bluuebunny/crossref_metadata_2025_split huggingface dataset:
892 Dual Platform 4th Generation Shoulder Replacement System-Medium Term Results
Authors: Komperla S , Giles W , Flatt E , Eyre-Brook A , Jones V , Papanna M , Eves T , Thyagarajan D 
Published: August 2023

Abstract

Aim
To report medium term outcomes following 4th generation VAIOS® shoulder replacement.

Method
We retrospectively analysed prospectively collected data following VAIOS® shoulder arthroplasty performed by the senior author between 2014-2020. This included anatomical (TSR), reverse(rTSR), revision and trauma shoulder replacements. The primary outcome was implant survival (Kaplan-Meier analysis). Secondary outcomes were Oxford Shoulder Scores (OSS), radiological outcomes and complications.

Results
152 patients met our inclusion criteria with 114 rTSR and 38 anatomical TSR
Reverse TSR
Reverse TSR- 55 primary, 31 revisions, 28 for trauma.
Primary rTSR- 0 revisions, average 3.35-year follow-up.
Revision rTSR-1 revision (4.17%), average 3.52-year follow-up.
Trauma rTSR- 1 revision (3.57%), average 4.56-year follow-up
OSS: Average OSS improved from 15.39 to 33.8 (Primary rTSR) and from 15.11 to 29.1 (Revision rTSR). Trauma rTSR-Average post-operative OSS was 31.4.
Anatomical TSR
38 patients underwent primary anatomical TSR. In 16/38 patients, glenoid bone loss was addressed by bone grafting before implantation of the metal back glenoid component. Mean age at time of surgery was 68.3 years (53 – 81 years). Mean follow-up was 34 months (12 – 62 months). The average Oxford shoulder score improved from 14 (7-30) to 30 (9-48).
There were 3 revisions (7.8%); two following subscapularis failure requiring revision conversion to reverse shoulder replacement and one for glenoid graft failure.

Conclusions
The medium-term results of the VAIOS® system suggest much lower revision rates across multiple configurations of the system than previously reported, as well as a low incidence of scapular notching. This system allows conversion to rTSR during primary and revision surgery.
909 Current Challenges and Future Prospects of Osseointegration Limb Reconstruction for Amputees
Authors: Akhtar M A , Low C , Blacklock C , Tiemessen C , Hoellwarth J S , Al Muderis M , Tetsworth K 
Published: August 2023

Abstract

Aim
The field of osseointegration has existed for almost 30 years and now appears to be on the verge of greater acceptance and widespread implementation. We reviewed the current challenges and future prospects of osseointegration limb reconstruction.

Method
A scoping review of the literature was conducted by researchers with an interest in Osseoinegration and key papers were identified and summarized.

Results
The 3 biggest challenges identified included Risk of Infection, High Cost and lack of outcome measures.
The solutions identified for the advances in Infection prevention and control included; Smart Implant Coating, Mechanical inactivation of Staphylococcus aureus and Pseudomonas aeruginosa, Biofilm erradication, Simultaneous Monitoring of Loosening and Temperature in Orthopaedic Implants, Realtime information on implant infection, Adjuvant therapeutic agents-Delivery Options, Nanotechnology and Nanomaterials, Nanobiotechnology- Prevention and Treatment of Orthopaedic Implant Associated Infection.
In order to cut the cost, we noted the following Advances in Production and Biomaterials; Three-dimensional (3D) Printing, Customised Implants, Natural Medicinal Compounds in Bone Tissue Engineering, Cost Effectiveness of 3D Printing implants, Meta-biomaterials, Functionalization of 3D-printed titanium alloy orthopedic implants.
We noted the following advances in Designs and feedback of Prosthetics; SMART (sensing, measuring, and advanced reporting technology) Implants, Technological Advances in Prosthesis Design and Rehabilitation, Biofeedback to Improve the Performance of Myoelectric Pattern Recognition, Neurophysiological Evaluation of Haptic Feedback for Myoelectric Prostheses.

