Sex differences in patients' recovery following an acute Achilles tendon rupture - a large cohort study (2022)

Type of publication:
Journal article

Author(s):
Larsson, Elin; Brorsson, Annelie; Carling, Malin; Johansson, Christer; *Carmont, Michael R; Nilsson Helander, Katarina

Citation:
BMC Musculoskeletal Disorders, October 2022, 23(1): 913-913.

Abstract:
Introduction: The incidence of Achilles tendon ruptures (ATR) has increased over the past few decades. Treatment may be individualised based upon multiple factors including age, pre-injury activity level and the separation of the ruptured tendon ends. Several studies indicate that women may have a poorer self-reported and clinical outcome compared with men, but the number of women in these studies is often small due to the different incidence of ATR between the genders. Aims: The primary aim of this study was to evaluate whether there is a difference in self-reported outcome after an acute ATR between women and men at one to five years following injury. The second aim was to compare the outcome between the surgically and non-surgically treated patients. Methods: Data were obtained from the medical charts of patients treated for an acute ATR between 1 and 2015 and 31 December 2020 at Sahlgrenska University Hospital/Mölndal. The Achilles tendon total rupture score (ATRS) and additional questions relating to treatment and recovery were determined. A multiple regression analysis was performed to isolate the impact of sex when comparing the patient-reported outcome between women and men. Results: A total of 856 patients were included of which 66% participated prospectively. Sex, BMI and age were found to be significant factors influencing the total ATRS score. Female gender resulted in a lower ATRS, 7.8 points (CI = 3.3 to 12.3), than male gender. It was found that treatment did not significantly predict the results of the ATRS. Conclusion: To our knowledge, this is the first report with a larger number of women included showing that female sex predicts inferior self-reported results after an acute ATR.

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Retrograde tibiotalocalcaneal nailing for the treatment of acute ankle fractures in the elderly: a systematic review and meta-analysis (2022)

Type of publication:Systematic Review

Author(s):Lu V.; Tennyson M.; Zhou A.; *Patel R.; Fortune M.D.; Thahir A.; Krkovic M.

Citation:EFORT Open Reviews. 7(9) (pp 628-643), 2022. Date of Publication: 2022.

Abstract:Introduction: Fragility ankle fractures are traditionally managed conservatively or with open reduction internal fixation. Tibiotalocalcaneal (TTC) nailing is an alternative option for the geriatric patient. This meta-analysis provides the most detailed analysis of TTC nailing for fragility ankle fractures. Methods: A systematic search was performed on MEDLINE, EMBASE, Cochrane Library, and Web of Science, identifying 14 studies for inclusion. Studies including patients with a fragility ankle fracture, defined according to NICE guidelines as a low-energy fracture obtained following a fall from standing height or less, that were treated with TTC nail were included. Patients with a previous fracture of the ipsilateral limb, fibular nails, and pathological fractures were excluded. This review was registered in PROSPERO (ID: CRD42021258893). Results: A total of 312 ankle fractures were included. The mean age was 77.3 years old. In this study, 26.9% were male, and 41.9% were diabetics. The pooled proportion of superficial infection was 10% (95% CI: 0.06-0.16), deep infection 8% (95% CI: 0.06-0.11), implant failure 11% (95% CI: 0.07-0.15), malunion 11% (95% CI: 0.06-0.18), and all-cause mortality 27% (95% CI: 0.20-0.34). The pooled mean post-operative Olerud-Molander ankle score was 54.07 (95% CI: 48.98-59.16). Egger's test (P = 0.56) showed no significant publication bias. *Conclusion(s): TTC nailing is an adequate alternative option for fragility ankle fractures. However, current evidence includes mainly case series with inconsistent post-operative rehabilitation protocols. Prospective randomised control trials with long follow-up times and large cohort sizes are needed to guide the use of TTC nailing for ankle fractures.

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Achilles tendon resting angle is able to detect deficits after an Achilles tendon rupture, but it is not a surrogate for direct measurements of tendon elongation, function or symptoms (2022)

Type of publication:
Journal article

Author(s):
arsson E.; Helander K.N.; Falkheden Henning L.; Heiskanen M.; *Carmont M.R.; Gravare Silbernagel K.; Brorsson A.

Citation:
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. (no pagination), 2022. Date of Publication: 10 Sep 2022. [epub ahead of print]

Abstract:
PURPOSE: The aim of this study was to investigate how the Achilles tendon resting angle (ATRA), an indirect measurement of tendon elongation, correlates with ultrasonography (US) measurements of the Achilles tendon length 6 and 12 months after an acute ATR and relates to other clinical outcome measurements such as heel-rise height, jumping ability and patient-reported outcome measurements (PROMs). METHOD(S): Patients were included following acute Achilles tendon rupture (ATR). Achilles tendon length, ATRA, heel-rise height (HRH), drop countermovement jump (Drop CMJ) and PROMs (Achilles tendon total rupture score (ATRS) and physical activity scale (PAS)) were evaluated 6 and 12 months after injury. Achilles tendon length was evaluated using US, while the ATRA was measured with a goniometer. RESULT(S): Sixty patients (13 women, 47 men), mean (SD) age 43 (9) years, with an acute ATR undergoing either surgical (35%) or non-surgical (65%) treatment were evaluated. A negative correlation (r=- 0.356, p=0.010) between relative ATRA and tendon elongation was seen at 12 months after ATR. There were also significant positive correlations at 6 and 12 months between relative ATRA and HRH (r=0.330, p=0.011 and r=0.379, p=0.004). There were no correlations between ATRA and ATRS or ATRA and Drop CMJ, at either 6 or 12 months after the injury. CONCLUSION(S): In combination with other clinical evaluations such as HRH and US, ATRA could be a clinical tool for indirect measurements of tendon elongation. However, ATRA cannot be recommended as a direct surrogate for US for determining Achilles tendon length.

