bluuebunny/crossref_metadata_2025_split huggingface dataset:
1064 Extra-Articular Tibial Deformity Management in Total Knee Replacement
Authors: Choi S M , Kumar R , Morgan-Jones R , Agarwal S 
Published: October 2021

Abstract

Aim
In knee replacements, restoration of mechanical alignment is essential. Patients with extra-articular deformities (EAD) pose challenges in planning knee replacements. We present a method, based on our experience and review of literature on planning knee replacement surgery, in the presence of extra-articular coronal plane deformity of the tibia.

Method
Retrospective analysis was made of six patients with EAD of the tibia who underwent knee replacement at our centre. Mechanical axis of the tibia is considered and positioning of the tibia component is planned perpendicular to the mechanical axis of the tibia. The integrity of the collaterals determines the need for correction. Tibial resection &gt;15mm from medial or lateral aspect of the tibia is an indication for corrective osteotomy prior to replacement surgery. The hip knee ankle angle (HKA) was noted. Pre-operative, post-operative clinical score, degree of constraints and post-operative complications were recorded. A post-operative long leg alignment radiograph was obtained.

Result
All patients had total knee replacement without correction of deformity. Adequate alignment of the limb and restoration of mechanical axis was achieved in all six patients without the need for correction of tibial deformity. All patients had improvement in their HKA angle and Oxford knee score. No re-operations were required, and no complications recorded.

Conclusions
Our study will help provide guidance on operative planning and decisions making for patients with extra-articular coronal plane tibial deformities.
829 Perioperative Surgical Patients and The Availability and Utilisation Of ECGs Machines Pre- And Post-Pandemic
Authors: Wareing J , Sandhar H , Howitt A , Yiasemidou M , Craske D 
Published: October 2021

Abstract

Introduction
ECGs are a NICE recommended pre-operative investigation and an integral part of post-operative monitoring. Delay in recognition of cardiac pathology can be catastrophic. Therefore, ECG machines should be readily available. Here, we report the results of an audit assessing the availability of ECG machines in surgical wards.

Method
In 2018 and then 2020, a bespoke, nine-item audit proforma was disseminated to all foundation doctors.

Results
In 2018, 17/32 wards had a ward based, readily available machine, 6/32 shared with another ward and 15/32 did not have a ward-based machine. The same was noted in 2020. In 2018 and 2020, the average time to obtain an ECG machine was 27 and 23 respectively. When no ECG was available, a doctor would obtain the machine 24% in 2018 compare to 52% in 2020. The diagnoses of the patients who had ECGs in 2018 were: normal sinus rhythm, atrial fibrillation, bradycardia, supraventricular tachycardia, sinus tachycardia and STEMI. In 2020 were: normal sinus rhythm, atrial fibrillation, supraventricular tachycardia, sinus tachycardia, atrial flutter, bradycardia, prolonged QTc, hyperkalaemia, STEMI and NSTEMI. The average time for NSTEMI patients to have an ECG was 35mins while for STEMI patients was 11.6mins.

Conclusions
Whilst our audit has highlighted the importance of ECG machine availability, the time to obtain one remained static between the two cycles. A study investigating the impact on patient outcomes may highlight the necessity for available ECG machines further.
1224 Effect of Distal Brachioradialis Release During Open Reduction and Internal Fixation of Distal Radius Fractures
Authors: Hafez A , Shaat A , Zain M , Sajid M A , Butt A 
Published: October 2021

Abstract

Aim
The study aim is to determine the impact of the brachioradialis release during the open reduction and internal fixation of distal radius fractures using a volar approach

Method
Total of 40 patients was treated with Open reduction and internal fixation of intra articular distal radius fractures. Distal release of Brachioradialis was performed to 19 patients, while 21 patients had no release of BR during surgery. Radiological parameters including Radial height, Inclination and volar tilt were measured 1 month post-operatively, while functional outcomes assessed with modified mayo wrist scores and Quick-dash scores

Results
There is no significant difference between age, gender and pre-operative conditions indicating that both the groups (BR release and without BR release) have similar demographic characteristics. Pre-operatively both groups had disturbed values for radial height, inclination, and volar tilt. Postoperatively, the mean of both groups was closer to normal ranges for radial inclination and volar tilt; however, radial height was the least adequately restored radiological parameter for both study group (11.54 ± 1.35 for BR group versus 10.21 ± 2.29 for Non-BR group). Pain, functional status, and grip strength had similar values in both groups whereas BR group showed higher ROM and DASH scores with P values of 0.048 and 0.025 respectively.

