Author: Jason Curtis

#OrthoTwitter: social media as an educational tool (2020)

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Type of publication:Journal article

Author(s):Sahu MA; Goolam-Mahomed Z; Fleming S; *Ahmed U

Citation:BMJ Simulation & Technology Enhanced Learning, 2020 Sep 07; Vol. 7 (5), pp. 277-284

Abstract:Aims: The increased use of social media creates opportunity for new, effective methods of delivering medical and clinical education. Twitter is a popular social media platform where users can post frequent updates and create threads containing related content using hashtags. This study aims to investigate and analyse the type of content relating to orthopaedic surgery that is being posted on the platform of Twitter.Methods: A retrospective search was performed for tweets containing the words 'orthopaedic surgery' or 'orthopedic surgery' or the use of the hashtag '#OrthoTwitter' between November 2018 to November 2019. A total of 5243 tweets were included.Results: Tweets containing 'orthopaedic surgery' or 'orthopedic surgery' most frequently contained promotional or marketing content (30% promotional, 21% marketing), and private organisations were the category of author to which the greatest number of tweets belonged (30%). Tweets containing educational or research content were the least common among all tweets containing 'orthopaedic surgery' or 'orthopedic surgery' (11%). In contrast, of the tweets containing the hashtag '#OrthoTwitter', 44% contained educational or research content, 15% contained promotional content and no tweets containing marketing content. Furthermore, 87% of all tweets using the hashtag '#OrthoTwitter' were from orthopaedic surgeons, and the least number of tweets were from private organisations (2%).Conclusion: Twitter is a widely used social media platform regarding orthopaedic surgery. We propose that the hashtag '#OrthoTwitter' can be used to create an online community of orthopaedic surgeons where members can assist one another through sharing reliable and educational content.

The positive impact of GIRFT (getting it right first time) on arthroplasty services in times of COVID-19 (2022)

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Type of publication:
Journal article

Author(s):
*Khan MM; *Khawar H; *Perkins R; Pardiwala A

Citation:
Annals of medicine and surgery, 2022 May; Vol. 77, pp. 103655

Abstract:
Background: This observational study evaluates the trends in arthroplasty services across National Health Services (NHS) following the COVID-19 pandemic about GIRFT (Getting it Right First Time) guidelines concerning National joint registry data (NJR data). Introduction: Since the advent of the COVID-19 crisis sustainability of elective arthroplasty services have become a burning question in NHS. Capacity crisis, unknown COVID-19 infection status, lack of ring-fenced beds, winter crisis, and unprecedented trauma have aggravated the situation further leading to severe impairment in quality of life and service provision. GIRFT guidelines have suggested a few solutions to this crisis and one of them is dividing the hospitals into Hot (trauma) and cold (elective) sites. Objectives: To review NJR data for pre and post COVID era along with the service structure of the hospital and test the hypothesis that whether redistribution of services into hot and cold sites is a possible solution for sustainable arthroplasty service across NHS. Methodology: A search was made into the NJR data from 2019, 2020, and 2021. The First 7 months were taken from each year I.e. From Ist January to 31st of July. A review of entries for arthroplasty was considered for all hospitals across England and Wales. Hospitals in Scotland, Ireland, and Isles of Man and major trauma centers were excluded. Any hospital that was recording at least 15 arthroplasty cases for 4 out of 7 months in 2021 was considered for review. A brief evaluation of their service structure was made, and hospitals were divided into Elective Centres (EC), Urgent Care Centres (UCC), and District General Hospitals (DGH) with in-house emergency services based on the information provided on their official website. In NJR data "completed operations by submission date" column was considered as a reference for data collection. A total of 1807, 1800, and 1810 were identified for 2019, 2020, and 2021 respectively. However, after applying inclusion criteria total number of entries was reduced to 120 hospitals. Data analysis and selection of hospitals were reviewed twice by two authors (MMK and AP) at different times to avoid any bias and reduce the chances of human error that can affect the outcome. A sub-analysis of data for the last 3 months (May, June, and July) was also performed for the respective years to get a better picture of arthroplasty trends and reduce the flaws of data interpretation. Ethical Approval and Data Consideration: A formal approval was taken from the NJR team in the UK before the data processing was initiated. The data source being used was available for public review on the NJR website. The team was happy for us to process and evaluate the data as per needs of our study. However, they requested a disclaimer and appreciation note for the members of the NJR team and hospital personnel across the UK that have made the provision of data and subsequent analysis leading to this study feasible. Results: 18 EC were included. The mean number of cases recorded per center was 427, 68, 348 for 2019, 2020, and 2021 respectively.20 UCC were identified. The mean number of cases performed were 213, 24, and 195 in 2019, 2020, and 2021 respectively. Similarly, 60 DGH with emergency services were included and the average number of cases recorded were 194, 27, and 166 for 2019, 2020, and 2021 respectively. Compared to 2019 out of 148 DGH in 2019 only 60 can provide a sustainable arthroplasty service signifying a drop of 40% in 2021 in the number of DGH which are contributing to elective services. Conclusions: The overall productivity of theatres in terms of arthroplasty services has decreased since the reinitialization of services in 2021. There is a need of hour to divide the services into hot and cold sites in terms of A/E and elective centers to provide safe and uninterrupted provision of arthroplasty services and address long waiting times for patients. Provisional of ring-fenced beds and arthroplasty wards is more technically feasible in centers that are not providing in-house emergency admission pathways or are specialist, dedicated elective centers