Conclusions
We believe that the future of amputee rehabilitation is bright with the advances in implant manufacturing, biofeedback, and infection prevention.
1012 Evaluation of the ‘Clicky’ Hip in the Diagnosis of Developmental Dysplasia of the Hip (DDH)
Authors: Ross M , Poacher A , Froud J , Morgan E , Carpenter E , Ramage G 
Published: August 2023

Abstract

Aim
Early detection of developmental dysplasia of the hip (DDH) is associated with improved outcomes of conservative treatment. Therefore, we aimed to evaluate the use of a ‘clicky’ hip as an indication for secondary assessment as per the British Society for Children's Orthopaedic Surgery (BSCOS) consensus statement.

Method
Prospective cohort study of all patients born within the catchment area of a single tertiary centre (n = 27,731) all of whom underwent a new-born and 6–8-week examination and ultrasonographic screening of the hip. Multivariate odds ratios, cumulative risk difference, were calculated in relation to DDH (Graf type IIb-IV that required treatment) for those with ‘clicky’ hip as the only abnormality on examination.

Results
The prevalence of pathological DDH that required treatment within our population was 5.1/1000 live births (n = 148). An abnormal examination defined only by the presence of ‘clicky’ hip had a sensitivity of 11.5% [(95%CI6.84 to 14.75) 17/148)] and a positive predictive value of 4.39% (95%CI2.82 to 6.77%) for DDH. The increase in risk of having DDH from having a clicky hip during the 6-8-week examination was 10.1% and odds ratio 3.84 (95%CI2.33 to 6.32) demonstrated a significant association (p&lt;0.001).

Conclusions
This study has evaluated the role of the ‘clicky’ hip in neonatal hip screening. Clearly demonstrating a statistical association with pathological DDH and also providing important information relating to the risk and predicative value of a clicky hip, addressing the principal research need by the BSCOS consensus statement.
1062 Opioid Requirements During Rehabilitation After Pelvic Fracture
Authors: Zhang J , Stevenson A , Lu V , Zhou A , Bradshaw F , Duchniewicz M , Krkovic M 
Published: August 2023

Abstract

Aim
Pelvic fractures are highly traumatic and debilitating injuries for patients, with an arduous rehabilitation process. Our study analyses the predictors for opioid requirements in pelvic fractures.

Method
Data was collected from all pelvic fractures treated at a Major Trauma Centre from 2015-2021, including fracture location, demographics, and comorbidities. Opioid prescriptions in the first post-injury year were calculated every month up to 6 months, and then from the 7th-12th month period. We calculated the total strength in Morphine Milligram Equivalents (MME), and days with at least one opioid prescribed (“coverage”). Multivariate regression was performed on the outcomes.

Results
A total of 3137 patients with pelvic fractures were included, with mean 954 MME (95%, CI = 899-999) in the first year. Acetabulum fractures showed lower strength in the 1st, and 7–12-month periods, with lower coverage in the 1st- 3rd months (p&lt;0.05). Pubis fractures needed higher strength opioids for more days across all time intervals (p&lt;0.01). On multivariate comorbidity analysis, in every subinterval after 1st month and overall, higher BMI and age, pulmonary disease, and drug abuse were associated with higher strength. In every subinterval after 4th month and overall, liver disease was associated with higher strength (p&lt;0.05). Higher age and BMI were associated with increased coverage overall and every individual month (p&lt;0.01), with chronic kidney disease and rheumatological conditions associated with increased coverage after the 2nd month (p&lt;0.05).

Conclusions
Our study highlights the various injury, demographic and comorbidity factors that predispose patients to requiring higher strength and coverage of opioids during their rehabilitation from pelvic fractures.
1075 Community Outpatient Orthopaedic Clinics; a Post Pandemic Model of Care
Authors: Clowes R , Kohli S , Vincent J , Davis S , Smith J 
Published: August 2023

Abstract

Aim
In response to the elective orthopaedic backlog created by the Covid19 pandemic, we developed a secondary care community clinic service outside of the main hospital site. The facility provides a holistic, multidisciplinary alternative to the standard outpatient clinic model for Orthopaedic patients, in order to improve the quality and efficiency of the experience. This study describes patient satisfaction and experience of using the new temporary facility to inform the development of a permanent outpatient centre utilising the same model of care.