Conclusions
Brachioradialis release enhances the reduction and operative fixation, restoring the necessary radiological and subsequent functional parameters in distal radius fractures with reported no complications.
1254 Virtual Fracture Clinic Management of Little (5th) Metacarpal Neck Fractures; a Safe and Feasible Option?
Authors: Townley O , Flatman M , Hoyle A , Eastwood G 
Published: October 2021

Abstract

Aim
To determine the safety and efficacy of a Virtual Fracture Clinic (VFC) in managing little metacarpal neck fractures.

Method
Retrospective review of consecutive little MC neck fractures presenting to the ED June-December 2020 and subsequently referred on to VFC. Patient demographics and clinic outcomes were reviewed using electronic patient records and radiographs.

Results
Fifty patients were identified (Male:Female 37:13; mean age 26 years, range 3-89 years). Of these, 41/50 were discharged directly following VFC advice, with no adverse event. The remaining 9/50 had a face-to-face Fracture Clinic review due to safeguarding concerns (2), concurrent neck of fourth MC fracture (2), concerns regarding fracture pattern (4), and an unclear indication (1). These 9/50 were discharged after single review, with no adverse events to date.

Conclusions
Our data suggest that VFC review of patients with little MC neck fractures is a safe and feasible means of patient care which has the potential to reduce the requirement of face-to-face patient contact during the Covid-19 pandemic and reduce fracture clinic attendance. We suggest the routine incorporation of a Virtual Fracture Clinic for these hand injuries. Further work is needed to formally investigate associated patient satisfaction and the application of this approach to other trauma presentations.
1272 Tension Band Wire vs Apex Intramedullary Fusion Device for Hand Proximal Interphalangeal Joint Arthrodesis
Authors: Kamble R , Mills R , Williams C 
Published: October 2021

Abstract

Aim
Tension band wiring (TBW) is a popular arthrodesis technique for arthritic hand proximal interphalangeal joints (PIPJs), however often patients struggle with prominent metalwork and require further surgery to remove wires. This study compares outcomes of PIPJ fusion using traditional TBW with the newer Apex intramedullary implant and examines its cost-effectiveness.

Method
A retrospective analysis of 50 PIPJ fusions was performed in 37 consecutive patients using either TBW or Apex implant at a single unit between January 2013 and March 2020. Clinical and radiographic pre- and post-operative records were reviewed by two independent surgeons. The primary outcome measure was successful fusion of the joint, and complications or further surgery recorded as secondary outcomes. Cost-benefit analysis was performed to determine overall cost of procedure and any subsequent treatments.

Results
The TBW and Apex groups were comparable as to age, gender, diagnoses, and comorbidities. 27 fusions were performed using TBW compared with 23 fusions using Apex implant. Both cohorts demonstrated 100% union rates. 10 fusions (37%) from TBW group required removal of symptomatic metalwork at a mean 14.7 (± 10.9) months compared to none in the Apex cohort.

Conclusions
PIPJ fusion using the Apex implant demonstrated equivalent fusion rates to TBW and no additional surgery to remove hardware was required. The Apex implant has an additional cost of £655 (plus loan charge) but given that 37% of TBWs required further removal of metalwork, overall, the Apex implant proved to be cost effective. This study supports the use of the Apex implant as a favourable alternative to TBW.
1319 Factors Associated with Mortality in Older Patients Sustaining Pelvic or Acetabular Fractures
Authors: Harrison A , Ordas Bayon A , Chimutengwende-Gordon M , Fortune M , Chou D , Hull P , Carrothers A , Rawal J 
Published: October 2021

Abstract

Introduction
This study aimed to investigate potential factors, including delay to surgical stabilisation, affecting mortality in older patients sustaining pelvic or acetabular (PA) fractures.

