bluuebunny/crossref_metadata_2025_split huggingface dataset:
208 First and Second Metacarpal Arthrodesis - Salvage Procedure for Failed Thumb Carpometacarpal Joint Arthritis Surgery
Authors: Manoharan G , Edakalathur J , Pickard S 
Published: October 2021

Abstract

Aim
There are various surgical options for the management of thumb carpometacarpal joint (CMCJ) arthritis. These include first metacarpal osteotomy, trapeziectomy with or without ligament reconstruction, CMCJ arthrodesis and arthroplasty. However, if these operations fail, the options for salvage are limited. The authors aim to offer ‘first and second metacarpal arthrodesis (FSMA)’ as a salvage procedure for failed first CMC joint surgeries. The authors also reviewed the literature on FSMA.

Method
Literature search
Operative Technique

Results
Literature search

Conclusions
FSMA is a good salvage option for failed surgical treatment of thumb CMCJ arthritis. FSMA can also be utilised as a primary procedure for various indications.
233 Blood Tests and Radiographs After Hip and Knee Arthroplasty – We May Not Always Need Them
Authors: Olusegun A , Irpati G , Chuen C K , Norton M , Jewell W , Middleton R 
Published: October 2021

Abstract

Aim
Routine blood tests and radiographs are routinely performed after total joint arthroplasty as a pre-discharge requirement. This study aims to explore whether there might be sub-group of patients undergoing arthroplasty for whom post-operative blood tests and radiographs might not be mandated in the absence of clinical concern.

Method
A retrospective study of 612 ASA 1 and 2 patients underwent total hip or knee arthroplasty at a single orthopaedic centre. Variables purported to be of interest were sodium and Potassium levels, Haemoglobin concentration and eGFR. Return to theatre and alterations of the routine Physiotherapy rehabilitation were matched to post-operative radiographs.

Results
42 (6.9%) patients had post-operative haemoglobin below 10 g/L. Of these 4 were symptomatic, which required treatment. Acute kidney injury was identified in 13 patients (2.1%); 11 had pre-existing renal disease. The other two had both suffered pro-longed post-operative hypotension. Two patients had severe hyponatraemia and one of whom had pre-existing renal disease. Two patients had hypokalaemia and one of whom had metabolic syndrome but normalised within 24 hours after oral supplement. No patient had abnormal post-operative radiography that altered management.

Conclusions
Our study indicates that routine post-operative blood tests and radiographs may not be necessary in ASA 1 and 2 patients with normal pre-existing blood tests. Where patient is clinically symptomatic or there is evidence of pre-operative renal dysfunction, metabolic syndrome, electrolyte imbalance or anaemia, we would suggest blood tests are necessary. If there is no surgical concern, it is safe to delay check radiography until their first post-operative follow up.
256 Charcot-Marie-Tooth Disease as A Risk Factor for Periprosthetic Fractures in Tibiotalocalcaneal Fusion With Intramedullary Nailing
Authors: Bhadresha A , Teoh K , Hariharan K 
Published: October 2021

Abstract

Aim
The treatment for severe fixed hindfoot osteoarthritis secondary to Charcot-Marie-Tooth disease (CMT) disease is tibiotalocalcaneal (TTC) arthrodesis. In our centre, we have noticed a disproportionate rate of periprosthetic fractures in CMT patients following TTC arthrodesis with retrograde hindfoot nailing. The aim of this study was to test this hypothesis by evaluating our local cohort of TTC arthrodesis with retrograde hindfoot nailing.

Method
A retrospective review of patients who had TTC arthrodesis with intramedullary nailing was conducted over a seven-year period.

Results
There were 45 patients (30 male, 15 female) in our cohort. Forty-one patients achieved radiological and clinical fusion of their TTC arthrodesis. All three patients who had CMT sustained periprosthetic fracture at the tip of the nail at an average of 4 (range: 2.5 - 6) months from index operation. In comparison, no patients in the rest of the cohort sustained periprosthetic fractures. The nail position of the patients with CMT were central in both planes in all 3 patients. None of the patients with CMT had abutment of the cortex on either planes.

