bluuebunny/crossref_metadata_2025_split huggingface dataset:
335 Motor Sparing Peripheral Nerve Block: A Modern Approach to Total Knee Arthroplasty
Authors: Trivedi R , John J , Ito Y 
Published: November 2022

Abstract

Aim
To maximise postoperative analgesia, whilst minimising opioid use, motor sparing peripheral nerve blocks have been described as an alternative to local infiltration analgesia (LIA) with adductor canal block (ACB) in total knee arthroplasty (TKA). At The Robert Jones and Agnes Hunt Orthopaedic Hospital, we have developed a new technique, involving ten separate injections to the four genicular nerves, saphenous nerve, nerve to the vastus medialis, the popliteal plexus and to the medial, intermediate, and lateral cutaneous nerves of the thigh. The aim was to compare the analgesic effect of this type of motor sparing nerve block against LIA with ACB in TKA.

Method
Two groups were identified retrospectively. The test group included fifty patients who received 5ml each of 0.75% Levobupivacaine to the saphenous nerve and nerve to the vastus medialis, and 40ml of 0.25% Levobupivacaine to the four genicular nerves, the popliteal plexus, and to the cutaneous nerves. A matched control group received standard treatment with ACB and LIA.
The primary outcome was the consumption of opioid analgesics, measured as a total morphine equivalent.

Results
For patients in the test group, the mean amount of IV morphine equivalent administered in the first 48-hours postoperatively was 34mg vs 108mg. This equates to a 68% reduction in opioid consumption compared to the control group.

Conclusions
Motor sparing nerve blocks provide a significant reduction in opioid consumption compared to LIA with ACB in TKA. The results have implications in terms of pain management, reduced opioid-induced side effects and overall, enhanced patient recovery.
428 Ulna Shortening Osteotomy Using a Dorsal DCP Plate Versus Volar Low-Profile Plate: Which Is Superior?
Authors: Manley L , Rabbani M , Gupta N , Macmillan A , McKee A , Norris R , Jones J 
Published: November 2022

Abstract

Aim
There is limited literature comparing differing techniques and equipment used in ulna shortening osteotomy. This study reviewed operative outcomes of ulna osteotomies across one NHS Trust. Our aims were to compare outcomes of two different operative techniques: dorsal-approach DCP plates versus volar-approach low profile plates and to evaluate the impact of plate size on union rates.

Method
We performed a retrospective review of all patients undergoing an ulna shortening osteotomy between 2016–2021 at North West Anglia Foundation Trust. We reviewed patient demographics, surgical technique, plate size, complications, union rates and need for reoperation. Outcomes between two operative techniques were compared using Fisher's exact test.

Results
32 patients were identified. 21 had a dorsally placed DCP plate using the Stanley jig, 11 had a volar low-profile plate using alternative systems. The majority of DCP plates were 6 or 7 holes. One 5-hole plate was used, resulting in the only case of non-union. Overall complication rate was 41%. 38% of patients with a dorsal plate had symptoms of plate irritation post-operatively. 5 needed removals, which was significantly greater than in the volar plate group (rate of 0%, p = 0.03). There were no cases of nerve damage and one case of CRPS in the volar low-profile plate group.

Conclusions
We found that a 5-hole DCP plate should be avoided and dorsally placed DCP plates led to more cases of plate irritation requiring removal. Overall, rates of union and improvements in function and pain scores were acceptable and comparable regardless of surgical technique used.
497 Biomechanics of Fragility Hip Fractures and Its Effect on Fixation Implant Choice
Authors: Leow TW , Massoumi A , Hammouche S 
Published: November 2022

Abstract

Aim
Fragility hip fracture is associated with significant morbidity and mortality. Bone fracture biomechanics are central to orthopaedic surgery as it is vital to optimise patient outcomes. This review aims to provide the relevant biomechanics of hip fracture for clinicians.

Method
The following terms were used in Embase and Medline: biomechanics, hip fracture, proximal femoral fracture, and fragility fracture. Bibliographies of review articles were scrutinised to identify any articles that were not captured. A narrative review is performed to summarise all the relevant articles identified.

