between Turkey and Europe. There is an evident lack of scholarly attention on the evolution of mutual representations comparatively in the long durée. Most scholarly works focus on specific periods of time and investigate either how Turks view Europe or visa-versa. This systematic review provides the basis for an evolutionary analysis of mutual identity representations between Turkey and Europe over more than a two-hundred-year period.

The period under focus starts with the French Revolution (1789) triggering intensive identity debates between Ottomans and Europeans and lasts until mid-2010s when bilateral relations between Turkey and the European Union went into disarray. This long period has been divided into four shorter periods each starting and ending with a remarkable event in world politics or bilateral relations. The study examines each period in relation to four focal issues, namely, nationalism, civilization, status in international society, and state-citizen relations generating intensive identity discussions in both Turkey and Europe.

The article first presents the key findings of the relevant literature on European representations of Turkey and on Turkish representations of Europe in the four historical periods. Then it scrutinizes the extant literature on each period with respect to the four focal issues. Overall, the study, through a comprehensive literature review, demonstrates the ways in which mutual identity representations in Turkey and Europe have been contested over a two-hundred-year period.
Foreign Investments As the Most Important Resource of Economic Development and the Object of Management
Authors: Fraymovich D. , Kolosova M.
Published: July 2023

Over the past two decades, the international movement of capital has been a fundamental factor for the creation of foreign economic and political ties, has a significant impact on the economic development of the country, contributes to the growth of production, increased competitiveness, activation of innovation processes, as well as the formation of other important areas. International migration (movement) of capital includes the export, import and functioning of the capital of legal entities and individuals abroad in order to strengthen positions in the foreign economy, profit, and struggle for sales markets. But it is impossible to say about the unambiguously positive impact of foreign investments on the innovative and reproductive functioning of the state, i.e. there is a discussion about their quality and a natural question arises about the management of foreign cash flows in order to create a balance of commercial and social interests of all market participants.
Managing the Human Resources Potential of Local Governments As Maintaining the Sustainability of Socio-Economic Development
Authors: Tishkina N. , Molochaev Ya. , Zuev K.
Published: July 2023

The relevance of the topic of personnel management in local self-government is due to the need for optimal use of human resources to achieve sustainable socio-economic development of territories. The aim of this study is to identify factors influencing the effectiveness of personnel in local self-government and to develop personnel management strategies to increase staff productivity. The study used methods of analysis of scientific literature and a survey of employees of local self-government. The results showed that for successful personnel management in local self-government, both material and non-material factors such as respect, recognition, and opportunities for professional and personal development must be considered. It is recommended to use a comprehensive approach to personnel management, including creating a favorable working environment, developing corporate culture, training and development of employees, as well as transparent systems for evaluation and stimulation of achieving goals.
Intergenerational Transmission of Organizational Misconduct: Evidence from the Chicago Police Department
Authors: Frake Justin , Harmon Derek
Published: July 2023

This paper investigates how organizational misconduct is perpetuated through intergenerational transmission. We theorize that early exposure to a subculture of misconduct imprints newcomers with the belief that misconduct is normal, which is then carried by these individuals into managerial positions and passed down to their subordinates. We test this using longitudinal administrative data from the Chicago Police Department from 1980 to 2017. We exploit a lottery that assigns applicants to training cohorts to demonstrate that officers exposed early on to a subculture of misconduct not only engage in more misconduct over their entire careers, but also increase the misconduct of their subordinates after they become managers. We also find that this intergenerational dynamic is stronger when subordinate officers were exposed to a subculture of misconduct themselves, are earlier in their tenure, and have not yet received their annual review from their manager. Taken together, these findings reveal a bottom-up dynamic whereby beliefs about misconduct are developed in an organization’s lowest ranks, carried by these individuals over time, and passed down to future generations. This study expands our understanding of how organizational misconduct is perpetuated as well as offers important policy implications for addressing the problem of police misconduct.

This paper was accepted by Lamar Pierce, organizations.

Supplemental Material: The online appendix and data are available at https://doi.org/10.1287/mnsc.2022.00580 .
INTELECTUAIS INSURGENTES: NEPS-CEASM, O NÚCLEO DE ESTUDOS E PESQUISA DA FAVELA DA MARÉ
Authors: Manço de Souza Francisco Overlande , Salustriano da Silva Humberto , Paiva da Felicidade Aryanne
Published: July 2023

