bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP-491 Retrograde Hindfoot Nailing for the Treatment of Acute Ankle Fractures in the Elderly - A Systematic Review and Meta-Analysis
Authors: Lu Victor , Tennyson Maria , Zhou Andrew , Fortune Mary , Thahir Azeem , Krkovic Matija 
Published: November 2022

Abstract

Aim
Fragility ankle fractures are traditionally managed conservatively or with open reduction internal fixation (ORIF). Tibiotalocalcaneal (TTC) nailing is an alternative option for the geriatric patient. This meta-analysis provides the most detailed analysis of hindfoot nailing for fragility ankle fractures.

Methods
A systematic search was performed on MEDLINE, EMBASE, Cochrane Library, Scopus, Web of Science, identifying fourteen studies for inclusion. Studies including patients over 60 with a fragility ankle fracture, treated with TTC nail were included. Patients with a previous fracture of the ipsilateral limb, fibular nails, and pathological fractures were excluded.
Meta-regression analyses were performed to explore sources of heterogeneity, and publication bias was assessed using Egger's test.

Results
312 ankle fractures were included. The mean age was 77.3 (32–101) years. 26.9% were male, and 41.9% were diabetics. The pooled proportion of superficial infection, deep infection, implant failure, malunion, and all-cause mortality was 0.10 (95%CI:0.06–0.16; I2=44%), 0.08 (95%CI:0.06–0.11, I2=0%), 0.11 (95%CI:0.07–0.15, I2=0%), 0.11 (95%CI:0.06–0.18; I2=51%), and 0.27 (95%CI:0.20–0.34; I2=11%), respectively. The pooled mean post-operative OMAS score was 54.07 (95%CI:48.98–59.16; I2=85%). The best-fitting meta-regression model included age and percentage of male patients as covariates (p=0.0263), and were inversely correlated with higher OMAS scores. Egger's test (p=0.56) showed no significant publication bias.

Conclusion
TTC nailing is an adequate alternative option for fragility ankle fracture management. However, current evidence includes mainly case series with inconsistent outcome measures reported and post-operative rehabilitation protocols. Prospective RCTs with long follow-up times and large cohort sizes are needed to clearly guide the use of TTC nailing for ankle fractures.
EP-494 Ankle Fusion with Tibiotalocalcaneal Retrograde Nail for Fragility Ankle Fractures: Outcomes at a Major Trauma Centre
Authors: Lu Victor , Tennyson Maria , Zhang James , Zhou Andrew , Thahir Azeem , Krkovic Matija 
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.
EP-496 Hip Arthroscopy for the Primary Management of Femoroacetabular Impingement with Concomitant Chondral Lesions - A Systematic Review and Meta-Analysis
Authors: Lu Victor , Andronic Octavian , Zhang James , Khanduja Vikas 
Published: November 2022

Abstract

Introduction
Femoroacetabular impingement (FAI) is an important cause of hip pain in the young, active population. Treated by hip arthroscopy (HA), chondral lesions are frequently seen, and there are concerns that patients with chondral defects leading to hip osteoarthritis (OA) will not benefit from HA. This review analyses the use of HA in FAI patients with chondral lesions according to Outerbridge classification.

Methods
A systematic search was performed on MEDLINE, EMBASE, Cochrane Library, Web of Science. From twenty-four included studies, patient related outcome measures (PROMs), total hip arthroplasty (THA) conversion rate, radiological outcomes were collected. Clinical studies of HA used for primary FAI management, classifying chondral lesions according to Outerbridge classification were included. Patients treated with open procedure, osteonecrosis, Legg-Calve-Perthes disease, previous ipsilateral hip fractures were excluded. Risk of bias was assessed using ROBINS-I.