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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)

Type of publication:
Conference abstract

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

Citation:
British Journal of Surgery. Conference: ASiT Surgical Conference 2022. Aberdeen United Kingdom. 109(Supplement 6) (pp vi35), 2022. Date of Publication: September 2022.

Abstract:
Introduction: There has been a rise in trainee-led trauma & orthopaedic multi-centre research collaborative projects globally. These increase trainee involvement in research with an opportunity to deliver highly generalisable results on a particular topic. Objective(s): To evaluate the number of trauma & orthopaedic trainee-led research collaborative projects that took part since the start of the COVID-19 pandemic in the UK and compare them to projects from 2019. Method(s): This was a retrospective study that evaluated trauma & orthopaedic 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, pre Covid- 19 projects and projects of other surgical specialities. 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 6 being published so far. The level of evidence ranged between 3 and 4 and included 5 Audits and 5 cohort studies. The patients that were included in the studies ranged from 927 to 140,231 from a total of 2249 centres. Conclusion(s): Covid-19 has placed significant challenges across healthcare. However, one positive aspect 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 and the availability of new tools such as social media and centralised confidential online databases such as Redcap facilitates such projects. Therefore, we recommend expanding this trainee-led collaborative platform in the field of trauma & orthopaedics worldwide.

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Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: An international cohort study (2021)

