bluuebunny/crossref_metadata_2025_split huggingface dataset:
784 Management of Paediatric Epistaxis: An Appraisal of Cautery Versus Topical Antiseptics in The Prevention of Rebleeding Events
Authors: Sagua N , Fishpool S 
Published: May 2021

Abstract

Introduction
Epistaxis is a common acute presentation in childhood that with recurrence often causes great distress for both parent and child alike. For recurrent epistaxis it is common practice in the UK to trial either a topical antiseptic (Naseptin) or silver nitrate cautery. A literature review was conducted to assess which treatment confers greater protection against rebleeding events.

Method
The literature review was performed via a search on Medline via Ovid. As both cautery and topical antiseptics are not new treatments, an age limit was not set to allow older research to be included and provide perspective.

Results
In all but one study included, there was no statistically significant difference between the use of Naseptin versus cautery in the reduction of rebleeding events. A higher incidence of complications such as septal perforation and pain were reported in patients who underwent cautery, whilst no adverse side effects were reported with Naseptin.

Conclusions
The current evidence base relies mostly on short term outcomes, with most patients not being followed up for more than 2 months. If further longitudinal studies provide evidence to support there being a minimal difference in treatment outcomes, using topical antiseptics before considering cautery would be better clinical practice in paediatric patients.
993 Digital Monitoring of Paediatric Patients with Chronic Recurrent Multifocal Osteomyelitis at A National Orthopaedic Centre
Authors: Dave D , Choi J , Karamchandani U , Jacobs B 
Published: May 2021

Abstract

Introduction
Chronic recurrent multifocal osteomyelitis (CRMO) is a paediatric inflammatory bone condition requiring close monitoring by a multi-disciplinary team throughout childhood. Many UK patients are seen at the Royal National Orthopaedic Hospital, Stanmore for more than a decade of specialist management. Prior to the recent COVID crisis, we recognised need for more frequent monitoring without the inconvenience of cross-country travel and so piloted an online system of monitoring CRMO.

Method
An online assessment form was created using the GDPR-compliant Qualtrics system after consultation with CRMO paediatricians and a specialist nurse. 3 medical students telephoned parents of 31 patients to pilot the assessment form. Responses indicating issues were then referred to the CNS for follow-up.

Results
Response data confirmed need for close monitoring with 26% of respondents being seen quarterly, 29% reporting pain greater than 6/10, 29% having side-effects and 30% finding current treatment ineffective. 74% of respondents found online assessment extremely/very useful and 58% preferred it to face-to-face appointments.

Conclusions
A digital CRMO monitoring tool can successfully identify patients with both new and ongoing issues. In the COVID and post-COVID era, digital tools can closely monitor patients with chronic conditions like CRMO whilst improving quality of life by reducing need for face-to-face appointments.
82 A Case of Recurrent Calcifying Aponeurotic Fibroma of the Hand: Managing a Rare Hand Tumour in an Evolving Healthcare Landscape
Authors: Gallagher M , Cooper L , Mata J I 
Published: May 2021

Abstract

Introduction
Calcifying Aponeurotic Fibroma (CAF) is a rare benign tumour originating from the aponeuroses of tendons and their bony insertions. Our case illustrates the technical challenges and considerations of removing a large, recurrent CAF of the hand.

Case Report
A 15-year-old student presented to his GP with a one-year history of a progressively enlarging painless swelling on the dorsum of the middle phalanx of the left middle finger. Plain radiographs identified a calcified soft tissue swelling with no bony involvement. The lesion was excised by the local paediatric orthopaedic service and recurred rapidly. Histology confirmed the diagnosis. He was referred to our specialist hand surgery service and the lesion was excised with the overlying skin (which demonstrated histological but not clinical disease). At six months, there was no clinical evidence of recurrence.