Neste artigo, analisamos a perspectiva e produção  político-epistemológica do núcleo de pesquisa NEPS-CEASM a partir da atuação de seus pesquisadores no tempoespaço de 2020 a 2023. Os integrantes do referido núcleo de pesquisa são nomeados como intelectuais insurgentes. Neste sentido, realizamos a discussão teórica apontando as características e os pressupostos desta categorização. Nosso objetivo foi descrever a ação-reflexão destes pesquisadores,  a relação político-epistemológica através de suas ações e a contextualização dos princípios e valores que caracterizam o intelectual insurgente. A produção do artigo envolveu análise documental das atividades do NEPS-CEASM no recente período de 2020-2023 e bibliográfica. Foi realizada uma breve contextualização histórica da gênese do núcleo de pesquisa que não tem a intenção, neste texto, de aprofundar o período anterior a 2020, mas ressaltar as ações do núcleo com seus atuais participantes. Para tal procedimento de análise utilizamos as atividades presenciais e remotas que o  núcleo realizou e a produção acadêmica dos integrantes do núcleo. Destacamos a importância do núcleo como um espaço de fazer científico que utiliza a realidade como ferramenta de análise para pensar a sua produção  político-epistemológica.
DIFERENTES ABORDAGENS DA RESOLUÇÃO DE PROBLEMAS NO PROCESSO ENSINO-APRENDIZAGEM DE MATEMÁTICA
Authors: Martins Ana Célia De Jesus , Viana Maria Neuraildes Gomes , Costa Manoel Dos Santos
Published: July 2023

Apesar de haver um reconhecimento da importância da resolução de problemas nas aulas de Matemática, alguns autores defendem perspectivas diferentes quanto à sua aplicação no que tange ao processo de ensino e aprendizagem. Assim, o presente artigo tem por objetivo apresentar alguns conceitos sobre a resolução de problemas na visão de alguns pesquisadores e discutir as diferentes abordagens e possibilidades de utilizá-las em sala de aula, isto é, ensinar sobre resolução de problemas, ensinar para resolver problemas e ensinar através da Resolução de Problemas. Trata-se de uma pesquisa qualitativa de arcabouço bibliográfico, cujas informações foram coletadas por meio de materiais escritos e publicados em livros, anais de eventos científicos, periódicos e teses de doutorado que têm servido como referência para novos trabalhos científicos. O estudo analítico-descritivo desenvolvido possibilitou concluir que, dentre as três abordagens, a que mais leva em consideração os conhecimentos prévios dos estudantes e que promove a construção de novos conhecimentos, conceitos e conteúdos matemáticos e, consequentemente, o desenvolvimento de competências e habilidades é o ensino de Matemática “através” da Resolução de Problemas. Além disso, essa abordagem inclui no seu desenvolvimento as demais, ou seja, os ensinos “sobre” e “para” a resolução de problemas.
Nursing in Palestine
Authors: Aljafari Tamer
Published: July 2023

Tamer Aljafari, a palliative care coordinator nurse at Augusta Victoria Hospital, Palestine, details the successes and challenges facing palliative and oncology services in the region, as well as the recent steps taken to advance healthcare practice in nursing and clinical practice.
The first MSc-level nurse practitioner programme in mainland China
Authors: Jiang Hua , Lu Yue , Hou Shuxiao , Li Baohua , Wei Zhengxin , Pang Dong , Li Mingzi , Shang Shaomei
Published: July 2023

While nurse practitioners are a vital resource in addressing the increased demand on China's long-term care services, there has not been an educational programme that focuses on their training—until now
Taking Robots to the Next Stage of Evolution
Authors: Knight Helen
Published: July 2023

Humans to pass on skills through gloves fitted with sensors
New Device to Tackle Marine Pollution
Authors: Excell Jon
Published: July 2023

Dutch inventor in bid to clean up ‘Great Pacific garbage patch’
Concrete Use for Plastic
Authors: Wade Andrew
Published: July 2023

Substituting waste product for sand is boost for environment
Digitalisation and Materials Selection
Authors: Wildner Heiko
Published: July 2023

Research from BCGDV and Matmatch has found that 80 per cent of materials research starts with Google. Heiko Wildner asks if this is this preventing engineers from being more innovative
Engineers can Improve the Lives of Millions
Authors: Mair Lord Robert
Published: July 2023

It's time to use our skills to give everyone in the world access to clean water, power and healthcare, says the president of the Institution of Civil Engineers
Flat out in the Ariel Nomad
Authors: Pickering Chris
Published: July 2023

This fun supercar is possibly the craziest idea to come out of the British car industry in recent years, but it's also one of the best, writes Chris Pickering
COMPLEX ANKLE FUSION WITH CIRCULAR FRAMES: FACTORS INFLUENCING OUTCOMES, COMPLICATIONS, AND PATIENT SATISFACTION
Authors: Tay Kae Sian , Langit Mickhael , Muir Ross , Moulder Elizabeth , Sharma Hemant
Published: July 2023

Introduction

Circular frames for ankle fusion are usually reserved for complex clinical scenarios. Current literature is heterogenous and difficult to interpret. We aimed to study the indications and outcomes of this procedure in detail.

Materials & Methods

A retrospective cohort study was performed based on a prospective database of frame surgeries performed in a tertiary institution. Inclusion criteria were patients undergoing complex ankle fusion with circular frames between 2005 and 2020, with a minimum 12-month follow up. Data were collected on patient demographics, surgical indications, comorbidities, surgical procedures, external fixator time (EFT), length of stay (LOS), radiological and clinical outcomes, and adverse events. Factors influencing radiological and clinical outcomes were analysed.

