bluuebunny/crossref_metadata_2025_split huggingface dataset:
690 Orthopaedic Trauma Surgery: Has the COVID Pandemic Affected Surgical Outcomes?
Authors: Edwards T , Hristova K , Shiels S , Frostick R , Lostis E , Kumar N 
Published: October 2021

Abstract

Aim
To compare the surgical outcomes following orthopaedic trauma surgery before and during the COVID pandemic in an adult Major Trauma Centre.

Method
A retrospective chart review was conducted for all patients undergoing orthopaedic trauma surgery before (01/12/2019 to 29/02/2020) and during (01/03/2020 to 10/06/2020) the COVID pandemic. A Chi-square test was used to compare frequencies of type of anaesthetic used, postoperative ITU admission, any surgical complications and mortality. Data was collected 90 days after surgery.

Results
During the pre-COVID period, 501 patients (mean age at surgery 64y 4m; 222 male (44%)) underwent orthopaedic trauma surgery (395 lower limb (79%); 86 upper limb (17%); 28 pelvis (6%)) compared to 474 patients (mean age at surgery 61y 8m; 219 male (48%)) during the COVID period (388 lower limb (82%); 58 upper limb (12%); 23 pelvis (5%)). There was a significant increase in the use of a spinal as the main anaesthetic during the pandemic (9 (2%) vs 115 (24%), p &lt; 0.001) and fewer trauma patients were admitted to ITU postoperatively (42 (8%) vs 16 (3%), p0.001). There was no difference in the rate of postoperative complications (103 (21%) vs 95 (20%), p0.841) or mortality at 90 days (42 (8%) vs 43 (9%), p0.703). Of the 244 COVID swabs done during the COVID period, 8 (3%) were positive.

Conclusions
Despite widespread operational disruption and a change in anaesthetic practice, there was no change in the rate of postoperative complications or mortality following orthopaedic trauma surgery.
773 The Impact of Introducing an Enhanced Recovery Nurse Practitioner on Colorectal ERP Protocol Compliance and Surgical Outcome: A Single-Unit Experience
Authors: Teng W H , Mastoridis S , Shield E , Khanna A , Singh A 
Published: October 2021

Abstract

Introduction
The enhanced recovery programme (ERP) is a validated perioperative care plan that has consistently shown to reduce morbidity and improve patient outcomes. Our trust introduced ERP for major elective colorectal procedures in 2007. However, it had been noted that compliance to protocol was variable. This audit was conducted to see if introduction of an enhanced recovery nurse (ERN) improved compliance.

Method
This was a single-centre, retrospective, closed-loop audit; each cycle consists of resectional cases over a 1-year period. Perioperative data were collected from preoperative assessment documents, anaesthetic charts, operation notes and post-operative patient records. Compliance to 20elements of the agreed ERP protocol and length of stay (LOS) were assessed. First-cycle results were presented locally, leading to protocol revision and introduction of a dedicated ERN. Two years following ERN introduction, data were re-audited and compliance assessed. Statistical analyses were performed using Chi-squared test or independent t-test as appropriate.

Results
Among 101 procedures analysed in the first-cycle, compliance to ERP elements ranged between 30-95%. Following intervention, among 113 cases, compliance improved to 46-99%. Statistically significant improvements were observed in post-operative ERP elements. Compliance to early cessation of intravenous fluids increased from 44% to 61% (p = 0.02), and early urinary catheter removal increased two-fold, from 30% to 62% (p &lt; 0.01). Patients resumed light diet earlier and mobilised out of bed sooner. LOS improved from median of 7(1-48) to 6(2-50) days (p = 0.03).

Conclusions
This study demonstrates that the introduction of a dedicated ERN is associated with significantly improved protocol compliance and reduced LOS following major colorectal resection.
627 Trauma & Orthopaedic National Selection – What Is Really Going Through the Mind of Applicants?
Authors: Curtis A 
Published: October 2021

Abstract

Aim
Obtaining a training number in Trauma & Orthopaedics (T&O) remains highly competitive. This study aims to provide an insight into applicant’s perceptions and preparation for the T&O national selection interview.

Method
162 junior doctors applying to T&O national selection in 2021 were sent questionnaires using SurveyMonkey in December 2020. Applicants were identified from those attending the annual OrthoRevision ‘ST3 Core Knowledge Interview Course’. In total, 74 junior doctors (45.7%) covering all 16 surgical training regions in the UK completed feedback.