Conclusions
CAF may present atypically, and a high index of suspicion is warranted with calcified soft tissue hand lesions. Excision with conservative margins, and we newly suggest, the overlying skin, is recommended to preserve hand function but minimise recurrence (very common). Hand surgery provision in the UK is changing with adoption of the hub and spoke model and hand tumours may be more appropriately managed at specialist centres.
112 Trans-Scaphoid Perilunate Dislocation. Two Atypical Presentations with Enucleation of The Proximal Pole
Authors: Weale R 
Published: May 2021

Abstract
This article describes two cases of tran-scaphoid perilunate dislocation, both of which have an atypical presentation. In both cases, the proximal pole of the scaphoid was enucleated, one into the carpal tunnel, the other into the distal forearm. In addition, the capitolunate alignment was preserved, with dorsal dislocation of the entire carpus. These cases are presented for educational purposes, as these injuries are highly unstable, and require a different operative approach to a typical perilunate dislocation. In a typical Mayfield II perilunate dislocation, the lunate remains within the lunate fossa, and acts as a 'keystone' for fixation of the dislocated carpus. These cases do not fit the classic Mayfield classification. Given the lunate was also unstable, K-wires were placed through the distal radius into lunate, then from the scaphoid into the lunate.
Another learning point for all training levels is that the referring orthopaedic hospital referred one of these injuries incorrectly as a 'lunate dislocation'. This article provides an opportunity to re-cap the Mayfield classification, and clarify the distinction between lunate and perilunate dislocation. In all cases, stringent monitoring for any carpal tunnel syndrome is required, and urgent decompression should be performed if there is any concern.
124 Post-operative mortality and risk of COVID-19 in patients receiving urgent elective surgical care at a COVID clean facility during the COVID 19 pandemic: a cross-sectional study
Authors: Cheung Lok Ka , Shaikh Shafaque , Rai Shanju , Lawrie David , Qadir Abdul 
Published: May 2021

Abstract

Introduction
The Sars-Cov2 related COVID-19 pandemic has triggered the adoption of unprecedented approaches to contain it across the globe at a very short notice. The aim of this study is to determine post-operative mortality and the risk of developing COVID-19 in a COVID-19 negative population undergoing elective surgical care in a COVID-clean facility. We also explored patient experiences and satisfaction as well patient reported post-operative COVID related symptoms through a patient satisfaction survey.

Method
A patient satisfaction survey was built into the service which was performed by means of a telephone follow-up at 30 days from procedure. One of the aspects of the service review was to capture data on patients developing COVID-19 symptoms post-operatively but not requiring hospital admission or testing.

Results & Conclusion:
Our study has shown promising results with the early outcomes of elective surgical care delivered through a COVID-clean facility with no mortality, low morbidity and high patient satisfaction across all 5 specialties (Plastic surgery, Urology, Gynaecology, General Surgery) in 455 patients operated on over 10 weeks. We have demonstrated safe delivery of elective surgical services by utilising a COVID-clean facility minimising the negative impact of delays experienced due to the COVID-19 pandemic.
130 Boerhaave’s Syndrome: A Rare Complication of Cannabinoid-Induced Hyperemesis Syndrome
Authors: Clarke T 
Published: May 2021

Abstract
A 22-year-old man was referred to our surgical department with severe central chest pain after a three-day history of &gt; 200 episodes of vomiting a day on a known background of cannabinoid hyperemesis syndrome. A computed tomography (CT) scan showed a ruptured oesophagus and pneumomediastinum, in keeping with Boerhaave’s syndrome. Conservative treatment with keeping the patient nil by mouth and administering intravenous fluids, anti-emetics and broad-spectrum antibiotics was initiated. Follow up CT showed significant reduction in pneumomediastinum. The patient was discharged home 7 days after admission. Spontaneous rupture of the oesophagus is a rare but potentially fatal event. It is caused by an abrupt rise in intra-luminal pressure, usually secondary to forceful vomiting. CT scan should be performed in all suspected cases as the findings dictate management, this being conservative, endoscopic, or surgical. We report on the first published case of Boerhaave’s syndrome as a result of cannabinoid hyperemesis syndrome.
149 Emergency Clot Retrieval and Stenting for Posterior Circulation Stroke
Authors: Daga K , Ahmad M T , Taneja M 
Published: May 2021

Abstract
The current literature regarding the morphology and presentations of strokes due to basilar artery stenosis/occlusion is limited. This pathology is a rare cause of stroke and its management is not clearly decided in guidelines or published literature. Moreover, posterior circulation strokes are reported to be more devastating than anterior circulation. We present a case of a 68-year-old male who presented in an acute setting with reduced consciousness, myoclonic jerks, weakness and nausea due to a stroke from an occluded mid-segment basilar artery. MRI showed evidence of left cerebellar and right occipital infarcts. Emergent cerebral angiography was performed, and he was immediately treated by thrombectomy and stenting (Stryker Wingspan stent). The patient made a full recovery within one week and remained well at follow-up 3 months post-procedure. Emergency recanalization of basilar artery strokes, by clot retrieval and stenting, should be considered as a treatment option.
153 Staging Laparoscopy in Bilio-Pancreatic Malignancies Compared To Radiological Staging: A Comparative Study
Authors: Noureldin K , Shalaby A 
Published: May 2021

Abstract

Introduction
The study was to compare the accuracy of laparoscopy in staging and selecting patients diagnosed with malignant obstructive jaundice, to the traditional investigation.