Results

47 patients were included, with a mean follow-up of three years. The mean age at time of surgery was 63.6 years. Patients had a median of two previous surgeries. The median LOS was 8.5 days, and median EFT was 237 days. Where simultaneous limb lengthening was performed, the average lengthening was 2.9cm, increasing the EFT by an average of 4 months. Primary and final union rates were 91.5% and 95.7% respectively. At last follow-up, ASAMI bone scores were excellent or good in 87.2%. ASAMI functional scores were good in 79.1%. Patient satisfaction was 83.7%. 97.7% of patients experienced adverse events, most commonly pin-site related, with major complications in 30.2% and re-operations in 60.5%. There were 3 amputations. Adverse events were associated with increased age, poor soft tissue condition, severe deformities, subtalar fusions, peripheral neuropathy, peripheral vascular disease, and prolonged EFT.

Conclusions

Complex ankle fusion using circular frames can achieve good outcomes in complicated clinical scenarios, however patients can expect a prolonged time in the frame and high rates of adverse events. Multiple risk factors were identified for poorer outcomes, which should be considered in patient counselling and prognostication.
RADIATION DOSE WITH CIRCULAR EXTERNAL FIXATION: DOES THE SURGEON GET A DOUBLE WHAMMY?
Authors: Harris Peter C , Lacey Stephen , Perdomo Amanda , Ramsay Gabby
Published: July 2023

Introduction

The vast majority of orthopaedic surgeons use C-arm fluoroscopy in the operating theatre when building a circular external fixator. In the absence of previous research in this area, we hypothesised that the surgeon who builds a circular external fixator is exposed to a greater amount of radiation purely as a result of the presence of the metallic fixator in the x-ray beam. The aim of our study therefore was to investigate how the presence of a circular external fixator affects the radiation dose to the surgeon and the surgical assistant.

Materials & Methods

A simulated environment was created using a radiolucent operating table, an acrylic lower limb phantom (below knee segment), various configurations of metalic circular external fixation, and a standard size C-arm image intensifier.

The variables investigated were 1. the amount of metal in the beam 2. the orientation of the beam (PA vertical vs lateral) 3. the horizonal distance of the person from the beam (surgeon vs assistant) and 4. the vertical distance of the various body parts from the beam (e.g. thyroid, groin).

In terms of radiation dose, we recorded two things : 1. the dose produced by the image intensifier 2. the dose rate at standardised positions in the operating theatre. The latter was done using a solid-state survey sensor. These positions represented both where the surgeon and surgical assistant typically stand plus the heights of their various body regions relative to the operating table..

Results

The effect of the presence of the circular external fixator : all frame constructs tested resulted in a statistically significant greater radiation dose both produced by the image intensifier and received by the surgical team.

The effect of the beam orientation : the PA (vertical) orientation resulted in a statistically significant greater radiation dose for the surgeon than did the lateral orientation, but made no difference for the assistant.

The effect of horizontal distance from the beam : unsurprisingly, the surgeon (who was closer to the beam) received a statistically significant greater radiation dose than the assistant. The effect of vertical distance from the beam : for the surgeon, the dose received was highest at the level of the phantom leg / frame, whilst for the assistant there was no statistically significant difference for any level.

Conclusions

To our knowledge, this is the first study investigating the radiation dose rate to the orthopaedic surgeon when building a circular external fixator. We found that the surgeon does indeed receive a ‘double whammy’ because the image intensifier puts out a greater amount of radiation plus the metalic frame scatters more of the x-ray beam. Whilst the amounts are relatively small, we think that it's important to quantify doses that orthopaedic surgeons receive to ensure optimal radiation practices.
PROPHYLACTIC USE OF LOCAL ANTIBIOTICS IN OPEN FRACTURES: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Kapoor Dhruv , Condell Ross , Kennedy Niamh , Bakhshayesh Peyman
Published: July 2023

Introduction

The management of open long bone fractures is well described and has been standardised through a number of well-established guidelines. However, there is no consensus regarding the application of local antibiotics into the open fracture site as a means of reducing infection rates.

Materials & Methods

A systematic review and meta-analysis were undertaken as per PRISMA guidelines. PROSPERO Registration CRD42022323545. PubMed, EMBASE, Scopus and CENTRAL were the databases assessed. The Newcastle Ottawa Scale and the Rob 2 Tool were used to assess bias. A qualitative synthesis of all included studies and meta-analysis of suitable subgroups was undertaken.

Results

In total, 12 studies (11 observational, 1 RCT) assessing 2431 open fractures were included for analysis. All compared the addition of a local antibiotic therapy to a standard treatment versus the standard treatment alone. The methods of delivery were vancomycin powder (4 papers), tobramycin polymethylmethacrylate beads (4 papers), gentamicin coated intramedullary (IM) nails (2 papers), gentamicin injections (1 paper) and antibiotic released IM core cement (1 paper). The addition of vancomycin powder did not decrease infection rates in comparison to intravenous antibiotics alone (OR 1.3, 95% CI (0.75 – 2.26)). Antibiotic coated IM Nails appear to have an association with lower infection rates than standard IM Nails. PMMA antibiotics have shown varied results in reducing infection rates depending on the individual studies.

