bluuebunny/crossref_metadata_2025_split huggingface dataset:
1419 Targeted Use of Physiotherapy Resources in The COVID Era: How Does Face to Face Physiotherapy Compare with Simple Advice Sheets After Manipulation Under Anaesthetic for Frozen Shoulder?
Authors: Castelhano R , Woods J , Akehurst H , Mitra A , James M , Tasker A , Woods D 
Published: October 2021

Abstract

Introduction
This study compares two pathways for patients undergoing MUA for FS, one where physiotherapy advice is only given to the patient (Group 1), and the other where supervised hydrotherapy and physiotherapy occur post operatively (Group 2).

Method
A descriptive analysis of pre- and post-operative Oxford Shoulder Scores and change scores were performed. Analysis of covariance (ANCOVA) was used to measure the effect of physiotherapy on post-operative OSS, with pre-operative OSS as the only covariate.

Results
The results for post-operative OSS were significantly greater for Group 2 than for Group 1 (40.7 for NHS and 44.7 for private, improvement of 17.32 for NHS and 18.23 for Private). The effect of physiotherapy was significant (p &lt; 0.001). The estimated effect of physiotherapy on postoperative OSS was an increase of 3.2 (95% confidence interval 1.5 – 4.8).

Conclusions
We detected a statistically significant increase in post-operative OSS in patients treated for frozen shoulder with MUA + physiotherapy compared with patients receiving MUA plus advice alone. These results suggest that physiotherapy does confer a real benefit, however the increased OSS is below the clinically significant level. Therefore, in a resource poor environment, such as may exist during and after COVID in many health care systems, MUA plus physio advice alone gives an excellent outcome for the treatment of FS.
1450 Relationship between Spinopelvic Parameters and Symptomatic Femoroacetabular Impingment: A Scoping Review
Authors: Khokher Z , Rai A , Karoda Y , Saito M , Kumar K H S , Khanduja V 
Published: October 2021

Abstract

Aim
Reports have shown that spinopelvic mobility influences the outcome following total hip arthroplasty. The aim of this scoping review was to investigate the relationship between spinopelvic parameters (SPP) and symptomatic femoroacetabluar impingement (FAI).

Method
A systematic computer search of EMBASE, PubMed and Cochrane for literature related to SPPs and FAI was undertaken as per PRISMA guidelines. Clinical outcome studies and prospective/retrospective studies that investigated the role of SPPs in symptomatic FAI were included. Review articles, case reports and book chapters were excluded. Information extracted pertained to symptomatic cam deformities, pelvic tilt, deviations in acetabular version, decreases in pain-free hip range of motion (ROM) on dynamic hip movements and radiological signs of FAI.

Results
The literature search identified 46 papers out of 1168 investigating the link between SPPs and pathological processes characteristic of FAI. Anteior pelvic tilt was associated with radiographic over-coverage parameters of FAI. Three studies associated FAI pathology with a greater pelvic incidence (PI), while four associated it with a smaller PI. In dynamic movements, decreased posterior pelvic tilt and reduced saggital pelvic ROM was found in symptomatic FAI patients during hip flexion.

Conclusions
Our study shows that spinopelvic parameters can influence radiological and clinical manifestations of FAI, with pelvic incidence, acetabular version and muscular imbalances being aetiologically implicated. Individual spinopelvic mobility may predispose to the development of FAI, which may be amenable to non-surgical management. If FAI pathoanatomy already exists however, sagittal pelvic parameters can influence whether FAI symptoms develop, and the extent to which they do so.
1484 Tranexamic Acid Use to Decrease Blood Loss in Primary Shoulder and Elbow Replacement: A Systematic Review and Meta-Analysis
Authors: Varma J , Donovan R , Whitehouse M , Kunutsor S , Blom A 
Published: October 2021

