bluuebunny/crossref_metadata_2025_split huggingface dataset:
688 Burden of Trauma from Electric Scooter Related Accidents in Central Birmingham: A Retrospective Observational Study
Authors: Begum S , Tahir M , Ponnuru R , Prakash D 
Published: August 2023

Abstract

Aim
The Department of Transport deployed an e-scooter rental trial in multiple cities across the UK in 2020. Despite its environmental incentive, this trial has sparked safety concerns as national statistics have shown &gt;1,900 casualties in e-scooter collisions since 2020, including 15 fatalities. This study aims to assess the volume and type of e-scooter related injuries presenting to an inner-city Trauma and Orthopaedic (T&O) department.

Method
A retrospective study was conducted to identify all patients referred to the T&O department at a large trauma unit with e-scooter related injuries over the 2 years prior and 2 years after introduction of the Birmingham e-scooter rental scheme in October 2020.

Results
A total of 72 patients were identified with e-scooter related injuries, 4 of whom were pedestrians, median age 22 (range 2-86) years and 74% (n = 53) were male. Majority (74%, n = 53) had sustained limb fractures, of which 49% (n = 26) were long bone fractures and 11% (n = 6) were open fractures. The remaining 26% consisted of soft tissue trauma (18%), head injuries (0.07%), and spinal injuries (0.01%). Surgical management was undertaken in 78% (n = 56) of all patients. Majority of injuries (87.5%) occurred after the rental scheme was introduced.

Conclusions
The incidence of significant injuries to riders and pedestrians has increased since the introduction of the rental e-scooter scheme, which may result in further financial strain on the health service nationally. A review of e-scooter safety measures and their enforcement should be undertaken before any future legislation of this scheme.
863 Management of Paediatric Forearm Fractures Presenting to the Whittington Hospital Emergency Department: An Audit of Current Practice
Authors: Dighero I , Haider Z , Prinja A , Haddo O 
Published: August 2023

Abstract

Aim
The most common site of fractures in children is the forearm. According to BOAST standards, early closed reduction by manipulation, avoiding the need for admission and general anaesthesia, is the treatment of choice for most forearm fractures. Further, management should include a documented assessment of neurovascular status and formal consent. Our aim was to audit management of forearm fractures in our emergency department against these standards.

Method
Patients presenting to our emergency department with isolated and neurovascularly intact forearm fractures were retrospectively identified from Nov 2021 to April 2022. Initial case management was assessed against BOAST standards and, where early manipulation in the emergency department was not performed, cases were reviewed by an orthopaedic consultant to determine if this could have occurred.

Results
24 patients were identified. The mean age at time of injury was 10 years. 62.5% of patients underwent manipulation within the emergency department of which 47% (7/15) were unsuitable to continue non-operative treatment. 37.5% of patient did not undergo manipulation, of these 44.4% (4/9) were deemed as could have been suitable for manipulation. This led to 67% (16/24) of patients requiring a procedure under general anaesthesia. Neurovascular assessment was documented for 29% and formal consent for manipulation for 0% of patients.

Conclusions
There is scope for more forearm fractures to undergo early closed reduction by manipulation in our emergency department, potential avoiding intervention under general anaesthesia. Documentation of neurovascular assessment and formal consent requires significant improvement. A hospital protocol is currently being produced to help standardise care of such injuries.
873 Fixation and Graft Augmentation of Tibial Plateau Fractures: A Systematic Review and Meta-Analysis
Authors: Clarke A , Robinson M 
Published: August 2023

Abstract

Aim
Modern techniques have challenged the consensus of open reduction and internal fixation (ORIF) with autologous graft augmentation as the gold standard management of tibial plateau fractures. The objective of this review was to assess the outcomes of surgical techniques and graft materials for managing tibial plateau fractures.

Method
MEDLINE, Embase and CENTRAL searches were conducted alongside trial registers, conference abstracts and OpenGrey from their inception to July 2022. Randomized and quasi-randomized controlled trials comparing fixation techniques or graft materials were included. Bias was assessed using the Risk of Bias 2 (ROB2) framework, and certainty of evidence using the GRADE approach. Primary outcomes included functional and radiographic outcome scores, with secondary outcomes of complications, radiographic parameters, and time to union.

