Recent Submissions

  • Grade 3 AC joint injury: a survey of current practice in the United Kingdom

    Mahajan, Ravindra H.; Kumar, Sachin; Mishra, Bhanu Pratap.; Mahajan, Ravindra H.; Kumar, Sachin; Mishra, Bhanu Pratap.; Orthopaedics; Medical and Dental; George Eliot Hospital, Nuneaton (Sage, 2019-01)
    Acromio-clavicular (AC) joint injuries are a common injury seen in athletes and represent 9% to 12% of all shoulder injuries. There is no clear consensus on treatment of grade 3 injuries. We conducted a survey among upper limb surgeons in the United Kingdom to review commonly accepted practise. We found that majority of surgeons never did stress view. Most surgeons favoured surgery only if needed but not first choice. There is no consensus on timing of surgery. There are many fixation options available for AC joint dislocation and we found that surgeon's preferences were quiet wide for choosing fixation method. That is also evident from this questionnaire as there is no consensus in orthopaedic surgeons for ideal treatment of type 3 AC joint dislocations. Authors recommend randomized controlled trial to formulate definite treatment plan.
  • Tibiotalocalcaneal nailing for osteoporotic ankle fractures in the frail patient: a narrative review with a clinical score proposal for the decision-making process

    Herrera-Pérez, Mario; Martín-Vélez, Pablo; González-Martín, David; Domínguez-Meléndez, Miguel; Galhoum, Ahmed E; Valderrabano, Victor; Tejero, Sergio; Galhoum, Ahmed E; Trauma and Orthopaedics; Medical and Dental; et al. (BioScientifica, 2022-05-05)
    Osteoporotic ankle fractures result from mechanical forces that would not ordinarily result in fracture, known as 'low-energy' trauma, such as those equivalent to a fall from a standing height or less. Osteoporotic ankle fractures in frail patients are becoming more and more frequent in daily practice and represent a therapeutic challenge for orthopaedic surgeons. The main problems with frail patients are the poor condition of the soft tissues around the ankle, dependence for activities of daily living and high comorbidity. The decision to operate on these patients is complex because conservative treatment is poorly tolerated in unstable fractures and conventional open reduction and internal fixation is associated with a high rate of complications. The authors conducted a narrative review of the literature on primary tibiotalocalcaneal nailing of ankle fractures in frail patients and categorized the different factors to consider when treatment is indicated for this conditon. Difficulty of ambulation, age over 65 years old, deteriorated baseline state and instability of the fracture were the most frequently considered factors. Finally, the authors propose an easy and quick clinical scoring system to help in the decision-making process, although further comparative studies are required to explore its validity.
  • Does intraoperative tissue sample enrichment help or hinder the identification of microorganisms in prosthetic joint infection?

    Jordan, Robert W.; Saithna, Adnan; Smith, Nicholas; Norris, Rory; Sprowson, Andrew; Foguet, Pedro; Saithna, Adnan; Orthopaedics; Medical and Dental; University Hospitals Coventry and Warwickshire NHS Trust; George Eliot Hospital, Nuneaton; University of Warwick (Springer, 2015-05)
    Objectives: Biofilm formation reduces the efficacy of standard microbiological techniques in prosthetic joint infection. This study aimed to investigate the sensitivity, specificity and predictive values of tissue sample enrichment as a means to increase diagnostic yield. Methods: Patients undergoing revision arthroplasty surgery between May 2004 and January 2013 had intraoperative tissue samples cultured in standard media as well as enriched in brain heart infusion broth. Patients were separated into infected or non-infected groups according to modified criteria from the Musculoskeletal Infection Society. Results: A total of 197 revision arthroplasties were included (non-infected, n = 165; proven infection, n = 32). The mean time until revision in non-infected and infected groups was 75.9 and 41.7 months, respectively. The commonest microorganisms cultured were coagulase-negative staphylococci (42.9 %) and Staphylococcus aureus (34.4 %). The sensitivity and specificity of standard tissue culture were 0.25 (CI 0.18-0.33) and 0.98 (CI 0.95-0.99), respectively. Including enrichment culture results increased the sensitivity to 0.45 (CI 0.37-0.54), but decreased specificity to 0.59 (CI 0.52-0.66). Conclusion: Any potential increase in the sensitivity is far outweighed by the extremely high false-positive rate. Results of tissue samples cultured by enrichment should be used with caution and may lead to a worse outcome if incorrectly interpreted.
  • Improving theatre efficiency and utilisation through early identification of trauma patients and enhanced communication between teams