Method
Two surveys were created to evaluate the environment, design, flow, and experience of patients and staff who attended the community clinic. Data was collected from 05/01/2022 to 28/02/2022 and 01/08/2022 to 31/08/2022.

Results
A total of 296 responses were collected. The significant majority (82-96%) of patients and staff rated the overall environment as good or very good and would recommend the service to family or friends. Key atmospheric themes include positive remarks on a collaborative feel, welcoming and a spacious environment.

Conclusions
The community outpatients centre has had a significant impact on the care we deliver patients. The large open space with clinical hubs provides flexibility to develop new patient pathways and services. Patient and staff feedback from the experience has been very positive, with a high-cost efficiency.
1118 Epidemiology of Tibial Fractures, a UK Major Trauma Centre Perspective
Authors: Zhang J , Stevenson A , Zhou A , Lu V , Josipović M , Bradshaw F , Zhu J , Krkovic M 
Published: August 2023

Abstract

Aim
There is no recent large UK-based study on the epidemiology of tibial fractures. In our study, we report incidence and factors associated with tibial fractures treated at a Level I Trauma Centre over a 7-year period.

Method
We gathered data on fracture locations, age, gender, BMI, Charlson Comorbidity Index (CCI), and treatment options of all tibial fractures treated at a major trauma centre during the seven years from January 2015 to January 2022. The incidence of fracture types was calculated, as well as associations different fracture locations had with demographics, and their surgical managements.

Results
2018 patients suffered 2103 tibial fractures during the 7 years. This is composed of 735 proximal (plateau), 775 diaphyseal, and 593 distal (Pilon and tibial ankle component) fractures occurring, with overall incidence per 100,000 patients per year being 18.4, 19.1 and 14.6, respectively.
Of all fractures, the mean age, CCI score, and BMI was 46.9 years, 1.54, and 26.6, respectively. 56% were male, 26.3% were open fractures, and 52.4% were treated operatively.
Proximal and distal fracture patients had higher (50.9) and lower (43.2) ages, respectively (p&lt;0.01). Proximal and shaft fractures had lower (48.9%) and higher (61.4%) percentages of male patients. Distal (64.4%) and open (79.0%) fractures had higher rates of operative treatment, respectively.

Conclusions
This study describes the epidemiology and incidence of tibial fractures in the UK major trauma centre setting, and analyses the association between demographic factors, fracture location and management. This adds to the literature and allows for future comparisons between regions.
1127 Prophylactic PPIs in NOF Fractures- Can It Be a Lifesaving Intervention?
Authors: Jamal Z , Khawaja Z , Zafar N , Haider I , Siddiqui A 
Published: August 2023

Abstract

Aim
Assess the incidence of UGI bleed in patients with NOF fractures. Develop trust-based guidelines to include PPIs in the management of such patients.

Method
A total of 119 patients who were admitted with NOF fractures between January and March 2022 were included. All the patients admitted to RAEI with NOF fractures were included in the study. All the patients with a previous diagnosis of GORD, peptic ulcers, or perforated peptic ulcers and those who were already taking PPIs before admission were excluded from the study. Information was collected about the hospital number, age, gender and if there was any gastrointestinal bleeding was noticed in such patients during the hospital admission.

Results
Our results showed that most of the patients who were admitted with NOF fractures were elderly. A total of 5/119 patients had major gastrointestinal bleeding during their hospital admission thus warranting further procedures such as endoscopy, transfusions, and prolonged hospital stay.

Conclusions
Elderly patients with NOF fractures are at an increased risk of stress-related mucosal damage and subsequent UGIB. Due to the devastating and potentially threatening complications of mucosal damage, preventative measures are mandatory. Therefore, PPIs should a routine part of drug prescription in patients admitted with NOF fractures. This can not only help prevent this potential bleeding but can also be cost-effective in terms of preventing prolonged stays and readmissions. A reaudit is planned to be done in 1 months’ time after the implementation of the changes.
1130 Does Fracture Location and Patient Comorbidity Influence Opioid Requirements in Tibial and Ankle Fractures?
Authors: Zhang J , Stevenson A , Lu V , Zhou A , Josipović M , Bradshaw F , Krkovic M 
Published: August 2023

Abstract

Aim
Opioid requirement in post-operative rehabilitation is an important area in orthopaedic surgery, with no large UK-based studies. Guidelines should reflect anticipated patient requirements. Our study explores the characteristics predisposing surgically managed tibial fracture patients to increased opioid requirements.

