Trauma and Orthopaedics
Recent Submissions
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Treating metatarsalgia: current conceptsThe objective of this paper is to describe the anatomical and biomechanical considerations for treating metatarsalgia. We describe a method of classification incorporating the causes and lead onto a comprehensive description of the treatment of metatarsalgia. Important clinical findings and investigations are discussed in treating this common pathology and a case study used as an example to illustrate the above. This paper highlights the complex nature of metatarsalgia and describes the factors a surgeon needs to consider prior to embarking on treatment.
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Surgical approaches and applied anatomy of the wristA familiarity with common approaches to the wrist and their associated anatomy is essential for any surgeon operating in this area. Such knowledge reduces the likelihood of iatrogenic injury to adjacent structures; enabling the surgeon to progress purposefully and with confidence through an operation, to reveal underlying pathology. Furthermore, it is a favourite topic for the fellowship examiner. This article provides a description of the common dorsal, volar, radial and ulnar approaches to the carpus and distal radius. Safe corridors for external fixation are also considered. Additionally, clinical pearls are included for each approach, to enable the surgeon to avoid common pitfalls.
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Oxford lateral uni-compartmental knee replacement: up-to 10 years follow-up from an independent seriesBackground: Isolated lateral compartment arthritis of the knee is reported to occur in 10% of patients with knee osteoarthritis. Lateral uni-compartment knee replacement (UKR) is a valid treatment option. It can provide excellent function and patient reported outcomes (PROMS). Fixed-bearing (FB) and mobile-bearing (MB) designs are available. The aim of this study was to evaluate the clinical outcomes and survival of prostheses used in a consecutive series of lateral UKRs
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Cementless medial Oxford unicompartmental knee replacement. Five-year results from an independent seriesBackground: Unicompartmental knee replacement (UKR) is a common treatment option for patients with advanced medial compartment knee arthritis. The Oxford UKR (OUKR) is the most commonly used implant for partial knee replacement. A cementless Oxford prosthesis was introduced in 2004 aiming to reduce the revision rate by potentially reducing radiolucencies as well as errors of cementation associated with the cemented prosthesis. Whilst results from the designer centre have been reported, there is little independent clinical evidence of outcomes. The aim of this study was to evaluate the survival of the cementless OUKR in a single surgeon series at an independent centre and to assess clinical and radiographic outcomes. Methods: All patients who received a cementless medial OUKR and had a minimum of five-year follow-up were included in the series. The Oxford knee score was used to evaluate patient outcomes at five years postoperatively. Survival rates, complications and evidence of radiolucencies on plain radiographs were also reviewed. Results: One hundred and fifty-eight cementless medial OUKR were implanted in 126 patients. Three patients died and four knees were revised. The five-year survival was 97.4% and the median Oxford knee score was 43 at five years postoperatively. No Complete radiolucent lines were observed on radiographs at one year. Four tibial components subsided. Conclusions: This independent series shows that low revision rates and excellent results can be achieved with the use of the cementless OUKR at five years. Early subsidence of the tibial component, which is specific to the cementless prosthesis, warrants further investigation.
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Discussing sexual activities after total hip arthroplastyBackground: Hip pathology can affect functions including sexual activity. Sex after hip replacement (SAHR) is an important subject for patients but rarely discussed. A conversation prior to surgery can be difficult to initiate, and appropriate advice is then not given. This study has set out to find how physicians approach the subject, and how patients would the like the subject to be addressed. Thus, device a process that ensures appropriate discussions take place prior to Total Hip Replacement (THR) in all patients. Methods: Questionnaires were given to clinicians and patients. The clinicians' questionnaire asked how they dealt with the issue of SAHR. All patients below the age of 80 were asked how the issue was addressed, and how this could be improved. The aim of this study was twofold. Firstly, to address how SAHR should be approached, both by reviewing the clinicians present views and asking the patients their expectations. Secondly, to develop a process that will ensure patients' concerns are appropriately and consistently addressed prior to total hip replacement (THR). Results: All 17 clinicians responded. None used any printed information to give to patients dealing with SAHR nor did they routinely discuss it with patients. 244/340 patients responded. Over 90% of patients wanted the surgeon to discuss sex after THR with them, and would be happy to be asked directly about the subject. Conclusion: Clinicians do not routinely raise the subject of SAHR with patients, who often wanted to know, but rarely asked. There is unease around the subject, and therefore there is a need to establish a process that ensures this discussion takes place prior to THR.
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Audit of SWFT Ankle Fracture Management Compared to BOAST GuidelinesAim: In 2016 the BOA introduced an Audit Standard for Trauma (BOAST) for the management of ankle fractures. Our aim was to conduct an audit of SWFT compliance with the 2016 BOAST guidelines. Method: We conducted a retrospective analysis of 49 patients who attended SWFT in 2018-2019. Their admission X-Ray views, neurovascular status & co-morbidity documentation, time to theatre and weight bearing status post operatively were reviewed. We also reviewed the outcomes of follow up to determine whether a change in WB status was implemented. Result: 82% patients had their neurovascular status documented, 94% had their co-morbidities documented and 67% had correct imaging performed. 2 patients were initially treated conservatively, the average time to theatre for the remainder was 3 days. None of the patients were FWB post op - 6% could touch WB and 94% were NWB. On follow up, 78% patients remained NWB for 6 weeks, 9 were allowed to WB sooner & 2 patients were repatriated post op. Conclusion: The Orthopaedic department at SWFT is maintaining a correlation with BOAST 2016 ankle fracture guidelines in certain aspects such as NV status and co-morbidities. However, we are not adhering to guidelines regarding WB status of patients post-operatively.
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ARthroscopy in Knee OsteoArthritis (ARK-OA): a multicentre study assessing compliance to national guidelinesIntroduction: The use of arthroscopy to alleviate the symptoms of osteoarthritis has been questioned by recent high quality evidence. This has led to the development of guidelines by specialist and national bodies advocating against its use. Aims: To examine the trends of the rates of arthroscopy in patients with knee osteoarthritis over the past five years and determining compliance with guidelines. Methods: Multi-centre, retrospective audit in five hospital trusts in the United Kingdom. The number of arthroscopies performed by month from 2013 to 2017 was identified through hospital coding. Fifty randomly selected records from the year 2017 were further analysed to assess compliance with NICE guidelines. Results: Between 2013 and 2017, the number of arthroscopies performed annually in five trusts dropped from 2028 to 1099. In the year 2017, 17.7% of patients with no mechanical symptoms and moderate-to-severe arthritis pre-operatively had arthroscopy. Conclusion: Knee arthroscopy continues to be used as a treatment for osteoarthritis, against national guidelines. Whilst overall numbers are declining, further interventions, including implementation of high-quality conservative care is required to further eliminate unnecessary procedures.