Results
Eleven studies were included, five assessing surgical techniques and 6 graft materials. ROB2 assessments highlighted some concerns in nine papers and high risk in one. Improved functional outcomes were reported in minimally invasive techniques (mean difference = 3.25, 95% CI -0.17, 6.67) trending towards significance (p = 0.20). Trends towards significantly reduced complications were observed in both minimally invasive (risk ratio 0.58, 95% CI 0.26, 1.30, p = 0.19) and synthetic graft (risk ratio 0.66, 95% CI 0.37, 1.15, p = 0.14) groups.
sd definite conclusions regarding the best fixation and graft approach. However, greater efficacy and non-inferiority were demonstrated with minimally invasive techniques and synthetic grafts respectively. It is our judgement that the fixation approach is the most important prognostic factor in these injuries thus future research should be focused accordingly.
912 An Evaluation of Outcomes in G7 Dual Mobility Cup Arthroplasty for Primary Total Hip Arthroplasty: A Single Centre Retrospective Study
Authors: Aldridge W , Braimah F , Ahmed H , Jehan S , Ng A 
Published: August 2023

Abstract

Background
Hip instability is one of the commonest complications of total hip replacement (THR) and remains a leading indication for revision surgery. The G7 Dual Mobility Cup (G7-DMC) was designed to improve hip stability and increase range of movement. Our study aims to look at the use of G7-DMC in patients with varying risk of dislocation, to observe rates of hip instability, as well as their short and long term post-operative outcomes.

Method
Between 2017 and 2021, 177 patients received a G7-DMC for primary hip arthroplasty. These patients were divided into three groups: elective surgery with low risk for dislocation, elective surgery with high risk of dislocation or THR for trauma. Outcome measures included dislocation rate, Oxford Hip Score (OHS), short- and long-term complications and revision surgery.

Results
One traumatic dislocation (1.9%) was seen in the high-risk group following a fall in the post-operative period, no dislocations were seen in the low-risk or trauma groups. No patients required revision surgery for dislocation or hip instability.
OHS was significantly lower in the high-risk group (39.4 +/- 8.9) compared with low-risk (43.5 +/- 6.5) (P = 0.012), however no significant difference was seen against the trauma group (41.5 +/- 7.8). Long-term complications were similar in all three groups.

Conclusions
Despite higher rates of short-term complications and poorer OHS seen in the high-risk group of patients, no spontaneous dislocation or revision surgery for hip instability has been seen in any of the three groups. We therefore support its use in primary THR, particularly in those with high risk of dislocation.
924 The Epidemiology of Severe Obesity in Patients Undergoing Total Knee Replacement in the Kingdom of Fife Over the Last 20 Years
Authors: Akhtar M A , Thomson J , Blacklock C , Walmsley P , Ballantyne A 
Published: August 2023

Abstract

Aim
Obesity is associated with increased risk of postoperative complications such as wound infection and venous thromboembolism. The aim of our study was to assess changes in the epidemiology of severe obesity (WHO classification, BMI ≥ 40) in NHS Fife, Scotland, from 2001-2021 in patients undergoing Total Knee Replacement (TKR).

Method
A retrospective analysis of prospectively collected data was performed for 7320 patients, who underwent TKR between 2001 and 2021. Obese patients with BMI ≥ 40 were studied and their demographic details, rates of severe obesity, and length of stay were studied from 3 discrete years (2001, 2011 and 2021) in order to examine changes over time.

Results
A total of 474 patients with BMI ≥ 40 underwent TKR between 2001 and 2021. In 2001, 2.73% of TKR’s performed were in severely obese patients; this rose to 9.25% in 2011 and 10.24% in 2021. This constitutes a significant increase of 7.51% over the 20-year period (p = 0.0186).
Male/Female ratio was 67/33% in 2001, 41/59% in 2011 and 35/65% in 2021. Mean age was unchanged, from 61(SD13.23) in 2001 to 63 (SD 8.89) in 2021 (p = 0.807). Mean length of stay decreased significantly from 7.33 (SD 1.53) to 2.50 (SD 1.33) over the same period (p = 0.024).