Results
There were wide variations in how much applicants would spend on preparation for the interview (e.g., books, revision websites, courses): 45.9% spend £100 - £500; 21.6% spend £500-£1,000; and 6.8% spend &gt;£1,000. Most start preparation 3 months prior to the interview (42.5%) with the preferred method being practice with colleagues (49.3%). Almost all candidates (80.2%) use the ‘OrthoInterview’ question bank. Free mock interview courses were only available to 27% with candidates strongly in favour (78%) of the study budget covering preparatory courses in addition to study leave being granted to attend these courses (86%). At the first attempt at obtaining a training number, 69.9% were selective about where they would accept a job; in subsequent years candidates would be more willing to accept a job in any deanery (40.3%).

Conclusions
For the first time, we present the perceptions of applicants to T&O national training in the UK. Many candidates dedicate a large amount of time and money to the process and are initially more selective about where they apply.
643 How the Straight Leg Raise and Crossed Straight Leg Raise Sign Influence Patient Reported Outcome Measures in Patients with a Lumbar Disc Herniation
Authors: Stanley A , Jones T , McCarthy M 
Published: October 2021

Abstract

Aim
Low back pain (LBP) with associated lumbar radiculopathy is common. Clinical assessment utilises the straight leg raise (SLR) test and the more specific crossed straight leg raise (XSLR) test. Patient reported outcome measure (PROMs) scores can assess the contributary biopsychosocial factors to pain. Evidence shows links between radiculopathy and psychosocial issues, but little has assessed them in relation to clinical examination. The aim of this study was to assess the significance of the SLR and XSLR sign on PROMs in patients with an MRI-confirmed lumbar disc herniation.

Method
Patients with an MRI-confirmed lumbar disc herniation who presented with LBP and lumbar radiculopathy were identified. Collected data included the clinical examination outcome, level and side of disc prolapse, interventions and PROMs scores (VAS, ODI, EQ5D, GAD7, PHQ9). Statistical analysis was performed using SPSS.

Results
216 patients were included in this study (mean age 50.4, 41% female, 59% male), 102 had negative straight leg raise (NSLR), 94 had positive SLR and 20 had both a positive SLR and positive XSLR. Patients with a positive clinical test on examination had ‘worse’ PROMs scores, with a positive XSLR sign associated with the ‘worst’ PROMs scores. For each PROM, t-test analysis reported a significant difference between the NSLR and SLR groups and NSLR and XSLR groups (P &lt; .01).

Conclusions
PROMs scores indicating a lower health-related quality-of-life, increased levels of disability, pain, anxiety and depression and greater expectations are associated with a positive SLR or XSLR test.
702 The Role of Scapular Morphology in Traumatic Rotator Cuff Tears and Greater Tuberosity Fractures: A Retrospective Study
Authors: de Stadler K , Musbahi O , Ibrahim E 
Published: October 2021

Abstract

Aim
Traumatic Rotator Cuff Tears(RCT) and Greater Tuberosity fractures(GT) are associated with high morbidity and reduced quality of life. Diagnostic and treatment pathways for both RCT and GT fractures are different. In this study we look at whether scapular morphology features can aid in our understanding of these traumatic injuries and influence patient pathways.

Method
A retrospective study was conducted at 2 hospitals. All patients between the period of 2010 and 2020 with Traumatic GT fractures or RCT were identified. Patients were case matched by age and laterality of injury. Primary outcome measurement was the Critical Shoulder Angle(CSA) and timing to further imaging. Statistical analysis was conducted using STATA™.

Results
Eighty patients met the inclusion criteria(40 traumatic RCT and 40 GT). Mean age was 61.8 years with 58(72.5%) left sided injuries. The difference between RCT and GT was 3.96 degrees(95% CI 2.5 to 5.41, p &lt; 0.05). An CSA of 33.73 gave a sensitivity of 0.68 and a specificity of 0.8 to differentiate between RCT and GT fractures. The Area under the Curve(AUC) was 0.8 indicating high reliability. The overall difference in presentation to further scan between the 2 groups was 78. 3 days( P &lt; 0.05, 95% CI 48.7 – 108).