Method
a prospective study conducted in the period between September 2017 and December 2018.30 patients, having malignant jaundice, were divided into two groups for cancer staging to assess their resectability and operability. Staging of 15 patients in group A was limited to conventional diagnostic methods, while 15 patients were in group B,where Laparoscopy was added.

Results
Results showed that the accuracy of routine investigations in staging was 73%, while that of laparoscopy was 93%.The number of cases under staged by imagings were 8 cases(these were 3 in Group A and 5 in group B) thus they were diagnosed as operable. On the other hand, just 1 case was misdiagnosed by the laparoscopy. Regarding the morbidity and mortality, there were variable complications among those who had unrequired laparotomies including one mortality case.on the other side,the incidence of complications were markedly decreased in group B,with no mortality incidence.

Conclusions
Diagnostic laparoscopy has a crucial role in staging people with malignant jaundice and may decrease the rate of unnecessary laparotomy in people found to have resectable disease by conventional imagings.
176 Patient Perception on Fracture Healing
Authors: Sadozai Z , Bokhari S A , Mannan K 
Published: May 2021

Abstract

Introduction
Effective communication skills are an extremely important aspect of good medical practice. Fractures are common with over 1 million fractures occurring each year in the UK; of which 5-10% may have problems with healing. Patient perceptions of factors harmful to the fracture healing process are unknown and our study investigates this.

Method
A total of 418 responses were collected from participants in a single centre in our survey based study to determine patient perception on factors potentially affecting bone-healing.

Results
84% and 73% of patients believed tobacco and alcohol to be harmful to bone-healing. 31% thought that there was a harmful effect to bone-healing with ibuprofen and 25% perceived the same regarding caffeine. Paracetamol, vinegar, and chocolate were considered to be least harmful to bone-healing with 20%,15% and 11% responses respectively.

Conclusions
The majority of patients believed that there was a harmful association with tobacco and alcohol with regards to bone-healing. This harmful relationship is well understood in literature. However, we believe for the benefit of patients, they should all be aware of these detrimental effects. A clear possibility has been identified to improve fracture outcomes by empowering patients to take ownership of their injury by lifestyle modifications which are within their remit.
185 Vascular Hitch Procedure for Accessory Lower Pole Vessels
Authors: Fashina O , Rajimwale A 
Published: May 2021

Abstract

Introduction
The gold standard procedure for pelvi-ureteric junction obstruction has been the Anderson-Hynes dismembered pyeloplasty; involving the repositioning of the ureter and ureteropelvic anastomosis. However, the Hellstroem 'Vascular Hitch Procedure’ dictates the superior translocation of the accessory vessel and its fixation to the anterior pelvic wall. The latter has an estimated success rate &gt;90%.

Method
During 2016-2020, at Leicester Royal Infirmary, 16 operations occurred on paediatric patients with pelvi-ureteric junction obstruction. The dismembered pyeloplasty was performed on 5 patients, 9 patients underwent the vascular hitch procedure, and 2 patients are currently awaiting the latter operation. All patients had a pre-operative functional magnetic resonance urography (fMRU) to identify and localise the accessory lower pole vessel.

Results
The mean hospital stay for the vascular hitch procedure was 1.5 days (range=1-2) in comparison to 4 days (range=3-5) for the dismembered pyeloplasty. The follow-up period ranged from 6 months to 3 years. Overall, it was noted that the patients were asymptomatic, had markedly reduced hydronephrosis on imaging as well as stable renal function noted on the MAG 3 renogram scan.