Conclusions
Rates of severe obesity have significantly increased in patients undergoing TKR over the last 20 years in our region. Careful patient selection and informed discussion about the high risk of complications is extremely important to manage patient expectations in the presence of severe obesity.
928 The Golden Patient: A Concept to Improve Trauma Theatre Efficiency
Authors: McGurk C , Brasnic L , Tong E , Gerrie E , Duff J , Lim J W , Gardner T , Mitchell M , Boddie D 
Published: August 2023

Abstract

Aim
Golden patient (GP) is a pre-selected first patient on the next day’s trauma theatre list, with suitable medical fitness and a clear surgical plan. This study aimed to evaluate whether the GP concept improved the start times of theatre lists and the operating efficiency of the Aberdeen trauma unit.

Method
This prospective study compared theatre starting times before and following an intervention to improve consideration of the GP concept among both trauma and theatre staff. Data was collected from pre-planned trauma theatre lists on Bluespier software the evening before and the morning of the list. The comparative mean of operation start times between the groups was established and a two-sided t-test was performed to evaluate the significance between the groups.

Results
Post-interventional analysis identified 32 GPs out of which 28 persisted as first patients on the lists. The remaining 4 patients were deferred either due to an overnight emergency that took priority or a change in medical status that required them to be moved down the list. The mean operation start time was 10:00 compared to 10:14 pre-intervention. Further, in the re-audit, the mean operation start time was reduced by 39 minutes (p&lt;0.01) when the GP remained first on the list.

Conclusions
The concept of GP has improved the theatre start times which is further evident in the delay to the start of the list when the GP is not employed. Additional contributing factors that influence theatre efficiency and require further review include anaesthetic planning, patient transport and others.
952 The Use of Cell-Salvage in Periprosthetic Femur Fractures: A Cheaper and Safer Alternative?
Authors: Kapuge L , Brunt R , Crosswell S 
Published: August 2023

Abstract

Aim
Periprosthetic femur fractures (PFF) are becoming increasingly frequent due to an ageing population and growing number of arthroplasties. PFF revision surgery is associated with significant peri-operative blood loss and higher transfusion requirements. There are few strategies to reduce rates of transfusion. One of which is the use of cell-salvage. The aim of this study was to determine whether cell salvage should be routinely implemented during PFF revision surgeries.

Method
All admission with PFF were retrospectively reviewed over a period of 18 months. Data points including patient demographics, admission/operation dates, fracture site, anticoagulation status, pre/post-op Hb and number of transfusions were collected.

Results
There were a total of 38 PFF. Average age was 83.4 years with admission Hb 11.65g/dl. Mean time for operation was 2.9 days. 56% of total hip replacement PFF received a blood transfusion post-operatively with an average of 2.6 units per patient. 100% of total knee replacement PFF received a post-operative transfusion with an average of 1.6 units per patient. Of note there was no increased transfusion requirements for patient on anticoagulation (Warfarin/DOAC).

Conclusions
We identified that &gt;50% of PFF required a post-op transfusion. The cost of 1 unit of RBC locally was found to be £145.99. The average cost of a cell salvage filter is £100 per patient. Considering the above and the well-known risk of allogenic red blood cell transfusion, it was concluded that the routine use of cell salvage could be a cheaper and safer alternative to allogenic red blood cell transfusion.
1052 Safety of Drain-Less Anterior Cervical Discectomy and Fusion (ACDF) and Effects on Length of Stay
Authors: Kuligowska A , Geddes J , Wong F , Fakouri B 
Published: August 2023

Abstract

Aim
The use of drain in ACDF surgery is to avoid post-operative catastrophic haematomas compressing the airway. However, studies associate drains with dysphagia, infection and longer inpatient stays. This study assesses whether drain-less ACDF could avoid drain-site morbidity and reduce length of stay (LoS) without increasing complications.

Method
All consecutive adult patients who had ACDF under a single surgeon over a 4-year period were identified, where routine post-operative care did not involve drain placement when meticulous intra-operative haemostasis was achieved. Data was collected using electronic patient records. From Autumn 2020, patients were pre-operatively counselled on potential same-day discharge. This group of patients (PC) was compared with those without counselling (Control) for assessing secondary outcomes, including LoS and GP or A&E attendance.

