bluuebunny/crossref_metadata_2025_split huggingface dataset:
859 A Single Center Retrospective Study Comparing Retrograde TibioTaloCalcaneal Nailing vs Open Reduction Internal Fixation of Ankle Fractures in a Comorbid Elderly Population
Authors: Oochit KK , Imran A , Brown MJC , Hrycaiczuk A , Jamal B 
Published: November 2022

Abstract

Aim
The aim of this paper is to compare the functional outcomes and complication rates of ankle fractures treated with retrograde tibiotalocalcaneal nail (TTC) and open reduction internal fixation (ORIF).

Method
Matched cohorts according to age and Charlson Comorbidities Index (CCI) (mean=6) were established by performing a retrospective search of a prospectively collated Bluespier® database for patients within our unit who underwent TTC nailing and open reduction internal fixation (ORIF) for acute trauma from 2015 to 2021.

Results
32 patients (8 males/ 24 females) were identified in both the TTC and ORIF groups with mean ages of 78.4 (55–96) and 78.3 (52–93) respectively. Mean follow-up length was 6 months in both groups. All fractures were classified according to AO classification. 3.1% of fractures were 44A, 71.9% 44B, 25% 44C in the TTC group compared to 3.1% 44A, 59.4% 44B and 37.5% 44C fractures in the ORIF group. Surgical site infection rate was 9.4% in the TTC group compared to 6.3% in the ORIF group. Both groups had a similar implant failure rate of 9.4%. 2/32 (6.3%) suffered from periprosthetic fractures in the TTC group and 1 of them required re-operation. 45% of patients in the TTC group returned to their pre-injury level of mobility compared to 40.6% in the ORIF group at their last follow up.

Conclusions
Our study showed that retrograde TTC nailing can be a useful treatment option for ankle fractures in the comorbid elderly, restoring function and enabling return to full weight bearing immediately after surgery.
866 Improving the Quality of Clinical Coding and Documentation to Record Accurate Outcomes in Non-Operatively Managed Hip Fractures
Authors: Shrestha S , Khatir MAA , Iyengar KP , Sangani C 
Published: November 2022

Abstract

Background
Our 2019 Clinical Audit for non-operatively managed hip fractures at our Trust was 9.76% against the national standard of 5% at The National Hip Fracture Database (NHFD) annual report 2017. A re-audit was conducted to review reasons for higher incidence as recommended by NICE and improve outcomes.

Method
Hip fracture patients admitted between 1st April 2019 and 31st August 2020 to Southport and Ormskirk NHS Trust were reviewed clinico-radiologically. Data was collected from NHFD, EVOLVE patient records, and PACS imaging systems. Following appropriate “Primary Diagnosis” of hip fracture, confirmation of operative or non-operative management was undertaken following a joint assessment by the Orthopaedic staff and the Clinical Coding department evaluating reasons behind the decision. Secondary outcome measures compared 30-day and one-year mortality with the previous cohort.

Results
In the re-audit, 512 cases were reviewed, 50 patients excluded following correct Clinical Coding, 440 hips were operated and 22 (4.8%) managed non-operatively. However, 30-day mortality rose from 30.5% during the audit to 54.50% possibly due to the effect of COVID-19.

Conclusions
The newly introduced “Neck of Femur Proforma” has remarkably improved the quality and organization of clinical documentation of diagnosis. Appropriate Clinical Coding allows correct information for the NHFD Trust figures.
877 Improving Daily Inpatient Neck of Femur Fracture (NOFF) Patient Care Using a Focused Review Proforma
Authors: Sambhwani S , Rayan F , Hirschowitz D , Shrestha S , Madhavan B , Shyamsundar S 
Published: November 2022

Abstract

Aim
The National Hip Fracture Database (NHFD) encompasses key parameters to reduce mortality and improve care in NOFF patients. Current practice across the NHS incorporates several different inpatient orthogeriatric models. Our quality improvement project sought to improve inpatient care delivered by orthopaedic staff with a geriatric targeted focus.

Method
An initial audit on 50 patients was conducted and key areas of concern were highlighted. A focussed proforma for daily reviews was implemented which encompassed local and national (NHFD) recommendations and this was re audited for a further 50 patients.