Conclusions
Patients with a traumatic RCT and GT fractures have different scapular morphology and radiographic features which predisposes them to have these injuries. Patients presenting with a traumatic RCT are more likely to have a higher CSA and have a greater delay to further scan.
741 Restarting Elective Orthopaedic Surgery During The COVID-19 Pandemic: Experiences and Patient Outcomes
Authors: Laurent E , Saleh M , Vusirikala A , Castillo T , Kuzhupilly R , Fahmy A , Tsekes D 
Published: October 2021

Abstract

Aim
The COVID-19 pandemic resulted in postponing all non-urgent elective surgeries from April 2020. As we emerged from the first peak, restarting non-urgent services such as elective orthopaedic surgery was important for patients with chronic debilitating conditions. Our hospital successfully restarted orthopaedic surgery during the pandemic to help improve the quality of life of patients. This study describes the development of local protocols and pathways to allow for a safe restart of elective orthopaedic surgery in a COVID-19 free site. It presents the morbidity and mortality outcomes of those patients.

Method
This is a prospective cohort study evaluating all patients undergoing non-emergency orthopaedic procedures through a COVID-19 free pathway in a DGH from 18th May – 10th July 2020. 104 patients were identified, and their outcomes analysed during the 2 weeks following their surgery.

Results
No patients developed COVID-19 in the 2-weeks post-operative period. There were no ITU admissions or in-hospital deaths. 22(21.15%) out of 104 patients developed 23 complications within 2 weeks of surgery. These included: TIA, PE, AF, superficial wound infection, oozy wound and post-operative anaemia. They all made full recovery. There was no statistical difference in the development of complications for age (&lt; 70; &gt;70), gender, BMI, or ASA grades.

Conclusions
This study describes a roadmap to setting up a protocolised elective operating service for orthopaedic surgery. It has shown that standardised protocols in a COVID-19 free site, pre-operative COVID-19 testing and adherence to national guidelines on self-isolation prior to surgery can help prevent COVID-19 infection and its related risks post-operatively.
854 Mortality Associated with Conversion of Total Hip Arthroplasty for Failed Fixation/Hemiarthroplasty for Neck of Femur Fractures
Authors: Khan W , Baig A , Afzaal Q , Davison J , Hutchings S , Kulkarni A , Brown A , Ashford R 
Published: October 2021

Abstract

Aim
To identify the mortality associated with failed internal fixation and hemiarthroplasty of neck of femur fractures.

Method
Patients undergoing conversion of internal fixation / hemi arthroplasty were identified from theatre records and surgical databases. Data was stored in Microsoft Excel spreadsheet. Clinical outcomes at 30 days, 1 year and 5 years post conversion total hip replacement.

Results
60 cases were collected between June 2006 and November 2016. 46 females and 14 males involved in the case. The mean age of male patients was 66.5 and for females 67.9. 32 patients had previous sliding hip screw fixation,12 had intra-medullary nails, 8 had cannulated screw fixation and 5 patients had hemiarthroplasty. The mean time to failure was 22 months (Range: 2 weeks to 60 months) and there were 6 cases of late posttraumatic arthritis (range 4 yrs to 23 yrs). Average time from documented failure to conversion THR was 2 months. There were 2 superficial wound infections which were successfully treated with antibiotics. There were 2 cases of deep infection which required multiple debridement, washout, and prolonged inpatient stay. Average duration of hospital stay was 5.7days. 18 patients died before 5 years for reasons unrelated to their hip. All had a functional prosthesis at time of last review. 42 patients alive at 5 years had a functional prosthesis at last review

Conclusions
Total Hip Arthroplasty is a successful procedure for failed fixation / hemiarthroplasty despite the technical challenges. A 3–5-year mortality rate of 33.33 % reflects well against the NHFD 1year mortality of 30 %.
910 The Value of a Compressive Base Layer Bandaging in Post-Surgical Plaster Application: Reductions in Early Face-To-Face Times and Early Dressing Changes. Improved Patient and Plaster Technician Satisfaction
Authors: Tebby J , Ahmadi M , Gadd R , Van Breevoort C , Farndon M 
Published: October 2021

Abstract

Aim
Plaster immobilisation alongside wound compression after surgery is often required but not easy to balance. If a plaster is too loose then it may not produce sufficient wound compression but if the cast is too restrictive it may be uncomfortable and lead to complications. Our aim is to provide a technique that addresses these imbalances.

Method
Compressive base layer banding technique involves tightly wrapping the wound dressing with wool and crepe then applying a well-padded plaster on top. The technique was prospectively audited and compared to other practice within our centre. The aims were to show that the technique was safe and to look for potential benefits for patients and healthcare staff. Both groups included trauma and elective patients treated by a similar set of foot and ankle operations. We audited patients on their experiences, concerns and time spent having their cast changed.