Results
Seventy-four patients were included in this study. None had post-operative drain placement and there were no reports of post-operative haematoma or return to theatre. There were 12 and 15 patients for PC and Control groups respectively. For same-day discharge, there were two patients in the PC group and none in Control group. Median LoS was also shorter in PC (1.0 day; IQR:1-1.3) compared to Control (2.0 days; IQR:1-3.5). Three patients from each group had persistent mild radicular symptoms, but none required GP or A&E attendance within 6 weeks post-operatively.

Conclusions
Our results support that routine drain placement may not be required for safe ACDF surgery. Additionally, with appropriate counselling, shorter LoS can be achieved. This could help develop safe daycase surgery pathways, easing bed demands while improving access to treatment.
1061 Improving the Emergency Management of Unstable Ankle Fractures in a District General Hospital: A Quality Improvement Project
Authors: Frank A , King A , Cunnington R , Bradman H 
Published: August 2023

Abstract

Aim
To assess and improve initial casting techniques in the emergency management of unstable ankle fractures.

Method
All patients who underwent operative management of ankle fractures over two consecutive 3-month periods were selected, before and after an intervention. Following the first cycle, an intervention included presentation of results and teaching delivery to the Emergency Department, with agreement to advocate for backslab as preferred casting technique.

Results
A total of fifty-two patients were identified, with an age range of 8 to 96 years. The majority were female (63%). Initial results demonstrated 61% were managed in below ankle backslabs, 33% in full casts and 1 patient in a moonboot. Subsequent loss of reduction was demonstrated in 27% of patients. Rates were higher with full casts (45.4%) compared to backslabs (20%). Following intervention, results demonstrated a 28% increase in use of backslab casting method (89%). Only 5% were managed with a full cast (28% decrease) and 1 inappropriately discharged without immobilisation. There was a 7% decrease in overall loss of reduction (21%). There was no loss of reduction within the full cast group and 22% with backslab management.

Conclusions
The use of backslab immobilisation in the management of unstable ankle fractures is preferred. Following a brief intervention, rates of backslab immobilisation increased and loss of reduction decreased. Results show an improvement in casting techniques in the management of these patients in an NHS Trust.
1070 Epidemiology and Incidence of Pelvic Fractures
Authors: Zhang J , Stevenson A , Zhou A , Lu V , Bradshaw F , Duchniewicz M , Zhu J , Krkovic M 
Published: August 2023

Abstract

Aim
There is a lack of recent UK based literature reporting on the incidence of pelvic fractures, and the demographic associations with fracture locations. Our study reports the incidence and factors associated with pelvic fractures at a major trauma centre over a 7-year period.

Method
Data from pelvic fractures treated at a Level 1 Trauma Centre was collected from January 2015 to January 2022. Fracture location, patient demographics, and operative status were collected and analysed.

Results
A total of 3137 patients with pelvic fractures were included, with an incidence of 78.6/100,000 patients per year. The mean age was 63.0, 53% of patients were female and the mean BMI was 25.3. The mean length of hospital admission was 20.5 days.
Patients with Pubis fractures had the highest mean age (65.55), whilst those with ilium fractures had the lowest (51.14), both significantly different from the mean (p&lt;0.001). Female patients were more likely to have pubis (60.1%) fractures but less likely to have acetabulum (30.0%) fractures (p&lt;0.01). Patients with acetabular fractures had a higher BMI (p&lt;0.01) and the highest rate of operative fixation (48.5%).

Conclusions
Our study provides insight into the incidence and epidemiology of pelvic fractures in a UK major trauma centre setting, the first study in over 15 years in this context. This contributes to the literature, and allows inter-country comparisons to be conducted, and guidelines and policies to be more informed.
1151 The Accuracy and Diagnostic Value of Gram Staining from Joint Aspirates in Suspected Joint Infection
Authors: Zhang J , Stevenson A , Zhou A , Krkovic M 
Published: August 2023

Abstract

Aim
Septic arthritis is a debilitating pathology. Joint aspirate gram stain is often performed followed by definitive culture. We review the accuracy of gram staining for suspected septic arthritis, and investigate factors associated with aspirate cultures positive for bacterial growth.

Method
We reviewed all theatre performed joint aspirates at a Major Trauma Centre from 2015-2021 for suspected septic arthritis. Information collected included aspirate-site, gram stain and culture results delay, patient demographics, orthopaedic/rheumatological history of affected joint, and various comorbidities.
Outcomes included sensitivity and specificity of the gram stain. Factors that predisposed patients to positive cultures and false-negative gram stains results were calculated via multivariate binary logistic regression.