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Vesicourachal diverticulum (2022)

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Type of publication:Journal article

Author(s):*Mohamed G; *Ghani Z; *Lynn N; *Masilamani M; *Rowlands J

Citation:Annals of the Royal College of Surgeons of England. 104(9) (pp e255-e257), 2022. Date of Publication: 01 Nov 2022.

Abstract:We report a rare complication involving a healthy 45-year-old male patient who underwent an emergency laparoscopic appendicectomy for acute perforated gangrenous appendicitis. The patient was catheterised pre- procedure and the ports were inserted under vision. Upon completion of the procedure, a 15 Fr Robinson drain was left in the pelvis and was fed through the suprapubic port hole. Postoperatively the patient developed worsening, generalised abdominal pain and high output from the drain. The patient was re-catheterised but the computed tomography (CT) cystogram did not show any injury to the bladder. The drain fluid creatinine was noted to be raised (>4,000), indicating that urine was leaking into the drain. Conventional cystogram confirmed a contrast leak from the dome around the drain. Flexible cystoscopy confirmed that the drain had transversed the vesicourachal diverticula. The drain was pulled back and converted to a suprapubic catheter with the patient subsequently being discharged. Vesicourachal diverticula is a rare and often asymptomatic anomaly. When undertaking laparoscopic surgery, precautions should be taken to prevent port site injury such as catheterising the patient to ensure the bladder is empty and inserting the ports under direct vision. It is safer to visualise muscle rather than peritoneum during port insertion. In this case, the bladder diverticula was noticed extraperitoneally. Though the indirect CT cystogram reported no injury, this was unreliable as the bladder was not distended which led to the subtle injury being missed. Traditional cystogram should be considered in cases with a negative CT cystogram and a strong suspicion of bladder injury.

Abiraterone acetate plus prednisolone for metastatic patients starting hormone therapy: 5-year follow-up results from the STAMPEDE randomised trial (NCT00268476) (2022)

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Type of publication:Randomised controlled trial

Author(s):James N.D.; Clarke N.W.; Cook A.; Ali A.; Hoyle A.P.; Attard G.; Brawley C.D.; Chowdhury S.; Cross W.R.; Dearnaley D.P.; de Bono J.S.; Montana C.D.; Gilbert D.; Gillessen S.; Gilson C.; Jones R.J.; Langley R.E.; Malik Z.I.; Matheson D.J.; Millman R.; Parker C.C.; Pugh C.; Rush H.; Russell J.M.; Berthold D.R.; Buckner M.L.; Mason M.D.; Ritchie A.W.; Birtle A.J.; Brock S.J.; Das P.; Ford D.; Gale J.; Grant W.; Gray E.K.; Hoskin P.; Khan M.M.; Manetta C.; McPhail N.J.; O'Sullivan J.M.; Parikh O.; Perna C.; Pezaro C.J.; Protheroe A.S.; Robinson A.J.; Rudman S.M.; Sheehan D.J.; *Srihari N.N.; Syndikus I.; Tanguay J.; Thomas C.W.; Vengalil S.; Wagstaff J.; Wylie J.P.; Parmar M.K.; Sydes M.R.

Citation:
International Journal of Cancer. 151(3) (pp 422-434), 2022. Date of Publication: 01 Aug 2022.

