Bilateral Pseudoaneurysms Following Percutaneous Achilles Tenotomy for Congenital Talipes Equinovarus.

Pseudoaneurysm following percutaneous tendoachilles (TA) tenotomy is a rare complication found in children with congenital talipes equinovarus (CTEV). It is postulated that associated aberrant vascular anatomy in combination with CTEV may be the underlying aetiology. In this case report, we describe a case of a toddler who developed bilateral pseudoaneurysms following percutaneous tendoachilles tenotomy and explore the management and outcome in relation to this. Based on this case report and a review of the literature, the consistent clinical findings of swelling and/or discolouration due to pseudoaneurysm occur at three weeks post-tenotomy, and should raise suspicion for the diagnosis. Furthermore to the best of our knowledge, this is the first case report of bilateral pseudoaneurysms in the same setting, and we propose the possibility of an aberrant vessel arising from the peroneal artery that may be prone to injury.

Hip pain attributable to a ganglion of the psoas tendon: a common cyst in an uncommon region-the first case reported in a child.

Ganglion cysts of the psoas tendon are uncommon and rarely reported in the literature. Often they remain asymptomatic and are found incidentally or can be a cause of atypical groin/hip pain. We present a rare case of ganglion cyst in a child arising from the psoas tendon, causing symptomatic hip pain, which failed non-surgical treatment and eventually successfully treated with surgical excision.

Epidemiology of Paediatric Orthopaedic Trauma, Before, During, and After the Outbreak of COVID-19 Pandemic: An Observational Study From a Tertiary Referral Center in Wales.

Introduction The outbreak of coronavirus disease 2019 (COVID-19) and the resultant lockdown has had a great impact on global healthcare. This observational study aimed to analyse the consequences of national lockdown on the epidemiology of significant paediatric orthopaedic trauma, presenting to a tertiary referral centre in Wales, during the COVID-19 pandemic in the United Kingdom. Methods Paediatric patients presenting with orthopaedic trauma, from March 2019 to July 2019 (baseline period), March 2020 to July 2020 (lockdown period), and March 2021 to July 2021 (post lockdown period), were identified and compared. Those aged less than 16 years, presenting with a significant orthopaedic injury, defined here for the study as, those requiring either manipulation under anaesthesia or, surgical intervention were included in this study. Results Mean age of children with significant orthopaedic injuries during the lockdown dropped significantly to 6.52 years in comparison to those during the baseline period (7.9 years), and post lockdown period (8.85 years). The incidence of outdoor injuries plummeted significantly from 64.71% in the baseline period, to 41.27% during the lockdown period, but rose to 80.65% in the post lockdown period. There was a 48% reduction in the number of children who required intervention in operating theatre during the lockdown period, in comparison to the other two study periods. Conclusion Our study reports a significant decrease in the incidence of paediatric orthopaedic trauma needing intervention in operating theatre during the lockdown period, with a significant rise in the incidence of domestic injuries, and relatively younger children sustaining these injuries. A public information campaign could help reduce the incidence of such domestic accidents during future lockdowns. We recommend improving awareness among parents, creating a safe indoor as well as outdoor environment to help reduce the incidence of fractures in the paediatric population. This will subsequently help in reducing the financial burden on an already stretched healthcare system.

Trainee Principal Investigator Could Improve Recruitment in Trauma Trials: Review of Literature and Experience From a Trauma Center.

INTRODUCTION: Recruitment of patients to participate in randomized control trials (RCT) is a challenging task, especially for trauma trials in which the identification and recruitment are time-limited. Multiple strategies have been tried to improve the participation of doctors and the recruitment of patients. The aim was to study the effect of a trainee principal investigator (TPI) on the efficacy of recruitment for a multicenter hip fracture RCT. METHODS: A retrospective study comparing the number of junior doctors participating in the WHiTE 8 COPAL RCT and patients recruited before and after the introduction of formal TPI role at a major trauma center in the UK. Data was collected for nine months "before" (Nov 2018-July 2019) and six months "after" (Sept 2019-Feb 2020) the role of TPI was assigned. RESULTS: From November 2018 to February 2020, a total of 292 patients were eligible for recruitment into this trial, out of which 196 (67.12 %) were successfully recruited. Excluding the research team, there were seven junior doctors actively recruiting in the "before period" in comparison with 10 in the "after period." Significantly more patients were recruited by junior doctors after a TPI was assigned. Overall, more percentage of eligible patients were recruited into the trial after a TPI was assigned, and this was statistically significant. CONCLUSION: The allocation of a formal TPI significantly improved the recruitment of patients in a national RCT. TPI can work alongside the principal investigator and research team to be a valuable link person coordinating and engaging local trainees to take part in trials.

Results From an All Wales Trainee Led Collaborative Prospective Audit on Management of Ankle Fractures.