Conclusions

There are numerous methods available to deliver antibiotics locally to an open fracture site. Further high-quality research is required to provide a definitive conclusion on their efficacy irrespective of delivery method.
INTERNATIONAL FIELD TEST OF LIMB-Q KIDS: AN INTERNATIONALLY APPLICABLE PATIENT-REPORTED OUTCOME MEASURE FOR LOWER LIMB DIFFERENCES
Authors: Wright Jonathan , Messner Juergen , McMahon Sarah , Johnson Louise , Foster Patrick , Fernandes James , Chhina Harpreet , Klassen Anne , Cooper Anthony
Published: July 2023

Introduction

LIMB-Q Kids is a new patient-reported outcome measure (PROM) for children with Lower limb differences (LLDs). The objective is to conduct an international field test study.

Materials & Methods

A mixed method multiphase approach was used to develop LIMB-Q Kids. In phase one, a systematic review was conducted to identify concepts from existing PROMs used in research with children with LLDs. A preliminary conceptual framework derived from the systematic review informed an international qualitative study. The data from qualitative interviews were used to form the LIMB-Q Kids, which was further refined through multiple rounds of cognitive debriefing interviews with children. Input was obtained from parents and healthcare professionals from Australia, Canada, Ethiopia, India, UK, and the USA. LIMB-Q Kids was translated and culturally adapted into multiple languages.

Results

The final field-test version consists of 11 scales (159 items) that measure appearance, physical function, symptoms (hip, knee, ankle, foot, and leg), leg-related distress, and school, social and psychological function. This version was rigorously translated into Danish and German. Translations that are in progress include Arabic, Finnish, Hindi, Swahili, Portuguese, Spanish, and Luganda. An international field-test study is underway in nine countries (15 sites with a target recruitment of 150 participants per country). At the time of abstract submission, 190 patients from seven sites have completed LIMB-Q Kids. The UK collaborative has worked on language adaption for the UK and is currently validating the score across five paediatric limb reconstruction units.

Conclusions

No internationally applicable PROM exists for children with LLDs. We present the current progress in developing and validating such a score. Data from the international field-test study will be used to reduce items and perform psychometric testing of LIMB-Q Kids. The rigorous translation and cultural adaption process will provide versions of LIMB-Q Kids in different languages. Once completed, the LIMB-Q Kids will provide a common metric for outcome assessment for children with lower limb differences internationally.
THE FITBONE LEARNING CURVE: WHEN DOES IT END?
Authors: Tissingh Elizabeth , Goodier David , Wright Jonathan , Timms Anna , Campbell Michelle , Crook Grace , Calder Peter
Published: July 2023

Introduction

The FitBone lengthening nail (Orthofix UK) is an intramedullary device licensed for the lengthening of long bones in adults in the UK. It contains a motor powered by electricity transmitted via an induction coil placed underneath the skin. It was developed in Germany two decades ago but uptake in the UK has only started more recently. The aim of this study was to review the first cohort of FitBone lengthening nails in a unit with significant experience of other lengthening nails (including PRECICE and Stryde).

Materials & Methods

Demographic, clinical and radiological data was prospectively collected on all FitBone cases starting in February 2022. Accuracy of lengthening rate, patient satisfaction and implant issues were all considered. Complications and learning points were recorded and discussed by the multidisciplinary team involved in the patients care.

Results

Eleven lengthening nails were inserted between February and November 2022 (6 right femurs, 5 left femurs). The average patient age was 31 (16–57) with 4 females and 7 males. The average lengthening achieved was 44mm (13– 70) over an average of 59 days (35 to 104). Significant technical issues were encountered in this cohort of patients including slow opening up at osteotomy site (3 requiring speeding up of programme), early consolidation (one requiring re-do osteotomy) and backing out of locking screws (3 out of 11 nails). There were also patient use concerns with difficulty using the motor and the inability to reverse the lengthening without an additional component to the motor.

Conclusions

We present the first UK cohort of patients with femoral lengthening using the FitBone implant and device. We highlight the technical and patient issues encountered during this learning curve and propose solutions to avoid these pitfalls.
CURRENT FRACTURE-RELATED INFECTION PRACTICE IN THE UK: IS THERE A CASE FOR CHANGE?
Authors: Tissingh Elizabeth , Wright Jonathan , Goodier David , Calder Peter , Vris Alex , Iliadis Alexios
Published: July 2023

Introduction

A greater emphasis has been placed on fracture related infection (FRI) orthopaedic practice as a separate entity in recent years. Since the publication of the FRI consensus definition and guidelines, there has been an increase in the published literature on the topic and a move towards considering FRI as separate from general orthopaedic practice and as work that requires a more specialist approach. The aim of this study was to audit current FRI practice in the UK.