Abstract:Abiraterone acetate plus prednisolone (AAP) previously demonstrated improved survival in STAMPEDE, a multi-arm, multi-stage platform trial in men starting long-term hormone therapy for prostate cancer. This long-term analysis in metastatic patients was planned for 3yrs after the first results. Standard-of-care (SOC) was androgen deprivation therapy. The comparison randomized patients 1:1 to SOC-alone with or without daily abiraterone acetate 1000mg+prednisolone 5mg (SOC+AAP), continued until disease progression. The primary outcome measure was overall survival. Metastatic disease risk group was classified retrospectively using baseline CT and bone scans by central radiological review and pathology reports. Analyses used Cox proportional hazards & flexible parametric models, adjusted for baseline stratification factors. 1003 patients were contemporaneously randomized (Nov-2011–Jan-2014): median age 67yr; 94% newly-diagnosed; metastatic disease risk group: 48% high, 44% low, 8% un-assessable; median PSA 97ng/mL. At 6.1yr median follow-up, 329 SOC-alone deaths (118 low-risk, 178 high-risk) and 244 SOC+AAP deaths (75 low-risk, 145 high-risk) were reported. Adjusted HR = 0.60 (95%CI:0.50-0.71; P =0.31×10-9 ) favoured SOC+AAP, with 5-yr survival improved from 41% SOC-alone to 60% SOC+AAP. This was similar in low-risk (HR = 0.55; 95%CI:0.41-0.76) and high-risk (HR = 0.54; 95%CI:0.43-0.69) patients. Median and current maximum time on SOC+AAP was 2.4yr and 8.1yr. Toxicity at 4yr post-randomisation was similar, with 16% patients in each group reporting grade 3 or higher toxicity. A sustained and substantial improvement in overall survival of all metastatic prostate cancer patients was achieved with SOC+abiraterone acetate + prednisolone, irrespective of metastatic disease risk group.

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Patient Outcomes Related to In-Hospital Delays in Appendicectomy for Appendicitis: A Retrospective Study (2022)

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Type of publication:
Journal article

Author(s):
Claydon O; Down B; *Kumar S

Citation:
Cureus, 2022 Mar 10; Vol. 14 (3), pp. e23034

Abstract:
Background and objective In many hospitals, the availability of operating theatres and access to senior surgical and anaesthetic support diminish during night hours. Therefore, urgent surgery is sometimes postponed until the following morning rather than performed overnight, if it is judged to be safe. In this study, we aimed to determine if a delay in laparoscopic appendicectomy in cases of acute appendicitis of over 12 hours, analogous to an overnight delay, correlated with worse patient outcomes. Our primary outcome was delayed discharge from the hospital. Our secondary outcomes were appendicitis severity, conversions, and postoperative complications. Methods We undertook a retrospective review of the medical records of patients who underwent laparoscopic appendicectomy for appendicitis at a UK district general hospital between 01/01/2018 and 30/08/2019. For each patient, clinical and demographic information, and time of hospital admission, surgery, and discharge were collected. Delayed discharge was defined as "time to discharge" >24 hours after surgery. Results A total of 446 patients were included in the study. In 137 patients (30.7%), "time to surgery" was under 12 hours; in 309 patients (69.3%) "time to surgery" was over 12 hours. Of note, 319 patients (71.5%) had a delayed discharge; 303 patients (67.9%) had complicated appendicitis, and 143 patients had severe appendicitis (32.1%). No statistically significant association between "time to surgery" and delayed discharge, appendicitis severity, conversion, or 30-day re-presentations was observed. Conclusion Time from admission to the start of appendicectomy did not affect patient outcomes. Short in-hospital delays in appendicectomy, such as an overnight delay, may be safe in certain patients and should be determined based on clinical judgement.

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Endoscopically assisted reconstruction of chronic Achilles tendon ruptures and re-ruptures using a semitendinosus autograft is a viable alternative to pre-existing techniques (2022)

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Type of publication:
Journal article

Author(s):
Nilsson N; Gunnarsson B; *Carmont MR; Brorsson A; Karlsson J; Nilsson Helander K

Citation:
Knee Surgery, Sports Traumatology, Arthroscopy : official journal of the ESSKA, 2022 Apr 09 [epub ahead of print]