Results
Vertical loading of the hip joint results in the upper cortex being stretched and lower cortex being compressed. Consequently, the neck breaks from the upper subcapital border to the lesser trochanter, which is rare in clinical practice. In contrast to vertical loading, sideways impact on the greater trochanter compresses the femoral neck. The resulting fracture are more often basicervical or trochanteric fracture.
Dynamic hip screw (DHS) remains the preferable implant for stable extracapsular fracture. On the other hand, intramedullary nail (IM) is a better choice for unstable extracapsular fracture due to its biomechanical and clinical superiority over DHS. Lag screw placement in the inferior-central position (inferior on anteroposterior and central on lateral radiograph) is thought to provide the greatest stability and outcomes.

Conclusions
Vertical loading often leads to subcapital hip fracture and horizontal impact results in trochanteric or basicervical hip fracture. The choice of implant used to treat hip fracture depends on the specific needs of the implant to counter the different forces that caused the fracture.
523 Effect of the COVID-19 UK Lockdown on Lower Limb Tendon Ruptures
Authors: Yasen Z , Islam Saad , Hasnain Adil , Ali Shahanoor , Raja Hassan , Tsitskaris Konstantinos 
Published: November 2022

Abstract

Aim
Achilles tendon ruptures are known to be prevalent in the ‘weekend warrior’, individuals who are intermittently active on a background of sedentary behaviour. There is minimal literature that looks at whether this impacts the incidence of rupture of other tendons. In the spring of 2020, a ‘lockdown’ was announced in the UK in response to the COVID-19 pandemic. In this study we aim to assess whether the incidence of lower limb tendon rupture had increased compared to other years, and whether the incidence changed as exercise allowance was increased.

Method
A retrospective study was performed at a London district general hospital assessing the incidence of Achilles, patellar and quadricep tendon rupture presenting during the lockdown period, and the corresponding periods in 2019 and 2021.

Results
In 2020 there was a significant increase in incidence of Achilles (2021: 16, 2020: 14, 2019: 8) and patellar (2021: 2, 2020: 7, 2019: 1) tendon ruptures, whereas quadricep (2021: 0, 2020: 2, 2019: 0) tendon ruptures did not differ significantly. There was an increase in the incidence of Achilles tendon rupture as exercise allowance was increased.

Conclusions
This study reinforces the necessity of stepwise return to play protocol for deconditioned athletes as well as the advantages of an active lifestyle for the general population. The results also indicate that patellar rupture may be influenced by the same lifestyle factors as Achilles rupture and should prompt larger studies across multiple sites to confirm this.
588 Incidence and Clinical Significance of Incidental Findings in Major Trauma Patients
Authors: Dixon S , Knight C , Smith S 
Published: November 2022

Abstract

Aim
This study aimed to characterise and demonstrate the clinical importance of incidental findings (IF) for patients presenting to a Major Trauma Centre (MTC).

Method
A prospective review of 941 consecutive patients who were imaged and subsequently admitted to hospital as Major Trauma. IF unrelated to the trauma were analysed from radiological imaging reports and documented management was reviewed.

Results
594 patients (63.1%) received a pan/trauma CT, 225 (23.9%) had isolated CT scans and 122 (13%) had X-Rays only. 365 (38.7%) patients had a total of 647 IF. Of these: 15 (2.3%) were suggestive of malignancy (e.g., colon mass, liver tumour). 41 (6.3%) represented acute pathology requiring urgent intervention (e.g., pulmonary embolism, consolidation). 148 (22.9%) represented likely benign pathology but required further investigation or routine follow-up (e.g., pulmonary nodules, pancreatic cysts). 443 (68.5%) represented benign or chronic pathology not requiring any specific follow-up (e.g., hiatus hernia, diverticular disease). The reporting radiologist advised further investigation or review in 61 (6.5%) cases. This was actioned and documented in 44 (72.1%) cases by the MTC clinician as part of the tertiary survey. 9 patients still lacked adequate documentation, 2 were transferred to a different hospital, 1 self-discharged and 5 were never reviewed by the major trauma team.

Conclusion
The common utilisation of pan/trauma CT scanning in Major Trauma identifies a high volume of IF. Over a quarter represented potentially clinically significant findings that require onward investigation. MTC should ensure they have appropriate systems to capture and document IF including actioning further investigation and follow up.
603 Evaluation the First Ray Instability Using the Double Dorsiflexion Test: A Prospective Observational Case-Controlled Study
Authors: Solomou G , Pasapula C , Al-Sukaini A , Liew I , Goetz J , Cutts S 
Published: November 2022