Results
Improved post-operative PROMs included mHHS (n=18; mean difference:-2.42; 95%CI:-2.99 to -1.85; p&lt;0.0001), NAHS (n=8; mean difference:-1.73; 95%CI: -2.23 to -1.23; p&lt;0.0001), VAS (n=7; mean difference:2.03; 95%CI:0.93–3.13; p&lt;0.0001). Pooled rate of revision surgery was 10% (95%CI: 7%-14%). Most of this included conversion to THA, with a 7% pooled rate (95%CI: 4%-11%).
Patients had worse PROMs if they underwent HA with labral debridement (p=0.0149), have Outerbridge 3 and 4 lesions (p=0.0116), kissing lesions (p=0.0292). Reconstructive cartilage techniques were superior to microfracture (p=0.0416). Even in “kissing” lesions, employing either microfracture or cartilage repair/reconstruction provided a benefit in PROMs (p=0.0267).

Conclusion
This meta-analysis suggests that acceptable post-operative outcomes following HA in patients with FAI and concomitant moderate-to-severe chondral lesions, can be achieved.
EP-506 Kidney transplant rejection rate comparing Alemtuzumab versus Basiliximab during covid pandemic against pre-covid period
Authors: Rai Jason , Sinha Sanjay 
Published: November 2022

Abstract

Aims
To review kidney transplant rejection rate following change in immunosuppression regime due to covid pandemic. Induction immunosuppression changed from Alemtuzumab pre-covid to Basiliximab during covid pandemic period. Maintenance immunosuppressant included the addition of prednisolone to tacrolimus and mycophenolate in the covid period.

Methods
Retrospective analysis of patients that underwent cadaveric kidney transplant in a single transplant surgical unit. Rejection was confirmed following transplant kidney biopsy.

Results
Total of 192 patient records were reviewed. 96 patients underwent kidney transplant between March to November 2019 (pre-covid group). 96 patients underwent kidney transplant between March to July 2020 (covid pandemic group). Rejection number pre-covid group was 6 (total number of biopsy was 30). Rejection number covid group was 5 (total number of biopsy was 14). Pre-covid group follow up was for 16 months. Covid group follow up period was for 6 months.

Conclusions
Early follow up result suggests possibly higher rejection rate with Basiliximab when compared to Alemtuzumab group. Longer term follow up in post-covid kidney transplant needs to be carried out to draw stronger conclusion. Risk of lymphocyte depleting induction agent during covid crisis versus potential higher risk of rejection with non-depleting agent needs to be balanced.
EP-511 The influence of the national lockdown during the COVID-19 pandemic on surgical presentations and admissions in a university hospital
Authors: Dhunnoo Vedika , Haq Iram , Rutka Olga 
Published: November 2022

Abstract

Background
The COVID-19 pandemic has significantly revolutionised medical practice around the world. Healthcare resources had to be prioritise for the management of patients infected with the virus whilst routine and elective surgeries were postponed in order to free up hospital beds in anticipation for the influx of patients with COVID-19 requiring hospital admission. With the government announcing a national lockdown in March 2020, a striking reduction in the number of patients presenting to hospital was noted.

Aim
Our aim was to establish how the COVID-19 pandemic has impacted on the number and presentations of general surgical patients in a university hospital.
Method: We conducted a retrospective study on general surgical patients who were reviewed by the surgical team at the University teaching hospital. Data was collected over two 7-weeks periods; between the 23rd March and 10th May 2020 (the first lockdown duration in the UK) and the corresponding 7-weeks in 2019 (that is between 25th March and 12th May 2019).

Results
The analysis of our data showed that there was a significant reduction in the number of surgical patients being admitted. 399 patients were admitted between 25th March and 12th May 2019 compared to only 245 patients during the lockdown period. The average admissions per day over the 7-weeks period dropped from 9 admissions per day in 2019 to 5 admission per day during national lockdown. Small bowel obstruction and pancreatitis remained common diagnoses in both 7-weeks periods, however diverticulitis was less common during lockdown.
EP-519 A Bit of a Headache: Management of Head Injuries in a District General Hospital
Authors: Bruce Nikki , Young Jamie 
Published: November 2022

Abstract

Aim
Head Injury is a common presentation in our DGH, which covers a large rural area and is now a regional trauma centre. We audited our management of head injuries against current guidelines and planned a new pathway to ensure patients receive the correct advice and follow up on discharge.