Type of publication:Journal article

Author(s):Ward A.E.; Nepogodiev D.; Ahmed I.; Chaudhry D.; Dhaif F.; Bankhad-Kendall B.; Mahmood A.; Marais L.; Metcalfe A.; Parsons N.; Siaw-Acheampong K.; Dawson B.E.; Evans J.P.; Glasbey J.C.; Gujjuri R.R.; Heritage E.; Jones C.S.; Kamarajah S.K.; Keatley J.M.; Li E.; McKay S.C.; Pellino G.; Tiwari A.; Simoes J.F.F.; Trout I.M.; Venn M.L.; Wilkin R.J.W.; Ademuyiwa A.O.; Agarwal A.; Al Ameer E.; Alderson D.; Arnaud A.P.; Augestad K.M.; BankheadKendall B.; Benson R.A.; Chakrabortee S.; Blanco-Colino R.; Brar A.; Minaya Bravo A.; Breen K.A.; Lima Buarque I.; Caruana E.; Cunha M.F.; Di Saverio S.; Elhadi M.; Farik S.; Fiore M.; Fitzgerald J.E.; Gallo G.; Ghosh D.; Gomes G.M.A.; Hutchinson P.; Isik A.; Lawani I.; Lederhuber H.; Leventoglu S.; Loffler M.W.; Mazingi D.; Mohan H.; Moore R.; Moszkowicz D.; Ng-Kamstra J.S.; Metallidis S.; Moug S.; Niquen M.; Ntirenganya F.; Outani O.; Pata F.; Pinkney T.D.; Pockney P.; Radenkovic D.; Ramos-De La Medina A.; Roberts K.; Santos I.; Schache A.; Schnitzbauer A.; Shaw R.; Shu S.; Soreide K.; Spinelli A.; Sundar S.; Tabiri S.; Townend P.; Tsoulfas G.; Van Ramshorst G.; Wright N.; Mak J.K.C.; Kulkarni R.; Sharma N.; Nankivell P.; Tirotta F.; Parente A.; Breik O.; Kisiel A.; Cato L.D.; Saeed S.; Bhangu A.; Griffiths E.; Pathanki A.M.; Ford S.; Desai A.; Almond M.; Kamal M.; Chebaro A.; Lecolle K.; Truant S.; El Amrani M.; Zerbib P.; Pruvot F.R.; Mathieu D.; Surmei E.; Mattei L.; Dudek J.; Singhal T.; El-Hasani S.; Nehra D.; Walters A.; Cuschieri J.; Davidson G.H.; Ho M.; Wade R.G.; Johnstone J.; Bourke G.; Brunelli A.; Elkadi H.; Otify M.; Pompili C.; Burke J.R.; Bagouri E.; Chowdhury M.; Abual-Rub Z.; Kaufmann A.; Munot S.; Lo T.; Young A.; Kowal M.; Wall J.; PeckhamCooper A.; Winter S.C.; Belcher E.; Stavroulias D.; Di Chiara F.; Wallwork K.; Qureishi A.; Lami M.; Sravanam S.; Shah K.; Chidambaram S.; Smillie R.; Shaw A.V.; Bandyopadhyay S.; Cernei C.; Bretherton C.; Jeyaretna D.; Ganau M.; Piper R.J.; Duck E.; Brown S.; Jelley C.; Tucker S.C.; Bond-Smith G.; Griffin X.L.; Tebala G.D.; Neal N.; Vatish M.; Noton T.M.; Ghattaura H.; Maher M.; Fu H.; Risk O.B.F.; Soleymani Majd H.; Sinha S.; Aggarwal A.; Kharkar H.; Lakhoo K.; Verberne C.; Mastoridis S.; Senent-Boza A.; Sanchez-Arteaga A.; Benitez-Linero I.; Manresa-Manresa F.; Tallon-Aguilar L.; Melero-Cortes L.; FernandezMarin M.R.; Duran-Munoz-Cruzado V.M.; Ramallo-Solis I.; Beltran-Miranda P.; Pareja-Ciuro F.; Anton-Eguia B.T.; Dawson A.C.; Drane A.; Oliva Mompean F.; GomezRosado J.; Reguera-Rosal J.; Valdes-Hernandez J.; Capitan-Morales L.; Del Toro Lopez M.D.; Tang A.; Beamish A.J.; Price C.; Bosanquet D.; Magowan D.; Solari F.; Williams G.; Nassa H.; Smith L.; Elliott L.; McCabe G.; Holroyd D.; Jamieson N.B.; Mariani N.M.; Nicastro V.; Li Z.; Parkins K.; Spencer N.; Harries R.; Egan R.J.; Motter D.; Jenvey C.; Mahoney R.; Fine N.; Minto T.; Henry A.; Gill C.; Dunne N.; Sarma D.R.; Godbole C.; Carlos W.; Tewari N.; Jeevan D.; Naredla P.; Khajuria A.; Connolly H.; Robertson S.; Sweeney C.; Di Taranto G.; Shanbhag S.; Dickson K.; McEvoy K.; Skillman J.; Sait M.; Al-Omishy H.; Baig M.; Heer B.; Lunevicius R.; Sheel A.R.G.; Sundhu M.; Santini A.J.A.; Fathelbab M.S.A.T.; Hussein K.M.A.; Nunes Q.M.; Jones R.P.; Shahzad K.; Haq I.; Baig M.M.A.S.; Hughes J.L.; Kattakayam A.; Rajput K.; Misra N.; Shah S.B.; Clynch A.L.; Georgopoulou N.; Sharples H.M.; Apampa A.A.; Nzenwa I.C.; Sud A.; Podolsky D.; Coleman N.L.; Callahan M.P.; Dunstan M.; Beak P.; Gerogiannis I.; Ebrahim A.; Alwadiya A.; Goyal A.; Phillips A.; Bhalla A.; Demetriou C.; Grimley E.; Theophilidou E.; Ogden E.; Malcolm F.L.; Davies-Jones G.; Ng J.C.K.; Mirza M.; Hassan M.; Elmaleh N.; Daliya P.; Bateman A.; Chia Z.; A'Court J.; Konarski A.; Faulkner G.; Talwar R.; Patel K.; Askari A.; Jambulingam P.S.; Shaw S.; Maity A.; Hatzantonis C.; Sagar J.; Kudchadkar S.; Cirocchi N.; Chan C.H.; Eberbach H.; Bayer J.; Erdle B.; Sandkamp R.; Kaafarani H.; Breen K.; Bankhead-Kendall B.; Alser O.; Mashbari H.; Velmahos G.; Maurer