Abstract
Tranexamic acid (TXA) is an inexpensive, commonly used antifibrinolytic agent that has been shown to significantly reduce perioperative blood loss and transfusion requirements after total hip and knee replacement. We conducted a systematic review and meta-analysis to synthesise the latest evidence regarding the effects of TXA on blood loss in total shoulder replacement (TSR) and total elbow replacement (TER).
We systematically searched MEDLINE, EMBASE and CENTRAL from inception to 03 September 2020 for randomised controlled trial (RCTs) and observational studies. Our primary outcome was blood loss, and secondary outcomes included the need for blood transfusion and venous thromboembolic (VTE) complications.
Four RCTs and five retrospective cohort studies (RCS) met eligibility criteria for TSRs, but none for TERs. RCT data determined that TXA administration significantly decreased estimated total blood loss, postoperative blood loss, change in haemoglobin (Hb) and total Hb loss when compared to placebo. RCS data demonstrated significant association between TXA administration and decreased in postoperative blood loss, change in Hb, change in Hct and length of stay.
This meta-analysis demonstrates that TXA administration in primary TSR significantly decreases blood loss compared with placebo and is associated with lower blood loss and shorter length of stay compared with no treatment with no increase in VTE complications. TXA administration should be part of a wider blood management strategy to minimise perioperative blood loss and blood transfusion requirements in patients undergoing TSR. Further research is needed to demonstrate if a similar treatment benefit exists in patients undergoing TER.
1499 The Statistical Value of Different Clinical Characteristics in Evaluation of Suspected Cauda Equina Syndrome
Authors: Levitt W , Kamalakannan B , Leung Y 
Published: October 2021

Abstract

Introduction
Cauda Equina Syndrome(CES) is a potentially disabling condition caused by compression of the thecal sac in the lumbar spine. Traditional teaching suggests red flags include back pain, sciatica, saddle anaesthesia and bladder disturbance. Current guidelines from the British Association of Spinal Surgeons recommend prompt investigation with MRI should these symptoms be present.

Method
A retrospective electronic case note review was undertaken from a one-year period to identify patients referred to the on call orthopaedic team with suspected CES and were investigated with MRI. Notes were reviewed for the presence of each clinical characteristic and correlated with MRI findings.

Results
334 referrals underwent urgent MRI with 25 scans showing CES. Poor statistical association was observed with unilateral leg pain (sensitivity 0.28, specificity 0.48), back pain (sensitivity 0.92, specificity 0.13) and bladder dysfunction (sensitivity 0.72, specificity 0.36). Much closer statistical association was seen with bilateral leg pain (sensitivity 0.6, specificity 0.7, OR 5.03, 95% CI 2.16-11.68, p0.0002), leg weakness (sensitivity 0.68, specificity of 0.72, OR 5.35, 95% CI 2.23-12.85, p0.0002), leg sensory deficit (sensitivity 0.72, specificity 0.60, OR 3.79, 95% CI 1.54-9.36, p0.004) and altered perianal sensation (sensitivity 0.6, specificity 0.67, OR 3.03, 95% CI 1.31-6.99, p 0.009)

Conclusions
The diagnostic accuracy for some conventional red flag characteristics in CES is low. In our series back pain, unilateral sciatica and bladder disturbance showed low predictive value while bilateral sciatica, saddle anesthesia and lower limb sensorimotor deficits showed closer association and therefore should be closely evaluated for when reviewing such patients.
1514 Higher Mortality in Pelvic Acetabular Fractures Is Associated with Lower Body Mass Index
Authors: Waseem S , Lenihan J , Davies B , Rawal J , Hull P , Carrothers A , Chou D 
Published: October 2021

Abstract

Aim
Fractures of the pelvis and acetabulum can be life-threatening or life changing injuries. Multiple factors can contribute to outcome including age, frailty, and baseline nutritional status. The aim of this study was to identify if low BMI (&lt;18.5) was a predictor of outcome for patients with such injuries in terms of morbidity and mortality.

Method
We retrospectively analysed 1033 patients with pelvic or acetabular fractures referred to a single level 1 major trauma centre over a 4.5-year period (August 2015 - January 2020). Of these patients, 569 were admitted to the centre and included in our analysis. Data was collected on demographics, injury pattern, operative intervention, and complications. Comparison was made between patients that were underweight (BMI&lt;18.5) and patients that were not, for in-hospital and post discharge complications including pulmonary embolus (PE), deep venous thrombosis (DVT), ileus, infection, loss of reduction and mortality at 6 months.

Results
Underweight patients had a statistically significant increase in mortality both in-hospital (p = 0.019) and at 6 months post injury (p = 0.039) when compared to other BMI groups. No statistical significance was found between these BMI groups comparing morbidity: DVT (p = 0.712), PE (p = 0.736) nor ileus (p = 0.149). Covariate analysis showed that a low BMI was associated with 3 times increased in-hospital mortality after correction for age and energy of injury (adjusted OR 3.028, 95% CI 1.059-8.659).