Results
Documentation of demographics, comoribidites and pre-operative social parameters improved from 70 to 100%. Examination of general health systems improved from 80 to 100%. Identification of nutritional abnormalities improved from 66 to 95%. Documentation of skin condition including wound care and pressure ulcers improved from 55 to 90%. Management of perioperative indwelling urinary catheters improved from 55 to 90%. Identification of unwell patients and thromboembolic risk assessments improved from 65 and 70 to 90 and 95% respectively.

Conclusions
Our targeted focused proforma facilitated an easy and comprehensive daily review for vulnernable geriatric patients. Additionally, it formed a basis for daily handover amongst juniors changing wards and was adopted formally and adapted for other geriatric services.
923 Exploring the Impact of Interhospital Transfers on Patients Who Are Managed Conservatively Following Traumatic Spinal Injury: A Scoping Review
Authors: Nedham M 
Published: November 2022

Abstract

Introduction
Traumatic spinal injury (TSI) is a devastating event that could lead to serious permanent disability to patients. Therefore, a multidisciplinary team is needed to manage such cases. In the UK, patients with a TSI score a minimum of 16 on the Injury Severity Score (ISS) and are transported to a Major Trauma Centre (MTC). In cases where patients initially present to a none MTC, patients are stabilised and transferred to MTC prominently. Specialised Spinal Cord Units (SCIU) are centres specialised in the definitive management of TSI patients and it is advised that patients get referred to SCIU in a timely manner as studies demonstrate improved patient outcomes. Early transfers are recommended due to the positive impact of early surgical decompression of the injury, which relieves the pressure on the neural tissue. Nevertheless, is this impact still positive if patients are managed conservatively?

Aim
To explore the impact of intermediate interhospital transfers on TSI patients when no surgical intervention is taking place.

Method
A scoping review is utilised to explore the research question. CINAHL, MEDLINE, Pubmed, Cochrane library and ASSIA were the search engines utilised.

Results
The search resulted in 4,595 papers. 15 met the inclusion and exclusion criteria and included in the review.

Conclusions
There are no studies that directly explored the impact of transfer on conservatively managed patients, and most of the studies were of low-quality evidence. Age, length of stay, mechanism of injury and cost were all explored as factors related to patients transfer status.
926 Peri-Operative Antibiotic Prophylaxis in K-Wire Fixation: Systematic Review and Meta-Analysis
Authors: Abul A , Karam M , Alshammari S , Alashqar M , Nisar S 
Published: November 2022

Abstract

Aim
There are presently no established standards on whether antibiotic prophylaxis is necessary during Kirschner wire (K-wire) fixation in order to reduce infection rates. The outcomes of antibiotic prophylaxis vs no antibiotic prophylaxis in K-wire fixation, were compared.

Method
A systematic review and meta-analysis were carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines, and an electronic search was carried out to identify all Randomised Controlled Trials (RCTs) and non-randomised studies comparing the outcomes of antibiotic prophylaxis groups versus those without antibiotic in patients undergoing K-wire fixation. The primary outcome was the rate of infection. The depth of infection was used as a supplementary outcome measure. The analysis employed fixed effects modelling.

Results
Four retrospective cohort studies and one randomised controlled trial with a total of 2316 patients were found. In terms of infection rate, there was no significant difference between the preventive antibiotic and no antibiotic groups (Odds Ratio [OR] = 0.72, P = 0.18). In terms of secondary outcomes, antibiotic prophylaxis had the same depth of infection rates as no antibiotics.

Conclusions
Giving antibiotics peri-operatively showed no significant difference in managing infection rates. However, more clinical trials are required to ascertain this evidence.
956 Patient-Reported Outcomes After Platelet Rich Plasma Injections for Elbow Tendinopathies
Authors: Haruna M , Stevens R , Macinnes S 
Published: November 2022

Abstract

Introduction
Elbow tendinopathies affect 1–3% of the population, with 35–50 years old most commonly being affected. It is work-related as such can lead to significant morbidity, time off work, and affect the income of patients as well as daily activities. Non-operative management is the recommended first step however, success is influenced by patient compliance. Autologous platelet-rich plasma injections are a novel approach to managing tendinopathies however, evidence of efficacy was determined by NICE to be inadequate as such recommended more research into its use.

