bluuebunny/crossref_metadata_2025_split huggingface dataset:
1036 Gender Equality in Heart Transplantation: A Single Centre Study
Authors: Surendran A 
Published: November 2022

Abstract

Background
International Society for Heart and Lung Transplantation categorises female gender in donor/recipient, as a significant risk factor for mortality after heart transplantation. Further, donor-recipient gender mismatch is also reported to be a determinant of post-transplant morbidity/mortality. To examine the effect of gender in survival outcomes, we conducted a retrospective study.

Method
Population comprised of 298 patients undergoing heart transplantation from 2001 to 2021, divided into four groups on the basis of donor and recipient matching. Group A consisted of men who received male donor-hearts, group B of women who received female donor-hearts, group C of women who received male donor-hearts, and group D of men who received female donor-hearts. Standard heart transplantation protocols were applied to all patient groups for graft preservation, surgical technique, donor-recipient size matching, induction & immunosuppressive-therapy.

Results
The study groups were found to be homogeneous to the major preoperative- risk- factors (aetiology, transplantation status, donor-recipient-age, total ischemic time). Donor gender, recipient gender and donor-recipient gender mismatching did not significantly modify the short and mid-term survivals, functional recovery, and primary graft dysfunction post-surgery.

Conclusions
Even though previous reports suggest that gender negatively affects survival, this proved to have no influence on the outcomes in our study. These results can be explained by a correct donor-recipient size matching. The well-documented female recipients’ tendency to more frequent and fatal rejection was not confirmed in our experience. The patient's age at transplantation, the routine use of induction therapy and an aggressive immunosuppressive regimen may be the substrate of these findings.
3 Establishment of Virtual Fracture Clinic in Princess Royal Hospital Telford; Experience and Recommendations During the First 9 Months
Authors: Khaleeq T , Ahmed U 
Published: November 2022

Abstract

Introduction
Virtual fracture clinics (VFC) have been shown to be a safe and cost-effective way of managing outpatient referrals to the orthopaedic department. During the coronavirus pandemic there has been a push to reduce unnecessary patient contact whilst maintaining patient safety.

Method
A protocol was developed by the clinical team on how to manage common musculoskeletal presentations to A&E prior to COVID as part of routine service development. Patients broadly triaged into 4 categories; discharge with advice, referral to VFC, referral to face to face clinic or discussion with on call team. The first 9 months of data were analysed to assess types of injury seen and outcomes.

Results
In total 2489 patients were referred to VFC from internal and external sources. 734 patients were discharged without follow-up and 182 patients were discharged to physiotherapy. 3 patients required admission. Regarding follow-ups, 431 patients had a virtual follow-up while 1036 of patients required further face to face follow up. 87 patients were triaged into subspecialty clinics. 37 patients were referred inappropriately.

Discussion
BOA guidelines suggest all patients need to be reviewed within 72 hours of their orthopaedic injury. Implementation of a VFC allows this target to be achieved and at the same time reduce patient contact. Almost half the patients were discharged following VFC review, the remaining patients were appropriately followed up. This is especially relevant in the current pandemic where reducing unnecessary trips to hospital will benefit the patient as well as make the most of the resources available.
12 Trends in Neck of Femur Fracture Incidence in EU15+ Countries From 1990–2017
Authors: Ali R , Sugand K , Goodall R , Salciccioli J , Marshall D , Schuster-Bruce J , Abdul-Jabar HB , Shalhoub J 
Published: November 2022

Abstract

Background
Neck of femur fractures (NOFF) pose significant socio-economic costs to society with a high degree of morbidity and mortality. Its incidence rate has been collated within the Global Burden of Disease (GBD) database; however, to date, no comparison across countries has been reported.

Method
NOFF age-standardised incidence rates (ASIR) per 100,000 population were extracted from the GBD database for European Union (EU) 15+ countries over the period 1990 to 2017. Joinpoint regression analysis of the data identified trends in ASIR and associated estimated annual percentage changes (EAPC). These were analysed by specified timeframe, country, and gender.