    Roberts, Simon; Saithna, Adnan; Bethune, Rob; Roberts, Simon; Saithna, Adnan; Bethune, Rob; Orthopaedics and Trauma; Medical and Dental; George Eliot Hospital NHS Trust, Nuneaton (BMJ Publishing Group, 2015-02-27)
    Surgical departments are increasingly put under pressure to improve services, cut waiting lists, increase efficiency and save money. At a district general hospital in the west-midlands we approached the challenge of improving efficiency and optimising the services available in our orthopaedic theatres. Data was collected on: anaesthetic start times, operation start and finish times, and reasons for delay in our trauma theatre over a period from October 2014 to January 2015. During this period a change was implemented to improve the start time of the first operation of each day in the trauma theatre. Through adaptation of a method developed by Javed S et al, a patient was pre-selected by the on-call team and given the name the "golden patient" the day before they were due to be operated upon. This nominated patient would then be fixed at the start of the trauma theatre list the following day. The list would only then change if a "life or limb threatening" case was admitted overnight. The on-call team would prioritise that this patient was optimised for theatre and the theatre staff would ensure the surgical instruments were prepared. A PDSA cycle method was used, collecting data on 80 orthopaedic trauma cases during the period, and demonstrated a 59 minute (95% CI 45-72) improvement in start times from 10:49 AM to 9:50 AM with a p-value of 0.00024 with the intervention of early allocation of the first patient on the trauma list. A relatively simple intervention tool designed to improve communication within and between health-care teams can have a significant impact on the efficiency of a complex environment such as a trauma theatre.
  • Outcome after conservatively managed intracapsular fractures of the femoral neck

    Moulton, L S.; Green, N L.; Sudahar, T; Makwana, N K.; Whittaker, J P.; Green, N. L.; Medical and Dental; University Hospital of North Midlands; George Eliot Hospital, Nuneaton; Wrexham Maelor Hospital (Royal College of Surgeons of England, 2015-05)
    Introduction: In 2012, 2.6% of hip-fracture patients in the UK were treated conservatively. There is little data on outcome for these patients. However, one study demonstrated that though 30-day mortality is higher, mortality over the rest of the year is comparable with that in surgical groups. Therefore, we assessed conservatively managed patients in our unit. Methods: Patients with intracapsular fractures of the femoral neck treated by conservative means between 2010 and 2012 inclusive were identified. Data were collected: American Society of Anaesthesiologists (ASA) grade, Nottingham Hip Fracture Score (NHFS), mobility, mortality (30 days and one year) and pain levels. Results: Thirty-two patients formed the study cohort. Mean age was 85.6 years. Median ASA grade was 4. Mortality at 30 days and one year was 31.3% and 56.3%, respectively. There was one case of pneumonia and one of infection. Pressure sores or venous thromboembolism were not documented. Three patients underwent surgery once their health improved. In general, mobility was decreased, but 30.8% of patients could mobilise with two aids or a frame. Only two cases had ongoing problems with pain. Conclusions: Our data are similar to those published previously. Our patients were likely to have higher mortality data due to selection bias. Thirty-day mortality was significantly higher than the national average, but patients surviving 30 days had a prevalence of mortality similar to those managed by surgical means. Despite mobility decreasing from the pre-admission status, a considerable number of patients were free of pain and could mobilise. These data suggest that conservative management of intracapsular fractures of the femoral neck can produce acceptable results.
  • Technique for gentle accurate reproducible closed reduction of intracapsular fracture of neck of femur

    Mahajan, Ravindra H.; Kumar, Sachin; Mishra, Bhanu; Mahajan, Ravindra H.; Kumar, Sachin.; Mishra, Bhanu; Trauma & Orthopaedics; Medical and Dental; George Eliot Hospital, Nuneaton (Elsevier, 2017-03)
    Non-anatomic reduction with either inferior offset or varus angulation was the strongest predictor of re-displacement of the fracture and poor outcome after fixation of intracapsular fracture of neck of femur. There are many techniques for closed reduction and can be broadly divided into non-invasive and invasive techniques. We describe a minimally invasive technique, which we believe is easy, reproducible and successful in achieving good anatomical reduction.
  • Leiomyosarcoma of the lower limb presenting as a benign mass : a case report