Aim
Assess patient-reported outcomes after PRP injections for management of elbow tendinopathies.

Method
Retrospective study of 28 patients with chronic elbow tendinopathies treated with PRP injections between 2018–2020. Pre-and Post-procedure outcomes were measured using the Oxford Elbow Score questionnaire. Average f/u duration-234 days.

Results
27 patients answered the questionnaire out of 28 total patients that underwent the procedure. Of the 27 patients, 20 patients (74%) reported improvement in symptoms and were satisfied with their outcomes after one injection.

Conclusions
This study shows PRP injections are reasonable and efficient management for elbow tendinopathies in patients not managed medically. This helps strengthen arguments for PRP injections over steroids for tendinopathies as studies have shown that steroids have potential side effects, usually requires more than 1 injection for symptomatic relief and despite being beneficial in short term, is worse than other treatment options in the intermediate and long term for patients with tendinopathies.
Our numbers also coincide with previous larger studies that showed ∼70% of patients reported symptoms improving after 1 injection.
974 Fragility Fractures of the Hip: A Matched Cohort Study of Acetabular Fractures and Neck of Femur Fractures
Authors: Ali F , Musbahi O , Petohazi A , Sindhar J , Akilapa S , Bailey D , Harnett P 
Published: November 2022

Abstract

Aim
Due to an ageing population, acetabular fractures in the elderly are on the rise. Management of this group of patients remains controversial, especially as it is associated with high morbidity and mortality. With an ageing population, there will be an increasing trend in low energy associated acetabular fractures. We present the largest cohort of operatively treated acetabular geriatric patients in the UK, comparing complications and mortality, and also comparing them to patients with neck of femur fractures.

Method
A review of a prospectively collected acetabular database was conducted. All patients over the age of 60 that had an operative fixation for an acetabular fracture from 2015 to 2020 were identified. Demographic data, operative details and complications were recorded. We cohort-matched these patients with neck of femur fractures during the same period to compare patient outcomes and cohort demographics.

Results
204 patients were included in the study. The mean age was 76. The most common mechanism of injury was a fall from less than 1 metre (64%). The mean length of stay for acetabular fractures was 25 days. In-hospital mortality was 3% and 10% for acetabular fractures and neck of femur fractures respectively.

Conclusion
There is little difference in demographic information between geriatric acetabular fractures and neck of femur fractures. Operatively treated geriatric acetabular fractures are associated with greater length of stay than neck of femur fractures.
1015 Reducing Waiting Time to Surgery for Patients with Femoral Peri-Prosthetic Fractures (FPP#s): A Quality Improvement Project
Authors: Ayathamattam J , Kumar V , Shah N 
Published: November 2022

Abstract

Introduction
Research has shown that early fixation and return to mobility in femoral fragility fractures improves post-operative outcomes. Based on this, in patients with neck of femur fractures (NOF#), NICE guidelines advise fixation ‘on the day of or the day after admission’. However, no guidelines exist in the case of femoral periprosthetic fractures (FPP#) despite emerging evidence showing improved outcomes in this cohort of patients also.

Method
We retrospectively analysed the waiting times from admission to surgery for NOF#s and FPP#s admitted between 1/9/20 to 1/4/21 at St. Richard's and Worthing Hospitals that required surgery. 30 FPP# and 503 NOF# patients were admitted during this period. Data was collected on all FPP# patients and a randomly selected cohort of 30 patients from the NOF# group.

Results
There was an average waiting time of 1.3 days for NOF#s and 3.7 days for FPP#s from admission to surgery.