Method
A retrospective review of the Trauma Audit and Research Network (TARN) database was performed to identify older patients (aged 65 and over) sustaining PA fractures treated surgically in a UK Major Trauma Centre (MTC) between 2015 and 2019. Chi-squared and Fisher tests were used to compare 1-year mortality rates following operative intervention between patients treated within 72-hours and after 72-hours. Kaplan-Meier curves were used to visualise survival probability; significant predictors of survival were found using Cox proportional hazard models.

Results
Of 564 older patients with PA fractures, 70 met the inclusion criteria. The mean age was 76.1 years. The overall 1-year mortality rate was 20%. When patients were grouped by time to surgery, there was no statistically significant difference in 1-year mortality. Patients whose surgery was delayed more than 72-hours were more likely to have longer hospital stays (p = 0.002) or to have suffered from polytrauma (p = 0.025). Age, Charlson Co-morbidities Index and pre-op mobility status were associated with statistically significant differences in overall mortality. Patient gender, mechanism of injury, polytrauma and head injury were not significant predictors of mortality.

Conclusions
Surgical intervention within 72-hours of injury did not result in decreased mortality in older patients with PA fractures. The 1–year mortality rate between older PA fractures and hip fractures was comparable. Consideration should be given to a combined multidisciplinary approach to managing these patients.
1445 Using BOAST Guidelines to Boost Standards: An Audit of Adherence to BOAST Open Fracture Guidelines
Authors: Wensley K , Rafie A , Orfanos G , MacFayden I 
Published: October 2021

Abstract

Aim
Open fractures require prompt management and appropriate infrastructure is required to deliver optimal care. The BOAST Open Fracture guidelines (2017) set out best practice in their management and advocate a combined Orthoplastics approach.

Method
All patients with open tibial fractures who presented to or were referred to our hospital from January 2018 - March 2020 were included in our audit. The standard used was the BOAST Open Fracture Guidelines. Data was collected retrospectively for cycle one (January – December 2018) then prospectively for cycle two (November 2019 – March 2020). Between cycles, results from cycle one was used to facilitate a business case for the creation of a second scheduled weekly Orthoplastics list in our hospital.

Results
61 injuries met inclusion criteria in cycle one and 23 in cycle two. In cycle one, 28% of cases missed the 72-hour soft tissue coverage target, 11% missed the 7-day target. Only 10% of cases had both Orthopaedics and Plastics consultants involved at initial debridement. Following the invention of an additional weekly Orthoplastics list, the percentage of patients missing the 7-day target for soft tissue coverage halved to 5% and the percentage of cases with both Orthopaedics and Plastics consultants involved at initial debridement more than doubled to 26%.

Conclusions
We advocate multiple weekly Orthoplastics lists to ensure prompt consultant-led management and minimise delays for patients with open fractures. We have demonstrated that audit of current practice is a simple and effective tool to facilitate improvement in guideline compliance.
198 Immediate Post-Operative PDE5i Therapy Improves Early Erectile Function Outcomes after Robot-Assisted Radical Prostatectomy (RARP)
Authors: Nathan A , Rashid A , Shukla S , Sinha A , Sivathasan S , Rassam J , Smart S , Patel K , Shah N , Lamb B 
Published: October 2021

Abstract

Aim
To assess whether the timing of post-operative Phosphodiesterase Inhibitor (PDE5i) therapy after Robot Assisted Radical Prostatectomy (RARP) is associated with a change in early erectile function, continence, or safety outcomes.

Method
Data was prospectively collected from a single surgeon in one tertiary centre and retrospectively evaluated. 158 patients were treated with PDE5i therapy post RARP over a two-year period.

Results
There were no significant differences in pre-operative characteristics between the therapy groups. Patients that had bilateral nerve sparing had a mean drop in Erectile Function (EF) score by 5.4 compared to 8.8 in the unilateral group. Additionally, 34.9% of bilateral nerve sparing patients returned to baseline compared to 12.1% of unilateral. Drop in EF scores and percentage return to baseline for unilateral nerve sparing was respectively 9 and 11.1% of immediate (day 1-2), 7 and 14.8% of early (day 3-14) and 9.7 and 9.5% of late (day &gt;14) therapy (p = 0.9 and p = 0.6). For bilateral nerve sparing this was respectively 3.5 and 42.9% immediate therapy, 5.5 and 35.5% early therapy and 7.3 and 25% late therapy (p = 0.017 and p = 0.045). Pad free and social continence was achieved in 54% and 37% of those receiving immediate therapy, 60% and 33% for early therapy and 26% and 54% for late therapy. There were no differences in compliance, complication, or readmission outcomes.

