Improving the Safety of Tourniquet Use in a Trauma Theatre According to the British Orthopaedic Association Guidelines: A Closed Loop Audit.

Introduction Tourniquets are used widely in trauma and orthopaedic surgery to reduce blood loss and facilitate better visualisation of the operative field; however, some complications can result from improper use such as pressure sores, chemical burns, compartment syndrome, and deep vein thrombosis. We audited the use of intraoperative tourniquets in our trauma theatre against the guidance published by the British Orthopaedic Association (BOA) in 2021. Methods This was a closed-loop audit evaluating 80 trauma operations that utilised tourniquets.

Predictors of mortality in periprosthetic fractures of the hip: Results from the national PPF study.

Introduction: Periprosthetic fractures (PPFs) around the hip joint are increasing in prevalence. In this collaborative study, we aimed to investigate the impact of patient demographics, fracture characteristics, and modes of management on in-hospital mortality of PPFs involving the hip.

Methods: Using a multi-centre cohort study design, we retrospectively identified adults presenting with a PPF around the hip over a 10-year period.

A pragmatic single centre retrospective comparative review of complication profile between PEEK cages and Zero-P cage screw constructs.

Background: Anterior Decompression and Fusion (ACDF) is a common surgery recommended for symptomatic cervical degenerative disc disease after failed conservative care. There is no consensus on the choice of implants, and it varies between surgeons. This study aims to analyse the early complications following ACDF performed using a standalone cage versus a Zero-P (Cage Screw - (CS)) construct for patients with cervical degenerative disc disease.

Mortality risk of surgically managing orthopaedic trauma during the COVID-19 pandemic.

Aims: It is imperative to understand the risks of operating on urgent cases during the COVID-19 (SARS-Cov-2 virus) pandemic for clinical decision-making and medical resource planning. The primary aim was to determine the mortality risk and associated variables when operating on urgent cases during the COVID-19 pandemic. The secondary objective was to assess differences in the outcome of patients treated between sites treating COVID-19 and a separate surgical site.

Traumatic hip dislocation in the paediatric population: A case series from a specialist centre.

Introduction: Traumatic hip dislocation is a rare injury in the paediatric population. It can occur after high energy trauma, but also after lower energy injuries especially in younger children. Posterior dislocation is the most common pattern of hip dislocation.

Prosthetic Neck Fracture in Exeter V40 Stems: A Report of Two Cases and Review of Literature.

This report contains 2 acute fractures of the Exeter V40 stem with 2 different types of neck fracture, one at the subcapital level and another at the base of the neck. A review of relevant literature provides an insight into a similar pattern of failures reported in a certain subset of cases. We hypothesize that for high-BMI cases, attention to proper preoperative templating is mandatory.

Salvage of failed in-situ pinning in severe unstable slipped capital femoral physis by surgical dislocation and capital realignment.

Aims: We describe surgical dislocation with capital realignment as an option for management of failed in-situ pinning in children with severe unstable slipped capital femoral physis.

Patients And Methods: A retrospective data collection from our hospital hip database retrieved 7 patients with severe unstable slipped capital femoral physis who had failed in-situ pinning with severe deformity and grossly restricted movements. The failure of pinning in-situ was due to slip progression with inadequate screw purchase in four patients, stress fracture of the femoral neck in one patient, and screw head impingement in two patients.

Different Patellar Indices and Their Role in Decision-Making: An MRI-Based Study.

Magnetic resonance imaging (MRI) of knee has become the integral part of knee evaluation, hence any MRI based study adds more value if it helps in the decision-making process, especially for surgery in treating patellofemoral pain. We tried to determine normal patellar indices using knee MR images and the correlation between them and also compared the results with different ethnic population. We analyzed the prospectively collected MR images of 117 knees/patients, and Insall-Salvati (IS) index, modified IS index, patellotrochlear (PT) index, and patellophyseal (PP) index were calculated.

Avascular necrosis post unstable slipped capital femoral epiphysis: a treatment algorithm with staged hinged hip distraction: mid-term results.

Background: Management of avascular necrosis (AVN) of the femoral head in slipped capital femoral epiphysis (SCFE) is difficult. We proposed to ascertain if staged hip distraction could prevent collapse and recover the femoral head.

Methods: A retrospective review of the hip database retrieved 16 children with unstable SCFE and AVN.

Moderate and severe SCFE (Slipped Capital Femoral Epiphysis) arthroscopic osteoplasty vs open neck osteotomy-a retrospective analysis of results.

Aim: We intend to compare the outcomes of arthroscopic osteoplasty with open neck osteotomy for correction of the hip impingement and improvement of hip function in children with moderate to severe healed Slipped Capital Femoral Epiphysis (SCFE). Our aim is to verify if arthroscopic osteoplasty could achieve the same outcome as open procedures.

Patients And Methods: A retrospective analysis of the hospital hip database retrieved 187 cases of SCFE from 2006 to 2013.