Results
Of the 19 EU15+ countries, 11 (58%) had overall increases in NOFF ASIRs in 2017 compared to 1990. The median ASIRs were 240/100,000 and 322/100,000 for males and females, respectively, in 1990. By 2017, this had increased to 259/100,000 and 325/100,000, respectively. Females consistently had relatively higher NOFF ASIRs with a median gender fracture gap of 62/100,000 in 2017. Males had a higher percentage change in increasing ASIRs, with a smaller percentage change in decreasing ASIRs for all included countries. The highest national ASIRs was observed in Australia, followed by Finland and Belgium. Conversely the Mediterranean countries demonstrated the lowest ASIRs, closely followed by the USA.

Conclusions
Despite significant advances in primary and secondary hip fracture prevention strategies over the 28-year study period, significant increases in NOFF ASIRs among most EU15+ countries were observed, especially with respect to gender.
35 Medical Complications After Total Ankle Arthroplasty: A Review of the Evidence
Authors: Curlewis K , Leung B , Sinclair L , Chan G , Bendall S , Ricketts D 
Published: November 2022

Abstract

Aim
Total Ankle Arthroplasty (TAA) is increasingly being undertaken globally for the treatment of end-stage ankle arthritis. For each TAA procedure informed consent is required. This requires disclosing all material risks that the patient may find significant. The consent process should include discussion of all relevant complications, both medical and regional. There is a lack of data regarding the medical complications of TAA. This might cause problems in obtaining valid informed consent.

Methods
A literature review was performed. The medical complications and mortality rate of TAA were identified and summarised.

Results
The average rate of systemic medical complications after TAA was 3% (range: 0% - 7%). The average mortality rate following TAA was 0.3% (range: 0% - 0.72%). The following risk factors were identified for medical complications: obesity, diabetes, systemic co-morbidities, preoperative blood transfusion, revision procedures, and long anaesthetic duration.

Conclusions
As part of obtaining informed consent for TAA, the medical complication rate of 3% and mortality rate of 0.3% ought to be included, documented, and conveyed to patients alongside the regional complications.
86 An Emerging Role of Cannabis as an Anti-Nociceptive Agent in the Treatment of Chronic Back Pain
Authors: Damisa J , Richardson M , Adewuyi M 
Published: November 2022

Abstract

Aim
This review aims to provide insight into current research regarding a role for the endocannabinoid signalling pathway as a target in the treatment of chronic pain with particular emphasis on potential use as part of the treatment of lower back pain.

Method
A literature review was conducted using PubMed, Google scholar, and web of science database. The terminologies used were endocannabinoids, cannabis-based medicines, chronic pain, and lower back pain.

Results
The analgesic effect of cannabinoids is produced by stimulating cannabinoid receptors within the endocannabinoid system. Animal studies show cannabinoid type 2 receptors stimulate the release of endogenous opioids, further enhancing anti-nociceptive properties.
Pre-clinical studies demonstrated the amount of morphine required to achieve median effective dose was around 3.6 times lower when morphine was administered with cannabinoids compared to morphine alone.
A systematic review of 24 RCT trials and 1334 participants revealed that inhaled cannabis results in improved neuropathic pain symptoms compared to placebo; however, only two studies showed clinical significance.
The medicinal use of cannabis comes with adverse effects. Up to a tenth of users are at risk of developing Cannabis use disorder, characterized by psychosocial problems, increased drug-seeking behaviours including craving, withdrawal, and tolerance.

Conclusions
The use of cannabis is gaining traction as an alternative to opiates despite the ethical and legal considerations.
There is scope for cannabinoids to be successful anti-nociceptive agents in the management of chronic back pain.
The long-term effects and side effect profile of cannabis- based medicines need more research.
114 Bone Transport Using the Monorail External Fixator Over an Intramedullary Nail for Post-Traumatic Femoral Defects
Authors: Lu V , Zhang J , Krkovic M 
Published: November 2022

Abstract

Aim
The management of limb-length discrepancy secondary to traumatic bone loss poses a unique challenge for surgeons. The Ilizarov technique is popular but is associated with long external fixator time and many complications. This retrospective study assessed outcomes of post-traumatic femoral defects managed by monorail external fixation over an intramedullary nail.