Conclusions
We found that there was a disproportionate rate of periprosthetic fractures in CMT patients in our cohort of TTC arthrodesis with retrograde hindfoot nailing. This suggests that CMT is a significant risk factor. The authors propose a longer nail to reduce the lever arm, with a long period of protected weight bearing till union. Elective removal of the nail to prevent this phenomenon from occurring should also be considered.
257 The Effect of the COVID-19 Pandemic on Mental Health Associated Trauma, Admissions and Fractures at a London Major Trauma Centre
Authors: Jamal M S , Hay D , Al-Tawil K , Petohazi A , Gulli V , Bednarczuk N , Baldwin-Smith R , Gibbons J , Sinha J 
Published: October 2021

Abstract

Aim
Non-injury related factors have been extensively studied in major trauma and shown to have a significant impact on patient outcomes, with mental illness and associated medication use proven to have a negative effect on bone health and fracture healing. We report the epidemiological effect of COVID-19 pandemic on mental health associated Orthopaedic trauma, fractures, and admissions to our centre.

Method
We collated data retrospectively from the electronic records of Orthopaedic inpatients in an 8-week non-COVID and COVID period analysing demographic data, referral and admission numbers, orthopaedic injuries, surgery performed and patient co-morbidities including psychiatric history.

Results
here were 824 Orthopaedic referrals and 358 admissions (6/day) in the non-COVID period with 38/358 (10.6%) admissions having a psychiatric diagnosis and 30/358 (8.4%) also having a fracture. This was compared to 473 referrals and 195 admissions (3/day) in the COVID period with 73/195 (37.4%) admissions having a documented psychiatric diagnosis and 47/195 (24.1%) a fracture. 22/38 (57.9%) and 52/73 (71.2%) patients were known to mental health services, respectively.

Conclusions
Whilst total numbers utilising the Orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affected those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. The proportion of patients with both a fracture and a psychiatric diagnosis more than doubled and the number of patients presenting due to a traumatic suicide attempt almost tripled. It is imperative that adequate support is in place for vulnerable mental health patients, particularly as we are currently experiencing the “second wave” of COVID-19.
274 Use of DHS For Fixation of Unstable Hip Fractures – Are Outcomes Any Different from Nails?
Authors: Arora N 
Published: October 2021

Abstract

Aim
To determine if the outcomes and rate of complications differ based on choice of implant for unstable hip fractures.

Method
Retrospective analysis of 105 hip fractures operated in 2015 + 2016 with AO classification A2.2. A2.3 or A3. These were divided into 2 groups depending on whether DHS/Plate implant was selected (n = 86) or Nail implant was used (n = 19). Any complications occurring in their subsequent management or performance of any revision procedures were recorded. 6-month mortality rate was also calculated for both groups.

Results
When A2 and A3 fractures were assessed together the rate of acute complications was similar in both groups. 21% for nails and 19% for plates. The rate of delayed complications was not significantly different either, 16% for nails and 10% for plates. Revision procedures were more common where nails had been used (16%) compared to only 6% of plate fixations. Mortality rates were identical. When looking at A3 fractures in isolation, the rate of delayed complications is significantly higher when plates are used (24%) compared to 12% when nails are selected.

Conclusions
We did not identify any significant difference in acute complications including bleeding and infection based on choice of implant. This goes against common arguments raised against use of nails. Successful use of DHS fixation in unstable A2 hip fractures is possible, as evidenced by similar rates of delayed complications. Revisions were higher when nail was selected. It is however noted that for reverse oblique fractures nails perform demonstrably better, with half as frequent delayed complications and revisions.
345 A Novel Fixation Method for Unstable Ankle Fractures in The Elderly with Poor Quality Skin, Via Dual Percutaneous Tibiotalar Cannulated Screws
Authors: Hancock D , Hainsworth L , Pentlow A 
Published: October 2021

Abstract

Introduction
The incidence of ankle fractures is highest in the elderly population due to poor bone quality. Osteoporosis and poor overlying skin increase risk of infection, wound breakdown, and fixation failure. This ultimately results in worse functional outcomes. This retrospective case-series describes a novel dual percutaneous tibiotalar cannulated screw fixation method, for managing unstable ankle fractures, in high-risk elderly patient with low functional demand.