Abstract
First-Ray (FR) stability allows for foot propulsion in-stance, taking 60% weight. First-ray instability (FRI) is associated with middle column overload, synovitis, deformity, and osteoarthritis. Clinical detection can still be challenging. We propose to develop a clinical test that helps identify FRI using two simple manual manoeuvres.
10 patients with unilateral FRI were recruited. Stringent exclusion criteria were applied including hallux MTP pain, laxity, inflammatory arthropathy. A Klauemeter directly measured the sagittal plane dorsal first metatarsal head translation of affected vs unaffected feet. Maximum passive proximal phalanx 1st MTP joint dorsiflexion was measured using Tracker motion software analysis with and without applying a dorsal force at the 1st metatarsal head using a Newton meter. P-value of &lt;0.05 was considered significant.
FRI feet had dorsal translation greater than 8mm (median, 11.94; interquartile range [IQR], 10.23–13.81) vs 1.77 for unaffected control feet was (median, 1.77; interquartile range [IQR], 1.23–2.96) using the Klauemeter. The percentage reduction in 1st MTP joint dorsiflexion ROM when applying the double dorsiflexion test FRI (mean reduction of 67.98%) when compared to control feet (mean reduction of 28.44%)(P&lt;0.01). Receiver operating characteristic (ROC) analysis showed that a 50% reduction in dorsiflexion ROM of 1st MTPJ when performing the double dorsiflexion test achieved a specificity of 100% and sensitivity of 90% (AUC =0.990, 95%CI [0.958–1.000], P&gt;0.0001).
The double dorsiflexion (DDF) is easy to perform with manual manoeuvres that avoid complex instrumented and radiation-based assessment. A greater than 50% decrease in proximal phalanx motion has an over 90% sensitivity in identifying feet with FRI.
631 A Comparison of the Microbiology Profile for Two-Stage Revision Surgery in Periprosthetic Joint Infection (PJI) of Primary Knee Arthroplasty and Lower Limb Endoprostheses for Tumour Surgery
Authors: McCulloch RA , Adlan A , Jenkins N , Parry M , Stevenson J , Jeys L 
Published: November 2022

Abstract

Aim
To compare the microbiology organisms responsible for PJI in patients who underwent two-stage revision of infected primary knee replacement with two-stage revision of infected oncological endoprostheses of the lower limb in a single institution.

Method
118 patients were treated with 2-stage revision surgery for infected knee arthroplasty and lower limb endoprostheses between 1999 and 2019. 74 patients had two-stage revision for PJI of knee arthroplasty and 44 had two-stage revision to eradicate infection of lower limb endoprostheses for tumour resection. All microbiological data from the first stage sampling was collected and analysed retrospectively. Patient host and extremity criteria were categorised according to the MSIS Host and Extremity Staging System.

Results
According to the MSIS Staging System, the host and extremity grade of the knee arthroplasty PJI cohort were significantly better than endoprostheses PJI(p&lt;0.05). The incidence of multi-drug resistance (MDR) was higher, 36% in the endoprosthetic group compared to 17% in the infected primary knee replacement group (p=0.001). MDR was most common in coagulase-negative staphylococcus. Gram-positive organisms were isolated in more than 80% of cultures from both cohorts. Coagulase-negative staphylococcus (CoNs) was the commonest gram-positive organism and E Coli was the commonest Gram-negative organism in both groups.

Conclusion
Patients presenting with PJI after lower limb endoprostheses have a higher incidence of MDR organisms compared to an arthroplasty cohort. Pre-operative microbiological sampling and meticulous sampling methods intra-operatively are extremely important in these patients.
720 Dynamic Hip Screw vs Short Intra Medullary Nail - Which Is Safer for the Surgeon: A Retrospective Comparison of Radiation Exposure
Authors: Noton T , Khanom S , Kazzazi F , Magill H , Bagouri E , Abd Wahab EH , Vasireddy A 
Published: November 2022

Abstract

Aim
Dynamic hip screws (DHS) and short intra medullary (IM) nails are fixation methods used for neck of femur (NOF) fractures. Both require fluoroscopic assistance within the operating theatre, therefore exposing the surgeon and patient to ionising radiation. There is minimal literature investigating radiation exposure. Aims of this study are to compare the radiation doses in each procedure and to estimate a normalised dose.

Method
Retrospective data analysis was carried out for patients who underwent fluoroscopically assisted surgical management of NOF fractures using DHS and short IM nail over a 3-year-period. Data was sourced using electronic operative records and Sectra PACS imaging software. Radiation dose parameters collected were the cumulative dose in milligrays (mGy), cumulative dose area product (DAP) (Gy.cm2) and time of exposure in minutes and seconds. Statistical analysis was performed using SPSS statistical software.