L.R.; El Moheb M.; Gaitanidis A.; Naar L.; Christensen M.A.; Kapoen C.; Langeveld K.; El Hechi M.; Mokhtari A.; Main B.; MacCabe T.; Newton C.; Blencowe N.S.; Fudulu D.P.; Bhojwani D.; Baquedano M.; Caputo M.; Rapetto F.; Flannery O.; Hassan A.; Edwards J.; Ward A.; Tadross D.; Majkowski L.; Blundell C.; Forlani S.; Nair R.; Guha S.; Brown S.R.; Steele C.; Kelty C.J.; Newman T.; Lee M.; Chetty G.; Lye G.; Balasubramanian S.P.; Sureshkumar Shah N.; Sherif M.; Al-Mukhtar A.; Whitehall E.; Giblin A.; Wells F.; Sharkey A.; Adamec A.; Madan S.; Konsten J.; Van Heinsbergen M.; *Sou A.; *Simpson D.; *Hamilton E.; *Blair J.; Jimeno Fraile J.; Morales-Garcia D.; Carrillo-Rivas M.; Toledo Martinez E.; Pascual A.; Landaluce-Olavarria A.; Gonzalez De Miguel M.; Fernandez Gomez Cruzado L.; Begona E.; Lecumberri D.; Calvo Rey A.; Prada Hervella G.M.; Dos Santos Carregal L.; Rodriguez Fernandez M.I.; Freijeiro M.; El Drubi Vega S.; Van Den Eynde J.; Oosterlinck W.; Van Den Eynde R.; Sermon A.; Boeckxstaens A.; Cordonnier A.; De Coster J.; Jaekers J.; Politis C.; Miserez M.; Galipienso Eri M.; Garcia Montesino J.D.; Dellonder Frigole J.; Noriego Munoz D.; Lizzi V.; Vovola F.; Arminio A.; Cotoia A.; Sarni A.L.; Bekheit M.; Kamera B.S.; Elhusseini M.; Sharma P.; Ahmeidat A.; Gradinariu G.; Cymes W.; Hannah A.; Mignot G.; Shaikh S.; Agilinko J.; Sgro A.; Rashid M.M.; Milne K.; McIntyre J.; Akhtar M.A.; Turnbull A.; Brunt A.; Stewart K.E.; Wilson M.S.J.; Rutherford D.; McGivern K.; Massie E.; Duff S.; Moura F.; Brown B.C.; Asaad P.; Wadham B.; Aneke I.A.; Collis J.; Warburton H.; Fountain D.M.; Laurente R.; Sigamoney K.V.; Dasa M.; George K.; Naqui Z.; Galhoum M.; Lipede C.; Gabr A.; Radhakrishnan A.; Hasan M.T.; Kalenderov R.; Pathmanaban O.; Colombo F.; Chelva R.; Subba K.; Abou-Foul A.K.; Khalefa M.; Hossain F.; Moores T.; Pickering L.; Shah J.; Anthoney J.; Emmerson O.; Bevan K.; Makin-Taylor R.; Ong C.S.; Callan R.; Bloom O.; Vidya R.; Chauhan G.; Kaur J.; Burahee A.; Bleibleh S.; Pigadas N.; Snee D.; Bhasin S.; Crichton A.; Habeebullah A.; Bodla A.S.; Yassin N.; Mondragon M.; Dewan V.; Giuffrida M.C.; Marano A.; Palagi S.; Di Maria Grimaldi S.; Testa V.; Peluso C.; Borghi F.; Simonato A.; Puppo A.; D'Agruma M.; Chiarpenello R.; Pellegrino L.; Maione F.; Cianflocca D.; Pruiti Ciarello V.; Giraudo G.; Gelarda E.; Dalmasso E.; Abrate A.; Daniele A.; Ciriello V.; Rosato F.; Garnero A.; Leotta L.; Chiozza M.; Anania G.; Urbani A.; Koleva Radica M.; Carcoforo P.; Portinari M.; Sibilla M.; Archer J.E.; Odeh A.; Siddaiah N.; Baumber R.; Parry J.; Carmichael H.; Velopulos C.G.; Wright F.L.; Urban S.; McIntyre R.C.; Schroeppel T.J.; Hennessy E.A.; Dunn J.; Zier L.; Parmar C.; McCluney S.; Shah S.; Munoz Vives J.M.; Osorio A.; Gomez Diaz C.J.; Guariglia C.A.; Soto Montesinos C.; Sanchon L.; Xicola Martinez M.; Guardia N.; Collera P.; Diaz Del Gobbo R.; Sanchez Jimenez R.; Farre Font R.; Flores Clotet R.; Brathwaite C.E.M.; Liu H.; Petrone P.; Hakmi H.; Sohail A.H.; Baltazar G.; Heckburn R.; Madhvani K.; Hampton M.; Hormis A.P.; Young R.; Miu V.; Sheridan K.; MacDonald L.; Green S.; Onos L.; Dean B.; Luney C.; Myatt R.; Williams M.A.; McVeigh J.; Alqallaf A.; Ben-Sassi A.; Mellor K.; Joshi P.; Joshi Y.; Crichton R.; Sonksen J.; Aldridge K.; Layton G.R.; Karki B.; Jeong H.; Pankhania S.; Asher S.; Folorunso A.; Mistry S.; Singh B.; Winyard J.; Mangwani J.; Babu B.H.B.; Liyanage A.S.D.; Newman S.; Blake I.; Weerasinghe C.; Ballabio M.; Bisagni P.; Longhi M.; Armao T.; Madonini M.; Gagliano A.; Pizzini P.; Alga A.; Nordberg M.; Sandblom G.; Jallad S.; Lord J.; Anderson C.; El Kafsi J.; Logishetty K.; Saadya A.; Midha R.; Ip M.; Subbiah Ponniah H.; Stockdale T.; Bacarese-Hamilton T.; Foster L.; James A.; Anjarwalla N.; Marujo Henriques D.; Hettige R.; Baban C.; Tenovici A.; Salerno G.; Hardie J.; Page S.; Anazor F.; King S.D.; Luck J.; Kazzaz S.; Patel M.; Shabana A.; Alanbuki A.; Usman O.; Hkruijff S.; De Vries J.P.P.M.; Steinkamp P.J.; Jonker P.K.C.; Van Der Plas W.Y.; Bierman W.; Janssen Y.; Borgstein A.B.J.; Gisbertz S.S.; Van