Abstract:
Purpose: Achilles tendon ruptures are termed chronic after a delay in treatment for more than 4 weeks. The literature advocates surgical treatment with reconstruction to regain ankle push-off strength. The preferred technique is, however, still unknown and is often individualized. This study aims to present the technique and clinical outcome of an endoscopically assisted free semitendinosus reconstruction of chronic Achilles tendon rupture and Achilles tendon re-ruptures with delayed representation. It is hypothesized that the presented technique is a viable and safe alternative for distal Achilles tendon ruptures and ruptures with large tendon gaps.
Method: Twenty-two patients (13 males and 9 females) with a median (range) age of 64 (34-73) treated surgically with endoscopically assisted Achilles tendon reconstruction using a semitendinosus autograft were included. The patients were evaluated at 12 months post-operatively for Achilles tendon Total Rupture Score (ATRS), calf circumference, Achilles Tendon Resting Angle (ATRA), heel-rise height and repetitions together with tendon length determined by ultrasonography, concentric heel-rise power and heel-rise work.
Results: The patients reported a median (range) ATRS of 76 (45-99) out of 100. The median (range) ATRA on the injured side was 60° (49°-75°) compared with 49.5° (40-61°), p < 0.001, on the non-injured side. Eighteen out of 22 patients were able to perform a single-leg heel-rise on the non-injured side. Sixteen patients out of those 18 (89%) were also able to perform a single heel-rise on the injured side. They did, however, perform significantly lower number of repetitions compared with the non-injured side with a median (range) heel-rise repetitions of 11 (2-22) compared with 26 (2-27), (p < 0.001), and a median (range) heel-rise height of 5.5 cm (1.0-11.0 cm) compared with 9.0 cm (5.0-11.5 cm), (p < 0.001). The median calf circumference was 1.5 cm smaller on the injured side, 37.5 cm compared with 39 cm, when medians were compared. The median (range) tendon length of the injured side was 24.8 cm (20-28.2 cm) compared with 22 cm (18.4-24.2 cm), (p < 0.001), on the non-injured side.
Conclusion: The study shows that endoscopically assisted reconstruction using a semitendinosus graft to treat chronic Achilles tendon ruptures and re-ruptures with delayed representation produces a satisfactory outcome. The technique can restore heel-rise height in patients with more distal ruptures or large tendon defects and is therefore a viable technique for Achilles tendon reconstruction.
Level of Evidence: IV.

Establishment of virtual fracture clinic in Princess Royal Hospital Telford: Experience and recommendations during the first 9 months (2022)

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Type of publication:
Conference abstract

Author(s):
*Khaleeq T.; *Lancaster P.; *Fakoya K.; *Ferreira P.; *Ahmed U.

Citation:
British Journal of Surgery. Conference: ASiT Surgical Innovation Summit – Future Surgery Show. London United Kingdom. 109(SUPPL 1) (pp i13), 2022. Date of Publication: March 2022.

Abstract:
Introduction: Virtual fracture clinics (VFC) have been shown to be a safe and cost-effective way of managing outpatient referrals to the orthopaedic department. During the coronavirus pandemic there has been a push to reduce unnecessary patient contact whilst maintaining patient safety. Method(s): A protocol was developed by the clinical team on how to manage common musculoskeletal presentations to A&E prior to COVID as part of routine service development. Patients broadly triaged into 4 categories; discharge with advice, referral to VFC, referral to face to face clinic or discussion with on call team. The first 9 months of data were analysed to assess types of injury seen and outcomes. Result(s): In total 2489 patients were referred to VFC from internal and external sources. 734 patients were discharged without follow-up and 182 patients were discharged for physiotherapy review. Only 3 patients required admission. Regarding follow-ups, 431 patients had a virtual follow-up while 1036 of patients required further face to face follow up. 87 patients were triaged into subspecialty clinics. 37 patients were felt to have been referred inappropriately. Conclusion(s): BOA guidelines state all patients must be reviewed within 72 hours of their orthopaedic injury. Implementation of a VFC allows this target to be achieved and at the same time reduce patient contact. Almost half the patients were discharged following VFC review, the remaining patients were followed up. This is especially relevant in the current pandemic where reducing unnecessary trips to hospital will benefit the patient and make the most of the resources available.

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The rise in trauma & orthopaedic trainee-led research and audit collaborative projects in the united kingdom since the start of the COVID-19 pandemic. (2022)

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Type of publication:
Conference abstract

Author(s):
*Khaleeq T.; *Kabariti R.; *Ahmed U.

Citation:
British Journal of Surgery. Conference: ASiT Surgical Innovation Summit – Future Surgery Show. London United Kingdom. 109(SUPPL 1) (pp i13), 2022. Date of Publication: March 2022.

Abstract:
Introduction: There has been a significant rise in trainee-led trauma & orthopaedic (T&O) multi-centre research collaborative projects globally. Since the start of the COVID-19 pandemic, more emphasis has been on global collaborative research efforts to tackle important research questions. The aim was to evaluate the number of T&O trainee-led research collaborative projects that took part since the start of the COVID-19 pandemic in the UK. Method(s): A retrospective study that evaluated T&O trainee-led national collaborative projects within the UK since the start of the COVID-19 pandemic lockdown (March 2020 to June 2021). Our exclusion criteria included any regional collaborative projects, projects that were started pre-COVID and projects of other surgical specialities. The number of projects identified was compared to that in 2019. Result(s): In 2019, 0 trainee-led collaborative projects were commenced nationally in the UK. Since the COVID-19 pandemic, we identified 10 trainee-led collaborative trauma & orthopaedic projects with 3 being published so far. The level of evidence ranged between 3 and 4. Conclusion(s): Covid has placed significant challenges across healthcare. One positive aspect that has been noted is the increase in multi-centre trainee-led collaborative projects within the UK. Our study highlights the feasibility of a trainee-led high quality collaborative research projects in the UK, emphasising the growing contribution of trainees towards research. Wide-spread availability of new technological tools suchas social media and Redcap facilitates such projects in terms of recruitment and data collection. We would, therefore, recommend expanding this trainee-led collaborative platform across in Europe and Worldwide.

