A cross-sectional study of the impact of physiotherapy and self directed exercise on the functional outcome of internally fixed isolated unimalleolar Weber B ankle fractures.

This study aimed to measure the functional outcome and quality of life in a group of patients with the same fracture type (unimalleolar Weber B ankle fractures) treated operatively at various time points and to explore the determinants of such outcomes. A cross-sectional retrospective population study was conducted. Validated Patient Related Outcome Measures (PROMs) and patient interviews were used. Fifty-one patients were included with a mean age of 54.9 years. Mean follow-up was 25 months (range 4-46 months). Mean functional scores were high (mean AOFAS 79.2, O&M 75.7, VAS-FA 80.5). However, 32% of patients did not classify themselves as fully recovered during interviews. Patient reported self-directed exercise had a statistically significant positive effect on self-reported patient perceptions of outcome (p=0.022) and PROMs (AOFAS p=0.01, O&M p=0.016, VAS-FA p=0.011). Formal physiotherapy rehabilitation was found to have no effect on self-reported patient perceptions (p=0.242) or PROMs (AOFAS p=0.8, O&M p=0.73, VAS-FA p=0.46). Our finding that physical activity is associated with improved outcome would suggest structured exercise programmes should be considered in place of physiotherapy to optimise patient outcomes.

Antibiotic prophylaxis in orthopaedic surgery: difficult decisions in an era of evolving antibiotic resistance.

Prophylactic antibiotics can decrease the risk of wound infection and have been routinely employed in orthopaedic surgery for decades. Despite their widespread use, questions still surround the selection of antibiotics for prophylaxis, timing and duration of administration. The health economic costs associated with wound infections are significant, and the judicious but appropriate use of antibiotics can reduce this risk. This review examines the evidence behind commonly debated topics in antibiotic prophylaxis and highlights the uses and advantages of some commonly used antibiotics. Cite this article: Bone Joint J 2016;98-B:1014-19.

The investigation and management of suspected malignant pathological fractures: a review for the general orthopaedic surgeon.

The management of malignant pathological fractures necessitates careful diagnostic work-up, pre-operative investigation, planning and multidisciplinary input from specialists in the fields of radiology, pathology, oncology, trauma and orthopaedics. Malignant and non-malignant conditions including metabolic disorders, benign tumours and pharmacological therapies can be implicated. The majority of patients who present with suspected pathological fractures will be managed by general orthopaedic and trauma surgeons rather than specialists in orthopaedic oncology. Skeletal metastases can result in considerable morbidity and predispose to pathological fractures. With advances in the medical management of malignancy, life expectancy in cancer patients is increasing, leading to an increasing risk of skeletal metastasis and the potential for pathological fractures. Conventional modes of trauma fixation for pathological fractures may not be appropriate. The aim of this review is to outline diagnostic and management strategies for patients who present with a long bone fracture that is potentially pathological in nature.

Trends in orthopaedic antimicrobial prophylaxis in the UK between 2005 and 2011.

INTRODUCTION: Antimicrobial prophylaxis remains the most powerful tool used to reduce infection rates in orthopaedics but the choice of antibiotic is complex. The aim of this study was to examine trends in antimicrobial prophylaxis in orthopaedic surgery involving the insertion of metalwork between 2005 and 2011. METHODS: Two questionnaires (one in 2008 and one in 2011) were sent to all National Health Service trusts in the UK using the Freedom of Information Act. RESULTS: In total, 87% of trusts that perform orthopaedic surgery responded. The use of cefuroxime more than halved between 2005 and 2011 from 80% to 36% and 78% to 26% in elective surgery and trauma surgery respectively. Combination therapy with flucloxacillin and gentamicin rose from 1% to 32% in elective and 1% to 34% in trauma surgery. Other increasingly popular regimes include teicoplanin and gentamicin (1% to 10% in elective, 1% to 6% in trauma) and co-amoxiclav (3% to 8% in elective, 4% to 14% in trauma). The majority of changes occurred between 2008 and 2010. Over half (56%) of the trusts stated that Clostridium difficile was the main reason for changing regimes. CONCLUSIONS: In 2008 a systematic review involving 11,343 participants failed to show a difference in surgical site infections when comparing different antimicrobial prophylaxis regimes in orthopaedic surgery. Concerns over C difficile and methicillin resistant Staphylococcus aureus have influenced antimicrobial regimes in both trauma and elective surgery. Teicoplanin would be an appropriate choice for antimicrobial prophylaxis in both trauma and elective units but this is not reflected in its current level of popularity.

Pelvic circumferential compression devices (PCCDs): a best evidence equipment review.

PURPOSE: Traumatic disruption of the pelvis can lead to significant morbidity and mortality. ATLS(®) guidance advocates temporary stabilisation or 'closure' of the disrupted pelvis with a compression device or sheet. We undertook a best evidence equipment review to assess the ease and efficacy of the application of two leading commercially available devices, the T-POD(®) and the SAM Pelvic Sling™ II. METHODS: Fifty health care professionals and medical students participated in pelvic circumferential compression device (PCCD) education and assessment. Participants received a 10-min lecture on the epidemiology and aetiology of pelvic fractures and the principles of circumferential compression, followed by a practical demonstration. Three volunteers acted as trauma victims. Assessment included the time taken to secure the devices and whether this was achieved correctly. All participants completed a post-assessment survey. RESULTS: Both devices were applied correctly 100% of the time. The average time taken to secure the SAM Pelvic Sling™ II was 18 s and for the T-POD(®), it was 31 s (p ≤ 0.0001). Forty-four participants (88%) agreed or strongly agreed that the SAM Pelvic Sling™ II was easy to use compared to 84% (n = 42) for the T-POD(®). Thirty-nine participants (78%) reported that they preferred and, given the choice in the future, would select the T-POD(®) over the SAM Pelvic Sling™ II (n = 11, 22%). CONCLUSIONS: The results of this study indicate that both PCCDs are easy and acceptable to use and, once learned, can be applied easily and rapidly. Participants applied both devices correctly 100% of the time, with successful application taking, on average, less than 60 s.