Method
Data was requested from IT for all head injury episodes in 2019, to reflect usual numbers pre-pandemic.
Electronic letters, radiology and notes were used to identify whether imaging criteria was met/carried out, discharge destinations, re-presentations, specialty discussions, and head injury advice on discharge.

Results
307 individual patients identified.
13 re-presentations.
10 required neurosurgical discussions.

Destinations
226 (73.6%) discharged direct from ED. Admissions; Surgical - 37 (12%), Medical - 6 (2%), Paeds – 14 (4.5%), ITU 2 (0.7%), Did not wait – 2 (0.7%), Not Recorded – 7 (2.3%).

Imaging
100 patients met NICE criteria for CT, 100% were documented in notes and had CT. 76% reported normal, 18% had a bleed, contusion or haematoma.
HI advice 90% of ED discharges, 16% of Surgical and 16% of Medical discharges had head injury discharge advice documented.

Conclusions
Guidelines were met for 100% of patients requiring imaging Head injury advice was well documented in ED but fell down in ward paperwork.
We have written a robust pathway where all inpatients have a proforma completed during admission with prompts for discharge advice and rehab referral where appropriate, this is currently undergoing a re-audit to ensure improvement and if successful will become an established part of the trauma pathway in our hospital.
EP-534 Review of Types of Intravenous Fluid and Rate of Administration in Resuscitation of Acute Pancreatitis Patients
Authors: Rakhimov Iskandar , Badawi Marwa , Lee Sara , (Allenis) Mak Tsz Lun 
Published: November 2022

Abstract

Aim
Acute pancreatitis even in its mildest form leads to dehydration that requires correction by intravenous fluid in timely fashion. The pathophysiology of fluid deficit is caused by fluid shift as a result of severe inflammation in the abdomen, lung damage and compromise to renal functions.
The evidence behind choice of fluid used for resuscitation is limited, but delayed resuscitation is linked to increased mortality, however overly aggressive fluid administration could lead to lung injuries.
Aggressive fluid resuscitation is defined as 15ml/kg/hour or &gt;3.1L in the first 24 hours while conservative administration is defined as 5–10ml/kg/hour.

Methods
We reviewed our admissions with acute pancreatitis in August & September 2021. The age range was 24–94 years, diagnosis was confirmed by raised amylase, clinical symptoms and radiological evidence.
55.5% received Hartman's solution, 18.5% of patients received normal saline and 26% received both. The mean amount of fluids was 3Litres and the mean rate of first, second and third Litres was 4hours, 3.4 hours and 3.7 hours/Litre respectively in the first 24 hours.

Results
The mean LOS was 3.2 days, none of our patients were re-admitted for complications related to pancreatitis within 90 days, 1 patient had complicated necrotising pancreatitis and 1 patient deceased during their stay.

Conclusion
NICE guideline NG104 did not specify clear guidance on rate of fluid resuscitation, low quality evidence suggested possible benefit of aggressive therapy comparing mortality and systemic complications. We recommend individual assessment of rate of fluid administration for every patient to ensure absence of contraindications to aggressive therapy.
EP-546 Management of breast cancer in different age groups during pandemic single institute review
Authors: Muhibullah Nazli , Ng James , Cuffolo Giulio , Whisker Lisa 
Published: November 2022

Abstract

Introduction
Covid 19 has huge impact on healthcare in general and challenges in cancer services in particular. In breast cancer prioritization strategies for management have been introduced at start of pandemic by different medical associations.

Aim
We aim to see impact of prioritization strategy in treatment of premenopausal and postmenopausal breast cancer patient. This is further stratified as under 50, 50 to 70 and over 70.

Methods
A prospectively collected database from March 2020 to March 2021 analysed. This include patient demographic, tumour characteristics, Neoadjuvanct endocrine NAET), Neoadjuvanct chemotherapy (NACT), primary endocrine (PE), type of surgery: breast conservation surgery (BCS) with or without oncoplastic procedure, Mastectomy with or without reconstruction and utilization of private sectors.

