bluuebunny/crossref_metadata_2025_split huggingface dataset:
1085 Equestrian Related Pelvic and Acetabular Fractures – Experience from a Major Trauma Centre in England
Authors: Hussain A , Ghobrial M , Davies B , Hull P , Carrothers A , Rawal J , Chou D 
Published: October 2021

Abstract

Introduction
Equestrianism is enjoyed by three million people in the UK; however, there is a lack of literature on pelvic and acetabular (P&A) injuries incurred through the sport. We aim to describe P&A injuries sustained in equestrian accidents, discuss management, and establish their outcomes.

Method
Data was extracted from a prospectively collected database of referrals to the P&A Service of a Major Trauma Centre (MTC) from 01/01/2016 to 31/12/2020 and cross-referenced with medical records.

Results
60 of the 1,218 P&A referrals were secondary to horse-riding accidents. Mean age 45 (SD 16.59); 46 female; 33 managed non-operatively and 27 managed operatively at the MTC. There was sufficient information for 59 cases to be classified; 46 of the injuries were pelvic fractures (10 anterior-posterior compression; 29 lateral compression; 4 sacral and 3 pubic rami fractures) and 13 were acetabular (2 anterior column; 1 anterior wall; 2 associated both columns; 1 posterior column and posterior wall; 1 posterior wall; 2 T-shaped and 4 transverse fractures). The operative group were managed by examination under anaesthesia (n = 3), open reduction internal fixation (n = 22) or percutaneous fixation (n = 2). Mean hospitalisation was 9.2 days (SD 5.44). 81% were non-weight-bearing post-operatively and mean time to independent mobilisation was 12.6 weeks (SD 7.09). Return-to-riding information was available for 8 patients with a mean of 29.5 weeks (SD 11.55).

Conclusions
Equestrianism can result in significant P&A injuries. Patients should be counselled that they may have a long recovery, a protracted return-to-riding time and some may never return to the sport.
1128 Fracture Neck of Femur Patients in The Age of Covid-19
Authors: Karagiannidis G , Toma O 
Published: October 2021

Abstract

Aim
The current climate of the COVID19 pandemic has forced various changes in the function of Trauma & Orthopaedic department and the management of fracture neck of femur (NOF) patients.We aim to assess the effect of reduced theatre capacity and delayed time to operative management due to the COVID19 outbreak on the 30-day mortality rate of fracture neck of femur (NOF) patients admitted to our trust.

Method
Retrospective data collection for all patients admitted to a single centre with NOF fractures since lockdown came into effect in England on March 23rd up to July 31st 2020 and the same time frame in 2019.

Results
During that period 129 patients were admitted with NOF fracture and of those 110 (85%) had outdoor injury and 19 (15%) were care home residents. The mean Length of Stay (LOS) was 8 days. In 2019, 121 patients were admitted, of whom 87 (72%) had outdoor injury and 34 (28%) were care home residents and the mean LOS was 22 days. In 2019 84% of patients went into theatre before 36 hours post-injury while only 70% in 2020. In 2020 8 patients treated conservatively while only 1 patient received conservative management in 2019.In total, during the COVID19 period there were 14 (11%) inpatient deaths, while only 2 (2%) inpatients deaths in 2019. The 30-day mortality rate was similar in both periods.

Conclusions
Due to COVID19 we noted a significant decrease in length of stay and increase in the conservative management of NOF fractures and inpatient deaths compared to 2019.
1170 Outcome of Various Fixation Techniques for Talo-Navicular Arthrodesis
Authors: Khattak M , Sharoff L , Thomas-Fernandez K , Rahman N 
Published: October 2021

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

Conclusions
Concurrent infection of COVID -19 in patients with NOF fractures increases the 30-day mortality 6 times compared to the negative group. Efforts should be made to optimise time to surgery as well as postoperative care via higher dependency units. Updates in mortality predicting scores is deemed necessary to include the SARS-CoV-2 infection as a factor.