Method
Six elderly patients were identified between January 2019-2020 who underwent dual tibiotalar cannulated screw fixation for unstable ankle fractures. Pre-operative and post-operative pain and mobility scores were obtained via telephone consultation and case-note review. Radiographs were analysed pre-operatively for fracture type and post-operatively for complications such as, talar shift. Wound Infection post-operatively was monitored.

Results
The mean age was 86.8 with an average ASA grade of three. Functional outcomes were excellent with 83.3% of patients remaining ambulatory with no post-operative pain at an average follow-up of 10.25 months. Three patients (50%) had excellent post-operative radiographs with evidence of union and no talar shift. Two patients (33.3%) had either non-union or minor talar shift, and one patient (16.7%) had multiple radiological complications likely due to delayed fixation. All three patients remained ambulatory and had minimal post-operative pain. There were no reports of soft tissue injury or infection due to the surgery.

Conclusions
Dual percutaneous tibiotalar cannulated screws can be used to manage unstable ankle fractures in the low demand elderly patient, with poor skin quality. Function outcomes were good with satisfactory post-operative mobility and minimal pain in the majority of cases.
358 Surgical Management of Spinal Cord Injuries: An Overview of Controversies
Authors: Jamal S , Sheeraz A 
Published: October 2021

Abstract

Aim
Spinal Cord Injuries (SCI) are incredibly debilitating injuries associated with significant morbidity and financial burden, with an incidence of 12-16 per million population in the UK. There is currently no cure for SCI, with majority of interventions focusing on primary prevention of SCI or of further damage once SCI is sustained. We present an overview of the role of closed reduction, timing of surgery and role of steroids, and provide an algorithm for management of SCI.

Method
A search was carried out on PubMed, looking at notable reviews, consensus statements and trends in management of spinal cord injuries. This was cross-referenced with the NICE and BOAST guidelines for SCI.

Results
The efficacy of closed reduction in cervical fractures and necessity of pre-reduction MRI is still equivocal and remains a source of major debate amongst spinal surgeons. The timing of surgery remains controversial as studies have not consistently shown improved outcomes with early, aggressive surgery but there have been trends noted in the newer studies with some benefit of early surgery. The use of steroids in acute SCI has fallen out of favour with most guidelines not recommending them due to their equivocal benefit and unequivocal side-effect profile.

Conclusions
Prevention and pre-hospital management are crucial in the management of SCI, along with early spinal alignment restoration, decompression and stabilisation augmented by good long-term rehabilitation measures. There is a need for new randomised controlled trials assessing the role of closed reduction, need for pre-reduction MRI and timing of surgery in SCI.
360 The Impact COVID-19 Has Had on Paediatric Supracondylar Fractures: A Closed Loop Audit Demonstrating How Compliance to BOAST 11 Guidelines Has Changed in An Orthopaedic Department
Authors: Yeoh T , Arslanboga E , Yeoh C 
Published: October 2021

Abstract

Aim
Supracondylar fractures of the humerus in the paediatric patient is a common orthopaedic injury. Resultantly, strict guidelines were created by the British Orthopaedic Association of Standards in Trauma 11 (BOAST 11). In 2020, the COVID-19 pandemic, drastically affected the way medicine was practised. This audit aims to highlight, the extent to which compliance with BOAST 11 changed.

Method
Children with a supracondylar fracture of the humerus (Gartland 2 or 3) were included in this study. Standards from BOAST 11 were selected and the orthopaedic department were audited against these over a period of 2 years. After the first audit cycle, an information booklet was created and distributed to all doctors within the department. At the end of 2020, the department was re-audited, comparing pre-COVID results (2019) with COVID results (2020).

Results
Compliance improved within five BOAST 11 domains assessed on re-audit. With significant changes in neurovascular status being appropriately assessed and documented in clerking notes (improvement of 28%); and 2mm k-wire being used and documented in operation notes (improved by 23%). However, significant regression in results in patient’s being operated on within 24hours.