Conclusions
The laparoscopic vascular hitch procedure appears to be the superior operation for the management of pelvi-uteric junction obstruction as the patients had notably reduced hospital stay lengths.
276 Management of Giant Coronary Artery Aneurysms as a Coronary Sequelae of Kawasaki Disease – Surgical or Conservative Management?
Authors: Quek F F , Tulloh R 
Published: May 2021

Abstract

Introduction
Kawasaki Disease (KD) is the commonest childhood acquired heart disease in developed countries, predominantly affecting children younger than 5 years of age. These patients are at high risks of developing coronary arterial aneurysms (CAA) and CAA with absolute internal luminal diameters measuring ≥8mm or Z-score ≥10 is classified as giant coronary aneurysms (GCA).

Case Report
A 19-year-old girl with previous history of Kawasaki disease was diagnosed with giant coronary aneurysms on echocardiograms. Her subsequent CT coronary angiography showed large aneurysms in the right coronary artery (29mm x 25mm) and left anterior descending artery (10mm x 10mm) with signs of calcification. However, surprisingly, despite the evidence of large coronary aneurysms, she was completely asymptomatic and was physically active. Her cardiac MRI scan showed right coronary perfusion deficit in the distal right coronary territory but with no evidence of myocardial infarction. After having a detailed discussion in the MDT and with colleagues from San Diego, USA, a conservative approach was decided to be in the patient’s best interest. She has been advised to avoid competitive or strenuous exercise due to the associated risks. She is fit-and-well and is currently on Warfarin variable dose and Aspirin 75mg OD, with annual cardiac MRI surveillance.
288 Management of Lateral Third Clavicle Fractures: A Five-Year Review in a Regional Trauma Unit
Authors: Hickland P , Goodland C , Zachariah S , Murphy L , Neil M 
Published: May 2021

Abstract

Introduction
Due to an increased risk of complications, lateral clavicle fractures are usually managed operatively. Unfortunately, there is no consensus on the optimal method of fixation.

Method
We assessed practice in our regional trauma unit by retrospectively identifying patients who underwent fixation of a lateral clavicle fracture between 1st August 2014 and 31st July 2019. Data was extracted from electronic care records and imaging systems.

Results
44 patients were included, with the following demographics: mean age 26 years, 63.6% male, 65.9% high energy injury, and 68.2% Neer II fracture. The following operations were performed; hook plate fixation (HPF) = 10, locking plate fixation (LPF) = 16, coracoclavicular ligament reconstruction (CCLR) = 12, and LPF + CCLR = 6. Patients having LPF had a significantly larger post-operative coracoclavicular distance (7.6mm vs 13.5mm, p &lt; 0.01), and a trend towards incomplete acromioclavicular joint reduction (50.0% vs 89.3%, p = 0.11). There was a significantly higher re-operation rate after HPF (100% vs 23.5%, p &lt; 0.01).

Conclusions
In our unit there is no favoured method of fixation of lateral clavicle fractures. When LPF is used, there should be consideration of concomitant CCLR. The high rate of re-operation after HPF must be considered.
405 Radiological Analysis of Gentamicin Eluting Synthetic Bone Graft Substitute Used in The Management of Gustilo IIIB Open Fractures
Authors: Aljawadi A , Madhi I , Naylor T , Elmajee M , Islam A , Niazi N , Pillai A 
Published: May 2021

Abstract

Background
Management of traumatic bone void associated with Gustilo IIIB open fractures is challenging. Gentamicin eluting synthetic bone graft substitute (Cerament-G) had been recently utilised for the management of patients with these injuries. This study aims to assess radiological signs of Cerament-G remodelling.

Method
Retrospective data analysis of all patients admitted to our unit with IIIB open fractures who had Cerament-G applied as avoid filler. Postoperative radiographic images of the fracture site at 6-weeks, 3-months, 6-months and at the last follow-up were reviewed. The radiological signs of Cerament-G integration, percent of void healing, and bone cortical thickness at the final follow-up were assessed.

Results
34 patients met our inclusion criteria, mean age: 42 years. Mean follow-up time was 20 months. 59% of patients had excellent (&gt;90%) void filling, 26.4% of patients had 50-90% void filling, and 14.6% had &lt; 50% void filling. Normal bone cortical thickness was restored on AP and Lateral views in 55.8% of patients. No residual Cerement-G was seen on X-rays at the final follow-up in any of the patients.

