Satisfaction of the Irish Trauma and Orthopaedic training programme with the Intercollegiate Surgical Curriculum Programme.

BACKGROUND: Surgical training has undergone extensive changes in recent years. The Intercollegiate Surgical Curriculum Programme (ISCP) has been utilised in the UK for many years to facilitate the education and assessment of trainees. It was adopted by the Irish Trauma and Orthopaedics (T&O) training programme in July 2015. This study sought to evaluate the use satisfaction with ISCP in the Irish context. METHODS: A total of 58 T&O trainers and trainees undertook a paper-based survey during national training days in March and April 2017. RESULTS: Eighty-nine percent of trainees responded to the survey along with 85% of trainers. Seventy-nine percent of respondents had been using ISCP for over a year. Most aspects of ISPC were rated as average, with the induction process, online multi-source feedback (MSF) and overall user friendliness rating poorly amongst respondents. Seventeen percent felt that ISCP had a positive impact on training, while 66% felt that it did not adversely affect their training opportunities. Forty-three percent reported a negative impact on the trainer-trainee relationship with adoption of ISCP and only 24% felt that the educational feedback was improved with the new system. Forty-two percent agreed that ISCP created a more structured and supervised framework to the training scheme. CONCLUSIONS: Our survey demonstrated significant concerns and reservations amongst the Irish users of ISCP. The demonstrable level of trainee dissatisfaction with ISCP may represent a frustration that key problems such as the regulated training content of jobs remains unaddressed while ISCP does little to improve meaningful formative feedback.

Hip Hemiarthroplasty in Neurologic or Cognitively Impaired Patients: A Case Series of Post-operative Dislocations.

INTRODUCTION: Hemiarthroplasty is the operation of choice for displaced intracapsular neck of femur fracture in elderly patients with low physical demands. Dislocation in this frail patient cohort can have devastating consequences. The patients with neurological and cognitive impairment are at additional risk secondary to imbalance of muscle tone and a reduced ability to engage with rehabilitation. CASE REPORT: We present three cases of early post-operative dislocation of hip hemiarthroplasties, all of whom suffered from neurological and cognitive impairment, and highlight the uncontrollable patient factors that contributed to dislocation. CONCLUSION: The posterior approach was associated with all cases of dislocation in patients who also were neurologic or cognitively impaired. Posterior approach is safe to perform in the general population for hip hemiarthroplasty; however, the surgeon should consider avoiding the use of the posterior approach in this high-risk group.

Total Hip Replacement Revision in a Single Brand Small Cementless Stem - Our Experience after the Findings of the National Joint Registry.

BACKGROUND: Cementless total hip replacement is the common THR performed in England, Wales, Northern Ireland and the Isle of Man. The Corail stem is the most popular cementless implant and has a ODEP 10A rating. Review of its performance in the registry identified an increase rate of revision amongst the smaller stem sizes. However, clarity was not provided on the explanation for this finding. We reviewed our own experience of smaller stems with a view to understanding the reasons for revision. METHODS: We reviewed a single centre, single surgeon experience of the smaller Corail stem sizes for a ten-year period from 2003 to 2013. All data was collected from a prospectively maintained database. Details of clinical and radiological follow up were collected for all patients who had Corail stem size 8 and 9 implanted. Revision for any cause was taken as our endpoint. RESULTS: 542 patients underwent total hip arthroplasty using the Corail stem during the study period. 53 small size Corail stems were implanted. The average age was 59 (range 17-88 years) and the average follow up was 41.4 months (range 1-118 months). 6 patients underwent revision during the study period, but only 4 stems required revision. The reasons for revision were aseptic loosening, fracture and metal-on metal complications. Only two stems required revision for stem related factors (3.8%). CONCLUSION: There was no evidence of an increased rate of revision in the small Corail stems in our cohort.

Sternal metastasis - the forgotten column and its effect on thoracic spine stability.

Sternal metastases are not studied extensively in the literature. There is a paucity of information on their role in metastatic disease. The concept of the fourth column was described by Berg in 1993, and has been proven in case report, clinically and biomechanical studies. The role of the sternum as a support to the thoracic spine is well documented in the trauma patients, but not much is known about its role in cancer patients. This review examines what is known on the role of the fourth column. Following this we have identified two likely scenarios that sternal metastases may impact management: (1) sternal pathological fracture increases the mobility of the semi-rigid thorax with the loss of the biomechanical support of the sternum-rib-thoracic spine complex; and (2) a sternal metastasis increases the risk of fracture, and while being medical treated the thoracic spine should be monitored for acute kyphosis and neurological injury secondarily to the insufficiency of the fourth column.

Iliopsoas tendon rupture: a new differential for atraumatic groin pain post-total hip arthroplasty.

Groin pain post-total hip arthroplasty (THA) is of concern for the patient and the surgeon, especially when there is no history of any traumatic event. Obvious concern centres on complications from the prosthesis. The use of multiple imaging modalities allow for accurate diagnosis of groin pain. Atraumatic iliopsoas rupture is rare and has only been reported once before in the setting of THA. We present the case of 53-year old female with atraumatic rupture of the iliopsoas tendon that presented with severe groin pain and limited flexion. We discuss the clinical presentation, radiological features and follow-up of the patient. We also discuss the relevant published literature on the topic. This is a rare phenomenon but should be consider in patients with groin pain post-THA, especially after prosthesis complications have been ruled out.