Aim The purpose of this all Wales national audit was to compare compliance against British Orthopedic Association Standards for Trauma (BOAST) guidelines on the management of ankle fractures. Methods A multi-center prospective audit of the management of adult ankle fractures was conducted between February 2, 2020, and February 17, 2020, via the Welsh Orthopedic Research Collaborative (WORC). Regional leads were recruited in nine NHS hospitals across six university health boards, and recruited collaborators in their respective hospitals. Questionnaires for the data collection on both surgical and conservative management were made available via a password-protected website (walesortho.co.uk). We defined early weight-bearing (EWB) as unrestricted weight-bearing on the affected leg within three weeks of injury or surgery and delayed weight-bearing (DWB) as unrestricted weight-bearing after three weeks of injury or surgery. Results A total of 28 collaborators contributed data for 238 ankle fractures. Poor documentation at the time of injury was noted. Less than 50% of patients with posterior malleolus fracture had a CT scan for further evaluation. Eighty-four percent of the non-operatively treated patients did not have a weight-bearing X-ray (WBXR). Patients who had a WBXR were more likely to be allowed EWB but this was not statistically significant. EWB was allowed in 59.43% and 10% of the non-operatively and operatively treated patients, respectively. DWB was higher in patients who had fixation of the posterior malleolus or syndesmosis. Conclusion There is poor compliance with BOAST guidelines on the management of ankle fractures across Wales. We need to improve documentation and also consider performing a CT scan when the posterior malleolus is fractured. A weight-bearing X-ray should be performed more often to ascertain the stability of an ankle fracture, and those that are deemed stable should be treated with early weight-bearing. The guidelines need to be clearer regarding weight-bearing after fixation especially when posterior malleolus and/or syndesmosis are fixed.

Acetabular Defect Reconstruction with Trabecular Metal Augments: Study with Minimum One-year Follow-up.

PURPOSE: High rates of mechanical failure have been reported in type III acetabular defects. Recently porous trabecular metal augments have been introduced with, excellent biomechanical characteristics and biocompatibility, allowing early stability and greater bone ingrowth. The aim of the study was to assess the short term clinical and radiological outcome of the trabecular metal augments. MATERIALS AND METHODS: We performed, 22 revision total hip arthroplasties (THA) and 6 primary THA (total 28) using trabecular metal augments to reconstruct acetabular defect between 2011 to 2015. Among 28 patients, 18 were males, 10 females. Mean age of patients was 61.21 years. Paprosky classification for acetabular bone defects was used. Eighteen cases were classified as grade 3 A and 10 cases as grade 3B. Hip center was calculated in each case preoperatively and compared postoperatively to check whether it has been brought down. Clinical outcome assessed using Harris hip score (HHS) and radiological outcomes as osteolysis in acetabular zones and osseointegration, according to Moore's criteria. RESULTS: HHS improved from 58.00 to 86.20. Centre of rotation of hip joint corrected from 38.90 mm preoperatively to 23.85 mm postoperatively above the interteardrop line. Among 28 patients, 18 patients had three or more signs of osseointegration (Moore's criteria), during final follow up and 10 had one/two signs. No radiolucency, osteolysis, or loosening found during follow up radiographic examination. CONCLUSION: Our study showed that trabecular metal augments were highly satisfactory in short term. However, long term study is required for better evaluation.

Functional and radiological outcomes of thoracolumbar traumatic spine fractures managed conservatively according to Thoracolumbar Injury Severity Score.

AIM: To study the functional and radiological outcomes in cases managed conservatively for single-level traumatic thoracolumbar spine fractures without neurological deficit. MATERIALS AND METHODS: In this prospective study design, thirty patients who presented to tertiary care hospital and diagnosed with posttraumatic thoracolumbar vertebral fracture without any neurodeficit were recruited. All the patients were managed conservatively as per the protocol which included bed rest, spinal braces, and physiotherapy. Adequate analgesia was given wherever necessary. The patients were followed at regular intervals up to a maximum of 2 years. Clinically visual analog scale (VAS) score and Roland Morris Disability Questionnaire (RMDQ)-24 were assessed and radiologically local vertebral kyphosis, scoliosis, and loss of body height were noted at each follow-up. RESULTS: The data was statistically analyzed and the results were as follows. Thoracolumbar fractures were more in young adults (<26 years) and more so among the males (80% cases). The most common fracture type in our study was compression fracture. The most common site involved in our study was L1 vertebra (36.7%). There was a significant decrease of VAS score (pain score) in 79% cases with the maximum decrease in type A1 fracture. The mean RMDQ-4 score in our study was 5.53. The overall progression of kyphosis was 1.9°. There was no relation found between the kyphotic deformity and the clinical outcomes (VAS and RMDQ-24 scores). Canal size changes were found to be insignificant at the end of 2 years compared to baseline. CONCLUSION: Study showed favorable outcomes in terms of return to daily activities, making it a good option in managing Type A1 dorsolumbar fractures. Though there was a progression of kyphosis but no neurological deficit was seen.