Berge Henegouwen M.I.; Enjuto D.; Perez Gonzalez M.; Diaz Pena P.; Gonzalez J.; Marqueta De Salas M.; Martinez Pascual P.; Rodriguez Gomez L.; Garces Garcia R.; Ramos Bonilla A.; Herrera-Merino N.; Fernandez Bernabe P.; Cagigal Ortega E.P.; Hernandez I.; Garcia De Castro Rubio E.; Cervera I.; Kashora F.; Siddique M.H.; Singh A.; Barmpagianni C.; Basgaran A.; Basha A.; Okechukwu V.; Bartsch A.; Gallagher P.; Maqsood A.; Sahnan K.; Leo C.A.; Lewis S.E.; Ubhi H.K.; Exley R.; Khan U.; Shah P.; Saxena S.; Zafar N.; Abdul-Jabar H.; Mongelli F.; Bernasconi M.; Di Giuseppe M.; Christoforidis D.; La Regina D.; Arigoni M.; Liew I.; Al-Sukaini A.; Mediratta S.; Saxena D.; Boal M.; Dean H.; Higgs S.; Stanger S.; Abdalaziz H.; Constable J.; Ishii H.; Preece R.; Dovell G.; Gopi Reddy R.; Dehal A.; Shah H.B.; Cross G.W.V.; Seyed-Safi P.; Smart Y.W.; Kuc A.; Al-Yaseen M.; Jayasankar B.; Balasubramaniam D.; Abdelsaid K.; Mundkur N.; Gallagher B.; Hine T.; Keeler B.; Soulsby R.E.; Taylor A.; Davies E.; Ryska O.; Raymond T.; Rogers S.; Tong A.; Hawkin P.; Kinnaman G.; Meagher A.; Sharma I.; Holler E.; Dunning J.; Viswanath Y.; Freystaetter K.; Dixon J.; Hadfield J.N.; Hilley A.; Egglestone A.; Smith B.; Arkani S.; Freedman J.; Youssef M.; Sreedharan L.; Baskaran D.; Shaikh I.; Seebah K.; Reid J.; Watts D.; Kouritas V.; Chrastek D.; Maryan G.; Gill D.F.; Khatun F.; Ranjit S.; Parakh J.; Sarodaya V.; Daadipour A.; Khalifa M.; Bosch K.D.; Bashkirova V.; Dvorkin L.S.; Kalidindi V.K.; Choudhry A.; Marx W.; Espino Segura-Illa M.; Sanchez Aniceto G.; Castano-Leon A.M.; Jimenez-Roldan L.; Delgado Fernandez J.; Perez Nunez A.; Lagares A.; Garcia Perez D.; Santas M.; Paredes I.; Esteban Sinovas O.; Moreno-Gomez L.; Rubio E.; Vega V.; Vivas Lopez A.; Labalde Martinez M.; Garcia Villar O.; Pelaez Torres P.M.; Garcia-Borda J.; Ferrero Herrero E.; Gomez P.; Eiriz Fernandez C.; Ojeda-Thies C.; Pardo Garcia J.M.; Wynn Jones H.; Divecha H.; Whelton C.; Board T.; Hardie C.; Powell-Smith E.; Alotaibi M.; Maashi A.; Zowgar A.; Alsakkaf M.; Izquierdo O.; Ventura D.; Castellanos J.; Lara A.; Escobar D.; Arrieta M.; Garcia De Cortazar U.; Villamor Garcia I.; Cioci A.; Ruiz G.; Allen M.; Rakoczy K.; Pavlis W.; Saberi R.; Sobti A.; Khaleel A.; Unnithan A.; Memon K.; Pala Bhaskar R.R.; Maqboul F.; Kamel F.; AlSamaraee A.; Madani R.; Kumar L.; Nisar P.; Agrawal S.; Llaquet Bayo H.; Duchateau N.; De Gheldere C.; Martin J.; Cheng D.; Yang H.; Fayad A.; Wood M.L.; Persad A.; Groot G.; Pham H.; Hakami I.; Boeker C.; Mall J.; Smith H.; Haugstvedt A.F.; Jonsson M.L.; Caja Vivancos P.; Villalabeitia Ateca I.; Prieto Calvo M.; Marin H.; Martin Playa P.; Gainza A.; Aragon Achig E.J.; Rodriguez Fraga A.; Melchor Corcostegui I.; Mallabiabarrena Ormaechea G.; Garcia Gutierrez J.J.; Barbier L.; Pesantez Peralta M.A.; Jimenez Jimenez M.; Municio Martin J.A.; Gomez Suarez J.; Garcia Opere G.; Pascua Gomez L.A.; Onate Aguirre M.; Fernandez-Colorado A.; De La Rosa-Estadella M.; Gasulla-Rodriguez A.; Serrano-Martin M.; Peig-Font A.; Junca-Marti S.; Juarez-Pomes M.; Garrido-Ondono S.; Blasco-Torres L.; Molina-Corbacho M.; Maldonado-Sotoca Y.; Gasset-Teixidor A.; Blasco-Moreu J.; Turrado-Rodriguez V.; Lacy A.M.; De Lacy F.B.; Morales X.; Carreras-Castaner A.; Torner P.; Jornet-Gibert M.; Balaguer-Castro M.; Renau-Cerrillo M.; Camacho-Carrasco P.; Vives-Barquiel M.; Campuzano-Bitterling B.; Gracia I.; Pujol-Muncunill R.; Estaire Gomez M.; Padilla-Valverde D.; Sanchez-Garcia S.; Sanchez-Pelaez D.; Jimenez Higuera E.; Picon Rodriguez R.; Fernandez Camunas A.; Martinez-Pinedo C.; Garcia Santos E.P.; Munoz-Atienza V.; Moreno Perez A.; Lopez De La Manzanara Cano C.A.; Crego-Vita D.; Huecas-Martinez M.; Domenech J.; Rosello Anon A.; Sanguesa M.J.; Bernal-Sprekelsen J.C.; Catala Bauset J.C.; Renovell Ferrer P.; Martinez Perez C.; Gil-Albarova O.; Gilabert Estelles J.; Aghababyan K.; Rivas R.; Rivas F.; Escartin J.; Blas Laina J.L.; Nogues A.; Cros B.; Talal El-Abur I.; Garcia Egea J.; Yanez C.; Kauppila J.H.; Sarjanoja E.; Tzedakis S.; Bouche P.A.; Gaujoux S.; Gossot