Conclusions
Global improvement of results during the national pandemic in 2020 demonstrates that our department did not compromise patient care despite limited resources but in fact strived for clinical excellence. The reason for a regression in compliance with regards to patients not being operated on within 24hours was likely due to protect paediatric patients from unnecessary stay in hospital, in a strategy to reduce COVID-19 transmission rates.
377 Expanding the Use of Wide-Awake Local Anaesthesia Non-Tourniquet (WALANT) Technique in The Management of Hand Trauma Patients During the COVID 19 Pandemic
Authors: O'Sullivan S , Macfarlane R , Khan K , Horwitz M 
Published: October 2021

Abstract

Aim
COVID19 produced a unique challenge to the management of hand trauma. There was reduced theatre capacity and inpatient beds as staff and resources were lost to make way for the critically unwell1, however the burden of patients (albeit reduced) requiring emergency procedures remained2. During 1stUK peak we adopted a one-stop hand trauma clinic where patients were assessed by senior surgeons and immediately operated on under local anaesthesia with Adrenalin, a model mirrored by other units across the UK during this time3,4. Subsequent to surgery they were either seen on the same day for advice with a hand therapist or booked for immediate hand therapy follow up.

Method
A retrospective review of 158 cases operated on over a 4-month COVID19 period compared to the same 4-month period 1 year previously. Indications for surgery and type of anaesthesia were recorded. Follow up and complication rates were reviewed for the COVID19 patients.

Results
There were similarities in the demographic of patients across both cohorts and in mechanism of injury, with trauma the highest indication for surgery. The comparable data sets showed only 21% of patients treated used WALANT pre-COVID19 versus 100% of patient during COVID19.

Conclusions
WALANT is a viable model by which to perform emergency hand trauma surgery in a low cost and low resource setting. Previously this model was not utilised to full effect in our hospital. The results demonstrate the adaptability of WALANT in an adverse and dynamic situation, such as COVID19, thus highlighting benefits to patient care and service provision.
537 Open vs Closed Pilon Fractures: Comparison of Management, Outcomes, and Complications
Authors: Lu V , Zhang J , Thahir A , Lim J A , Krkovic M 
Published: October 2021

Abstract

Aim
Despite the low incidence of pilon fractures, their high impact nature presents difficulties in surgical management/recovery. Current literature is varied, with no universal treatment algorithm. We aim to highlight differences in treatment, outcomes, complications between open and closed pilon fractures.

Method
This retrospective study was conducted at a major trauma centre, including patients over 5-year period. 135 patients were included (open:48, closed:87). Primary outcome was AOFAS score at 3-, 6- and 12-months post-injury. Secondary outcomes include time to partial weight-bear (PWB) and full weight-bear (FWB), bone union time, follow-up time. Post-operative complications were collected.

Results
Open fractures had lower AOFAS score 3 months post-injury, longer bone union time, and time to FWB. For both open and closed fractures, compared to ORIF patients, those treated with fine wire fixator (FWF) had lower AOFAS scores 3- and 6-months post-injury. Closed fracture patients treated with ORIF had shorter bone union time, time to PWB and FWB. Patients with AO/OTA 43A fractures needed shorter time to PWB and FWB than those with 43C fractures. Common complications (closed:open) were superficial infection (22%:54%), post-traumatic arthritis (25%:16%), non-union (11%:24%).

Conclusions
Open fractures, with more extensive soft tissue damage, were likely more suited for FWF, rather than ORIF (18% of open vs 72% of closed were treated with ORIF). Due to greater associated trauma, more frequent complications, and delayed definitive fixation, open fractures had lower AOFAS scores. Nevertheless, use of staged approach involving temporary external fixation, followed with ORIF or FWF achieved low complication rates and good functional recovery.
New insights into ribosomal DNA variation in apomictic and sexualTaraxacum(Asteraceae)
Authors: Macháčková Petra , Majeský Ľuboš , Hroneš Michal , Bílková Lucie , Hřibová Eva , Vašut Radim J 
Published: October 2021