Conclusions
Immediate PDE5i therapy should be considered in patients following nerve sparing RARP in order to maximise functional outcomes, especially in those undergoing bilateral nerve spare.
384 What Proportion of Pyelonephritis Admissions Under Urology Care Have Surgical Pathology
Authors: Elsllabi M 
Published: October 2021

Abstract

Aim
To identify the proportion of pyelonephritis patients admitted with true urological pathology

Method
Retrospective audit

Results
The majority of adults admitted with diagnosis of pyelonephritis (80%) remain under urology team from 1st day of admission Of the 80% only 9% had an underlying urological pathology confirmed by imaging AND requiring invasive intervention

Conclusions
High rate of inappropriate admission to surgical / urological ward with subsequent pressure on beds and inevitable cancellations on some occasions Acute pyelonephritis should not be routinely admitted under urology unless there is clear evidence of underlying obstructing pathology or no obvious improvement on antibiotics Consider imaging in terms of US/CT KUB in first instance before making any referral to urology
459 Timeline in Management of Muscle Invasive Bladder Cancer (MIBC): Single Centre Outcomes of District General Hospital
Authors: Yee S H , Ljegbai A , Saqib M 
Published: October 2021

Abstract

Aim
According to the European Association of Urology (EUA) guidelines, patients with muscle invasive bladder cancer (MIBC) have better overall survival outcome if they receive definitive treatment within 90 days from point of referral. Our objective was to assess the average timeline of these patients from their 2 week wait (2WW) referral to definitive treatment.

Method
This was a retrospective study in all patients diagnosed with MIBC from 1st January 2018 to 31st December 2019 at Furness General Hospital (UHMBT). Treatment delay was defined as delay in more than 90 days from initial referral to definitive treatment (radical cystectomy /radical radiotherapy with or without adjuvant chemotherapy).

Results
47 patients met the inclusion criteria. Patients had imaging within 27 days, with 32 patients (68%) having a computed tomography (CT) scan and 15 patients (32%) having magnetic resonance imaging (MRI). The duration from referral point to transurethral resection of bladder tumour (TURBT) was 40 days. Multidisciplinary team (MDT) discussion took place within 12 days post-surgery. On average, the journey from date of referral to MDT was 52 days. From MDT discussion to the first tertiary centre appointment took another 27 days making it a total of approximately 79 average days for the patient to have a definitive treatment plan.

Conclusions
12 patients (26%) exceeded the 90-day mark from duration between referral to having treatment. This is mainly due to TURBT being used as the ‘stop the clock’ treatment. The trust has, thus, created a departmental standard operating procedure (SOP) with the aim of minimising this duration.
842 Teleurology; A Prospective Study of Patient’s Perception and Real Time Experience in A Tertiary UK Centre
Authors: Abdalla O , Patel S , Nambi Rajan T , Kumar M 
Published: October 2021

Abstract

Aim
To evaluate the clinical outcome and patient’s satisfaction of our real-time teleurology experience.

Materials
A prospective study, the whole cohort of face-to-face [FTF] clinics was shifted for telephone clinics. The data were collected prospectively for all appointments from 30th March to 3rd April. The primary objectives were clinic outcome and patient’s satisfaction evaluated using a validated questionnaire. The secondary objectives were number of non-attendance, percentage of face-to-face clinics and clinic demographics.

Results
Overall, 95 scheduled appointments for 7 consultants and 2 trainees. Telephone consultations performed for 75 patients, while 6 patients reviewed in FTF Clinics, and 14 patients classified as non-attendant. The non-attendance rate was 14.7%, with estimated 50% reduction in comparison to FTF rate prior to pandemic. The majority of patients (58%) treated conservatively while 14 (17.2%) patients commenced on medications, and 20 patients (24.6%) were listed for surgery. All patients but one (98.1%) agreed that cancelling FTF clinics was reasonable. The majority of the patients 94.2%, 96.2%, 84.6% found the telephone clinic was effective, long enough, and was easy to express their concerns over the phone, respectively. Approximately 90.4% and 100% satisfied with teleurology service and that clinicians were careful, respectively.