Method
All tibial fractures from 2015-2022 at a Major Trauma Centre were evaluated. 1890 patients were included. Post-operative opioid prescriptions in the 1st post-operative year were calculated every month up to 6 months and then from the 7th-12th month. Overall prescribed Morphine Milligram Equivalents (MME) “strength” and days with at least one opioid prescription (“coverage”) were calculated. Demographic, fracture location and various comorbidities were included in the multivariate modelling.

Results
Compared to the tibial average, plateau and Pilon fractures had x1.51 and x1.20 times the strength in the first year, with significance at every sub-interval (p&lt;0.01) and ankle fractures had x0.756, significance at every individual time-interval (p&lt;0.05).
For relative strength and coverage, for all time intervals, obesity, pulmonary disease, and drug abuse were associated with higher opioid requirements (p&lt;0.05). Age, Charleston Comorbidity Index (CCI) and BMI were each positively associated with coverage in each of the first 3 months, with age and CCI associated with strength in 1st month (p&lt;0.05).

Conclusions
Our study begins to elucidate a range of patient factors that can predispose to increased opioid usage in total strength and overall coverage. This, begins to construct an evidence-based tool for clinicians to base opioid prescriptions, manage patients effectively, and guide opioid stewardship.
1161 The Financial Impact of Electric Scooter Orthopaedic Injuries at a Large District General Hospital in England
Authors: Antonik M , Sankar S , Hassan S 
Published: August 2023

Abstract

Aim
Electric scooters are becoming an increasingly popular method of transportation in major urban cities worldwide. As their popularity gains, there are concerns about safety and injuries sustained, of which significant proportion are orthopaedic injuries. The aim of this study was to see the financial impact of e-scooter related orthopaedic injuries.

Method
In a retrospective study, we investigated the overall burden and the financial impact of the orthopaedic injuries as a result of the use of e-scooter transportation in a large District General Hospital in England over a 16-month period between September 2020 and December 2021.

Results
Seventy-nine patients were identified with a mean age of 30.1 years (SD 11.6). Sixty-two of these patients were males and seventeen were females. There were eighty-six orthopaedic injuries, with fractures being the most occurring type of injury. Twenty-three patients required twenty-eight different surgical procedures. The combined theatre and recovery time was 5500 minutes, while the surgical procedures operating time was 2088 minutes. The cost total cost of theatre running time for these patients was £77,000. Seventeen patients required hospital admission under Trauma and Orthopaedics, which accounted for total stay of ninety-nine days with a mean length of stay of 5.8 days per patient.

Conclusions
We have demonstrated that although there are environmental benefits to e-scooters; there have been a significant increase in healthcare system burden as demonstrated by additional emergency attendances, frequent outpatient clinic appointments, surgical procedures, and hospital inpatient admissions.
1167 Assessing Femoral Cementing Qualities in Total Hip Replacements
Authors: Cooper C , Tse S , Dick A 
Published: August 2023

Abstract

Aim
High quality cement mantles are important to the long-term survival of femoral stems in total hip replacements (THRs). There’s variability in the quality of cement mantles and positioning of cement restrictors. The audit aim was to assess current practice of cemented femoral stems in THRs against local standards.

Method
All patients who underwent THR with a cemented femoral stem between March 2021 and April 2022 were included in the study. TraumaCad software was used to retrospectively collect data on post-operative radiographs for overall cement mantle quality, coronal stem alignment, tip of stem to radio-opaque cement restrictor marker distance, and tip of stem to end of cement mantle distance (Gruen Zone 4).
We audited against the following standards:90% of stems have Barrack and Harrison Grade A ratingKhalily angle &lt;5°Tip of stem to radio-opaque marker of 20-40mmGruen zone 4 of 10-30mm

Results
126 cemented femoral stems were included. Evaluation of Barrack grading showed 55% (N = 69) compliance with grade A, 45% (N = 57) of stems were grade B, with 0% grade C or D. Mean Khalily angle was 1.67° (98.4% compliance). Mean distance from tip of stem to cement restrictor was 36.5mm (60% compliance). Mean length of cement mantle in Gruen zone 4 was 18.9mm (71% compliance).