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Plain film x-ray reporting in orthopaedic patients: A reaudit in a district general hospital (2022)

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Type of publication:
Conference abstract

Author(s):
*Khaleeq T.; *Shah Foridi J.; *Reading J.

Citation:
British Journal of Surgery. Conference: ASiT Surgical Innovation Summit – Future Surgery Show. London United Kingdom. 109(SUPPL 1) (pp i13), 2022. Date of Publication: March 2022.

Abstract:
Aim: To assess clinical evaluation of plain film x-rays requested for patients in the orthopaedic department (clinic and ward) Standards: Ionising radiation (medical exposure) regulations irmer 2017 procedure j: recording clinical exposure, national guideline and local guidance is in keeping with irmer and good clinical practice. Method(s): 50 plain films of randomly selected (using random number generator) who had attended new patient fracture clinic and ward. An initial audit was done in June and an reaudit in September. The radiology system, clinical notes and clinic letters were reviewed to obtain the relevant data. Result(s): Audit: 20 films were documented 30 were not documented Reaudit 32 films were documented by referring clinician 18 films were not documented by referring clinician Audit: Clinical evaluation documented 18 Clinical evaluation not documented 32 Reaudit: Clinical evaluation documented – 29 Clinical evaluation not documented – 21 Discussion: Whose responsibility? Radiographs commented on in trauma meetings not documented. New radiographs not commented on in clinic. Limitations – access to more notes from ward. Conclusion(s): As outlined in guidance orthopaedic and fracture clinic plain films should be reported by referring clinician or their team. Currently this is being done 64% of the time, significant improvement was seen. This may have medicolegal consequences as it does not follow GMC guidance for good medical practise. Recommendations: Clinicians to specifically dictate x-ray findings in fracture clinic. Junior staff to take responsibility for documenting x-ray findings as discussed with senior clinicians for trauma patients. Junior staff to review post-op x-rays for all patients and to document.

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Incidence of acute kidney injury in neck of femur fracture patients during the COVID-19 pandemic in Princess Royal Hospital, Telford (2022)

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Type of publication:
Conference abstract

Author(s):
Alaguraja P.; Younas W.; Mabeza T.; *Makam A.; *Khaleeq T.; *Reading J

Citation:
British Journal of Surgery. Conference: ASiT Surgical Innovation Summit – Future Surgery Show. London United Kingdom. 109(SUPPL 1) (pp i13), 2022. Date of Publication: March 2022

Abstract:
Aim: Patients undergoing surgical repair of neck-of-femur (NOF) fractures are at higher risk of acute kidney injury (AKI). NICE and BOAST have published guidelines to help prevent the occurrence of AKI, including adequate fluid resuscitation pre- and post-operatively. An audit was conducted during the COVID-19 pandemic to explore whether the department was adhering to NICE guidelines. Method(s): AKI was defined, as per NICE Clinical Knowledge Summaries, as an increase in serum creatinine levels by 26 mumol/L or greater. Data was collected prospectively starting from December 2020 to February 2021 in the Princess Royal Hospital during the COVID-19 pandemic. All patients with NOFs were included and data on sex, age, comorbidities, and type of surgery were collected. Result(s): In total, 32 patients were included in the audit with an average age of 82 years; of these, eleven patients had dynamic hip screws and eighteen patients had hemiarthroplasties. Five patients had chronic kidney disease, six patients had previous myocardial infarctions and thirteen patients had hypertension. Two patients (6.3%) were found to have an AKI post-surgery with increased creatinine levels of 27 and 28 mumol/L. Both had hypertension and underwent hemiarthroplasties. Conclusion(s): Complications such as AKIs are reversible and preventable. Especially during the COVID-19 pandemic such complications can increase morbidity and mortality of patients suffering from NOF leading to longer hospital stays. The low rate of AKI following NOF repair in our Department of Trauma and Orthopaedic is attributable to adherence to NICE and BOAST fluid resuscitation guidelines.

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