Results
Primarily, the results showed that the technique was safe with no severe complications. The time for a plaster change reduced by a third, from 24 minutes (control group n = 28) to 16 minutes (intervention group n = 27). Dressing changes at the same time were reduced by 80%. The intervention group were happier with their casts, had lower levels of concerns regarding their attendance and their risk of infection.

Conclusions
Our audit has shown that the compressive bandaging technique is safe (non-inferior) compared to current practices at our hospital. The technique has the benefit of reducing the time patients spend being face-to-face during plaster change and reduces both their discomfort and concern.
965 Complication Rates in Operatively Managed Ankle Fracture/Dislocations - The Effect of Pre-Reduction Imaging and Compliance with BOAST 12 Guidance
Authors: Phoon K M , Ward A , O'Dowd D , Pitcher F , Amos L , Butler J , Brewer P , Davies M , Chadwick C , Davies H , Blundell C 
Published: October 2021

Abstract

Aim
The BOAST-12 guidelines for the management of ankle fractures aims to optimise functional recovery and reduce complications. They advise against having radiographs prior to urgent reduction of clinically deformed ankles as it could cause an unacceptable delay to subsequent management. Our study aimed to assess the effect of time to acceptable reduction on the risk of complications and time to definitive reduction.

Method
This was a retrospective observational study of patients with ankle fracture-dislocations between 2013 to 2017 at the Northern General Hospital’s Emergency Department (ED). Information collected from 2 patient groups (with and without pre-reduction radiographs), included patient demographics, time to accepted reduction, number of manipulations, operations, and subsequent complications.

Results
242 patients were identified. Time from arrival in ED to acceptable reduction was significantly longer in patients with pre-reduction radiographs versus patients without (184.5 vs 82 minutes, p &lt; 0.00), but did not increase the overall risk of complications (p = 0.62). Pre-reduction radiographs were associated with insignificantly higher rates of post-traumatic osteoarthritis (p = 0.17) and slightly longer wait time for definitive intervention (1 vs 2 days, p = 0.72). However, this had no relationship with the number of manipulations (p = 0.53).

Conclusions
The use of pre-reduction radiographs significantly increased time to acceptable reduction of ankle fracture-dislocations. However, this was not associated with increased risk of complications or time to definitive management.
1013 Dupuytren’s Contracture Treatment with XIAPEX Injection: Reviewing A Single Surgeon's Experience
Authors: Malik M , Fourie B 
Published: October 2021

Abstract

Aim
To review a single surgeon's experience for the treatment of Dupuytren's disease with XIAPEX injection and the clinical outcomes as measured by a URAM score.

Method
Retrospective review of patient notes, clinical photography and URAM scores for patients who underwent the procedure between August 2013 and October 2016.

Results
33 patients underwent the procedure. 25 patients completed pre and post URAM scores. Average pre procedure score was 19.4 and avergae post procedure score was 3.28 a difference of 16.12 (clinically important change for URAM score is 2.9). Average pre procedure MCPJ contracture was 46.67 degrees and average post procedure contracture was 3.3 degrees. Average pre procedure PIPJ contracture was 66.8 degrees and average post procedure contracture was 8.2 degrees. Where both MCPJ and PIPJ affected of the same digit average pre procedure MCPJ and PIPJ contracture was 60 degrees. The post procedure contracture was 0 degrees in the MCPJ and 29.7 degrees in the PIPJ. 1 patient underwent surgery for progressive disease.

Conclusions
XIAPEX injection has shown a clinically significant result in the treatment of Dupuytren's disease. There were minimal complications and only 1 patient needed further surgery. However, a small sample size thus conclusions have to be cautious.
1036 Operative Versus Non-Operative Management of Osteoporotic Femoral Fractures
Authors: Lenihan J , Waseem S , Rawal J , Hull P , Carrothers A , Chou D 
Published: October 2021

Abstract

Background
he incidence of diaphyseal and distal osteoporotic femoral fractures (OFFs) is increasing. This cohort of patients is often frail with multiple medical co-morbidities. No published data exists neither reporting severity of pain associated with these fractures nor pain in managing their fractures. There are no comparative studies investigating outcomes between conservative (CM) and surgical management (SM). We investigated pain and outcomes between CM and SM OFFs.