Conclusions
Our results showed successful integration of Cerament-G with excellent void filling and normal cortical thickness achieved in more than half of the patients.
418 The Management of Distal Radius Fractures in Adults with A Removable Soft Cast During the Peak Of The Covid-19 Pandemic: Patient Reported Outcomes And Experiences
Authors: Baawa-Ameyaw J , Kabariti R , Rhee J 
Published: May 2021

Abstract

Introduction
Immobilisation tools for non-operative management of distal radius fractures (DRFs) in adults, include plaster casts, orthotic splints, and recently removable soft cast as per the BOAST COVID-19 guidelines. Limited evidence exists on the effectiveness of removable soft casts in adults with DRFs. We assessed patient reported functional outcomes and experiences of adults with DRFs managed non-operatively in a removable soft cast during the COVID-19 pandemic.

Method
We retrospectively reviewed adults with DRFs, treated with a removable soft cast for 6 weeks between 9th April 2020 and 18th May 2020. Functional scores - Disabilities of the Arms, Shoulders and Hands (DASH) and a 7-question Patient Reported Experience Questionnaire (PREQ) were conducted at 6 weeks, along with a record of complications. A DASH score of &lt; 25 was deemed a satisfactory functional score.

Results
34 patients formed our cohort, with a 65% (22patients) completion rate, mean age of 69years. 82% had a DASH score &lt; 25 and 18% had a DASH score &gt; 25 at 6 weeks. 86% reported satisfactory comfort in the PREQ with 14% reporting discomfort. Two patients re-attended hospital with soft cast related problems.

Conclusions
Most adults with DRFs managed in a removable soft cast reported good early functional outcomes, satisfactory experiences, and no clinic visits at 6weeks.
440 Abdominal Heterotaxia: A More Nuanced Anatomy
Authors: Shaji V , Lander A 
Published: May 2021

Abstract

Introduction
The cardiac anomalies associated with left and right atrial appendage isomerism (LAAI and RAAI) are systematically described. However, for the associated abdominal abnormalities, only the laterality of the organs, cardinality of the spleen (asplenia or polysplenia) and the presence or absence of intestinal malrotation are noted. This study aimed to describe in greater detail the abdominal anatomy in abdominal heterotaxia.

Method
A detailed review of the imaging and clinical records of 23 patients (16 LAAI, 7 RAAI) with abdominal heterotaxia in a cardiac database was performed.

Results
In no patient was a complete description of abdominal anatomy possible, with all patients displaying unique anatomical presentations.
There was a significant association between isomerism and splenic cardinality (12/16 LAAI had polysplenia and 6/7 RAAI had asplenia, p = 0.02). Right-sided stomachs were more commonly associated with gastro-oesophageal reflux (p = 0.048). The stomach and pylorus were ipsilateral in 15/20 patients, with marked variation in gastric orientation; these were novel observations. Ladd’s procedures were performed in 15/23 patients but terminology for intestinal malrotation was inconsistently used.

Conclusions
The heterotaxic anatomy demands better descriptions for scholarly reasons, but these may lead to a better understanding of upper intestinal dysfunction and the subsequent management of these patients.
483 Complete Sciatic Nerve Transection from A Closed Femoral Fracture: A Case Report
Authors: Johnston E , McGarry K , Martin S , Lewis H 
Published: May 2021

Abstract

Introduction
Complete transection of the sciatic nerve following a closed femoral fracture is exceedingly uncommon. Delayed diagnosis may result due to this unrecognised injury pattern.

Case Description:
An 18-year-old male motorcyclist was referred following a significantly displaced closed, femoral fracture. The patient was sedated at the scene and transferred to theatre for definitive fixation, where an open reduction was performed via an anterior approach. Symptoms of paresthesia and weakness were reported immediately postoperatively, and formal neurological examination prompted an emergency MRI. On this basis, the patient was transferred to plastics and underwent surgical exploration, where complete transection of the sciatic nerve was identified just proximal to the bifurcation into the common peroneal and tibial nerve. A nerve gap of five centimetres was identified requiring reconstruction with grouped fascicular sural nerve grafts.

Discussion:
Complete transection of the sciatic nerve is a devastating injury that compromises the function of the posterior compartment of the thigh and all motor function below the knee. To our knowledge, reports of complete sciatic nerve transection secondary to a closed fracture of the femoral shaft are extremely rare in the pertinent literature, with only two other cases reported to date.