Materials & Methods

Orthopaedic practice related to FRI in the UK was audited using a semi-structured questionnaire. Respondents were from a range of institutions, specialties and clinical roles to reflect the multi-disciplinary nature of treating FRI. The online tool SurveyMonkey was used to share the survey at the 2022 annual meeting of the British Limb Reconstruction Society. Twenty-one questions were asked in the following domains: scope of practice, theatre and clinic capacity, availability of the multidisciplinary team, renumeration for work and scope of FRI networks.

Results

Of the 36 respondents, the majority (64%) worked in a major trauma centre. In the majority of cases, bone infection was managed by the limb reconstruction team (68%) although in most centres the wider team was often also involved including the general on call, the trauma team and the arthroplasty team. When referrals were made elsewhere, this was usually done to known individuals rather than established FRI networks. 80% of respondents said that there was a bone infection MDT in their unit and this usually met weekly. This usually included orthopaedics and microbiology but plastics in only 43% of cases and radiology in only 23% of cases. Most respondents said that the lack of funding and appropriate tariffs were the main barrier to FRI management locally (62%) and nationally (83%). Most respondents (83%) said that bone infection practice should be centralised. The overwhelming majority of this cohort (90%) said that patient outcomes would be improved by cases being managed in dedicated centres.

Conclusions

There is variation in practice for the management of bone infection in the UK. This reflects the lack of clear national guidelines and the lack of established networks for management and onward referral. There is agreement that patient outcomes would be improved by more formal networks and specialised centres but also recognition that remuneration is a significant barrier to implementing change. This survey reflects practice in units with an interest in limb reconstruction and bone infection. Further work is needed to evaluate practice across district general hospitals in the UK and to build consensus around best practice and national strategies for improved care.
MANAGEMENT OF GERIATRIC OPEN ANKLE FRACTURES
Authors: Airey Grace , Chapman James , Mason Lyndon , Harrison William
Published: July 2023

Introduction

Open fragility ankle fractures involve complex decision making. There is no consensus on the method of surgical management. Our aim in this study was to analyse current management of these patients in a major trauma centre (MTC).

Materials & Methods

This cohort study evaluates the management of geriatric (≥65years) open ankle fractures in a MTC (November 2020–November 2022). The method, timing(s) and personnel involved in surgical care were assessed. Weightbearing status over the treatment course was monitored. Patient frailty was measured using the clinical frailty score (CFS).

Results

There were 35 patients, mean age 77 years (range 65–97 years), 86% female. Mean length of admission in the MTC was 26.4 days (range 3–78). Most (94%) had a low-energy mechanism of injury.

Only 57% of patients underwent one-stage surgery (ORIF n=15, hindfoot nail n=1, external frame n=4) with 45% being permitted to fully weightbear (FWB). Eleven (31.4%) underwent two-stage surgery (external fixator; ORIF), with 18% permitted to FWB. Of those patients with pre-injury mobility, 12 (66%) patients were able to FWB following definitive fixation. Delay in weightbearing ranged from 2–8weeks post-operatively. Seven patients (20%) underwent an initial Orthoplastic wound debridement. Ten patients (28.6%) required plastic surgery input (split-skin grafts n=9, local or free flaps n=3), whereby four patients (40%) underwent one stage Orthoplastic surgery.

Eighteen (51.4%) patients had a CFS ≥5. Patients with a CFS of ≥7 had 60% 90-day mortality. Only 17% patients had orthogeriatrician input during admission.

Conclusions

These patients have high frailty scores, utilise a relatively large portion of resources with multiple theatre attendances and protracted ward occupancy in an MTC. Early FWB status needs to be the goal of treatment, ideally in a single-staged procedure. Poor access to orthogeriatric care for these frail patients may represent healthcare inequality.
DOUBLE-BARREL DRILL SLEEVE: A SURGICAL INNOVATION FOR PERCUTANEOUS OSTEOTOMY
Authors: Rashid Lutfi , Trompeter Alex , Saw Aik
Published: July 2023

Introduction

Osteotomy is a key step in distraction osteogenesis. Various techniques of osteotomy have been described with its own benefits and pitfalls. Percutaneous osteotomy using multiple drill holes is one of the most widely used osteotomy techniques. It still remains a challenge however to keep the drill holes aligned prior to the osteotomy. Moreover, the efficacy of percutaneous irrigation practice to keep the temperature low during drilling with this technique is also debatable. With an aim to overcome these challenges, we are introducing a device called the Double Barrel Drill Sleeve (DBDS) to perform percutaneous osteotomies. We attempted to compare this method to the conventional multiple drill holes technique using laboratory experiments and clinical data.

