Factors Influencing Functional Outcomes in Supracondylar Humerus Fractures: A Retrospective Study of Paediatric Patients in a Level One Trauma Centre.

Background The outcomes after fixation of the supracondylar humerus fracture (SCHF) are not documented in the current literature. In our study, we endeavour to determine the factors that influence the functional outcome and gauge their respective impact. Methodology We retrospectively reviewed the outcomes of patients who presented to our tertiary care centre (Royal London Hospital) with SCHFs between September 2017 and February 2018. We analysed patient records to assess several clinical parameters, including age, Gartland's classification, comorbidities, time to treatment, and fixation configuration. We conducted a multiple linear regression analysis to determine each of the clinical parameter's impact on the functional and cosmetic outcome, as reflected in Flynn's criteria. Results We included 112 patients in our study. Pediatric SCHFs had good functional outcomes based on Flynn's criteria. There was no significant statistical difference in functional outcomes with respect to sex (p= 0.713), age (p= 0.96), fracture type (p= 0.14), K-wire configuration (p=0.83), and time elapsed since surgery (p= 0.240). Conclusions Our results demonstrate that good functional outcomes can be expected with paediatric SCHFs based on Flynn's criteria, regardless of age at injury, sex, or pin configuration, provided satisfactory reduction is achieved and maintained. The only variable with statistical significance was Gartland's grade; Grades III and IV were correlated with poorer outcomes.

Temporary circular external fixation for spanning the traumatised ankle joint: A cohort comparison study.

BACKGROUND: Temporary spanning fixation aims to provide bony stability whilst allowing access and resuscitation of the traumatised soft-tissue envelope. Conventional monolateral fixators are prone to half-pin morbidity in feet, variation in construct stability and limited weight-bearing potential. This study compares traditional delta-frame monolateral external fixators to ankle spanning circular fixators. METHODS: Two cohorts were matched for demographics and fracture patterns. The quality of initial reduction and the maintenance of reduction until definitive surgery was assessed by two authors and categorised into four domains. Secondary measures included fixator costs, time to definitive surgery and complications. RESULTS: Fifty-five delta-frames and 51 circular fixators were statistically matched for demographics and fracture pattern. "Excellent" and "Good" initial reduction was achieved in 50 (91%) delta-frames and 51 (100%) circular fixators (p = 0.027). Deterioration of initial reduction quality was seen in 12 (22%) delta-frames and two (4%) circular fixators (p < 0.001). Post-fixator dislocation occurred in five (9%) delta-frames and one (2%) circular fixator (p = 0.147). Median duration in spanned fixation was 11 days in both groups (p = 0.114). Three (5%) delta-frames and 13 (25%) circular fixators were used as definitive fixation. The mean implant cost was 4,307 USD for delta-frames and 3747 USD for circular fixators. CONCLUSION: Temporary spanning circular fixation offers superior intra-operative reduction and maintenance of reduction and provides more opportunity to be used as definitive fixation. Circular fixation implants also proved to be less expensive and protected against further scheduled or unscheduled returns to theatre. LEVEL OF EVIDENCE: IV, retrospective cohort study.

NHS staff mental health status in the active phase of the COVID-19 era: a staff survey in a large London hospital.

BACKGROUND: Experiencing a pandemic can be very unsettling and may have a negative impact on the mental health of frontline healthcare workers (HCWs). This may have serious consequences for the overall well-being of HCWs, which in turn may adversely affect patient safety and the productivity of the institution. AIMS: We designed a study to assess the prevalence of generalised anxiety disorder (GAD), depression and work-related stress experienced by the National Health Service staff in a large tertiary London hospital treating patients with COVID-19 during the current active phase of the COVID-19 era. METHODS: An anonymous survey was designed with demographic data and three questionnaires. The Generalised Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 were used to assess anxiety and depression, respectively. The Health and Safety Executive Management Standards Indicator Tool was used to assess work-related stress. Staff from multiple specialties embracing cardiothoracic surgery, cardiology, respiratory medicine, endocrinology, oncology, imaging, anaesthesia and intensive care at our hospital were asked to complete the questionnaire between 25 May and 15 June 2020. RESULTS: A total of 302 staff members (106 males and 196 females) completed the survey. The overall prevalence of GAD and depression was 41.4% and 42.7%, respectively. The prevalence of GAD and depression was significantly higher in females than in males and was statistically significant. Nurses were four times more likely to report moderate to severe levels of anxiety and depression as compared with doctors. Work-related stress was also observed to be prevalent in our surveyed population with the following standards: relationships, role, control and change showing a need for improvement. CONCLUSIONS: Our study presents early evidence suggestive of a high prevalence of GAD, depression and work-related stress in HCWs. It is imperative that coherent strategies are implemented to improve the healthcare work environment during this pandemic and mitigate further injury to the mental health status of the healthcare population.