Conclusions
This initial data demonstrates the longer waiting times for FPP# patients. We identified key areas where improvements could be sought decreasing time until CT scanning for evaluation of fracture pattern and decreasing time until a specialist opinion from a hip surgeon to decide between operative fixation or conservative management. By addressing these and educating team members about the positive outcomes by reducing delays to surgery in FPP# patients we hope to decrease their waiting times. We are currently re-auditing to identify any improvements and any further facets for advances in the future.
1034 Radiological Outcomes Following Surgery for Developmental Dysplasia of the Hip
Authors: Czyzykowska K , Baird E 
Published: November 2022

Abstract

Aim
Developmental dysplasia of the hip (DDH) is a condition affecting newborns, in which abnormal acetabulum development can result in femoral head subluxation or dislocation. This study aims to retrospectively evaluate radiological outcomes of patients with DDH, treated by either closed reduction, open reduction, or open reduction with osteotomy.

Method
This study included 59 hips of 54 patients with a median age of 19.6 months at the time of surgery. Radiographs were assessed for the International Hip Dysplasia Institute (IHDI) grade of dislocation, acetabular index (AI), centre-edge angle (CEA), Severin classification and avascular necrosis (AVN).

Results
Median duration of follow up between primary operation and latest available radiograph was 4.9 years. Pre-operatively, 41 hips were IHDI Grade IV, 16 hips were Grade III and two hips were Grade II. Mean pre-operative AI was 37.9°, which decreased to 22.7° at the latest follow up. Mean CEA was 22.9°. 25 hips were found to be Severin class I, eight hips were class II and three hips were class III. Four hips developed Group II AVN and one hip developed Group III. Nine hips required further surgery.

Conclusions
The study found overall favourable radiological outcomes of treatment of DDH, with minimal differences between each operation. Longer follow up is needed to evaluate time-dependent outcomes such as Severin class and AVN. A patient-reported outcome questionnaire is necessary to provide information on the correlation of radiological outcomes and physical function.
1048 In Vitro Evaluation of the Response of Human Tendon-Derived Stromal Cells to a Novel Electrospun Suture
Authors: Nezhentsev A , Abhari R , Baldwin M , Mimpen J , Augustyniak E , Isaacs M , Mouthuy PA , Carr A , Snelling S 
Published: November 2022

Abstract

Aim
Recurrent tears after surgical tendon repair remain common, with 40% of rotator cuff repairs failing within one year. Repair failures can be partly attributed to the use of sutures not designed for the tendon cellular niche. Synthetic electrospun materials can mechanically support the tendon while providing topographical cues that modulate the immune response to promote wound healing. Here, a novel electrospun suture made from twisted polydioxanone (PDO) polymer filaments is compared to PDS II, a PDO suture clinically utilised in tendon repair.

Method
We evaluated the ability of electrospun suture and PDS II to support the attachment and proliferation of human tendon-derived stromal cells using PrestoBlue cell viability assays and scanning electron microscopy. Suture surface chemistry was analysed using X-ray photoelectron spectroscopy (XPS). Bulk RNA-Seq interrogated the transcriptional response of primary tendon-derived stromal cells to sutures after 14 days.

Results
The electrospun suture showed increased initial cell attachment compared to PDS II. XPS revealed that both sutures had similar local surface chemistry, indicating that the tendon-like architecture of electrospun suture was responsible for the greater cell attachment. Furthermore, electrospun suture elicited a stronger transcriptional response compared with PDS II, with relative enrichment of pathways including mTorc1 signalling and depletion of epithelial-to-mesenchymal transition and extracellular matrix gene sets. Neither suture induced transcriptional upregulation of inflammatory pathways.

Conclusion
Twisted electrospun sutures show promise in improving outcomes in surgical tendon repair by allowing increased cell attachment while maintaining a tissue response indicative of cell proliferation and wound healing, without significant fibrosis.
17 Is Group and Saving Before the Modern Transurethral Resection of the Prostate Still Necessary?
Authors: Kretzmer L , Damola A , Libotte C , Apakama I 
Published: November 2022

