A Virtual Clinic for DDH Pavlik Harness Monitoring.

BACKGROUND: Pavlik harness (PH) treatment is successful in treating over 90% of newborns with developmental dysplasia of the hip (DDH). There is a need for close supervision, frequent adjustments, size changes, and monitoring of complications. This paper aims to provide a safe criterion for remote follow-up of DDH patients treated in a PH to reduce the risk of COVID-19 (coronavirus disease 2019) exposure to patients, parents, and health practitioners. METHODS: All infants with stable hips (Graf I, IIa/b/c/d, treated III/IV) with consenting parents after appropriate counseling were enrolled in a virtual clinic. Clinics were conducted using the NHS "Attend anywhere" virtual link service by an extended scope practitioner-specialist physiotherapist and a clinical nurse specialist. The virtual clinic group was compared with a matched cohort of patients from 2018/2019. RESULTS: A total of 141 patients were referred to the neonatal hip clinic; 45 patients were eligible for harness treatment and 20 patients were selected for virtual clinics. In total, there were 35 virtual clinic appointments. Each of the patients had an average of 1.7 virtual appointments ranging from 1 to 3 (26.3% of total number of clinics). Age at presentation of the treated group was 7±4.2 weeks and control group 5.7±5.5 weeks (P=0.59). PH duration of the study group was 9±2.6 weeks and the control group, 7.8±2.5 weeks (P=0.12). There were no missed complications at the follow-up face-to-face appointment. Patients saved an average of 76 km total travel distance. CONCLUSIONS: This study demonstrates adequate evidence that children requiring routine follow-up appointments involving PH adjustment, skincare, and identification of clinical anomalies, can be treated and followed up safely using virtual clinics. Clinical triage of suitable patients for virtual clinic provision must always be made by experienced clinicians. Children presenting with Graf IIa, IIb, IIc, IId, as well as those with stable and improving Graf III at initial diagnoses, had successful treatment with virtual clinic follow-up appointments in this study. LEVEL OF EVIDENCE: Level IV.

Anthropometric method for estimating component sizes in total hip arthroplasty.

BACKGROUND: Preoperative templating is essential in total hip arthroplasty (THA) as it not only helps to facilitate the correct implant type and size but also determines the post-operative biomechanics. Templating is also increasingly important from a medico-legal perspective and recommended in the British Orthopaedic Association Guide to Good Practice. Although templating has become increasingly digitised, there are no simple anthropometric models to predict implant sizes in the absence of digital methods. AIM: To assess the accuracy of using an easily obtainable measurement (shoe size) to predict component sizes in THA compared with digital templating. METHODS: Digital radiographs from a cohort of 102 patients (40 male, 62 female) who had undergone uncemented or hybrid THA at a single centre were retrospectively templated to desired cup and stem sizes using TraumaCad ® . We compared the templated size to the actual size of the implant and assessed if there was any correlation with the patient's shoe size. RESULTS: Statistically significant positive correlations were observed between: shoe size and templated cup size (ρ = 0.92, P < 0.001); shoe size with implanted cup size (ρ = 0.71, P < 0.001); shoe size and templated stem size (ρ = 0.87, P < 0.001); and shoe size with implanted stem size (ρ = 0.57, P < 0.001). Templated and implanted acetabular cup sizes were positively correlated (ρ = 0.76, P < 0.001) and were exact in 43.1% cases; 80.4% of implanted cup sizes were within 1 size (+/- 2 mm) of the template and 100% within 2 sizes (+/- 4 mm). Positive correlation was also demonstrated between templated and implanted femoral stem sizes (ρ = 0.69, P < 0.001) and were exact in 52.6% cases; 92.6% were within 1 size of the template and 98% within 2 sizes. CONCLUSION: This study has shown there to be a significant positive correlation between shoe size and templated size. Anthropometric measurements are easily obtainable and can be used to predict uncemented component sizes in the absence of digital methods.

Osteochondral Fractures After Patellar Dislocation: Current Concepts.

Osteochondral fractures of the knee occur frequently after acute patellar subluxation or dislocation. They can be challenging to manage because of the difficulty in diagnosing and treating these injuries in a timely fashion, in addition to choosing the optimum fixation method. This review presents the background, considerations for patient evaluation, and the best treatment options available for osteochondral fractures.

Is Surgical Training Prepared for the "Second Wave" of COVID-19? A Collaborative Perspective.

Restructuring of surgical services during the 'first wave' of the coronavirus-disease 2019 pandemic led to significant disruption in surgical learning opportunities provided to junior surgeons. Recent challenges faced by trainees have never been faced before. These include disruption to surgical opportunities available, completing assessments and attending educational events. With a 'second wave' now upon the United Kingdom it is vitally important we reflect upon the 'first wave' to ensure junior surgeons are able to achieve appropriate surgical case numbers, complete assessments and progress to the next stage of training. Alternate assessment methods in the United Kingdom need to be considered should the pandemic continue and clear information should be provided to surgical trainees regarding career progression. These are difficult times for surgical training and we need to endeavor that trainees are provided with opportunities similar to their predecessors albeit in difficult circumstances. This is to ensure the future standard of surgical patient care remains of the highest standard.