D.; Seguin-Givelet A.; Fuks D.; Grigoroiu M.; Sanchez Salas R.; Cathelineau X.; MacEk P.; Barbe Y.; Rozet F.; Barret E.; Mombet A.; Cathala N.; Brian E.; Zadegan F.; Conso C.; Baldwin A.J.; West R.; Gammeri E.; Catton A.; Marinos Kouris S.; Pereca J.; Singh J.; Patel P.; Handa S.; Kaushal M.; Kler A.; Reghuram V.; Tezas S.; Oktseloglou V.; Mosley F.; De La Cruz Monroy M.F.I.; Bobak P.; Omar I.; Ahad S.; Langlands F.; Brown V.; Hashem M.; Williams A.; Ridgway A.; Pournaras D.; Britton E.; Lostis E.; Ambler G.K.; Chu H.; Hopkins J.; Manara J.; Chan M.; Doe M.; Moon R.D.C.; Lawday S.; Jichi T.; Singleton W.; Mannion R.; Stewart G.D.; Ramzi J.; Mohan M.; Singh A.A.; Ashcroft J.; Baker O.J.; Coughlin P.; Davies R.J.; Durst A.Z.E.D.; Abood A.; Habeeb A.; Hudson V.E.; Kolias A.; Lamb B.; Luke L.; Mitrasinovic S.; Murphy S.; Ngu A.W.T.; O'Neill J.R.; Waseem S.; Wong K.; Georgiades F.; Hutchinson P.J.; Tan X.S.; Pushpa-Rajah J.; Colquhoun A.; Masterson L.; Abu-Nayla I.; Walker C.; Balakrishnan A.; Rooney S.; Irune E.; Byrne M.H.V.; Durrani A.; Richards T.; Sethuraman Venkatesan A.; Combellack T.; Williams J.; Tahhan G.; Mohammed M.; Kornaszewska M.; Valtzoglou V.; Deglurkar I.; Rahman M.; Von Oppell U.; Mehta D.; Koutentakis M.; Syed Nong Chek S.A.H.; Hill G.; Morris C.; Shinkwin M.; Torkington J.; Cornish J.; Houston R.; Mannan S.; Ayeni F.; Tustin H.; Bordenave M.; Robson A.; Vimalachandran D.; Manu N.; Eardley N.; Krishnan E.; Serevina O.L.; Martin E.; Jones A.; Roy Mahapatra S.; Clifford R.; Matthews W.; Mohankumar K.; Khawaja I.; Palepa A.; Doulias T.; Premakumar Y.; Jauhari Y.; Koshnow Z.; Bowen D.; Uberai A.; Hirri F.; Stubbs B.M.; McDonald C.; Manickavasagam J.; Ragupathy K.; Davison S.; Dalgleish S.; McGrath N.; Kanitkar R.; Payne C.J.; Ramsay L.; Ng C.E.; Collier T.; Khan K.; Evans R.; Brennan C.; Henshall D.E.; Drake T.; Harrison E.M.; Zamvar V.; Tambyraja A.; Skipworth R.J.E.; Linder G.; McGregor R.; Brennan P.; Mayes J.; Ross L.; Smith S.; White T.; Jamjoom A.A.B.; Pasricha R.; Holme T.; Abbott S.; Razik A.; Thrumurthy S.; Steinke J.; Baker M.; Howden D.; Baxter Z.; Osagie L.; Bence M.; Fowler G.E.; Massey L.; Rajaretnam N.; John J.; Goubran A.; Campain N.; McDermott F.D.; McGrath J.S.; Ng M.; Pascoe J.; Phillips J.R.A.; Daniels I.R.; Raptis D.A.; Pollok J.M.; MacHairas N.; Davidson B.; Fusai G.; Soggiu F.; Xyda S.; Hidalgo Salinas C.; Tzerbinis H.; Pissanou T.; Gilliland J.; Chowdhury S.; Varcada M.; Hart C.; Mirnezami R.; Knowles J.; Angamuthu N.; Vijay V.; Shakir T.; Hasan R.; Tansey R.; Ross E.; Loubani M.; Wilkins A.; Cao H.; Capitelli-McMahon H.; Hitchman L.; Ikram H.; Andronic A.; Aboelkassem Ibrahim A.; Totty J.; Tayeh S.; Chase T.; Humphreys L.; Ayorinde J.; Ghanbari A.; Cuming T.; Williams K.; Chung E.; Hagger R.; Karim A.; Hainsworth A.; Flatman M.; Trompeter A.; Hing C.; Brown O.; Tsinaslanidis P.; Benjamin M.W.; Leyte A.; Tan C.; Smelt J.; Vaughan P.; Santhirakumaran G.; Hunt I.; Raza M.; Labib A.; Luo X.; Sudarsanam A.; Rolls A.; Lyons O.; Onida S.; Shalhoub J.; Sugand K.; Park C.; Sarraf K.M.; Erridge S.; Kinross J.; Denning M.; Yalamanchili S.; Abuown A.; Ibrahim M.; Martin G.; Davenport D.; Wheatstone S.; Andreani S.M.; Bath M.F.; Sahni A.; Judkins N.; Rigueros Springford L.; Sohrabi C.; Bacarese-Hamilton J.; Taylor F.G.; Patki P.; Tanabalan C.; Reynolds J.; Alexander M.E.; Smart C.J.; Stylianides N.; Abdalla M.; Newton K.; Bhatia K.; Edmondson R.; Abdeh L.; Jones D.; Zeiton M.; Ismail O.; Naseem H.; Advani R.; Fell A.; Smith A.; Halkias C.; Evans J.; Nikolaou S.; English C.; Kristinsson S.; Oni T.; Ilahi N.; Ballantyne K.; Woodward Z.; Merh R.; Robertson-Smith B.; Mahmoud A.; Ameerally P.; Finch J.G.; Gnanachandran C.; Pop I.; Rogers M.; Yousef Y.; Mohamed I.; Woods R.; Zahid H.; Mundy G.; Aujayeb A.; Townshend D.; McLarty N.; Shenfine A.; Jackson K.; Johnson C.; Dass D.; Ford D.; Khan J.; Thiruchandran G.; Toh S.K.C.; Ahmad Y.; Allana A.; Bellis C.; Babawale O.; Phan Y.C.; Lokman U.; Ismail M.; Koc T.; Witek A.; Duggleby L.; Shamoon S.; Stefan S.; Clancy H.; Singh S.; Mukherjee