Results
A total of 408 joint aspirates were included, of which 37 did not receive initial gram staining. Gram staining and culture results’ delay were on average 1.1 and 5.4 days respectively. Logistic regression revealed that prosthetic joint (p = 0.007), past joint infections (p = 0.006), arthritis (p&lt;0.001), hypertension (p = 0.007), currently smoking (p = 0.019) were positively associated with positive cultures, and past joint infections (p = 0.004) were significantly positively associated with false negative gram stain results. Patients on antibiotics at time of aspirate were at higher risk of false-negative gram stain results (OR = 5.538, 95% CI [2.802-10.948], p&lt;0.001).

Conclusions
Whilst the initial gram stain is fast, it has poor sensitivity. We recommend caution when lending any weight to a negative result. Moreover, if the comorbidities highlighted are present or the patient is on antibiotics at time of aspirate, hyper-vigilance should be exercised to risk stratifying patients with any clinical hallmarks of joint infection.
1159 Achilles Tendon Rupture Rate – Is There a COVID-19 Pandemic Effect?
Authors: Ismail R 
Published: August 2023

Abstract

Aim
The COVID-19 pandemic has caused a noticeable shift in trauma injuries across the United Kingdom. Achilles tendon ruptures (ATR) – a common sports-related injury – are frequently seen in athletes who are active intermittently. This retrospective study is aimed at proving the hypothesis that restriction easing and shift in activity levels during the COVID-19 pandemic has led to a higher prevalence of ATR in comparison to pre-pandemic numbers.

Method
Our study looked at ATR cases referred to the Virtual Fracture Clinic locally. We reviewed historical cases from 2015 to 2021 to compare rates and incidences of pre-pandemic cases with those during the pandemic and after restrictions were lifted. Additionally, we developed a scoring system to quantify the level of physical activity and exercise restrictions during the pandemic. The incidence and rate of ATRs were recorded and mapped against a restriction score over the course of the pandemic.

Results
Pre-pandemic, the yearly average number of ATR referrals was 77, but was 110 in 2021 after restrictions were lifted. In addition, the number of cases in 2020 during the pandemic was 63. Furthermore, when cases were mapped against activity restrictions throughout the pandemic period (2020-2021), a clear elevation in the number of cases emerges as the restrictions ease.

Conclusions
After restrictions were lifted, yearly cases were revealed to be considerably higher than the average pre-pandemic numbers. This shows that after a period of more sedentary lifestyle during the pandemic, the risk of ATR becomes higher upon return to play, hence supporting our hypothesis.
1198 Outcomes Following Internal Bracing for Anterior Sternoclavicular Joint Instability: A Systematic Review
Authors: Kapur K , Zaki P , Chaudhury S , Tytherleigh-Strong G , Panayiotou D 
Published: August 2023

Abstract

Aim
There is a paucity of data regarding optimal treatment strategies for atraumatic sternoclavicular joint (SCJ) instability, as this is a relatively uncommon aetiology. Atraumatic SCJ instability may be due to capsular laxity, muscle sequencing or a combination of both.
This study aims to systematically review the literature regarding SCJ instability with isolated capsular laxity to determine whether anterior capsular surgical plication and augmentation with internal bracing can prevent further episodes of instability in a population that is refractory to non-operative management.

Method
Studies that reported functional surgical outcomes were identified using the search terms “sternoclavicular AND joint AND dislocation AND reconstruction”. Nine studies and a total of 111 patients were identified to have met the inclusion criteria.

Results
Of the 111 patients identified, 9% of patients reported residual instability. 5.4% required a reoperation due to persistent impairment of shoulder function related to SCJ instability or osteoarthritis. There were satisfactory reported outcomes in 91% of patients.

Conclusions
Internal stabilisation techniques for atraumatic sternoclavicular joint (SCJ) instability have shown to be an effective method to improve shoulder function and patient symptoms. Revision rates remained at only 5.4% with a significant improvement in functional status. Complications were rare and included haematoma formation and discharging wound site. Therefore, internal bracing techniques should be considered in patients with chronic anterior SCJ instability after a course of failed conservative treatment.