Postoperative outcomes of total elbow replacement in haemophilic elbow arthropathy: A systematic review.

INTRODUCTION: Total elbow replacement (TER) is a surgical treatment option for haemophilic elbow arthropathy. AIM: To review the outcomes of TER in haemophilic elbow arthropathy. The primary outcome measures were perioperative blood loss, postoperative complications, revision rates and length of hospital stay (LOS). Secondary outcomes were elbow range of motion (ROM), functional outcome scores and the visual analogue pain scale (VAS). MATERIALS AND METHODS: PubMed, Medline, Embase and the Cochrane register were searched conforming to the PRISMA guidelines. Only studies with a minimum postoperative follow-up of 1 year were included. Quality appraisal was performed utilizing the MINORS criteria. RESULTS: One hundred and thirty-eight articles were identified. Following article screening, only seven studies met the inclusion criteria. A total of 51 TERs in 38 patients were performed, with the Coonrad-Morrey prosthesis utilized in 51% of cases. The pooled postoperative complication and revision rates were 49% and 29%, respectively. Surgery-related postoperative mortality was 3.9%. The mean preoperative Mayo elbow performance score (MEPS) was 43 ± 20 whereas the mean postoperative MEPS was 89 ± 6. Mean preoperative VAS was 7.2 ± 1.9 while the mean postoperative VAS was 2.0 ± 1.4. Mean preoperative and postoperative elbow flexion arcs were 54 ± 15 and 91 ± 10 degrees, respectively. Mean preoperative and postoperative forearm rotation arcs were 86 ± 40 and 135 ± 19 degrees, respectively. CONCLUSION: TER for haemophilic elbow arthropathy provides good to excellent improvements in pain and elbow ROM postoperatively. However, the overall complication and revision rates are relatively high, when compared to TER performed for other indications.

Mid-to long-term postoperative outcomes of ankle joint fusion in patients with haemophilia: A systematic review.

INTRODUCTION AND AIM: The ankle joint is the most common site for haemophilic arthropathy. The aim of this study was to review the outcomes of ankle joint fusion in patients with haemophilia A or B. The primary outcome measures were union rates, time to union, perioperative blood loss/transfusion, postoperative complications and length of hospital stay (LOS). Secondary outcome measures were hind foot functional outcome scores and the visual analogue pain scale (VAS). MATERIALS AND METHODS: A search of PubMed, Medline, Embase, Journals@Ovid and the Cochrane register was performed conforming to the PRISMA guidelines. Only human studies with a minimum follow-up of 1-year were included. The MINORS and ROBINS-1 tools were used for quality appraisal. RESULTS: A total of 952 articles were identified and only 17 studies met the eligibility criteria after the screening. The mean age of the patients was 37.6 (SD 10.2). A total of 271 ankle fusions were performed with the open crossed-screw fixation being the most common technique. Union rates were 71.5%-100% at 2-6 months. The pooled postoperative complication and revision rates were 13.7% and 6.5%, respectively. The range of LOS was 1.8-10.6 days. The mean preoperative American orthopedic foot and ankle society (AOFAS) ankle-hindfoot score was 35 (SD 13.1) whereas the mean postoperative AOFAS score was 79.4 (SD 5.3). The mean preoperative VAS was 6.3 (SD 1.6) while the mean postoperative VAS score was .9 (SD .4) across 38 ankle fusions. CONCLUSION: Ankle arthrodesis offers improved pain and function in haemophilic ankle arthropathy with lower revision and complication rates than that reported in the literature for total ankle replacement.

Lessons From a Near-Peer Junior Doctor Teaching Program in Trauma and Orthopedics.

INTRODUCTION:  A junior doctor teaching program delivered by near-peers can foster collaboration in a less-pressured and conducive learning environment. The aim of this study was to provide an analysis of an orthopedic teaching program in a high-resource environment utilizing readily available tools and resources that are potentially available in most hospitals globally.  Methods: This study involved the utilization of an outcome-based learning approach with regular formal feedback. An anonymized Google Forms survey using a 10-point Likert scale was conducted after a 30-week period. The survey tool was sent out to 28 doctors and two senior nurse practitioners who participated in the program either as tutors, learners, or both. A total of 19 out of 30 respondents completed the survey giving a 63% survey completion rate. The setting for this study was the trauma and orthopedics department in a United Kingdom district general hospital. RESULTS:  Learners' confidence in their orthopedic knowledge and skills pre-program had a median response of eight with a mode of seven whereas confidence following engagement on the program improved with a median response of nine and a mode of 10. At an alpha level of 0.05, this observed improvement was statistically significant using the Mann-Whitney U test (p=0.466). Tutors' perception of the usefulness of the teaching feedback had a median response of nine with a mode of 10. Relevance of the selected topics had a median response of nine and a mode of 10. Inclusion in the teaching program to cater to learner diversity had a median response of nine and a mode of 10. The effectiveness of a blended approach for learning had a median response of nine and a mode of 10.  Conclusion: This study has provided evidence of the benefits of a near-peer teaching program. This is especially important in the post-coronavirus disease (COVID) pandemic recovery period where easily accessible and well-grounded educational programs will be useful to complement the deanery teachings for trainees. This is important as this may be the main source of formal teaching for non-trainee junior doctors in many hospital settings. Additional research will be needed to further explore the pros and cons of such programs within a surgical specialty like orthopedics with an emphasis on the various pedagogical approaches to teaching and learning for junior doctors working in a busy clinical setting.