    Papageorgiou, Konstantinos; Goodwin, Peter; Travlos, John; Dramis, Asterios; Dramis, Asterios; Trauma and Orthopaedics; Medical and Dental; The Royal Wolverhampton Hospitals NHS Trust; University of Warwick; George Eliot Hospital NHS Trust (Indian Orthopaedic Research Group, 2018-11)
    Introduction: Soft tissue sarcomas are rare tumors that often present with pain, increasing size and a location deep to the fascia. If they do not present with the aforementioned symptoms and signs, delayed diagnosis can occur. Case report: We present an unusual case of a 51-year-old patient who presented with clinical features of a benign mass of the lower limb that turned out to be a soft tissue sarcoma - a leiomyosarcoma. Conclusion: Medical practitioners must consider the possibility of soft tissue sarcoma in patients that present with a benign looking mass. Diagnostic imaging can be inconclusive on these cases and definite diagnosis is made on histological examination. Treatment includes surgery and radiotherapy.
  • Surgical treatment of hallux valgus : the Gibson-Piggott technique revisited

    Arvinte, Dan; Quarcoopome, Wilfred; Kane, Vijay; Steingold, Raymond; Reddy, Raj; Arvinte, Dan; Quarcoopome, Wilfred; Kane, Vijay; Steingold, Raymond; Reddy, Raj; et al. (Acta Medica Belgica, 2006-08)
    More than 130 surgical procedures have been described to treat hallux valgus deformity. The "spike" first distal metatarsal osteotomy was first described by Gibson and Piggott in 1962. Despite having the advantage of using only patient's "material", this technique has been abandoned by most orthopaedic surgeons, due to fear of complications such as breaking of the bony peg and loosening of fixation at the osteotomy site. A group of surgeons at our hospital have performed 422 Gibson-Piggott procedures between 1985 and 2005 with consistently good results. This fact convinced us to "revisit" the procedure. Thirty seven consecutive patients (43 feet) who had surgery between July 2000 and December 2002 were randomly selected as "sample". A Questionnaire based on the American Orthopaedic Foot and Ankle Society (AFOS) Score was used for evaluation. Thirty three patients (36 feet), i.e. 89% responded to our survey. Average follow-up after surgery was 47 months (between 31 and 63 months). Results showed that 30 patients (91%) had no or only mild pain, 29 patients (88%) had no or only slight limitation in activities of daily living and 31 patients (94%) were able to use fashionable or comfortable shoes with no problems. When using numerical evaluation, 28 patients (85%) scored 65 or more points (from a total of 95 points), representing a good postoperative result, comparable with other "modern" distal metatarsal osteotomies. In conclusion, the Gibson-Piggott procedure was shown to be a valuable technique in the treatment of mild or moderate hallux valgus deformity.
  • Impact of maternal HbA 1c on offspring glucose at 4-7 years of age: role of childhood adiposity and other potential confounders

    Periyathambi, Nishanthi; Sukumar, Nithya; Weldeselassie, Yonas; Saravanan, Ponnusamy; Saravanan, Ponnusamy; Sukumar, Nithya; Academic Department of Diabetes, Endocrinology and Metabolism, George Eliot Hospital, Nuneaton, UK.; Medical and Dental; University of Warwick; George Eliot Hospital NHS Trust; University of Warwick; George Eliot Hospital NHS Trust. . (Springer, 2021-06-22)
    Impact of maternal HbA 1c on offspring glucose at 4-7 years of age: role of childhood adiposity and other potential confounders
  • Management of Ankle Charcot Neuroarthropathy: A Systematic Review