Sternal wound infections during the COVID-19 pandemic: an unexpected benefit.

BACKGROUND: The novel coronavirus, now termed SARS-CoV-2, has had a significant impact on cardiac surgical services globally. Although drastically reduced, our institution has maintained a significant level of cardiac surgical activity during the pandemic. Rigorous COVID-19 guidelines have been instituted to mitigate the risk of viral transmission. We observed a reduction in sternal wound infections since the institution of new perioperative surgical guidelines. METHODS: We performed a retrospective analysis of all patients who underwent cardiac surgery at our institution since a national lockdown was declared in March 2020. A retrospective analysis of all patients who underwent cardiac surgery in the 12 months preceding the national lockdown, as a baseline cohort group, was also performed. RESULTS: A total of 2600 patients (493 during the COVID-19 pandemic) were included in this study. Urgent/emergency procedures accounted for more than 60% of procedures performed during the lockdown compared to 39% previously. During the COVID-19 pandemic, there were 4 sternal wound infections with an overall incidence of 0.8%. In comparison, the incidence of sternal wound infections was significantly higher at 3.0% in the 12-month period prior to lockdown with 63 sternal wound infections (p = 0.006). CONCLUSION: This report suggests a significant role of iatrogenic causes in sternal wound infections prior to the pandemic. The strict implementation of guidelines in the perioperative period suggests that sternal wound infections can be prevented. We propose that the now widespread COVID-19 guidelines to reduce transmission risk be adapted to help reduce the incidence of sternal wound infections.

Can custom 3D printed implants successfully reconstruct massive acetabular defects? A 3D-CT assessment.

We report on the accuracy, measured with three-dimensional (3D) computed tomography (CT) postoperatively, in positioning custom 3D printed titanium components in patients with large acetabular defects. Twenty patients (13 females and 7 males) received custom-made acetabular implants between 2016 and 2018; the mean age was 66 years (SD = 11.6) and their mean body mass index was 28 (SD = 6.1). The median time to follow up was 25.5 months, range: 12 to 40 months. We describe a comparison method that uses the 3D models of CT-generated preoperative plans and the postoperative CT scans to quantify the discrepancy between planned and achieved component positions. Our primary outcome measures were the 3D-CT-measured difference between planned and achieved a component position in six degrees of freedom: center of rotation (CoR), component rotation, inclination (INC), and version (VER) of the cup. Our secondary outcome measures were: Oxford hip score, walking status, and complication rate. All components (100%) were positioned within 10 mm of planned CoR (in the three planes). Eighteen (95%) components were not rotated by more than 10° compared to the plan. Eleven (58%) components were positioned within 5° of planned cup angle (INC and VER). To date one complication has occurred, a periprosthetic fracture. This is the largest study in which postoperative 3D-CT measurements and clinical outcomes of custom-made acetabular components have been assessed. Accurate pre-op planning and the adoption of custom 3D printed implants show promising results in complex hip revision surgery.

Detection of incorrect manufacturer labelling of hip components.

We describe the case of a 53-year-old man who underwent a left metal-on-metal hip resurfacing in 2015. Component size mismatch (CSM) was suspected because of the patient's immediate post-operative mechanical symptoms and high metal ion levels. Surgical notes indicated the appropriate combinations of implants were used. However, we detected a mismatch using computed tomography. Revision was performed and subsequent measurements of explanted components confirmed the mismatch. To our knowledge, this case is the first report of a CT method being used in a patient to pre-operatively identify CSM.

Calculating the hip center of rotation using contralateral pelvic anatomy.

Failure to place an artificial hip in the optimal center of rotation results in poor hip function and costly complications. The aim of this study was to develop robust methodology to estimate hip center of rotation (hCoR) from preoperative computed tomography (CT) scans, using contralateral anatomy, in patients with unilateral diseased hips. Ten patients (five male, five female) with normal pelvic anatomy, and one patient with a unilateral dysplastic acetabulum were recruited from the London Implant Retrieval center image bank. 3D models of each pelvis were generated using commercial software. Two methods for estimation of hCoR were compared. Method 1 used a mirroring technique alone. Method 2 utilized mirroring and automatic alignment. Predicted versus actual hCoR co-ordinates were compared using intraclass correlation coefficients and paired T-tests. Both methods predicted hCoR with excellent agreement to original co-ordinates (>0.9) in all axes. Both techniques allowed prediction of the hCoR within ± 5 mm in all axes. Both techniques provided useful clinical information for planning acetabular reconstruction in patients with unilateral defects. Method 1 was less complex and is suitable for patients with developmental and degenerative pathologies. Method 2 may provide greater accuracy in a discrete group of patients with normal development prior to pathology (e.g., acetabular fractures). © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1077-1083, 2016.