S.; Ferguson D.; Smith C.; Mansuri A.; Thakrar A.; Wickramarachchi L.; Cuthbert R.; Sivayoganathan S.; Chui K.; Karam E.; Dott C.; Shankar S.; Singh R.; Lane J.; Colvin H.V.; Badran A.; Cadersa A.; Williams S.; Cumpstey A.; Hamady Z.; Aftab R.; Wensley F.; Byrne J.; Morrison-Jones V.; Sekhon G.K.; Shields H.; Shakoor Z.; Yener A.; Talbot T.; Khan A.; Alzetani A.; Cresner R.; Johnson D.; Hughes I.; Hall J.; Rooney J.; Chatterji S.; Zhang Y.; Owen R.; Rudic M.; Hunt J.; Zakai D.; Thomas M.; Aladeojebi A.; Ali M.; Gaunt A.; Barmayehvar B.; Gowda M.; Mansour F.; Jarvis M.; Halliday E.; Lefroy R.; Nanjaiah P.; Ali S.; Kitchen M.; Lin D.J.; Rajgor A.D.; Scurrah R.J.; Kang C.; Watson L.J.; Harris G.; Royle T.; Cunningham Y.; James G.; Steel B.; Luk A.C.O.; Stables G.; Doorgakant A.; Thiruvasagam V.G.; Carter J.; Reid S.; Mohammed R.; Marlow W.; Ferguson H.; Wilkin R.; Konstantinou C.; Yershov D.; Vatish J.; Denning A.; Das R.; Powell S.; Magee C.; Agarwal K.; Mangos E.; Nambirajan T.; Flindall I.; Mahendran V.; Hanson A.; De Marchi J.; Hill A.; Farrell T.; Davis N.F.; Kearney D.; Nelson T.; Picciariello A.; Papagni V.; Altomare D.F.; Granieri S.; Cotsoglou C.; Cabeleira A.; Branco C.; Serralheiro P.; Alves R.; Teles T.; Lazaro A.; Canhoto C.; Simoes J.; Costa M.; Almeida A.C.; Nogueira O.; Oliveira A.; Athayde Nemesio R.; Silva M.; Lopes C.; Amaral M.J.; Valente Da Costa A.; Andrade R.; Guimaraes A.; Guerreiro P.; Ruivo A.; Camacho C.; Duque M.; Santos E.; Breda D.; Oliveira J.M.; De Oliveira Lopez A.L.; Garrido S.; Colino M.; De Barros J.; Correia S.; Rodrigues M.; Cardoso P.; Martins R.; Teixeira J.; Soares A.P.; Morais H.; Pereira R.; Revez T.; Manso M.I.; Domingues J.C.; Henriques P.; Ribeiro R.; Ribeiro V.I.; Cardoso N.; Sousa S.; Martins Dos Santos G.; Miranda P.; Garrido R.; Peralta Ferreira M.; Ascensao J.; Costeira B.; Cunha C.; Rio Rodrigues L.; Sousa Fernandes M.; Azevedo P.; Ribeiro J.; Lourenco I.; Gomes H.; Mendinhos G.; Nobre Pinto A.; Taflin H.; Abdou H.; Richmond M.; Clark J.; O'Meara L.; Hanna N.; Cooper Z.; Salim A.; Hirji S.A.; Brown A.; Chung C.; Hansen L.; Okafor B.U.; Roxo V.; Raut C.P.; Jolissaint J.S.; Mahvi D.A.; Reinke C.; Ross S.; Thompson K.; Manning D.; Perkins R.; Volpe A.; Merola S.; Ssentongo A.; Ssentongo P.; Oh J.S.; Hazelton J.; Maines J.; Gusani N.; Garner M.; Horvath S.; Martin R.C.G.; Bhutiani N.; Choron R.; Peck G.; Soliman F.; Abbas A.; Soliman A.; Kim B.; Jones C.; Dauer M.D.E.; Renza-Stingone E.; Hernandez E.; Gokcen E.; Kropf E.; Sufrin H.; Hirsch H.; Ross H.; Engel J.; Sewards J.; Diaz J.; Poggio J.; Sanserino K.; Rae L.; Philp M.; Metro M.; McNelis P.; Petrov R.; Rehman S.; Pazionis T.; Quintana M.; Jackson H.; Lumenta D.B.; Nischwitz S.P.; Richtig E.; Pau M.; Srekl-Filzmaier P.; Eibinger N.; Michelitsch B.; Fediuk M.; Papinutti A.; Seidel G.; Kahn J.; Cohnert T.U.; Kantor E.; Kahiu J.; Hossain N.; Hosny S.; Sultana A.; Taggarsi M.; Vitone L.; Lambert J.; Vaz O.P.; Sarantitis I.; Shrestha D.; Timbrell S.; Shugaba A.; Jones G.P.; Gardner A.; Tripathi S.S.; Greenhalgh M.S.; Emerson H.; Vejsbjerg K.; Pearce L.; McCormick W.; Fisher A.; Singisetti K.; Aawsaj Y.; Barry C.; Blanco J.; Vanker R.; Ghobrial M.; Jones G.; Kanthasamy S.; Fawi H.; Awadallah M.; Chen F.; Cheung J.; Tingle S.; Abbadessa F.; Sachdeva A.; Rai B.; Chan C.D.; McPherson I.; Booth K.; Mahmoud Ali F.; Pandanaboyana S.; Grainger T.; Nandhra S.; Patience A.; Rogers A.; Roy C.; Williams T.; Dawe N.; McCaffer C.; Riches J.; Bhattacharya S.; Moir J.; Kalson N.S.; Elamin Ahmed H.; Mellor C.; Saleh C.; Koshy R.M.; Hammond J.; Sanderson L.; Wahed S.; Phillips A.W.; Ghosh K.; Rogers L.J.; Labib P.L.; Miller D.; Minto G.; Hope N.; Marchbank A.; Emslie K.; Panahi P.; Ho B.; Perkins C.; Clough E.; Roy H.; Enemosah I.; Campbell R.; Natale J.; Gohil K.; Rela M.; Raza N.; Menakaya C.; Webb J.I.; Antar M.; Modi N.; Sofat R.; Noel J.; Nunn R.; Adegbola S.; Eriberto F.; Sharma V.; Tanna R.; Lodhia S.; Carvalho L.; Osorio C.; Antunes J.; Lourenco S.; Balau P.; Godinho M.; Pereira A.; Keller D.S.; Smart N.J.

