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.

Comparison of Medial Parapatellar and Transpatellar Tendon Approach in Intramedullary Interlocking Nailing for Tibial Fracture: A Retrospective Analysis.

Introduction Tibial fractures are one of the most common traumatic fractures, particularly in automobile accidents. Percutaneous reduction with conventional reduction forceps and un reamed intramedullary nailing, transpatellar, and medial parapatellar tendon approaches are all used, but tibial intramedullary nails are still primarily inserted through a transpatellar tendon splitting or medial parapatellar tendon approach. Objective The aim and objectives of this study are to assess the mean pain score after nailing for a tibial fracture using a medial parapatellar versus a transpatellar tendon method retrospectively in order to enhance operational planning. Materials and methods This is a retrospective study that took place in a UK level 1 trauma center. Data from 60 patients were included between February 2019 and February 2020. An equal number of patients were selected for both approaches to maintain accuracy. The advanced trauma life support (ATLS) protocol was used to handle all of the patients in both groups in order to rule out any other injuries or fractures, after which they were scheduled for surgery after stabilization. They were subsequently evaluated during a three-month follow-up in an outdoor clinic, where they were given a pain score using the visual analogue score (VAS) while moving their knee joints. The mean pain score was differentiated by age, gender, body mass index (BMI), injury side, and injury type. Results Patients were divided into groups based on their ages. Patients in the transpatellar tendon group were 32.83±5.13 years old, whereas those in the medial parapatellar tendon group were 31.4 ±5.42 years old. The gender distribution of the patients revealed that the majority of the patients in both groups were male. In both groups, the left side was the most usually affected. The difference between the two groups' mean pain scores at three months was substantially lower in the medial parapatellar approach (p=0.005). Conclusion For patients having intramedullary nailing for tibial fractures, the medial parapatellar route is associated with a lower mean pain score than the transpatellar route. As a result, we may use this method in these individuals regularly.

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.

Comparison of Open and Closed Nailing for Femoral Shaft Fractures: A Retrospective Analysis.

Introduction Open and closed nailing are the two reduction methods used for the fixation of femoral shaft fractures. The study aims to assess the clinical and functional outcomes of open and closed nailing for closed femoral shaft fractures. Methodology A total of 398 patients who underwent intramedullary nailing fixation of nonpathological femoral shaft fracture between January 2016 to December 2019 were reviewed retrospectively. Two hundred seventy-four underwent closed nailing, and 124 were considered for open nailing. Results The primary outcome reviewed was the union rate of fracture. Other outcomes analyzed were complications, intraoperative blood loss, time to union, and the duration of the procedure. Patients in the open group had a union of fracture in 15.71 weeks, closed nailing group had a union in 15.53 weeks (p-value 0.495). Patients with open nailing had a mean Radiological union scale in tibial (RUST) fracture score of 11.435, whereas the closed nailing group had a mean of 11.664 (p-value 0.187). Operative time was higher in the open group when compared to the closed nailing group (p-value 0.000). However, intraoperative blood loss was more in open nailing in comparison to closed nailing. Furthermore, 15 patients with closed nailing had non-union, whereas 11 had non-union after open nailing (p-0.204). Superficial infection and deep infection requiring debridement were equally observed among the two treatment groups. Conclusion Fixation of femoral shaft fractures with open nailing has similar outcomes in union rates, time to union, and rates of significant complication similar to those of close nailing.

Comparison of in-phase and opposed-phase T1W gradient echo and T2W fast spin echo dixon chemical shift imaging for the assessment of non-neoplastic, benign neoplastic and malignant marrow lesions.

OBJECTIVE: The objective of this study is to compare T1-weighted gradient echo (T1W GrE: control technique) chemical shift imaging (CSI) with T2-weighted fast spin echo (T2W FSE: experimental technique) CSI for differentiating non-neoplastic and neoplastic marrow lesions. MATERIALS AND METHODS: Patients undergoing MRI for various marrow lesions were investigated with T1W GrE and T2W FSE Dixon CSI. Signal intensity (SI) change between in-phase (IP) and opposed-phase (OP) sequences was calculated, and SI drop > 20% considered to represent non-neoplastic lesions while SI drop < 20% considered to represent neoplastic lesions. Final diagnosis was based on imaging features (n = 42) or histology (n = 43) and classified as non-neoplastic, benign neoplastic, and malignant neoplastic. Inter-observer and inter-technique agreement between 2 readers was calculated. RESULTS: The study included 85 patients (44 males and 41 females; mean age 41.1 years, range 2-83 years). Final diagnosis included 19 (22.4%) non-neoplastic lesions, 27 (31.8%) benign neoplasms, and 39 (45.9%) malignant neoplasms. On T1W GrE CSI, 19-21 lesions were classed as non-neoplastic and 64-66 as neoplastic, while on T2W FSE Dixon CSI, 22-24 lesions were classed as non-neoplastic and 61-64 as neoplastic. Lesion classification matched between the 2 techniques in 91.8-96.5% of cases. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of T1W GrE CSI for differentiating non-neoplastic and neoplastic marrow lesions were 66.7-72.2%, 88.1-89.6%, 61.9-63.2%, 90.9-92.2%, and 84.7%, and of T2W FSE Dixon CSI were 72.2-77.8%, 85.1-86.6%, 58.3-59.1%, 92.1-93.4%, and 83.5%. CONCLUSIONS: T1W GrE CSI and T2W FSE Dixon CSI produce similar results in the assessment of non-neoplastic and neoplastic marrow lesions.

A review of staging chest CT in trunk and extremity soft tissue sarcoma.

OBJECTIVES: To determine the incidence of pulmonary metastases on chest CT in trunk and extremity soft tissue sarcoma based on two size criteria, and to identify factors associated with metastases. METHODS: Retrospective review of chest CT studies in patients with trunk and extremity soft tissue sarcoma over an 18-month period. Data collected included patient age/sex, tumour location, size and relationship to fascia. All chest CTs were reviewed for the presence of metastases which were diagnosed according to two size criteria: multiple nodules > 5 mm in size or multiple nodules > 10 mm in size. Follow-up CT studies were reviewed in cases initially considered indeterminate. RESULTS: 127 males and 73 females were included (mean age 57.1 years; range 10-90 years). 147 (73.5%) tumours were deep to the fascia and 53 (26.5%) superficial. Tumour size classified according to the 12 AJCC 2019 criteria was: T1 = 52, T2 = 76, T3 = 39, T4 = 33. Based on nodule size >5 mm, 73 (36.5%) patients had no metastases, 42 (21%) had metastases, while 85 (42.5%) studies were indeterminate. Based on nodule size >10 mm, 73 (36.5%) patients had no metastases, 28 (14%) had metastases, while 99 (49.5%) studies were indeterminate. Larger maximum dimension of the primary tumour was a risk factor for pulmonary metastases using both size criteria. CONCLUSION: The incidence of pulmonary metastases at presentation in trunk and extremity soft tissue sarcoma is 14-21%. 42.5-49.5% of chest CTs were indeterminate. ADVANCES IN KNOWLEDGE: The incidence of pulmonary metastases at presentation in trunk and extremity soft tissue sarcoma is 14-21%. Indeterminate pulmonary nodules are also very common.