Results
A total of 56 patients were treated with a DHS, and 46 with short IM nails (Short TFNA - Synthes). 79% of DHS cases were for extra capsular neck of femur fractures versus 100% of short IM nails. Cumulative radiation dose for the DHS group demonstrated a mean of 6.007mGy, compared to 1.153mGy for the short IM nail. Mean exposure times were 1:39 for the DHS group compared to 1:32 for the IM nail.

Conclusions
Our study showed the difference in cumulative radiation exposure was significantly less when using the short IM nail compared to the DHS. Additional radiation should be considered a safety hazard for the surgeon, theatre staff and patients.
748 A Comparison Between Arthroscopic Capsular Release and Hydrodilatation in the Treatment of Frozen Shoulder
Authors: Hunter J , Adam JR , Howell G 
Published: November 2022

Abstract

Aim
Frozen shoulder (FS) is a common but poorly understood condition with no gold standard identified, two options include arthroscopic capsular release (ACR) and hydrodilatation (HD). Recently, the use of HD has become increasingly popular, and this study aims to compare the outcomes of patients undergoing ACR and HD.

Method
A retrospective analysis of 171 patients diagnosed with FS and treated with either ACR or HD. Data was collected on demographics, range of motion (pre and post procedure), diabetic or trauma status and outcome. The primary outcome measure was whether the patient required further treatment. The secondary outcome measure was the range of motion. Subgroup analyses were also performed on diabetic and post-traumatic groups with frozen shoulder.

Results
A total of 71 patients had an ACR and 100 patients had HD, with 73.2% and 70% of patients being discharged respectively. The average age was 54.5 years in the ACR cohort and 54.1 years in the HD cohort. There was a significant improvement in range of motion for both cohorts and no difference in the efficacy of the treatments. The same result was found for diabetic and trauma patient subgroups. However, diabetics were 2.41 times more likely to require further treatment than non-diabetics.

Conclusion
ACR and HD are effective treatments, however, no significant difference in outcome between the two was found. HD has a lower cost and less risk attached compared to ACR, making it preferable. Where HD isn't successful, ACR provides another reliable option.
775 Role of Inversion Imaging in the Diagnoses of Neck of Femur Fractures
Authors: Ahmed M , Saad A , Bani-Khalid A , Kho J , Sonsale P , Iyengar K , Botchu R 
Published: November 2022

Abstract

Aim
The objective of this study was to assess whether inversion of grey scale radiograph images has any impact on the diagnostic sensitivity and inter-observer reliability in diagnosing neck of femur fractures.

Method
We performed a retrospective, single centre study, using 50 randomly selected AP pelvis radiographs. The images included a combination of normal, intracapsular and extracapsular neck of femur fractures, which had been confirmed on CT, MRI and/or subsequent surgery.
Four independent observers (two orthopaedic specialists, one registrar and one SHO in orthopaedics) reviewed the images and graded each radiograph image using the Likert scale in response to the statement “there is a fracture”. Following this, the same radiographs were inverted to grey scale images and sent for a second review using the same method. RAND correlation was used for statistical analysis.

Results
Overall, observers appeared to have similar accuracy and equivocal rates with normal and inversion radiographic imaging.
One of the T&O Consultant's had much higher equivocal rate when analysing inverted radiographs compared to conventional digital radiographs but had slightly higher accuracy with inversion (95.35% compared to 93.88%) as well as the Registrar (83.33% compared to 81.63%). The second Trauma and Orthopaedics Consultant had slightly more accuracy with conventional digital radiographs (89.58% compared with 87.50%).

Conclusions
Inversion of digital radiographs did not affect the diagnostic sensitivity of neck of femur fractures in our study, and similarly did to not have a statistically significant impact in clinician confidence in diagnosing neck of femur fractures.
796 Post Operative Drop in Haemoglobin Is Associated with Increased Morbidity and Mortality in Fracture Neck of Femurs
Authors: Ayesha R , Gravett E , Craig J , Anto J 
Published: November 2022

Abstract

Aim
Post-operative anaemia in hip fracture patients is associated with increased risk of blood transfusion, poorer outcomes, increased morbidity, and mortality. Our aim is measure the drop in haemoglobin(Hb) post-operatively in hip fracture surgery and its impact on length of stay, morbidity and 30-day mortality.