Materials & Methods

DBDS has two adjacent parallel barrels that can fit 3.2 to 3.5 mm diameter drill bits. It has a guide member at the drilling end that can be inserted through a pre drilled hole at the near and far cortices of a bone. This provides a constant rotating point for drilling of holes through the barrels. An osteotomy simulation was performed to compare percutaneous drilling with DBDS vis-a-vis a conventional single drill sleeve (SDS) by qualified orthopaedic surgeons, mainly to assess the drilling patterns of both techniques. Percutaneous drilling was done on PVC pipes wrapped in thick sponge to simulate tubular bone with surrounding soft tissue. We also assessed the effect of indirect irrigation on temperature during drilling using the DBDS against a control group on a cadaveric bone model. Ultimately we reviewed our patients who had undergone osteotomy for distraction osteogenesis with DBDS and the conventional technique, and compared their outcomes.

Results

Completion time for the osteotomy simulation in the DBDS group was significantly faster than the conventional drilling group; 74 seconds to 179 seconds. There was significantly less drilling deviation from the midpoint in the DBDS group as compared to the SDS group. Mean bone temperature during drilling with indirect irrigation using DBDS was significantly lower (32.6'C) compared to the control group (48.4'C). There was no significant difference in healing index between patients treated with DBDS and the conventional method. None of these patients developed non union.

Conclusions

Percutaneous drilling with DBDS was quicker and more linear compared to the conventional method. Its double-barreled feature allows effective indirect irrigation during drilling. A comparable healing index in both of the techniques shows its clinical efficacy. These attributes make DBDS a usefull tool to overcome some of the pitfalls associated with the conventional multiple drill holes technique.
FRACTURE-RELATED INFECTION: DIAGNOSIS AND MANAGEMENT AT A MAJOR TRAUMA CENTRE
Authors: Fernandes Ramon , Farid Mohammed , Desai Seema , McFadyen Iain , Maamoun Wareth , Huq Shahidul
Published: July 2023

Introduction

Fracture related infection (FRI) is a challenging complication to manage in an orthoplastic setting. Consensus guidelines have been created to standardise the diagnosis of FRI and comprise confirmatory and suggestive criteria. In this study, the aim is to assess the diagnostic criteria and management of FRI with a particular focus on soft tissue reconstruction.

Materials & Methods

A retrospective study to identify the outcomes of FRI in the lower limb over a five year period at a Major Trauma Centre. Fracture specific information that was analysed includes: open versus closed, fractured bone(s) and site, initial fracture management, method of diagnosis and soft tissue management.

Results

A total of 40 patients were identified, 80% of whom were male (n= 32). The mean age for FRI diagnosis was 54 years (range 18–83 years). In our patient cohort, 10% were immunosuppressed and another 12.5% had a formal diagnosis of Diabetes Mellitus. A diagnosis of acute FRI (i.e. < six weeks from time of injury) was made in 9 patients (22.5%). Chronic FRI was noted in 25 patients (62.5%). There was equal incidence of FRI in patients with closed fractures and open fractures (42.5%). Tibia and fibula fractures were most common (87.5%, n=35). Regardless of fractured bone(s), the more distal the fracture the higher the incidence of FRI (60% distal versus 12.5% proximal). Gram-positive cocci were the most commonly identified pathogens, identified in 25% of patients. Five patients underwent free flap reconstruction, two patients received pedicled muscle flaps and another two patients received split thickness skin grafts.

Conclusions

The diagnosis of FRI can be confirmed through the presence of a combination of confirmatory and suggestive criteria. We advocate a staged approach in the management of FRI with radical wound excision and temporary coverage followed by definitive soft tissue reconstruction.
CAN ARTHOPLASTY STEM INFLUENCE OUTCOME (CASINO): A RANDOMIZED CONTROLLED TRIAL OF STEM LENGTH IN CEMENTED TOTAL HIP ARTHROPLASTY
Authors: Gaston Paul , Clement Nicholas , Ohly Nicholas , Macpherson Gavin , Hamilton David
Published: July 2023

In this RCT the primary aim was to assess whether a short (125mm) Exeter V40 stem offered an equivalent hip specific function compared to the standard (150mm) stem when used for cemented total hip arthroplasty (THA). Secondary aims were to evaluate health-related quality of life (HRQoL), patient satisfaction, stem height and alignment, radiographic loosening, and complications between the two stems.

A prospective multicentre double-blind randomised control trial was conducted. During a 15-month period, 220 patients undergoing THA were randomised to either a standard (n=110) or short (n=110) stem Exeter. There were no significant (p≥0.065) differences in preoperative variables between the groups. Functional outcomes and radiographic assessment were undertaken at 1- and 2-years.

There were no differences (p=0.428) in hip specific function according to the Oxford hip score at 1-year (primary endpoint) or at 2-years (p=0.767) between the groups. The short stem group had greater varus angulation (0.9 degrees, p=0.003) when compared to the standard group and were more likely (odds ratio 2.42, p=0.002) to have varus stem alignment beyond one standard deviation from the mean. There were no significant (p≥0.083) differences in the Forgotten joint scores, EuroQol-5-Dimension, EuroQol-VAS, Short form 12, patient satisfaction, complications, stem height or radiolucent zones at 1 or 2-years between the groups.