Results
Total 454 patients reviewed. Mean age 61 yrs (26–97yrs).
Total patient less than 50 years were 116. BCS 66 (57%), Simple mastectomy 26 (22%), Mastectomy with reconstruction 24 (20%).In this group 45 patients were offered NACT and 6 patients had NAET.
Total patients older than 50 years were 236. BCS 191 (80%), Simple mastectomy 38 (16%) and Mastectomy with reconstruction 7(3%) patients. In this group 69 patients had NACT and 13 had NAET.
Patients over 70 years were 102. BCS 57(56%), Simple mastectomy 25(24%), 1 (1%) had mastectomy and reconstruction. 8 patients had NACT, 13 had NAET and 30 had primary endocrine.

Conclusion
Due to swift guidelines in pandemic times breast cancer services were largely intact and provide standard care.
EP-553 A Review of feedback for the Surgical department teaching for foundation doctors
Authors: Gulnaz Nadia , Tasleem Sadia , Siddique Khurrum 
Published: November 2022

Abstract

Aims
To assess the usefulness of departmental teaching for the foundation doctors.

Methods
Teaching sessions are arranged every Friday covering the most common surgical problems and the management steps appropriate for their level. A feedback questionnaire was sent out to the foundation doctors at the end of their rotation and the data was analyzed for the period of August 2020 to November 2020.

Results
The feedback completion rate was 93%. 18 sessions were planned 14 of which went ahead. 1 session was canceled due to junior doctors shortage. Maximum attendees in any session were 10/14 (mean 7) Almost all of them found these sessions useful to and agreed to recommend attending (6–10 on Likert score of 0–10) 75% rated these sessions as “excellent” and all the rest as “very good”. 76% showed satisfaction with the time and space allocation. 84% agreed that the session length of 1 hour was adequate. 91% were happy with the adequacy of communication from the organizer. A vast majority suggested flexibility in session timings and relief from ward jobs for improved attendance.

Conclusion
Overall Positive Response. Most suggested the timings/ days be changed.
The topics covered were appropriate for their level and helped them in their daily practice.
Interactive and simulations sessions were the most appreciated ones.
Some necessary changes to rota were suggested in order to make these sessions more accessible and useful.
EP-555 The telescoping sigmoid – a rare presentation of acute large bowel obstruction
Authors: Al-Sabbagh Ali , Alseifi Shaker , Kaur G 
Published: November 2022

Abstract

Background
Adult bowel intussusception is a rare cause of bowel obstruction (1–5%) and requires urgent treatment, usually emergency surgery.

Aim
We wish to highlight the diagnosis and management of the rare entity of acute bowel obstruction secondary to intussusception with our adult patient with sigmoid colon intussusception.

Case presentation
We present a 65 years old male who attended with constipation, abdominal discomfort and per-rectal bleeding. Clinical examination revealed multiple subcutaneous lipomas, mild LUQ tenderness and large ‘lump’ 10 cm from anal verge on rigid sigmoidoscopy. CT abdomen/pelvis showed intussusception of the sigmoid into the rectum with a large ‘polyp’ as the lead point. On- table Flexible sigmoidoscopy was unsuccessful in reducing the intussusception. We proceeded to laparotomy with reduction of intussusception, high anterior resection with end- to- end stapled anastomosis. He made an excellent recovery. Post-operative histology which was reviewed in detail in MDT did not reveal any neoplastic/lipomatous lesion to account for the intussusception. The patient was very well on outpatient review.

Conclusion
Adult bowel intussusception is rare (5% of all intussusceptions), especially in the left colon. When it does occur, it is usually secondary to lipoma, neoplasm, or nodal mass acting as a lead point. These patients can be diagnostically challenging due to lack of clear obstructive symptoms on presentation. Early diagnosis (via a CT scan) and treatment of adult colonic intussusception (usually via surgery) is necessary to avoid serious complications such as bowel perforation/peritonitis. Postoperative histology review is also imperative to plan any appropriate further management.
EP-567 Stress Thrombosis - A case of spontaneous DVT of upper extremity
Authors: B M Darshan , Somasekhar Kasa 
Published: November 2022

Abstract

Background
Primary spontaneous upper extremity deep vein thrombosis is rare with an estimated annual incidence of 1 to 2 cases per 100,000 population. The majority of cases are secondary and related to central venous cannulation (eg, central line, pacemaker) or prothrombotic states. On the offset of COVID-19 pandemic such cases could become a common entity.