Does the Surgeon-reported Outcome Correlate with Patient-reported Outcome after Total Knee Arthroplasty? A Cohort Study.

Background: Total knee arthroplasty (TKA) has been proved to be a successful and cost-effective treatment for improving pain and function in patients with knee arthritis. Total knee arthroplasty (TKA) is one of the most common orthopaedic surgeries performed worldwide and advancement in surgical techniques and prosthetic designs have improved the patient outcomes. However, concerns and priorities of patients and surgeons relating to joint replacement may differ.

Can Pixel Value Ratio be Used in the Assessment of Ceramic Bone Substitute Incorporation? Observations from a Pilot Study.

Background: Assessment of bone graft substitute incorporation is critical in the clinical decision making process and requires special investigations. We examined if the pixel value ratio (PVR) obtained in routine follow-up digital radiographs could be used for such assessment.

Material/methods: Radiographic images were acquired using either computed radiography or flat panel digital radiography systems.

Minimally invasive (MIS) Tönnis osteotomy- A technical annotation and review of short term results.

Aims: We detail a modified single incision approach to perform the Tonnis triple pelvic osteotomy by a minimally invasive approach.

Patients And Methods: 12 children underwent minimally invasive Tonnis Osteotomy. There were five boys and seven girls in this study group.

Bone marrow extract as a growth supplement for human iliac apophyseal chondrocyte culture.

Background & Objectives: Human bone marrow is rich in various growth factors which may support the chondrocyte growth. This study was conducted to compare the culture characteristics of human growth plate chondrocyte in foetal bovine serum (FBS) and human autologous bone marrow extract (BME) in monolayer culture.

Methods: Iliac crest apophyseal cartilage was harvested from four donors, aged between two and nine years, undergoing hip surgery.

Late correction of neck deformity in healed severe slipped capital femoral epiphysis: short-term clinical outcomes.

Purpose: Contemporary methods for the management of neck deformity following a healed severe slipped capital femoral epiphysis (SCFE) include subcapital neck osteotomy.

Methods: 18 patients with chronic severe SCFE in the oblique plane (mean slip angle = 70°) constituted the study group. 6 patients with an open physis underwent modified Dunn capital realignment and 12 patients with a closed physis underwent surgical dislocation with a corrective neck osteotomy.

Nonunion in a distal radius metaphyseal fracture in a child: Role of intact periosteal sleeve in management.

We present an adolescent with distal radius nonunion following an open fracture and failed surgery which eventually united when the length and stability was restored for eight weeks duration. The intact periosteal sleeve at the nonunion site formed new bone when its tension was restored by gradual differential distraction. This case report highlights the possibility of stimulating bony union in an established atrophic nonunion by distracting the minimally disturbed soft tissue and thick osteogenic periosteal envelope in the paediatric age group.

Triphasic ceramic scaffold in paediatric and adolescent bone defects.

We evaluated novel triphasic hydroxyapatite tricalcium phosphate calcium silicate scaffold (HASi) in the management of paediatric bone defects. Their main advantage is considered to be adequate strength and stimulation of bone formation without resorting to autograft. A total of 42 children younger than 16 years of age were recruited over a period of 1 year and were treated with this synthetic bone substitute as a stand-alone graft for pelvic, femur, calcaneal and ulnar osteotomies, cystic bone lesions, subtalar arthrodesis and segmental bone defects.

A retrospective analysis of loss of reduction in operated supracondylar humerus fractures.

Background: Loss of reduction following closed or open reduction of displaced supracondylar fractures of the humerus in children varies widely and is considered dependent on stability of the fracture pattern, Gartland type, number and configuration of pins for fixation, technical errors, adequacy of initial reduction, and timing of the surgery. This study was aimed to evaluate the factors responsible for failure of reduction in operated pediatric supracondylar fracture humerus.

Materials And Methods: We retrospectively assessed loss of reduction by evaluating changes in Baumann's angle, change in lateral rotation percentage, and anterior humeral line in 77 consecutive children who were treated with multiple Kirschner wire fixation and were available for followup.

Is there a role for Ender's nailing of paediatric femoral fractures in a resource-restricted hospital set-up?

Paediatric femur fractures are managed with the titanium elastic nail system (TENS) in the 5-16-year age group. TENS is costly and not easily available in public hospitals. This study compares TENS nailing with stainless-steel Ender's nail fixation of paediatric femur fractures.

Sjögren-Larsson syndrome--unusual presentation with pathological femoral neck fracture: a case report.

Patients with Sjögren-Larsson syndrome, an autosomal recessive syndrome characterized by ichthyosis, spastic diplegia/quadriplegia, mental retardation and ocular features that include pigmentary changes in the retina, rarely present to the orthopaedic surgeon. We detail a rare and unusual presentation of Sjögren-Larsson syndrome in an adolescent boy with bilateral femoral neck fractures.