Conclusions
This study suggests increased mortality in patients with pelvic or acetabular fractures who are underweight. Surgeons should consider these findings in initiating appropriate peri-operative optimisation for these patients.
1518 The Use of OrthoPathway, Decision Support Software, To Reduce Variation in Practice, Optimise Patient Care and Reduce Face-To-Face Appointments in Trauma and Orthopaedics
Authors: Jones M , Griffiths-Jones W 
Published: October 2021

Abstract

Introduction
Musculoskeletal problems account for 3.5million Emergency Department attendances annually. Front-line staff are under pressure, faced with complex decisions with limited supportive tools. Without adequate support there is greater variation in practice, poor patient outcomes, longer Emergency Department stays and unnecessary follow-up. OrthoPathway is a web application that enables the production of editable decision support pathways. We have published over 50 Consultant designed, locally approved, interactive pathways. Patient-facing staff can use these to follow national guidelines, by answering questions to establish appropriate treatments.

Method
New and follow-up fracture clinic patients were audited over a one-week period. Clinic letters and clerking documents were analysed to identify the diagnosis and management plan. From information and radiographs available OrthoPathway was used to generate a management plan, used as the audit standard.

Results
78 new patients and 83 follow-up patients were seen in fracture clinic over a one-week period. Clinical pathways were available on OrthoPathway for 42% of new patients and 40% of follow-up patients. Variation in practice was seen in 42% of new patients and 59% of follow-up patients. The associated saving in appointments was 11 and 21 and in the new and follow-up patients, respectively.

Conclusions
We have shown that OrthoPathway has the potential to reduce face-to-face appointments by 20%, with its current utilisation. Through the deployment of a full set of pathways we anticipated a reduction of greater than 40%, which is particularly pertinent given the current COVID-19 pandemic. This highlights the benefits of Consultant approved decision support pathways published on OrthoPathway.
1533 The Effect of Hip Fracture Anatomy and The Modality of Surgery on Red Blood Cell Transfusion and Mortality: A Retrospective Analysis
Authors: Greenhalgh M , Gowers B , Iyengar K , Adam R 
Published: October 2021

Abstract

Introduction
Hip fractures are common, with most requiring surgical management. Blood loss occurs from the fracture and intraoperatively. Often, blood transfusions are required. Hip fractures can be classified by their anatomy: intracapsular, intertrochanteric or subtrochanteric fractures. This study assesses the effect of fracture pattern and operation performed on transfusion rates within our centre. We aim to identify the patients most likely to require transfusion early, to improve outcomes.

Method
A retrospective cohort study of 324 consecutive hip fracture patients presenting to a district general hospital over one year. Data was collected from electronic patient records, the local transfusion laboratory, and the national hip fracture database.

Results
324 hip fractures were divided into 188 (58%) intracapsular, 121 (37%) intertrochanteric and 15 (5%) subtrochanteric fractures. The most common operation performed was hemiarthroplasty (128), followed by dynamic hip screw fixation (75). 75 (23%) of all patients received a blood transfusion. 28 (15%) of intracapsular, 42 (35%) of intertrochanteric and 5 (33%) of subtrochanteric fractures received transfusions. 47% of long intramedullary nails, 45% of short intramedullary nails, 29% of dynamic hip screws, 18% of hemiarthroplasties and 9% of total hip arthroplasties resulted in blood transfusions. One-year mortality in the transfused cohort was 52% and 30.5% in non-transfused.

Conclusions
Almost a quarter of hip fracture patients received a blood transfusion, which was associated with an increased risk of mortality. Intertrochanteric fractures most commonly led to a transfusion. The operation most associated with transfusions were long intramedullary nailings, and total hip arthroplasties were the least.
1550 Experience from A Level-1 Major Trauma Centre in England of Trauma Epidemiology After Easing of Lockdown Restrictions
Authors: Waseem S , Romann R , Lenihan J , Rawal J , Carrothers A , Hull P , Chou D 
Published: October 2021

Abstract

Aim
The COVID-19 pandemic transformed trauma care. We examined the effect of lockdown easing on trauma presentation and management.

Method
Data was retrospectively analysed from Trauma Audit and Research Network (TARN) on patients presenting to one Major Trauma Centre in the East of England with trauma. The first 47 days of lockdown (23rd March-9th May 2020, period 1) were compared with the next (10th May- 26th June 2020, period 2) and last 47 (27th June- 13th August 2020, period 3). Data collected included demographics, mechanism and severity of injury, management, and length of stay.