Arthroscopic Debridement and Lavage for Osteoarthritis of the Knee: Results From a Low-Resource Setting.

Introduction Osteoarthritis of the knee is a highly prevalent disease globally, causing strain on healthcare resources and leading to a reduced quality of life. There are many treatments proposed for this condition, from conservative measures like analgesics and physiotherapy to surgical options like arthroscopy and total knee arthroplasty (TKA). Arthroscopic debridement and lavage provide significant improvement in a cohort of patients with particular features and can be a temporizing measure before TKA. This study aimed to investigate the results of this procedure, in a case series in the short-term and mid-term, in a low-resource setting. Methods This was a case series of 20 patients, who presented with clinical and radiographic features of mild to moderate (Kellgren-Lawrence grades I-III) primary osteoarthritis of the knee. Arthroscopic debridement and lavage were performed and the Knee Society Score (KSS) was recorded pre-operatively and post-operatively in the short and mid-term at one month, three months, and twelve months. Statistical analyses was done for correlation, with different variables such as the presence of meniscal pathology, loose bodies, grade of osteoarthritis, malalignment, and body mass index (BMI). Results  The KSS improved at one month, three months, and twelve months for all the patients. The improvement in the KSS scores was associated with varus malalignment of less than 10 degrees, a BMI of less than 25, and the presence of loose bodies. There were no adverse events or complications from this study. Conclusions  There was a significant improvement in a patient cohort with malalignment of less than 10 degrees, BMI of less than 25, meniscal pathology, and loose bodies. We can therefore recommend arthroscopic debridement and lavage as a temporizing measure before TKA in this particular cohort.

Assessment of Virtual Peer Learning by Peer Feedback: A Pilot Project.

Introduction Virtual learning has become the preferred modality for health education during and after the coronavirus disease 2019 (COVID-19) pandemic. Peer learning is gaining a lot of significance lately and has been successfully tested in various settings. We combined virtual delivery of health education with peer-assisted learning and evaluated the effectiveness using peer-generated feedback and tested the effectiveness of the model for different cohorts. Methods We performed this study as part of a formal educational course on Health Professions Education. The educators were volunteers from different informal multi-disciplinary groups, working in varied healthcare settings, globally. This involved eight teaching sessions which were delivered virtually and the feedback was recorded as responses to six items (questions), which the learners graded on the Likert scale. The average for each item and the larger domains was then calculated and analyzed.  Results The feedback was provided by all the participants (53/53). In the feedback received item-wise, the best average rating was for legibility of the slides (4.8). The least rating was for adequate checking and assessment of prior knowledge (4.2). In terms of the broader domains, the best feedback was for the teaching material (4.6) and the lowest was for the planning of the sessions (4.4). Overall, the ratings for the domains and the items were above 3 on a scale of 1-5. Conclusions Virtual delivery of healthcare education, facilitated by peer-assisted learning, is an effective model for health education when delivered for a small group, as evidenced by the overall peer feedback. This model can be tested for larger cohorts in the future.

The Efficacy of Pre-Operative Self-Isolation Guidelines for Safe Elective Orthopaedic Surgeries: A Prospective Pilot Study.

Objectives This study aimed to determine the efficacy of the self-isolation guidance for elective orthopaedic surgery. We aimed to evaluate the relationship between patient compliance with the self-isolation guidance and the resulting COVID-19 status. This would give planning strategies for managing elective orthopaedic lists. Method For the study, 110 patients who underwent elective orthopaedic surgical procedures during a one-month period were identified. Patients scheduled for surgery were asked to take a SARS-CoV-2 PCR test three days prior to surgery and they were asked to follow the self-isolation guidance. On the day of admission, patients declared compliance with self-isolation regulations. Admission was refused in cases of non-compliance. After discharge, telephone calls were made to patients to determine the degree of compliance with the self-isolation guidance. Results Overall, 106 out of 107 patients that were compliant with the self-isolation guidance tested negative for COVID-19; 15 patients had their operation cancelled over the one-month period; of which one-third were cancelled by the patients themselves. Three patients were found to be non-compliant with the self-isolation guidance. Of these three non-compliant patients, one tested positive for COVID-19. Adherence to the self-isolation guidelines helped to prevent last-minute cancellations and manage the list effectively. Conclusions Compliance with our self-isolation guidance accompanied by PCR screening minimises the risk of testing positive for COVID-19 and is thus an effective system to safely perform elective orthopaedic surgery. Intentionally overbooking theatre lists by 10 to 12.5% may account for cancellations and improve theatre efficiencies during post-pandemic recovery plans for elective orthopaedic surgeries.