Method
Eight patients were included from over a four-year period with post-traumatic femoral defects, that underwent treatment with monorail fixator-assisted intramedullary nailing. Mean follow-up time was 232.83 weeks. Five were open fractures (Gustilo-Anderson type 3A:n=4, 3B:n=1), one had closed fracture. Average bone defect size was 8cm. Primary outcomes were lengthening index, consolidation time and index, external fixator index. Secondary outcomes were time to full weight bearing(FWB), time to union, complications. Patient reported outcome measures including EQ-5D-5L, SF-36, Oxford knee scores(OKS), Oxford hip scores(OHS) were recorded after recovery.

Results
Average consolidation time and index were 11.35months and 1.24months/cm, respectively. Mean lengthening and external fixator index were 20.2days/cm and 23.88days/cm, respectively. On average, patients achieved FWB and bone union 56.25 weeks and 68.83 weeks after bone transport initiation, respectively. Two patients had docking site non-union, treated by reamed intramedullary exchange nailing. Two patients had osteomyelitis. EQ-5D-5L and EQ-VAS scores were compared to UK population norms (p=0.104, p=0.238, respectively). Average OKS was 32.17 and OHS was 34.00.

Conclusions
Monorail external fixation over an intramedullary nail is an effective option for post-traumatic femoral defects, reducing external fixator time, lowering complication rate, returning patients’ quality of life to a level comparable with the normal population.
122 Outcomes in Young Adult Patients with Intracapsular Femoral Neck Fractures
Authors: Wagner B , Oliver W , Bell K , Scott C , Keating J , White T , Duckworth A 
Published: November 2022

Abstract

Aim
The aim was to evaluate short- and long-term outcomes for young adult patients undergoing fixation for an intracapsular femoral neck fracture.

Method
From 2008–2018, we retrospectively identified 112 consecutive patients (mean age 48yrs [20–60], 54% male). Complication details were determined from medical records and radiographs. Long-term patient-reported outcomes – including Oxford Hip Score (OHS), Forgotten Joint Score (FJS), EuroQol 5-Dimension (EQ-5D)/Visual Analogue Scale (EQ-VAS) and UCLA Activity Scale – were obtained via telephone survey.

Results
Union occurred in 77% (n=86/112) at a mean of nine months (3–87). Complications occurred in 23% (n=26/112), including fixation failure (5.4%, n=6/112), nonunion (4.5%, n=5/112) and AVN (14.3%, n=16/112). Alcohol excess (p=0.04), time to surgery &gt;24hrs (p=0.023) and fracture malreduction (p=0.002) were associated with complications. Overall, 35% required further surgery, including metalwork removal (18.8%, n=21/112), total hip replacement (18.8%, n=21/112) and excision arthroplasty (1.8%, 2/112).
Long-term outcomes were obtained for 72% (n=81/112) at a mean of 6.9yrs (2.8–12.8). The mean OHS was 41.4 (4–48), FJS 63.3 (0–100), EQ-5D 0.823 (-0.59–1.0) and EQ-VAS 79.5 (5–100). Mean EQ-5D was significantly lower than population controls (p=0.005). The mean UCLA score fell from 6.8 pre-injury to 6.0 post-injury (p&lt;0.001). Patients with complications had significantly lower OHS (p&lt;0.001), EQ-5D (p=0.001), EQ-VAS (p=0.01) and UCLA scores (p=0.001) compared with those who united uneventfully.

Conclusions
Most young adult patients united following fixation of their fracture. However, one in four experienced a complication, resulting in inferior long-term function and health-related quality of life. Time to surgery and fracture reduction were significantly associated with complications.
164 The Relationship Between Patient Reported Outcome Measures (PROMs) in Patients Undergoing Hip and Knee Joint Replacement Surgery and Social Deprivation on the Wirral
Authors: Gompels B , Donnachie N 
Published: November 2022

Abstract

Aim
This study investigated differences in patient reported outcome measures (PROMs) pre- and post-operatively and socio-economic deprivation in patients on the Wirral. The Wirral is an area s with a diverse socioeconomic spectrum but served by the same Musculoskeletal department.