The Assessment and Management of the Arthritic Knee: An Update.

Musculoskeletal disorders represent a significant primary care burden. Presentations pertaining to the painful knee are associated with a wide array of differentials; however, among these, osteoarthritis (OA) is the most common one in patients older than 45 years. We have found that a significant number of onward secondary care referrals are misdirected. Therefore, there is a need for a comprehensive assessment and workup to ensure holistic patient care and timely input from specialist services. In this article, we highlight an approach to the management of the arthritic knee.

How useful are virtual fracture clinics?: a systematic review.

BACKGROUND: Due to the overwhelming demand for trauma services, resulting from increasing emergency department attendances over the past decade, virtual fracture clinics (VFCs) have become the fashion to keep up with the demand and help comply with the BOA Standards for Trauma and Orthopaedics (BOAST) guidelines. In this article, we perform a systematic review asking, "How useful are VFCs?", and what injuries and conditions can be treated safely and effectively, to help decrease patient face to face consultations. Our primary outcomes were patient satisfaction, clinical efficiency and cost analysis, and clinical outcomes. METHODS: We performed a systematic literature search of all papers pertaining to VFCs, using the search engines PubMed, MEDLINE, and the Cochrane Database, according to the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) checklist. Searches were carried out and screened by two authors, with final study eligibility confirmed by the senior author. RESULTS: In total, 21 records were relevant to our research question. Six orthopaedic injuries were identified as suitable for VFC review, with a further four discussed in detail. A reduction of face to face appointments of up to 50% was reported with greater compliance to BOAST guidelines (46.4%) and cost saving (up to £212,000). CONCLUSIONS: This systematic review demonstrates that the VFC model can help deliver a safe, more cost-effective, and more efficient arm of the trauma service to patients.Cite this article: Bone Joint Open 2020;1-11:683-690.

The incidence of venous thromboembolism in total joint replacement during COVID-19 pandemic: has lockdown had an influence?

AIMS: As the first wave of the COVID-19 pandemic began to dip, restarting elective orthopaedics became a challenge. Protocols including surgery at 'green' sites, self-isolation for 14 days, and COVID-19 testing were developed to minimize the risk of transmission. In this study, we look at risk effects of 14-day self-isolation on the incidence of venous thromboembolism (VTE) in our green site hospital among patients undergoing total joint replacement (TJR). METHODS: This retrospective cohort study included 50 patients who underwent TJR. Basic demographic data was collected including, age, sex, American Society of Anesthesiologists (ASA) grade, body mass index (BMI), type of surgery, and complications at two and four weeks. Univariate and multivariate analysis were used to identify risk factors associated with an increased risk of VTE. RESULTS: A total of 50 patients were included in our study, with 24 males and 26 females. The mean age was 67.86 (SD 11.803). Overall, 8% of patients suffered a VTE complication; symptomatic non-fatal pulmoary embolism was confirmed in 6% of patients (n = 3) as an inpatient, and symptomatic deep vein thrombosis was diagnosed in 2% of patients (n = 1) within two weeks of their operation. All patients were found to be female (p < 0.001), had a BMI > 30 (p = 0.317), and were immobile prior to their operation using walking aids (p = 0.016). CONCLUSION: The incidence we report is much higher than the reported incidence in the literature, which we believe is related to the 14-day self-isolation period and immobility prior to their operation. We recommend that all patients undergoing TJR that require a period of self-isolation, are pre-assessed prior to self-isolation for their risk of VTE, potentially using mechanical and chemical prophylaxis to reduce the likelihood of developing VTE.Cite this article: Bone Jt Open 2020;1-12:751-756.

Apert syndrome: Be aware of the 'dodgy' hip!

Apert syndrome is a rare congenital disorder characterised by craniosynostosis, midface hypoplasia and syndactyly of hands and feet. Here we present a case of a 44-year-old woman, with a genetic diagnosis of Apert syndrome from birth, who presented with symptomatic left-sided hip osteoarthritis secondary to femoral abnormalities. She proceeded to have a total hip replacement. This case report describes the rare occurrence to identify a possible association between Apert syndrome and hip abnormalities.

A rare case of an acute lunate dislocation in a child.

Acute lunate dislocations are unusual and devastating injuries to the wrist. They are very rare in adult wrist injuries but extremely rare in children. Only six cases of perilunate dislocations in children have been reported in the literature, and in addition to this, only a single case of a lunate dislocation in a child has been reported.Here, we report a case of a 10-year-old boy who presented with an acute lunate dislocation of the wrist, following trauma, a second of its kind.