AbstractApomictic genera have a complex evolutionary history, including reticulate hybridization, polyploidization and variation in reproduction modes. Restrictions of functional meiosis in polyploid apomictic taxa considerably hamper gene conversion, leaving footprints of past hybridization events in their genomes, which are masked by the homogenization of tandemly organized arrays of nuclear ribosomal DNA in sexual species. Dandelions (Taraxacum) have a highly complex reticulate evolutionary history. Detailed knowledge remains hazy; earlier investigations of rDNA sequences have uncovered the complex pattern derived from evolution but without direct evidence for any particular processes. We investigated the position and number of 45S and 5S rDNA loci in 38 Taraxacum taxa (covering different reproduction modes, geographical regions and putative phylogenetic groups) using fluorescent in situ hybridization (FISH) and measured genome size and GC content. The ITS1-5.8S-ITS2 regions of four sexual and five apomictic taxa were sequenced to investigate inter- and intra-individual variation. Most species considerably differ in the chromosome positions of loci and karyotype patterns, but mostly share the same number of studied loci (45S:5S) in a 1:2 ratio per haploid genome (x = 8), with six exceptions (up to a 4:2 ratio). Genome size (2C) varies sixfold and with GC content partly distinguishes major evolutionary groups. Sexual taxa show limited variation in sequenced regions (with two to eight variants), but apomictic taxa vary significantly (with 20–36 variants). Extensive reticulate evolution in Taraxacum and subsequent phenomena such as genome repatterning and non-effective concerted evolution are probably the cause of the dynamic nature of Taraxacum karyotypes and the large variation in genome size and rDNA sequences.
Regional differences in BDNF expression and behavior as a function of sex and enrichment type: oxytocin matters
Authors: Faraji Jamshid , Lotfi Hamid , Moharrerie Alireza , Jafari S Yaghoob , Soltanpour Nasrin , Tamannaiee Rosa , Marjani Kameran , Roudaki Shabnam , Naseri Farhad , Moeeini Reza , Metz Gerlinde A S 
Published: October 2021

Abstract
The early environment is critical to brain development, but the relative contribution of physical versus social stimulation is unclear. Here, we investigated in male and female rats the response to early physical and social environmental enrichment in relation to oxytocin (OT) and brain-derived neurotrophic factor (BDNF) expression. The findings show that males and females respond differently to prolonged sensorimotor stimulation from postnatal days 21–110 in terms of functional, structural, and molecular changes in the hippocampus versus medial prefrontal cortex (mPFC). Physical enrichment promoted motor and cognitive functions and hippocampal BDNF mRNA and protein expression in both sexes. Combined physical and social enrichment, however, promoted functional and structural gain in females. These changes were accompanied by elevated plasma oxytocin (OT) levels and BDNF mRNA expression in the mPFC, while the hippocampus was not affected. Administration of an OT antagonist in females blocked the beneficial effects of enrichment and led to reduced cortical BDNF signaling. These findings suggest that an OT-based mechanism selectively stimulates a region-specific BDNF response which is dependent on the type of experience.
Primary hyperoxaluria type 1 in developing countries: novel challenges in a new therapeutic era
Authors: Soliman Neveen A , Mabrouk Sameh 
Published: October 2021

ABSTRACT
Primary hyperoxaluria type 1 (PH1) is an autosomal recessive inborn error of metabolism characterized by marked hepatic overproduction of oxalate due to deficiency of hepatic peroxisomal alanine-glyoxylate aminotransferase caused by AGXT gene mutation. One major hallmark of PH1 in developed as well as developing countries (DC) is the diagnostic delay. Notably in DC, where the disease is most prevalent and probably underdiagnosed, there are many challenges in PH1 diagnosis and management, with economic constrains and ethical concerns. This has led to the existing gap in the management of PH1 between developed and DC, which is expected to further deepen with the advent of novel therapeutic agents unless appropriate actions are taken. Until recently, treatment possibilities were limited to supportive measures. Thanks to a better understanding of the molecular basis of the disease a number of new therapies are developed, or being developed, leading to profound changes in management strategies. In this review we discuss the current situation of PH1 in DC as well as the accessibility challenges and the advantages of using promising novel therapeutics to bridge the currently existing gap. We also provide an overview of an integrated approach to ensure equitable access of sustainable therapeutics to PH1 patients in DC. This is expected to reduce global PH1 healthcare disparities, improve its standard of care and reduce disability linked to extrarenal complications of PH1 by implementing personalized medicine.