Routine Post-operative Radiographs Following Hip Hemiarthroplasty: Is It a Necessity?

Femoral neck fractures are one of the most common fractures treated by an Orthopaedic surgeon. Arthroplasty is the recommended management for intracapsular neck of femur fractures in the elderly population owing to the high risk of avascular necrosis of the femoral head following an internal fixation. Elderly patients with intracapsular fractures deemed high risk for anaesthesia (American Society of Anaesthesiology Grade more than 2) are recommended a hip hemiarthroplasty. Routine practice throughout the United Kingdom is to obtain a postoperative check radiograph for all hip hemiarthroplasty patients prior to their discharge from the hospital. This may be done for various reasons like checking the presence of any peri-prosthetic fracture, the position of the components along with the presence of any dislocation. However, it is unclear whether a radiograph is the sole identifier of such complications. Through this study, we aim to analyse whether routine recommendation of post-operative radiographs following hip hemiarthroplasty affects the clinical outcome, and whether it is effective in identifying potential complications before the patients report any signs or symptoms.

Use of abbreviations in consent forms for orthopaedic surgery: A pilot study.

BACKGROUND: Consent is a process of communication and the consent form is an important legal document of the evidence of discussion between doctor and patients. We observed frequent use of abbreviations in the consent forms in our department that can result in misunderstanding and miscommunication when consenting patients for orthopaedic procedures. METHODS: We completed an audit cycle starting by reviewing a total of 350 consent forms retrospectively in level one trauma centres in October-November of 2019 for different orthopaedic trauma procedures. The standards for the project were guidelines published by the general medical council (GMC), The royal college of surgeons (RCS) Glasgow, and the British orthopaedic association (BOA).The results were presented at our mortality and morbidity meeting. Written Feedback was obtained from the attending members on how a change can be implemented to increase ccompliance in filling consent forms. A generic email was sent to all medical professionals to avoid the use of abbreviations on the document and encourage colleagues to point out errors if they spot them. The use of full medical terms and to avoid abbreviations in consent form was well advertised, The re-audit was performed for the period of January & February 2020 that included 400 consent forms. The results were analysed and compared with our original audit results. RESULTS: The use of abbreviations declined from 54% in first audit to 22% in the re-audit. DVT and PE were the most common abbreviations. CONCLUSION: This audit cycle has shown the importance of education and reminders to the health professionals in achieving better adherence to the guidelines and improves patient care.

Study to estimate the average blood loss in different orthopedic procedures: A retrospective review.

BACKGROUND: In orthopedic surgery, bleeding is an inevitable side effect. The study's aim was to provide estimated blood loss values in various orthopedic procedures and take a step towards developing statistically reliable formulae. This can provide blood loss values in orthopedic surgery, which will be a very good tool for operative planning. MATERIALS AND METHODS: We reviewed case notes of 282 patients in a UK based trauma center from December 2020 to March 2021,who had undergone a various orthopedic procedures. The results were analyzed using SPSS version 25. RESULTS: Most common fracture was neck of femur (37.5%)followed by intertrochanteric fractures(27.6%). Paired t-test was used, and there is good evidence (t281 = 14.957, p = 0.000) that intraoperative transfusions increased HB levels in patients (t281 = 14.957, p = 0.000) by an average of 1.331 points, with a 95% confidence interval of 1.156-1.506. As a result, the variation between the Pre-op and Post-op HB levels is statistically important but minimal. We can see that the mean blood loss is statistically different in different age groups (0.03) of patients and by the existence of co-morbids using analysis of variance (0.04). The average number of days spent in the hospital varies by surgical type (0.01) performed on patients. CONCLUSION: Orthopedic surgery can be associated with high levels of blood loss. There is a significant relation between fracture form and age groups, change of wound dressing (COD), use of a tourniquet, and drain insertion, no connection was noted between gender and fracture types.

Ankle syndesmotic injury: Tightrope vs screw fixation, A clinical academic survey.

OBJECTIVE: The goal of the study is to find out the treatment of choice for ankle fractures involving syndesmotic injury based on level of experience of orthopaedic surgeons. METHODS: A survey was undertaken to analyse the management used for ankle fractures with syndesmotic injuries AO 44c in a 35-year-old patient. Surgeons attending an orthopaedic course were invited to take part in a survey sorted into groups: junior surgeons middle grades, and experienced. Pictures of an x ray were shown to the participants and treatment options were asked. RESULTS: 100 surgeons from 20 nations took part in the event. Juniors made up 39%, registrars made up 38%, and experienced doctors were 29%. Screws, were reported by 93% for syndesmosis fixation. 66% of surgeons who used screws for syndesmosis fixation favoured a single screw over two screws.3-4 cortices were virtually evenly divided in choice, with 54% preferring three and 46% preferring four cortices. Only 22% of the time did they utilise a washer with their screws. With 52% of patients, the most typical time for permitting them to weight bear was 4-6 weeks after surgery. At 1-2 months postoperatively, 34% preferred to remove the screw, and at 2-3 months postoperatively, 29% preferred to remove the screw. CONCLUSION: Data show that the majority of junior level doctors handle their patients according to AO principles. The majority prefer one 3.5 mm screw positioned between 2 and 4 cm above the ankle joint, with three cortices being somewhat preferred. Despite the lack of data to support one procedure, the majority of people remove their screws within 1-3 months.