Method
This was a retrospective cohort study of 1594 adult patients who underwent a hip or knee replacement between 2012–2019. Socioeconomic deprivation was quantified using the Index of multiple deprivation (IMD) Outcomes pre- and post-operatively (Q1 and Q2) were recorded using the Oxford Hip and Knee scores.

Results
The mean Q1 and Q2 score for each IMD decile was found to have a strong positive correlation with PROM score across both hip and knee replacements for both genders. The mean difference between Q1/Q2 score was not strongly correlated with IMD decile. Patients from areas of higher socioeconomic deprivation have lower PROMs pre- and post-operatively.

Conclusions
The Oxford Hip and Knee scores are widely used for assessing health status. The treating unit does not specify a score that triggers discussion regarding arthroplasty but undertakes a holistic assessment. This study supports this approach as it would appear scores are influenced by IMD decile. NHS Digital publishes PROMs scores using change in PROM score pre- and post-operation rather than absolute PROMs scores; this study supports this as both the pre- and post-operative scores appeared to be strongly correlated to IMD decile but change/improvement in score was poorly correlated and therefore is less influenced by catchment area deprivation.
185 A Review of the Systemic Medical Complications Following Joint Replacement
Authors: Curlewis K , Leung B , Thornhill C , Sinclair L , Chan G , Ricketts D 
Published: November 2022

Abstract

Aim
Arthroplasty procedures are commonly performed in the UK. For each procedure informed consent is required. To obtain informed consent the patient and their surgeon should discuss the risks and benefits of the proposed operation, including complication rates. In the literature the regional complications of arthroplasty are generally well documented. The systemic medical complications are less well described. This lack of accurate data could make it difficult for the treating surgeon to obtain valid consent.
The aim of this paper was to review and compare the literature regarding the rate of systemic medical complications after common arthroplasty procedures.

Method
A literature search was conducted using the PubMed, Cochrane Library and MEDLINE databases. Studies regarding the systemic medical complications and mortality rate of joint replacement published within the last 10 years were included. Any studies focusing purely on regional complications, non-English language or with no full text available were excluded.

Results
We found that systemic complications were more frequent than regional complications following arthroplasty. The systemic complication rates were hip: 5.1%, knee: 6.9%, ankle: 3.0%, shoulder: 11.2%, elbow: 8.5% and wrist: 0%. The most common systemic medical complication following arthroplasty was venous thromboembolism. Pre-operative co-morbidity was the most important risk factor for both post-operative mortality and systemic medical complications following arthroplasty procedures.

Conclusions
We recommend that to obtain informed consent for arthroplasty procedures, the given rates of systemic medical complications of joint replacement should be discussed and documented.
223 Joint Aspirations for Suspected Native Septic Arthritis: A Retrospective Audit of the Diagnostic Accuracy of Aspirations and Clinical Factors Associated with a Diagnosis of Septic Arthritis
Authors: Low JW , Bell KR , Oliver WM , White TO , Duckworth AD 
Published: November 2022

Abstract

Aim
This study aimed to determine the diagnostic accuracy of native joint aspirations for adult septic arthritis (SA), and to determine clinical factors associated with a positive diagnosis of SA.

Method
Retrospective review of adult patients (≥16yrs) undergoing a major joint aspiration at a single centre over a year period (2019) were identified. Patient demographics, clinical and biochemical data, joint aspiration details, post-aspiration diagnosis, management and patient outcomes were recorded. Culture negative SA was defined as Newman's Criteria C or D.

Results
There were 161 native joint aspirations identified. The rate of positive diagnosis of SA was 13.0%, (n=21), with 16 (9.9%) culture positive SA and five (3.1%) culture negative SA. The presence of organisms on gram stain, high synovial white cell count (WCC), history of fever, intravenous drug use (IVDU) and previous SA diagnosis were associated with a diagnosis of SA (all p&lt;0.05). A history of crystal arthropathy made the diagnosis of SA less likely (p=0.025). C-reactive protein (CRP) was not statistically different in the SA and non-SA groups (Area Under Curve of ROC=0.63, p=0.55).