The Exeter short stem offers equivalent hip specific function, HRQoL, patient satisfaction, and limb length when compared to the standard stem at 2-years post-operation. However, the short stem was associated with a greater rate of varus malalignment which may influence future implant survival.
ACETABULAR SECTOR ANGLES IN ASYMPTOMATIC AND DYSPLASTIC HIPS: DEFINING THRESHOLDS FOR DYSPLASIA
Authors: Verhaegen Jeroen , Devries Zach , Horton Isabel , Slullitel Pablo , Rakhra Kawan , Beaule Paul , Grammatopoulos George
Published: July 2023

Traditional radiographic criteria might underestimate or fail to detect subtle types of acetabular dysplasia. Acetabular sector angles (ASA) can measure the degree of anterior and posterior coverage of the femoral head on computed tomography (CT). This study aims to determine ASA values at different axial levels in a cohort of (1) asymptomatic, high-functioning hips without underlying hip pathology (controls); and (2) symptomatic, dysplastic hips that underwent periacetabular osteotomy (PAO). Thereby, we aimed to define CT-based thresholds for hip dysplasia and its subtypes.

This is an IRB approved cross-sectional study of 51 high functioning, asymptomatic patients (102 hips) (Oxford Hip Score >43), without signs of osteoarthritis (Tönnis grade≤1), who underwent a CT scan of the pelvis (mean age: 52.1±5.5 years; 52.9% females); and 66 patients (72 hips) with symptomatic hip dysplasia treated with peri-acetabular osteotomy (PAO) (mean age: 29.3±7.3 years; 85.9% females). Anterior and posterior acetabular sector angles (AASA & PASA) were measured by two observers at three CT axial levels to determine equatorial, intermediate, and proximal ASA. Inter- and intra-observer reliability coefficient was high (between 0.882–0.992). Cut-off values for acetabular deficiency were determined based on Receiver Operating Characteristic (ROC) curve analysis, area under the curve (AUC) was calculated.

The dysplastic group had significantly smaller ASAs compared to the Control Group, AUC was the highest at the proximal and intermediate PASA. Controls had a mean proximal PASA of 162°±17°, with a cut-off value for dysplasia of 137° (AUC: 0.908). At the intermediate level, the mean PASA of controls was 117°±11°, with a cut-off value of 107° (AUC 0.904). Cut-off for anterior dysplasia was 133° for proximal AASA (AUC 0.859) and 57° for equatorial AASA (AUC 0.868). Cut-off for posterior dysplasia was 102° for intermediate PASA (AUC 0.933).

Measurement of ASA on CT is a reliable tool to identify dysplastic hips with high diagnostic accuracy. Posterior ASA less than 137° at the proximal level, and 107° at the intermediate level should alert clinicians of the presence of dysplasia.
AUTOMATED VERSUS MANUAL COMPONENT IMPACTION IN TOTAL HIP ARTHROPLASTY: EFFECTS ON COGNITIVE FUNCTION, PHYSICAL FATIGUE, AND STRESS LEVEL
Authors: Vandeputte Frans-Jozef , Hausswirth Christophe , Dille Jeroen , Corten Kristoff
Published: July 2023

Total Hip Arthroplasty (THA) surgery is a physical and cognitive challenge for surgeons. Data on stress levels, cognitive and physical load of orthopaedic surgeons, as well as ergonomic impact, are limited. With and without the use of an automated impaction device, operational efficiency and the surgeon's ergonomic, mental, and physical load was investigated.

In a total of thirty THA procedures, a standard manual technique was compared with an automated impaction device. Three computerized cognitive tasks (Simon, pattern comparison, and pursuit rotor) and five physical tests (isometric wall-sit, plank-to-fatigue, handgrip, supra-postural task, and shoulder endurance) were used to assess psychophysiological load of the surgeon. Surgeon's cortisol concentration was evaluated from saliva samples. Postural risk was assessed by Rapid Upper Limb Assessment (RULA) and Rapid Entire Body Assessment (REBA). Efficiency was assessed by timing surgical steps and instrumentation flow.

Cognitive performances after automated impaction showed faster response times and lower error rates with a greater time-on-target (+1.5 s) and a lower mouse deviation from target (−1.7 pixels). Manual impaction showed higher physical exhaustion in the isometric wall-sit test (10.6% vs. 22.9%), plank-to-fatigue (2.2% vs. 43.8%), the number of taps in the supra-postural task (−0.7% vs. −7.7%), handgrip force production in the dominant (−6.7% vs. −12.7%) and contralateral hand (+4.7% vs. +7.7%), and in shoulder endurance (−15s vs. −56s). An increase of 38.2% in salivary cortisol concentration between the midday (1.31 nmol/l) and afternoon session (1.81 nmol/l) was observed with manual impaction. After using automated impaction, salivary cortisol concentration decreased (−51.2%). Manual broaching time was on average 6′20’’ versus 7’3’’ with automated impaction. RULA of manual impaction scored 6 for cup impaction and 5 for femoral broaching, versus 3 and 3 for automated impaction, respectively. REBA of manual impaction scored 9 for cup impaction and 5 for femoral broaching, versus 4 and 3 for automated impaction, respectively.