Abstract
A group and save (G&S) sample is routinely taken preoperatively for patients undergoing a transurethral resection of the prostate (TURP). This procedure has become a key endo-urological procedure; however, it can be associated with complications such as bleeding, potentially requiring blood transfusion. The aim of our study was to assess the need for preoperative G&S sampling in all patients undergoing TURP.
This study was a retrospective review of all patients who underwent a TURP from January 2009 until December 2019 in one centre. A total of 687 patients were identified during this period. Data was collected on G&S samples, blood products and post-operative complications such as clot retention or if patients required a blood transfusion.
All patients had G&S samples taken prior to their operation, of these, only six (0.87%) patients required a blood transfusion. Half were transfused intra-operatively and half post-operatively. Remarkably, none of the transfused patients were below the National Institute for Health and Care Excellence (NICE) threshold to transfuse of &lt;70g/dl(8). Six patients were also noted to develop clot retention following removal of catheter.
This study has determined that patients undergoing a TURP rarely require blood transfusions. We propose that the practice of routinely taking G&S samples prior to this procedure should be reviewed. This would give a financial benefit and relieve patients of an unnecessary test. We would recommend thorough optimisation of patients prior to surgery including review of anticoagulation and correction of any pre-operative anaemia.
75 A Single Centre Study Evaluating the Effectiveness of Shock Wave Lithotripsy for Ureteric Stones at a Tertiary Centre in the United Kingdom
Authors: Kumar A , Gada R , Sali G , Subramonian K 
Published: November 2022

Abstract

Aim
Extracorporeal shock wave lithotripsy (ESWL) is recommended as first-line management of acute presentation or readmission for ureteric stones, in accordance with NICE guidelines (1). This large-scale retrospective study aims to evaluate the effectiveness of ESWL via the Storz Modulith SLX-F2 Machine, identifying patients who may experience greatest benefit in our tertiary centre.

Method
The medical records and CT scans of all patients who underwent ESWL for ureteric stones between 2012–2021 were analysed (n=277) using SPSS software. Data demonstrated normal distribution, hence means and standard deviation were used for analysis. Logistical regression was used to identify factors independently associated with stone clearance.

Results
The overall success rate of ESWL was 62.64% (n=265; 12 lost to follow-up). Average time to success was 50.48 days (n=146). Elective ESWL accounted for 84.48% of procedures. Analysis of factors affecting ESWL success showed that stone size (p=0.004), stone density (p=0.01), and BMI (p=0.033) significantly favoured positive outcome. Success rate was subsequently stratified based on these factors. The highest success rate was found in patients with stones &lt;5mm, density &lt;984 HU, and BMI &lt;30kg/m2. Complication rates in the study group were low, with only 7.5% of patients requiring emergency re-admission. Of these, one patient was admitted with urosepsis requiring drainage, the remainder related to pain.

Conclusions
ESWL is very effective in treating patients presenting with ureteric stones, with minimal complications. Our study helps in predicting the success rate of treatment and therefore counselling patients prior to treatment.
120 Standardizing Consent Forms for Outpatient Urology Procedures
Authors: Shrestha S , Jiang E , Sandhu A , Pinnamaraju P , Swallow T , Pai A 
Published: November 2022

Abstract

Introduction
British Association of Urological Surgeons (BAUS) guidelines have provided comprehensive and standardized guidelines for urological procedures, including indications, benefits, risks involved, and alternatives. At our institution, currently, consent forms are handwritten resulting in generalized or incomplete information given to patients.

Aim
To improve patient understanding of the procedures they are undergoing by providing standardized consent form stickers for procedures as per BAUS guidelines.

Method
Single institution data were collected retrospectively for flexible cystoscopy, stent removal, transrectal ultrasonography (TRUS), and transurethral laser ablation (TULA). Consent forms compared to BAUS guidelines. A standardized consent form sticker for each procedure was developed in accordance with BAUS guidelines and reviewed via the trust's clinical governance process. Clinicians were educated in their use for future consenting.

Results
Consent forms of consecutive patients over a two-month period were analyzed. The initial audit showed that the proportion of patients who had all risks included was 0% for flexible cystoscopy, 0% for TRUS, and 100% for stent removal. Common and rare, but serious risks were not mentioned in all cases. 100% of patients had all risks mentioned for TULA. After education on the consent process and the introduction of consent form stickers, all risks (100%) were mentioned for all procedures.

Conclusions
It is imperative that patients are fully informed about the risks, indications, and alternatives of their treatment. Failure to provide this information in full may lead to unnecessary angst, morbidity, and litigation. Simple quality improvement projects can lead to measurable improvement in patient information.