Conclusions
Overall, cement mantle quality and femoral stem coronal alignment were acceptable. There is variability of cement mantle thickness below the tip of the stem and with restrictor placement. We recommend re-auditing following junior surgeon cementing technique education.
1173 What Influences Taylor Spatial Frame Effectiveness in the Treatment of Tibial Osteomyelitis? A Major Trauma Centre Perspective
Authors: Zhang J , Zhu J , Krkovic M 
Published: August 2023

Abstract

Aim
Treatment of tibial osteomyelitis can be challenging, with numerous complications possible during rehabilitation. We report on the usage of the Taylor Spatial Frame (TSF) and analyse factors that affect outcomes.

Method
Between 2015-2020, 51 patients were treated with TSF for osteomyelitis at a Major Trauma Centre. Demographic, infection, and treatment factors were collected, with microbiology results, antibiotic treatment regimes, and time to partial weight-bear (PWB) and full weight-bear (FWB) prescriptions also noted. Outcomes of complications and time to union were obtained.

Results
Radiological union was achieved at mean 11.0 months. Mean follow up was 24.1 months. Six/three patients were further treated with fusion/amputation respectively. Mean treatment time with TSF was 12.1 months. 78% had some complications, with pin-site infection, malunion, and non-union being most prevalent.
Staphylococcus epidermidis in bone debridement microbiology was significantly negatively associated with pin-site infection (OR = 0.093, 95% CI [0.011-0.828] ) and malunion (OR = 0.698 95% CI[0.573-0.849]), and enterococcus with non-union (OR = 0.775, 95% CI [0.656-0.916] ), during the treatment period. Time to union was significantly positively associated with time from admission to debridement (p = 0.035), time TSF was in (p = 0.021), presence of any complications (p = 0.045), bone loss complication (p = 0.037), time to FWB prescription (p = 0.001).

Conclusions
We have analysed the effectiveness of TSF in the treatment of tibial osteomyelitis, and elucidated the most important injury, treatment and rehabilitation factors that affect outcome. The negative bacterial-complication cross associations could be due to successful eradication as culture specific antibiotics were used postoperatively. Earlier patient full weight bearing could enhance callous formation leading to faster union.
1200 Polytrauma Clinic in a Major Trauma Centre in the UK – a Novel Approach for Polytrauma Patients
Authors: Cornish E , Gamble C , Telford J , Shah N , Lyle V , Walton K 
Published: August 2023

Abstract

Introduction
The UK major trauma network was successfully implemented in 2012. However, rehabilitation has mainly been described in military veterans. In our unit a multidisciplinary polytrauma clinic attended by an Advanced Physiotherapist, Rehabilitation Medicine Consultant and a Trauma and Orthopaedic Consultant was established to manage these patients after discharge.

Method
This observational study assessed the polytrauma rehabilitation clinic at a single UK Major Trauma Centre. Eligible patients had 2 or more significant limb injuries +/- pelvic fracture. A retrospective review between 1st July 2016 to 31st July 2021 was performed. Electronic records were assessed for mechanism of injury, number of injuries requiring surgery, length of inpatient stay, number of clinic appointments, diagnosis of post-traumatic amnesia and re-admission.

Results
Of a total of 87 patients, 68% sustained injuries following road traffic collisions. Mean number of injuries per patient was 5.9 SD+/- 2.6, mean operations performed per patient 4.3 SD+/- 4. Patients had a mean of 1.4 SD+/- 0.6 reviews per year in the clinic, with 1.5 +/- 0.6 years of follow-up. 14% of patients had post-traumatic amnesia. Re-admission was required for 24 patients, of which 21 (87.5%) were planned.

Conclusions
The polytrauma clinic introduced a multi-disciplinary approach to the aftercare of this patient population, whilst reducing their appointment burden. This study found patients required 1-2 appointments per year, demonstrating a cost-effective approach to follow up. The streamlining of required interventions in a timely manner is supported by the fact that over 70% of patients did not require further admissions for treatment.