Results
1,249 patients were included; 62.2% were male with a mean age of 57.73. Footfall declined in April 2020 compared with 2019 (56 vs 143) but rebounded by May (123 v 120 patients). Road traffic collisions increased over periods 1-3 (18.8% v 23% v 30.1%, p = 0.038); deliberate self-harm (DSH) increased in period 2 compared with 1 and 3 (6.3% v 3.4% v 1.4%, p = 0.03) respectively. The 2020 patient age was younger than 2019, with less trauma relating to alcohol (7.3% v 13.2%, p = 0.009). Compared with 2019 reductions in total length of stay (14.1 v 17.4 days, p = &lt;0.001), critical care length of stay (2.3 v 2.9 days, p = 0.04) and consultant driven care (54.9% v 64.9%, p &lt; 0.001) were noted in lockdown.

Conclusions
Our study suggests that after lockdown easing, trauma footfall rapidly rebounded to 2019 levels. This should be acknowledged in resource allocation decisions if future lockdowns are necessitated.
1567 Investigating the Effect Of COVID-19 On Internet Searches for Hip, Knee and Shoulder Pain in the UK
Authors: Williams C Y K , Townson A T , Pace A 
Published: October 2021

Abstract

Aim
In response to the COVID-19 pandemic, all non-urgent surgery was suspended, with orthopaedic surgery among the worst affected. We conducted an infodemiological study to explore changes in internet searches for joint pain at a population level since the start of the pandemic.

Method
Bayesian structural time-series methods were employed to evaluate the impact of cancelled orthopaedic operations on Google search interest in Knee, Hip and Shoulder pain in the UK. Data were extracted from Google Trends from January 2016-2021. The bsts package was used to construct counterfactual time series, incorporating local linear trend and yearly seasonal components. Causal effects were determined using the CausalImpact package, with 95% CIs and posterior probabilities calculated. 17 March 2020 was used for pre-/post-period cut-off as non-urgent surgery was suspended on this date. P value &lt; 0.05 was significant. R version 4.0.3 was used for analyses.

Results
Knee pain was the most popular search term, followed by Shoulder pain then Hip pain. The onset of the COVID-19 pandemic was associated with a significant increase in searches for Knee pain (Relative effect [95% CI] = 14% [-0.85%, 29%], p = 0.031). However, there was no significant effect on searches for Hip pain (Relative effect [95% CI] = -1.3% [-15%, 12%], p = 0.427) or Shoulder pain (Relative change [95% CI] = 6.5% [-7.9%, 21%], p = 0.195).

Conclusions
Our findings suggest a greater impact of COVID-19 on the prevalence of knee pain, compared to hip/shoulder pain. This has implications for planning future orthopaedic surgery delivery and deciding on the priority order for rescheduled operations.
1671 The Effect Of COVID-19 On the Management and Outcome of Neck of Femur Fractures in A District General Hospital - A Comparative Study
Authors: Linardatou Novak P , Davies B , Bacon A , MacDowell A 
Published: October 2021

Abstract

Aim
We wanted to see how the virus has impacted the management and outcome of our neck of femur fracture patients during Spring 2020.

Method
We performed a retrospective study of all neck of femur fracture patients presenting to our hospital from 23rd March 2020 (start of official lockdown in UK) until the end of May 2020 and compared them to patients presenting in the same time period in 2019. We recorded patient demographics, COVID-19 swab results, time to surgery, length of stay, transfers between wards, and 30-day mortality rates.

Results
We identified 75 patients in 2020 compared to 88 in 2019. Average length of stay was 11.4 days compared to 14.3 a year earlier. Mean time to surgery was 32.3 hours compared to 31.6 in 2019. The 30-day mortality increased significantly from 5.7% (5/88) in 2019 to 16% (12/75) in 2020 (p &lt; 0.05) From 73 patients tested for COVID-19, 3 had a positive swab. Of these, 2 died. During their admission, 14 patients were transferred to 3 or more wards; in this group, 30-day mortality was 42.9% (6/14).

Conclusions
There has been a significant increase in 30-day mortality during COVID-19. Despite maintaining our time to surgery and reducing overall length of stay, we saw an increase in mortality, associated with multiple ward transfers rather than a high number of COVID-19 positive swab cases. Changes in pathways and wards configurations led to some patients requiring multiple transfers. This can cause difficulties in coordinated, multidisciplinary care for patients with NOF Fractures.
66 Significance of Percutaneous Biopsy in the Clinical Management of Renal Masses
Authors: Cheah W , Marques S D B , Bhuvanagiri A , Kailasa A , Thangavelu M , Alexandrou K , Kannan S 
Published: October 2021

Abstract

Aim
Percutaneous renal mass biopsy is increasingly used in the management of renal masses. The objective of our study was to determine the significance of percutaneous renal mass biopsy and its impact on clinical management.

