Radiolucent cerclage for humerus fractures: beware of radial nerve injury-a case report.

A 73-year-old woman was referred to a National Centre for Peripheral Nerve Injury with a post-operative left radial nerve degenerative lesion following open reduction and internal fixation of a proximal third humerus fracture using radiolucent Arthrex FiberTape® Cerclage as an adjunct to plating to improve stability. Intra-operative photographs illustrate compression of the radial nerve under the cerclage construct. Use of radiolucent cerclage for humerus fractures is increasing with modern systems capable of withstanding an ultimate load of 4300 N. We highlight the risk of debilitating neurological injury when not deployed safely and describe anatomical high-risk zones for injury. We emphasize the impact of delay in diagnosis and treatment.

Virtual Hospital Induction for Medical Students: A Novel Approach.

Background and objective Face-to-face hospital induction has been reported to lead to information overload with poor knowledge retention. The coronavirus disease 2019 (COVID-19) pandemic has provided an opportunity to redesign the induction process, thereby taking it into the digital age. In this study, we aimed to discuss a comprehensive and effective approach toward the induction of medical students. Methods A video was filmed on an iPhone (Apple Inc., Cupertino, CA), edited using the iMovie program (Apple Inc.), and shared with students before the start of the placement. It included a walk-through of the hospital and an explanation of educational opportunities. Pre- and post-placement questionnaires were distributed and focus groups were conducted. Results Our findings revealed that the participants strongly preferred virtual induction, feeling more confident about where to go, and who to contact, and better orientated on day one of their placement. They felt that being able to re-watch the induction at their convenience was invaluable. Discussion COVID-19 has brought about rapid digitalisation of medical services. The feedback from our study shows that virtual induction improved the well-being of students during their placement. By using easily accessible equipment, we have produced a useful resource that can be easily recreated by others.

A comparison of hand function in Colles and scaphoid casts using a modified Jebsen Hand Function Test.

This study investigates the impact of Colles versus scaphoid casts on hand function in modern day activities using the Jebsen Hand Function Test with additional modified subtests including texting on a mobile phone, using a computer mouse and typing on a computer keyboard. Twenty healthy volunteers were recruited for the study. Study participants performed worse in a scaphoid cast compared to a Colles cast; most evident in tasks involving fine motor movements such as writing, picking up small objects and stacking checkers (mean time difference 2.3 seconds, 1.5 seconds and 1.2 seconds, respectively) and tasks involving forearm rotation such as card turning and picking up large light objects (mean time difference 1.6 seconds and 1.1 seconds, respectively). This study highlights the importance of careful consideration when assessing the need for thumb immobilization, due to its impact on hand function when performing both traditional and modern-day activities of daily living.

Restarting Elective Orthopaedic Surgery During the COVID-19 Pandemic: Lessons Learned.

Introduction  Coronavirus disease 2019 (COVID-19) resulted in postponing non-emergency elective surgeries beginning in April 2020. Our hospital successfully restarted elective orthopaedic surgery during the pandemic to help improve the quality of life of patients with chronic disabilities.  This study describes the development of local protocols and pathways to allow for a safe restart of elective orthopaedic surgery in a COVID-19-free 'green' site. It includes the morbidity and mortality outcomes of those patients who underwent non-emergency orthopaedic operations during this time.  Methods  This is a prospective cohort study over an eight-week period evaluating 104 patients undergoing non-emergency orthopaedic procedures through a COVID-19-free surgical pathway. The primary outcome measure was 14-day postoperative mortality. The main secondary outcome measures were the development of a COVID-19 infection in the hospital and 14 days postoperatively as well as the need for intensive care unit admissions.  Results  No patients developed a COVID-19 infection. There were no intensive care unit admissions or postoperative deaths during our study time frame. There was no statistical difference seen for age (< 70 or > 70), gender, body mass index, or American Society of Anesthesiologists (ASA) grades in the development of postoperative complications.  Conclusions  This study describes a roadmap to setting up a protocolised elective operating service for orthopaedic surgery. It has shown that standardised protocols in a COVID-19-free 'green' site, preoperative COVID-19 testing, and adherence to national guidelines on self-isolation can help prevent developing COVID-19 infection postoperatively and reduce the risk of postoperative mortality.