Septic Arthritis of Neonates: Descriptive Study of a Neonatal Intensive Care Unit Nosocomial Outbreak.

Purpose  This is a retrospective descriptive study of a nosocomial outbreak of septic arthritis in a neonatal intensive care unit with a Pseudomonas species as the predominant organism. There have been no previous reports of the same. The risk factors for this disease were analysed. The different diagnostic modalities that we used are described and the short-term outcomes are reported after antibiotic therapy and surgery. Methods  Fourteen patients and 16 joints were included in the study over a three-month period. The risk factors were analysed from the records and included prematurity, birth weight, sex and joint predilection. The causative organisms were also analysed from microbiological profiling. The outcomes after surgery and adjunctive antibiotic therapy were analysed in terms of clinical and laboratory parameters. Results  Pseudomonas aeruginosa was found to be the predominant organism in this series. The hip joint was predominantly involved and the majority of the patients were found to be premature. All the neonates affected were found to have low birth weight. Conclusion  Prematurity and low birth weight were found to have an association with risk for septic arthritis. In our setting of a nosocomial outbreak, a Pseudomonas species was more common than other organisms. A treatment regimen of arthrotomy surgery and adjunctive antibiotic therapy was found to be effective in all our patients.

Predictive Factors for the Complications of Dengue Fever in Children: A Retrospective Analysis.

Background and objective Dengue fever (DF) and its complications - dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) - are major public health problems in Southeast Asia. Predicting the development of DHF and DSS using hematological parameters and ultrasonic signs of vascular leakage will help in reducing morbidity and mortality associated with these diseases. Hence, this study aimed to test the association of platelets and packed cell volume (PCV) on day one (D1) of admission with gallbladder wall thickness (GWT) and ascites, which herald the onset of DHF and DSS. Methods The electronic health records of 52 pediatric patients admitted during a mini-outbreak were analyzed to assess platelets and PCV on D1, laboratory and ultrasonography findings, and outcomes. Correlations between D1 hematological parameters and GWT and ascites were tested. Results There was a positive correlation between GWT of more than 5 mm and ascites. However, there was no significant correlation of platelets and PCV on D1 with either GWT or ascites and consequently DHF or DSS. All the patients responded to fluid, blood, and supportive therapy. There were no mortalities. Conclusion Patients who develop GWT after DF are at an increased risk of developing ascites that deteriorate to DHF and DSS. D1 platelets and PCV are not reliable indicators for predicting the progression or worsening of the disease in the pediatric population.

Short- to Mid-Term Outcomes in Arthroscopic Debridement of the Knee: A Prospective Case Series.

Introduction Osteoarthritis of the knee is a common debilitating disease in the elderly population. There are many treatment options available including physiotherapy, analgesics, steroid injections, arthroscopic debridement, high tibial osteotomy (HTO) and arthroplasty. Arthroscopic debridement is beneficial when patients are chosen with certain characteristics. This is a prospective case series where we have correlated the patient and disease characteristics, with the pre- and post-operative Oxford Knee Scores (OKS). Methods This study was done in a single centre with appropriate ethical committee approval and consent. Forty-nine patients were enrolled in the study. The scores were recorded pre-operatively and at 12 months after the interventions. Analysis was done for correlation of the outcome with patient characteristics, radiological and arthroscopic grading. Results Patients below the age of 56 years, with partial thickness chondral lesions, grade I-III Kellgren-Lawrence (KL) radiological grading and grade I-II Outerbridge arthroscopic grading showed significant improvement at 12 months. Conclusion Arthroscopic debridement is effective in younger patients with mild to moderate arthroscopic and radiologically graded osteoarthritis of the knee joint.

Penetrating Abdominal Trauma: Descriptive Analysis of a Case Series From an Indian Metropolitan City.

Introduction Penetrating abdominal trauma (PAT) is a major injury that patients present to the emergency department in developed and developing countries. There are many modes and causes of injury. The aim of this study is to analyse the patterns of presentation and parameters at assessment, including investigations, interventions and outcomes of penetrating abdominal trauma at a major trauma centre in an Indian metropolitan city. Methods This is an observational descriptive study done over 18 months at a major trauma centre in a metropolitan city in India. The study was registered with the institutional ethics committee and the patients were recruited after obtaining consent on admission. The relevant details were collected from the patient's electronic records after admission and analysed. Results Stab wounds in the 21-40-year-old subset were the commonest. The small intestine was the most commonly injured organ. The mortality rates and the duration of the hospital stay were similar to other case series of the same condition. Conclusion The analysis of our case series has highlighted the patterns and outcomes of penetrating abdominal trauma in an urban demographic of a developing economy. Individuals in the prime of their lives, unfortunately, are victims of this mode of injury. Better implementation of standard management protocols can improve outcomes.