Conclusions
Our study elucidated the feasibility of teleurology in a real time setting and showed that it meets the tetrafecta of clinical outcomes, continuity of care, patient’s safety, and patient’s satisfaction. To our knowledge, this is the first study to assess patient’s perception of teleurology using a validated questionnaire.
1398 Active Surveillance Vs. Partial Nephrectomy in Small Renal Masses: Overall and Cancer Specific Survival in A Retrospective Single Centre Study
Authors: Shafi S , Kouli O , Nabi G 
Published: October 2021

Abstract

Introduction
Currently, the gold standard for T1a renal cell carcinoma treatment is partial nephrectomy (PN). However, active surveillance (AS) is increasing in elderly individuals with co-morbidities. Our hypothesis was that individuals choosing active surveillance would have similar cancer specific survival as partial nephrectomy.

Method
This retrospective study used electronic notes to collect patient data presenting with T1a renal cell carcinoma, identified over a 15-year period. Primary outcomes were to compare the survival outcomes of these patients while being related to their comorbidities using the Charlson Comorbidity Index (CCI).

Results
183 patients were identified with 62 (35%) and 121 (65%) undergoing PN and AS respectively. Patients treated with AS were older (mean age of 66 years vs 58 years; P &lt; 0.001) and had a higher CCI (median CCI 3 vs 2; P = 0.001). Overall, a total of 4 (6.5%) and 55 (45.5%) patients died from any cause after PN and AS respectively, with deaths attributed to kidney cancer was 2 (3.2%), and 10 (8.2%) respectively. Multivariate analysis showed only age &gt;70 affected overall survival independently between the two groups (HR 5.85; CI 3.29-10.42; P &lt; 0.001). Tumour size showed to be the only independent variable on cancer specific survival (HR 2.51; CI 1.14 -5.53; P = 0.023). No difference was seen between the treatment options in multivariate analysis in both overall and cancer specific survival.

Conclusions
The study agreed with the hypothesis of similar cancer specific survival. Highlighting for elderly individuals with significant co-morbidities, there is no observed benefit for undergoing partial resection.
894 An Audit of Venous Thromboembolism Prophylaxis in A Busy ENT Department
Authors: Connelly A , Williamson A 
Published: October 2021

Abstract

Aim
Venous thromboembolisms (VTEs) are a common and preventable cause of in-hospital morbidity and mortality. Assessment of risk factors (RFs) on admission and appropriate prescription of mechanical (e.g., TEDS) and/or pharmacological prophylaxis (e.g., low-molecular-weight heparin (LMWH)) is crucial. This is especially true in ENT where the variety of patient cohorts make a one-size-fits-all approach unsatisfactory. Guidelines from ENT UK reflect this.

Method
Electronic medical records were retrospectively reviewed for all emergency and pre-operative admissions (n = 173) to an adult ENT ward over 8 weeks. Adherence to the ENT UK guideline was assessed.

Results
58% of patients had VTE RFs, 27% had bleeding RFs, 2% had mechanical thromboprophylaxis contraindications. VTE risk assessment was clearly carried out for 39% of admissions. 63 patients (36%) met the criteria for LMWH prescription. 22 (35%) received it. 5 received LMWH without meeting the criteria. 96 patients (55%) met the criteria for TEDS prescription. 5 (5%) received it. 1 received TEDS without meeting the criteria. Overall, 45% of admissions had both prescribed according to the guideline. Using a pro-forma (n = 148) significantly improved risk assessment rates (43% vs. 12%), but not correct prescription rates (45% vs 40%) compared to freehand clerking (n = 25). No patients developed a VTE or unexpected bleeding.

Conclusions
Risk assessment and prescription of pharmacological and, especially, mechanical thromboprophylaxis for those who met the relevant criteria has significant room for improvement. However, no apparent harm occurred because of this. Further work will focus on developing a departmental policy and educating staff on its application.