Hello, can you hear me? Orthopaedic clinic telephone consultations in the COVID-19 era- a patient and clinician perspective.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has resulted in seismic changes in healthcare delivery. As a result of this, hospital footfall required to be reduced due to increased risk of transmission of infection. To ensure patients can safely access healthcare, we introduced orthopaedic clinic telephone consultations in our busy district general hospital. AIM: To investigate patients' and clinicians' perspective of telephone consultations during COVID-19, and whether this method of consultation could be a viable option in the post- pandemic future. METHODS: This is a single centre, prospective study conducted in a busy National Health Service district general hospital. In May 2020, 100 non- consecutive adult patients were contacted by independent investigators within 48 h of their orthopaedic clinic telephone consultation to complete a telephone satisfaction questionnaire. The questions assessed satisfaction regarding various aspects of the consultation including overall satisfaction and willingness to use this approach long term. Satisfaction and perspective of 25 clinicians conducting these telephone consultations was also assessed via an online survey tool. RESULTS: 93% of patients were overall satisfied with telephone consultations and 79% were willing to continue this method of consultation post- pandemic. Patients found telephone consultations to reduce personal cost and inconvenience associated with attending a hospital appointment. 72% of clinicians reported overall satisfaction with this service and 80% agreed that telephone consultations should be used in the future. The majority found it less laborious in time and administration in comparison to face to face consultations. Patients and clinicians expressed their desire for video consultations as a method of further improving their experience with remote consultations. CONCLUSION: Our study has shown that telephone consultations are a safe and rapid method of adaptation to the COVID-19 pandemic, achieving the aim of reducing hospital footfall. This method of consultation has resulted in immense clinician and patient satisfaction. Our findings suggest that this tool has benefits in post pandemic healthcare delivery. It has also highlighted that telephone consultations can act as a steppingstone to the introduction of the more complex platform of video consulting.

Lower limb intracast pressures generated by different types of immobilisation casts.

AIM: To determine if complete, split casts and backslabs [plaster of Paris (POP) and fiberglass] generate different intracast pressures and pain. METHODS: Increased swelling within casts was modeled by a closed water system attached to an expandable bag placed directly under different types of casts applied to a healthy lower limb. Complete fiberglass and POP casts, split casts and backslabs were applied. Twenty-five milliliter aliquots of saline were injected into the system and the generated intracast pressures were measured using a sphygmomanometer. The subject was blinded to the pressure scores to avoid bias. All casts were applied to the same right limb on the same subject to avoid the effects of variations in anatomy or physiology on intracast pressures. Pain levels were evaluated using the Visual Analogue Score after each sequential saline injection. Each type of cast was reapplied four times and the measurements were repeated on four separate occasions. Sample sizes were determined by a pre-study 90% power calculation to detect a 20% difference in intracast pressures between cast groups. RESULTS: A significant difference between the various types of casts was noted when the saline volume was greater than 100 mL (P = 0.009). The greatest intracast pressure was generated by complete fiberglass casts, which were significantly higher than complete POP casts or backslabs (P = 0.018 and P = 0.008 respectively) at intracast saline volumes of 100 mL and higher. Backslabs produced a significantly lower intracast pressure compared to complete POP only once the saline volume within casts exceeded 225 mL (P = 0.009). Intracast pressures were significantly lower in split casts (P = 0.003). Split POP and fiberglass casts produced the lowest intracast pressures, even compared to backslabs (P = 0.009). Complete fiberglass casts generated the highest pain levels at manometer pressures of 75 mmHg and greater (P = 0.001). Split fiberglass casts had significantly reduced pain levels (P = 0.001). In contrast, a split complete POP cast did not produce significantly reduced pain levels at pressures between 25-150 mmHg. There was no difference in pain generated by complete POP and backslabs at manometer pressures of 200 mmHg and lower. CONCLUSION: Fibreglass casts generate significantly higher intracast pressures and pain than POP casts. Split casts cause lower intracast pressures regardless of material, than complete casts and backslabs.