Citation:BMJ Open. 11(11) (no pagination), 2021. Article Number: e050830.

Abstract:Objectives: Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis. Setting: Prospective, international, multicentre, observational cohort study. Participants Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative). Primary outcome 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality. Results This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p<0.001), age >80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787). Conclusions: Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.

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Surgical Fixation of Three- and Four-Part Proximal Humeral Fractures Using the Proximal Humeral Interlocking System Plate (2022)

Type of publication:Journal article

Author(s):Saber AY; Said UN; Abdelmonem AH; Elsayed H; Taha M; Hussein W; *Al-Hashimi K; El-Omar O; Elbeshbeshy M

Citation:Cureus, 2022 May 26; Vol. 14 (5), pp. e25348

Abstract:Introduction The management of proximal humeral fractures ranges greatly from conservative management to surgical treatment. For those fractures requiring surgical treatment, internal fixation is the primary method. The aim of internal fixation is to achieve rigid fracture fixation until union occurs, return of shoulder range of motion, and minimise intra-and postoperative complications. The aim of this study was to evaluate the results of the Proximal Humeral Interlocking System Plate (PHILOS) used for the treatment of three-and four-part proximal humeral fractures. Materials and methods This study included 30 patients with a mean age of 54 years (range 20-80 years). Results were checked post-operatively with standard radiographs and clinical evaluation according to the Constant-Murley shoulder score. All patients were followed up for 12 months. Results Union was achieved in all patients with a mean neck/shaft angle of 130° (range 108°-150°). The mean Constant-Murley score at the final follow-up was 82.28 (range 67-96) correlating with good results. No patients developed an intraoperative or postoperative vascular injury, wound complications, or avascular necrosis of the humeral head. Conclusion Our study has shown that the surgical treatment of three- and four-part proximal humeral fractures with the use of the PHILOS plate leads to a good functional outcome. It has also demonstrated the PHILOS plate and is an effective system for fracture stabilisation provided the correct surgical technique is used with awareness of potential hardware complications.

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

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

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)

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)

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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