Automated impaction lowers surgeons’ cognitive and physical fatigue and leads to reduced stress and improved ergonomics without loss of surgical efficiency.
SLIDING HIP SCREW CONSTRUCTS ARE ASSOCIATED WITH EARLY MOBILIZATION, RETURN TO DOMICILE, AND SHORTER LENGTH OF STAY WHEN COMPARED TO AN INTRAMEDULLARY NAIL: RESULTS FROM THE SCOTTISH HIP FRACTURE AUDIT
Authors: Diffley Thomas , Ferry Jamie , Sumarlie Regina , Beshr Mostafa , Chen Bin , Clement Nick , Farrow Luke
Published: July 2023

Appropriate surgical management of hip fractures has major clinical and economic consequences. Recently IMN use has increased compared to SHS constructs, despite no clear evidence demonstrating superiority of outcome. We therefore set out to provide further evidence about the clinical and economic implications of implant choice when considering hip fracture fixation strategies.

A retrospective cohort study using Scottish hip fracture audit (SHFA) data was performed for the period 2016–2022. Patients ≥50 with a hip fracture and treated with IMN or SHS constructs at Scottish Hospitals were included. Comparative analyses, including adjustment for confounders, were performed utilising Multivariable logistic regression for dichotomous outcomes and Mann-Whitney-U tests for non-parametric data. A sub-group analysis was also performed focusing on AO-A1/A2 configurations which utilised additional regional data. Cost differences in Length of Stay (LOS) were calculated using defined costs from the NHS Scotland Costs book. In all analyses p<0.05 denoted significance.

13638 records were included (72% female). 9867 received a SHS (72%).

No significant differences were identified in 30 or 60-day survival (Odds Ratio [OR] 1.05, 95%CI 0.90–1.23; p=0.532), (OR 1.10, 95%CI 0.97–1.24; p=0.138) between SHS and IMN's.

There was however a significantly lower early mobilisation rate with IMN vs SHS (OR 0.64, 95%CI 0.59–0.70; p<0.001), and lower likelihood of discharge to domicile by day-30 post-admission (OR 0.77, 95%CI 0.71–0.84; p<0.001). Acute and overall, LOS were significantly lower for SHS vs IMN (11 vs 12 days and 20 vs 24 days respectively; p<0.001). Findings were similar across a sub-group analysis of 559 AO A1/A2 fracture configurations.

Differences in LOS potentially increases costs by £1230 per-patient, irrespective of the higher costs of IMN's v SHS.

Appropriate SHS use is associated with early mobilisation, reduced LOS and likely with reduced cost of treatment. Further research exploring potential reasons for the identified differences in early mobilisation are warranted.
THE INCIDENCE AND RISK FACTORS FOR ABNORMAL POSTOPERATIVE BLOOD TESTS FOLLOWING PRIMARY TOTAL JOINT REPLACEMENT: A SINGLE-CENTRE RETROSPECTIVE COHORT STUDY
Authors: Orfanos Georgios , Kumar Nakulan Nantha , Lowe David , Redfern Dan , Burston Benjamin , Banerjee Robin , Thomas Geraint
Published: July 2023

Primary total joint arthroplasty (TJA) is an increasingly common and safe way of treating joint disease. Robust preoperative assessment improved intraoperative techniques and holistic rehabilitation contribute to an uneventful postoperative period. Despite there being evidence against the utility of postoperative blood tests, it is still often part of routine practice. We aim to evaluate the usefulness of these tests by investigating their incidence following TJA as well as identifying preoperative risk factors for abnormal blood test results postoperatively especially pertaining to anaemia and acute kidney injury (AKI).

This is a retrospective cohort study of patients who had elective TJA between January and December 2019 at a tertiary centre. An independent student's t-test and Fisher's exact test was used to compare variables between the normal and abnormal postoperative results groups. An analysis of variance (ANOVA) was performed to identify risk factors for an abnormal blood test result. Analyses of receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used to determine cut off values that could be suggestive of abnormal test results postoperatively.

The study included 2721 patients with a mean age of 69 of which 46.6% were males. Abnormal postoperative bloods were identified in 444 (16.3%) patients. We identified age (≥65 years), female gender, ASA ≥ 3 as risk factors for developing abnormal postoperative blood tests. Preoperative haemoglobin (≤ 127 g/dL), haematocrit (≤ 0.395L/L) and potassium (≤ 3.7 mmol/L) were noted as cut-offs that could be predictive of postoperative anaemia or AKI respectively.

The costs outweigh the benefits of ordering routine postoperative blood tests in TJA patients. Clinicians should risk stratify their patients and have a lower threshold for ordering blood tests in patients with one or more of the risk factors we have identified. These risk factors are age (≥65 years), females, ASA ≥ 3, preoperative haemoglobin (≤ 127 g/L), haematocrit (≤ 0.395L/L), and potassium (≤ 3.7 mmol/L).