    Galhoum, Ahmed ElSayed; Trivedi, Vineet; Askar, Mohamed; Tejero, Sergio; Herrera-Pérez, Mario; AlRashidi, Yousef; Valderrabano, Victor; Galhoum, Ahmed ElSayed; unknown; Medical and Dental; et al. (MDPI, 2021-12-17)
    Background: Charcot neuroarthropathy is a non-infective, destructive process occurring in patients rendered insensate by peripheral neuropathy, which is caused mainly by diabetes. Repetitive trauma from standing and walking provides a neuro-traumatic stimulus that leads to dislocation, or peri-articular fracture, or both, within the ankle. This review concentrates on the management protocols regarding the ankle only. Methods: A Pubmed search for clinical trials performed to manage ankle Charcot neuroarthropathy and a systematic review of these articles were undertaken. Results: Twenty papers met the inclusion criteria: four of them describe non-surgical management, while the rest show different surgical management options of ankle Charcot neuroarthropathy. Conclusions: Surgical algorithms for the treatment of CN of the ankle are based almost entirely on level four. There is inconclusive evidence concerning the timing of treatment and the use of different fixation methods. Instability and ulceration are the main precursors for surgical interventions. Prospective series and randomized studies, albeit difficult to perform, are necessary to support and strengthen current practice.
  • Intestinal stenosis of Garré following emergency ventral hernia repair

    Padgett, Bethany; Gurung, Deborah; Seretis, Charalampos; Selvam, Lourdusamy; Padgett, Bethany; Gurung, Deborah; Seretis, Charalampos; Selvam, Lourdusamy; Department of General Surgery George Eliot Hospital NHS Trust. Address: College Street Nuneaton UK.; Medical and Dental; et al. (Wiley, 2021-08-15)
    Intestinal stenosis of Garré can occur as a result of prolonged ischemia after all types of hernia surgery.
  • Perioperative Blood Management Strategies for Patients Undergoing Total Hip Arthroplasty: Where Do We Currently Stand on This Matter?

    Vrontis, Konstantinos; Tsinaslanidis, Georgios; Drosos, Georgios I.; Tzatzairis, Themistoklis; Tsinaslanidis, Georgios; Medical and Dental; Bank of Cyprus Oncology Center; George Eliot Hospital NHS Trust; Democritus University of Thrace (Mashhad University of Medical Sciences, 2020-11)
    Total hip replacement (THR) has proved to be a reliable treatment for the end stage of hip osteoarthritis. It is a common orthopaedic procedure with excellent results, but is associated with significant blood loss and high rates of allogeneic blood transfusion (ABT). The potential complications and adverse events after ABT, combined with the ongoing research, have resulted in multimodel, multidisciplinary blood management strategies adoption, aiming to reduce the blood loss and transfusion rates. Many reviews and meta-analyses have tried to demonstrate the best blood management strategies. The purpose of this study is to review any evidence-based blood conserving technique, dividing them in three stages: preoperative, intraoperative and postoperative.
  • Diagnosis of subtle syndesmotic instability using conventional CT-imaging and axial force in different foot positions

    Chans-Veres, Juan; Vallejo, Mercedes; Galhoum, Ahmed E; Tejero, Sergio; Galhoum, Ahmed E.; Orthopaedics; Medical and Dental; University Hospital Virgen del Rocío, Seville, Spain; George Eliot Hospital. (Elsevier, 2023-01-11)
    Background: Currently, there is no available method that can objectively and reliably detect subtle instability of the distal tibiofibular joint. The purpose of this study is to diagnose, using computerized axial tomography and an adjustable simulated loading device, subtle instability of the tibiofibular syndesmosis. Methods: Fifteen healthy individuals and 15 patients with clinical suspicion of subtle instability of the tibiofibular syndesmosis (total 60 ankles) were studied using an adjustable simulated loading device (ASLD). This device allows to perform bilateral ankle CT scans in two forced foot and ankle positions (30° of plantar flexion, 15° of inversion, 20° of internal rotation and 15° of dorsal flexion, 15° of eversion, 30° of external rotation). Axial load was applied simultaneously in a controlled manner (70% body weight). Measurements on the axial image of computed tomography were: syndesmotic area (SA), fibular rotation (FR), position of the fibula in the sagittal plane (FPS), depth of the incisura (ID), anterior direct difference (ADD), middle direct difference (MDD) and posterior direct difference (PDD). Results: Statistically significant differences were observed in the variable syndesmotic area between healthy (mean=-0.14, SD=4.33) and diseased (mean=16.82, SD=12.3)(p < 0.001). No statistically significant differences were found in the variables ADD, MDD, PDD, ID, FPS and FR. Conclusions: Measurement of syndesmotic area employing axial force and forced foot positions using the ASLD may be useful for the diagnosis of subtle tibiofibular syndesmosis instability.