Method
A retrospective study of neck-of-femur patients looking at pre-op and discharge haemoglobin levels, taking into consideration conditions that could affect Hb, and adverse effects peri-operatively.Data collected from Medway, Clinic letters, ICE and NHFD database.

Results
257 patients were included in the study. Mean age was 82(range 43–100). Pre-operatively 60(23%) had normal Hb, 34(13%) had borderline, and 163(64%) had severe anaemia. 131(51%) had hemi-arthroplasty, 61(24%) had DHS, 45(18%) had IM nail and 20(7%) had THR.Normal Hb found in 62 patients (24%), 33(13%) had borderline and 162(63%) had severe anaemia at discharge.30 patients (11.7%) had post-op transfusions and 7 were prescribed oral iron. Readmission rate was 4.3%(11 patents) of which 8(73%) had severe anaemia.Average length of stay in patients with severe anaemia was 21 days.Overall 30-day mortality was 17%(43 patients); in patients with severe anaemia, mortality was 50%(21 patients).

Conclusions
Most patients (63%) had severe anaemia at discharge. There was a significant drop of Hb post-operatively especially THR and hemi-arthroplasty. Our study demonstrates pre-surgical anaemia in hip fracture patients is associated with increased hospital morbidity and mortality.Identification of anaemia at admission and discharge provides an opportunity for treatment to avoid transfusions and improve patient outcomes.
807 The Association between Blood Transfusion and Outcome in Hip Fracture Patients
Authors: Brasnic L , Martin C , Ward K , Adam K , MacLullich A , Farrow L 
Published: November 2022

Abstract

Aim
Hip Fractures are endemic in older adults across Europe, with potential increases in incidence expected as the population ages. Management of blood loss and anaemia is a mainstay of care for these patients, but there is still significant debate regarding balance between benefit and risk of liberal versus restrictive transfusion policies. Understanding the association between providing blood products and adverse healthcare outcomes in hip fracture patients is a key component in the transfusion decision-making process.

Method
This retrospective cohort study uses national audit data from the Scottish Hip Fracture Audit (SHFA) and the Scottish National Blood Transfusion Service (SNBTS) to examine the association between blood transfusion and important hip fracture process of care measures and healthcare outcomes.

Results
A total of 28 461 patient records were included for assessment across 19 acute hospitals. Blood transfusion during admission was associated with a small but statistically significant decrease in survival at both 30 and 60 days. Those receiving blood transfusion during admission were less likely to be mobilised by the end of the 1st post-operative day, less likely to have a length of stay below the average and had far lower probability of discharge.

Conclusion
This study found that blood transfusion is associated with poor healthcare outcomes following hip fracture, even when adjusted for potential confounding factors. This likely reflects the potential harm of perioperative anaemia rather than any direct impact from transfusion. Further work to reduce perioperative blood loss is therefore key to improving important hip fracture outcomes.
848 Cannulated Screws vs DHS Fixation for Undisplaced Intracapsular Neck of Femur Fractures
Authors: Fitzpatrick N , Lynch-Wong M 
Published: November 2022

Abstract

Introduction
The FAITH RCT (Lancet 2017) described the results of cannulated screws (CS) vs dynamic hip screw (DHS) fixation for undisplaced intracapsular NOF fractures in 1108 patients. Data compared reoperation rates, 24-month mortality and progression to avascular necrosis (AVN). Via retrospective analysis of data from 2018–2020 NHFD, we aimed to compare local outcomes over a 3-year period.

Method
Data was collected from NHFD, retrospectively analysed from the past 3 years. 93 patients were included, having undergone CS or DHS fixation for an undisplaced intracapsular NOF fracture. Data comparing length of hospital stay, reoperation rate and progression to AVN were compared.

Results
FAITH described reoperation rates of 20% for DHS fixation vs 22% for CS fixation. Data from the last 3 years suggests a reoperation rate of 0% in the DHS cohort vs 6.89% with CS. Locally, there was a 24-month mortality of 21% vs 14% in the study population. Those undergoing CS fixation had an acute inpatient stay of just 8.72 days vs 10.55 days in DHS patients, likely reflecting the less invasive nature of the former. No reports of avascular necrosis were reported locally, compared to 7% in the FAITH trial.

Conclusions
Cannulated screw fixation leads to shorter inpatient stays and had no higher incidence on AVN in those included in the study. Whilst it had a higher 24-month mortality, the study did not adjust for confounding variables such as concomitant injury. Locally, reoperation rates were lower than the FAITH trial suggested, as were rates of AVN.