Method
Retrospective study of all patients who had image guided percutaneous renal mass biopsy health-board wide from April 2011 to April 2019. Renal mass biopsies were performed for either a localised or metastatic renal mass. Results of the renal biopsies were compared to final diagnosis to determine diagnostic accuracy measured by sensitivity, specificity, negative predictive value and positive predictive value.

Results
Out of 429 patients who had a renal biopsy, 91 patients- 55 males (61%) and 36 females (39%) were included in the final analysis. The mean age of the study population was 66 years (range 46-87). Renal mass biopsies were performed using coaxial 18-gauge core needle technique. We categorised patients into two groups (metastatic renal masses and localised renal mass). Sixty-eight patients had biopsies for metastatic disease and 23 patients had biopsies for a localised renal mass. In the localised disease group, the sensitivity was 100%, positive predictive value was 82% (95% CI, 48.2-97.7%) and the negative predictive value was 100% (95% CI, 66.4-100%) (Clopper Pearson Method). For patients with metastatic renal mass the positive predictive value was 83%.

Conclusions
Percutaneous renal mass biopsy may have a role for metastatic renal cancers that require targeted therapy and localised masses that require curative treatment.
116 An Assessment of Current Practice for Suspected Paediatric Testicular Torsion
Authors: Gibb J , Babawale O , Hodgson D , Harrison R 
Published: October 2021

Abstract

Aim
British Paediatric surgery guidelines (2019) state ‘immediate surgery should be performed if testicular torsion is suspected’. However, imaging ‘may be considered for a small number of children under the guidance of a senior clinician in late presenters or in those with atypical features. This study reviewed current practice in our hospital.

Method
Boys aged 16 and under in 2017-2019 who underwent scrotal exploration for suspected testicular torsion were reviewed. Outcomes assessed were number having ultrasound prior to theatre, pathological findings, number who had an orchidectomy, and post-op complications. Additionally, all testicular ultrasounds in those aged under 16 were screened to establish how many were requested for possible or missed torsion.

Results
46 patients underwent surgical exploration of which 18 had a confirmed torsion. Six patients had imaging prior to surgery, of which five suggested torsions and four of these were confirmed in theatre. 202 boys under 16 had a testicular ultrasound; 26 of these were for late presentation or those with atypical features of torsion. Three underwent scrotal exploration two of whom had reports suggestive of torsion which was confirmed on exploration.

Conclusions
Most testicular torsions occur around the age of puberty with no torsion identified in patients under 10. Ultrasound is a useful tool for identification of vascularity or alternative pathology in late or atypical presentations of torsion; but does not replace clinical judgement. Imaging may have prevented unnecessary exploration in 23 cases, although negative imaging did not always preclude exploration.
878 Optimizing Follow Up for Melanoma Patients: Are We Meeting NICE Guidance?
Authors: Labib A , Massardi C , Salfity L , Powell B 
Published: October 2021

Abstract

Introduction
St. George’s University Hospitals NHS Foundation Trust is a designated tertiary referral Centre for all skin cancers serving a population of 3.5 million in and around South West London. It has an international reputation for its management of melanoma cases. All melanoma patients need frequent follow up visits for a long period of time which may extend to more than 10 years. Many aspects should be included when following up these patients including clinical assessment, laboratory, and radiological evaluation.

Aim
The aim of this project is to assess the quality of laboratory follow up of melanoma patients focusing on optimizing vitamin D level.

Method
We performed a retrospective review of cutaneous melanoma patients in 2019. Laboratory standards for follow up of vitamin D level was identified from NICE guidance 2015. After introduction of a condensed guide, a second review was performed in 2020.

Results
In the first cycle, 63 patients were included. Only 47% of them had their Vitamin D levels checked at time of diagnosis. Follow up check for vitamin D level was only done in 36%. Following introduction of guidance, 36 patients have been included. Significant improvement in both parameters with rate of 65% and 96% respectively.

Conclusions
Although we managed to improve our adherence to NICE guidance, more effort is still needed to improve all patients' care. We are willing to conduct a qualitative survey asking staff to explore their obstacles.