Conclusion
Joint aspiration is still the preferred diagnostic test when it comes to accurately diagnosing native joint SA. However, while synovial culture and gram stain are pending, a high index of suspicion for SA can be based on a combination of patient's presenting symptoms (history of fever), previous SA or IVDU, and a high synovial WCC. These factors can aid the decision as to whether an emergency surgical washout of the joint is indicated.
245 Ankle Fusion with Tibiotalocalcaneal Retrograde Nail for Fragility Ankle Fractures: Outcomes at a Major Trauma Centre
Authors: Lu V , Tennyson M , Zhang J , Thahir A , Zhou A , Krkovic M 
Published: November 2022

Abstract

Aim
Fragility ankles fractures in the geriatric population are challenging to manage, due to fracture instability, soft tissue compromise, and patient co-morbidities. Traditional management options include open reduction internal fixation, or conservative treatment, both of which are fraught with high complication rates. We aimed to present functional outcomes of elderly patients with fragility ankle fractures treated with retrograde ankle fusion nails.

Method
171 patients received a tibiotalocalcaneal nail over a six-year period, but only twenty met the inclusion criteria of being over sixty and having poor bone stock. Primary outcome was mortality risk from co-morbidities according to Charlson co-morbidity index (CCI), and patients’ post-operative mobility status compared to pre-operative mobility. Secondary outcomes include intra-operative and post-operative complications, six-month mortality rate, time to mobilisation and union.

Results
Mean age was 77.82 years old. The average CCI was 5.05. Thirteen patients returned to their pre-operative mobility state. Patients with low CCI are more likely to return to pre-operative mobility status (p=0.16;OR=4.00).
Average time to bone union and mobilisation were 92.5 days and 7.63 days, respectively. Mean post-operative AOFAS ankle-hindfoot and Olerud-Molander scores were 53.0 and 50.9, respectively. There were four cases of superficial infection. Patients with high CCI were more likely to acquire superficial infections (p=0.264,OR=3.857). There were no deep infections, periprosthetic fractures, nail breakages, non-unions. Average follow-up time was 499.3 days.

Conclusions
Tibiotalocalcaneal nailing is an effective and safe option for managing fragility ankle fractures in the elderly. This technique leads to lower complication rates and earlier mobilisation than traditional fixation methods.
298 Liver Disease Is a Risk Factor for Acute Septic Arthritis: Results from a Major Trauma Centre
Authors: Lu V , Zhou A , Thahir A , Krkovic M 
Published: November 2022

Abstract

Introduction
A hot swollen joint is commonly encountered in orthopaedics and rheumatology. With a broad range of differentials, septic arthritis (SA) is perhaps the most concerning, with delayed treatment leading to osteonecrosis, loss-of-joint-function, and mortality. To facilitate clinical decision making, we aimed to determine the risk factors for development of SA.

Method
All patients presenting to the emergency department, orthopaedic and rheumatology clinics at our major trauma centre between January 2020 and January 2021 with a hot, swollen joint were retrospectively evaluated.
The frequency of variables of interest in the three-month period preceding the diagnosis of SA were compared between SA and non-SA patients using univariate analysis. A multiple logistic regression model was formed for covariates that were significantly associated with SA (p&lt;0.05), which underwent a backwards elimination process to identify a predictive model for SA. Multi-collinearity was assessed between covariates and variables with significant intercorrelation were removed. Statistical significance was set at p&lt;0.05.

Results
221 patients were included (SA: 28; periprosthetic joint infection: 24; pseudogout: 32; gout:26; other conditions: 111). Multivariate analysis showed that RA, skin infection, and liver disease were risk factors for SA, with odds ratios of 2.656 (95%CI:1.090–6.475;p=0.032), 3.162 (95:CI:1.269–7.883;p=0.013), 4.993 (95%CI:1.156–21.559;p=0.031), respectively.

Conclusions
With a high mortality and morbidity rate, early diagnosis of septic arthritis is crucial. This requires understanding what the risk factors are, namely RA, skin infection, and liver disease. We believe that the models in this study are of prognostic value to clinicians who are presented with the common presenting compliant of a hot swollen joint.