Case Report
An elderly diabetic and hypertensive female patient presented with a history of acute onset swelling, heaviness, tingling and numbness of left upper limb since 1 week. Examination revealed, diffuse swelling of left upper limb extending to neck with small dilated veins in left upper chest. A provisional diagnosis of left upper limb DVT was made based on Constants criteria and was confirmed on Duplex scanning.
The patient was started on LMWH for anticoagulation. Evaluation for occult cancers was unremarkable. Patient showed symptomatic improvement and recanalisation of thrombosed veins was noted on repeat duplex scan.

Conclusion
Upper extremity DVT (UEDVT), once a rare entity, can be seldom thought of, due to widespread interventions and ongoing COVID-19 pandemic. Focus on evaluation of occult malignancy rather for hypercoagulable states which do not change the management. This case report highlights the importance of early recognition of UEDVT and stresses on the evidence that no added benefit is achieved by performing expensive tests to rule out prothrombotic states. Early diagnosis based on Constants criteria and anticoagulation would save time and prevent grave complications.
EP-568 A prospective study on single layer bowel repair
Authors: B M Darshan , Somasekhar Kasa 
Published: November 2022

Abstract

Aim
To determine the efficacy of single layer bowel repair with respect to postoperative complications such as leakage rates, duration of repair, overall length of hospital stay, cost effectiveness, to assess the morbidity, mortality and outcome.

Methods
This prospective study was done on 21 patients admitted under department of surgery from the period of January 2020 to September 2021. All the patients under bowel repair in continuous single layer extramucosal fashion for various etiology, follow up data was collected and analysed.

Results
In our study, 81% (17 cases) of the single layer bowel repair were done in an emergency setting. The study consisted of 42.9% (9 cases) of perforation repair and 57.1% (12 cases of resection and anastomosis of large or small bowel). The average time duration of anastomosis was 14.45 minutes with the average hospital stay of 13.2 days. Our study showed an anastomotic leak rate of 9.5% (2 cases) with an overall mortality of 19.04% (4 cases) which included 2 cases with COVID-19 related ARDS.

Conclusion
Our study was determined to analyse the effectiveness of single layer bowel repair and found that it is a quicker and theoretically better technique for bowel repair which avoids unnecessary tissue ischemia. The leakage rates within the study was comparable with other studies published and the studies with double layer bowel repair technique in terms of leak rates and mortality. A meticulously done single layer repair will best double layer repair and surgical trainees must be trained early to perfect the art of bowel anastomosis.
EP-573 Does type of surgery influence recurrence of breast cancer in younger patients?
Authors: Farrugia Alexia , Green Matt , Brookes Phil , Kasana Iqbal 
Published: November 2022

Abstract
It is well established that young age is a risk factor for outcome of breast cancer, and younger women are more likely to have adverse prognostic factors. Our aim was to investigate whether type of surgery (wide local excision vs mastectomy) had any effect on local or distant recurrence in women under the age of 35.
All women with breast cancer under the age of 35 treated between 1st January 2010 and 31st December 2020 were included. Data including age at diagnosis, comorbidities, type of surgery, neoadjuvant/adjuvant treatment, histology, lymph node positivity, expression of receptors, local/distant recurrence was collected.
There were 34 patients included, age range 21–34. Ten patients had a wide local excision (WLE) while the rest had a mastectomy. Four patients had local recurrence while nine patients had distal recurrence. In WLE group 1 out of 10 had local recurrence and 2 out of 10 had distant metastasis (one of these patients had both). In mastectomy group 2 out of 24 had local recurrence and 7 out of 24 had distant metastasis (two patients had both). The average recurrence time was 1.7 years after initial diagnosis. Using a Chi-square test, there was no significant difference found for local, distant or overall recurrence between patients having wide local excision or mastectomy (p=0.719, p=0.554, p=0.462 respectively).
Type of surgery did not affect the local or distant recurrence rate. The sample size is small, and a larger series is required to determine whether it is equally safer to offer WLE to younger women.