Method
We retrospectively analysed all OFFs admitted to our unit between 2018-2019. We analysed electronic patient records including patient-reported pain scores (PRPS). PRPS were calculated for set time periods: admission; 0-24hours CM versus day 1 post-operative; day 2-3; day 4-5. Primary outcome measure was PRPS. Secondary outcome measures included use of traction; PCA use; weightbearing status; length of stay (LOS); 30 day and 1 year mortality. Data was statistically analysed using SPSS software.

Results
22 patients were recruited (11CM, 11SM). There was no statistical difference between groups in terms of age; sex; cognition; Charlson Index; nor pre-morbid mobility status. There was no statistical difference for pain at admission nor PCA use. SM were less painful in the first 24-hour period postoperatively and in the first 3-day postoperative period compared to the same time period in CM. There was no difference in PRPS for the 72–120-hour period. There was no statistical difference between LOS; NWB status; 30 day nor 1 year mortality.

Conclusions
Operating on OFFs reduces pain in the perioperative period without increasing mortality or LOS in this frail population.
1049 Outcomes After Proximal Femoral Replacements in Metastatic Femoral Disease. A Systematic Review and Meta-Analysis
Authors: Gardner A 
Published: October 2021

Abstract

Aim
The aim of the study was to assess outcomes after a proximal femoral replacement (PFR). More PFRs are being performed in accordance with the British Orthopaedic Oncology Society (BOOS) best practice guidance 2016. The population studied was patients with metastatic proximal femoral disease with actual or impending fractures. The intervention and comparator were PFR and intra-medullary nailing (IMN) respectively. The primary outcome was hospital readmission rate (all cause). Secondary outcomes were reoperation rate (all cause, infection) and dislocation rate.

Method
A literature search was performed in Medline, Embase, Web of Science and the Cochrane Library. The search strategy combined free and MeSH search terms related to population (e.g., “femoral neoplasms” OR “pathological femoral fracture”), intervention and comparator (e.g., “osteosynthesis” “surgery” OR “proximal femoral replacement ”). To pool the outcome data of the studies Freeman–Tukey double arcsine transformation was used. Readmission rates were generated based on complications requiring absolute hospital admission.

Results
After exclusions, the search provided 12 studies. The pooled rate of hospital readmission (all cause) was 0.08 (95% CI 0.04 - 0.12) (Figure 2). The pooled rate of reoperation (all cause), reoperation for infection and dislocation rate was 0.05 (95% CI 0.03 – 0.08), 0.01 (95% CI 0.00 – 0.04) and 0.02 (95% CI 0.00 – 0.05) respectively.

Conclusions
Following a PFR for proximal metastatic femoral disease, patients have low rates of hospital readmission and reoperation. Compared to IMN, reoperations are performed for deep infection and dislocations. The major complication with IMNs of metalwork fatigue and failure is overcome with the use of PFRs.
1071 SUFE and the Internet: Are Healthcare Information Websites Accessible to Parents?
Authors: Mc Carthy A , Taylor C 
Published: October 2021

Abstract

Background
Slipped upper femoral epiphysis(SUFE) is an adolescent hip disorder requiring rapid surgical intervention. Faced with the prospect of their child undergoing surgery, many fearful parents will turn to the internet to provide information and reassurance. Previous studies have shown the orthopaedic information can be difficult to comprehend.

Objective
Assess the readability of healthcare websites regarding SUFE.

Method
The term Slipped Upper Femoral Epiphysis was searched in Google, Bing and Yahoo and evaluated using readability software with seven specialised readability tests. A Flesich Read Ease Score (FRES) score above 65 and a Reading Grade Level (RGL) of sixth grade and under was considered acceptable.

Results
21 unique websites were assessed. The average FRES was 52.5 +/- 15.4. Only 3 websites scored 65 or higher (14%). There was a statistically significant difference between website scores based on affiliation, with physician websites having the overall highest mean(P = 0.004). The average RGL was 8.67 +/- 1.8. Only two websites met the accepted RGL criteria (9.5%) while five websites were marked as extremely difficult to understand (23.8%). Only five websites offered translations (23.8%). There was no statistically significant difference in readability scores between websites which offered translation and those which did not. One-way t-tests showed that both the RGL (p &lt; 0.001; CI: 1.83-3.49) and the FRES (P &lt; 0.001, CI: -19.4 to -5.4) scores were significantly different from the accepted standard.

Conclusions
Most websites reviewed were deemed inaccessible. Improving readability would enhance the internet’s usability as a healthcare tool for parents.