Comparison of individually packed metalwork and on-the-tray metalwork: A review of clinical risks.

The use of metalwork, such as screws and plates, is common in orthopaedic trauma surgery, with a recent trend towards individually packed metalwork owing to concerns about sterilization efficacy and traceability. Despite this, there is no clinical evidence proving clinical risk from repeat sterilization of metalworks used in orthopaedic trauma of either increased infection rates or loosening or implant failure. On the contrary, the use of individually packed metalworks presents several practical challenges, including higher costs, increased risks of contamination, longer operative times and a larger carbon footprint.

Free fibula flap to achieve bone union after congenital pseudoarthrosis of the forearm in neurofibromatosis: Technical report based on 3 cases, and literature review.

Congenital pseudarthrosis of the forearm bones (CPFBs) is rare, with only 106 reported cases, and is frequently associated with neurofibromatosis (NF). Approximately 5% of patients with NF develop pseudarthrosis, and 50% of patients with pseudarthrosis have NF. Achieving bone union is difficult in congenital pseudarthrosis.

The comparison of functional bracing of humeral shaft fractures: thermoplastic custom against preprepared commercial braces.

Background: Functional humeral bracing of midshaft humeral fractures has been widely accepted as a gold standard for nonoperative treatment. Despite reported high union rates, there is no proven superiority of any orthosis. Here we aim to compare the outcomes after the use of custom-made thermoplastic vs.

The BioPro Thumb Carpometacarpal Hemiarthroplasty: Case Series and Surgical Technique.

Thumb carpometacarpal (CMC) osteoarthritis is painful and debilitating. Here, we explore outcomes of a modular, press-fit thumb CMC hemiarthroplasty prosthesis (BioPro). This surgical option permits minimal bone resection, sparing the trapezium, hence allowing revision options if necessary.

Assessing Bone Mineral Density Using Radiographs of the Hand: A Multicenter Validation.

Purpose: Osteoporosis and fragility fractures incur substantial costs to quality of life and global health care systems. The current gold standard for quantifying bone density is dual-energy X-ray absorptiometry. Our hypothesis is that bone density can be accurately predicted with a simpler method using plain radiographs of the hand.

Predicting Pathological Fractures at Metastatic Humeral Lesions.

Unlabelled: The humerus is the second most common site of metastatic disease involving long bones, yet it is still unclear which patients are at high risk for a fracture and may require prophylactic surgical fixation. The goal of this study was to assess the validity of the Mirels score to predict fractures of metastatic lesions in the humerus.

Methods: We performed a retrospective electronic chart review of patients with humeral metastases at our institution (2005 to 2021), with 188 patients meeting the inclusion criteria.

Insights and trends review: the role of three-dimensional technology in upper extremity surgery.

The use of three-dimensional (3-D) technology in upper extremity surgery has the potential to revolutionize the way that hand and upper limb procedures are planned and performed. 3-D technology can assist in the diagnosis and treatment of conditions, allowing virtual preoperative planning and surgical templating. 3-D printing can allow the production of patient-specific jigs, instruments and implants, allowing surgeons to plan and perform complex procedures with greater precision and accuracy.

Pyrocarbon Lunate Replacements Perform Well at Two Years: A Retrospective Case Series and Technique from Two UK Tertiary Centres.

We report medium-term results in our case series of patients with Kienböck disease receiving a pyrocarbon lunate replacement (Integra, Smith and Nephew, Watford, UK). Patients with Kienböck receiving a pyrocarbon lunate between September 2012 and November 2020, with stage 3b and above were included. Patients were staged preoperatively with radiographs and MRIs.

Hand Carpometacarpal Joint Instability in Elite Boxers: Injury Characteristics, Surgical Technique, and Outcomes.

Purpose: We describe a single-surgeon's experience of managing hand carpometacarpal joint (CMCJ) instability in elite boxers, focusing on injury characteristics, surgical technique, and outcomes.

Methods: This retrospective cohort included consecutive elite boxers undergoing surgery for hand CMCJ instability from 2009 to 2021. CMC joint instability is usually clear on clinical examination using a 'seesaw' test.

The Shoulder Lever Test - Technical Tip for Instability Assessment in Large Shoulders.

Introduction: The classical shoulder tests for instability of the glenohumeral joint are the load and shift and drawer tests. Here, the humeral head is gripped between fingers and thumb to assess translation. This can be challenging to perform accurately in obese individuals and muscular athletes.

Legalisation of e-scooters in the UK: the injury rate and pattern is similar to those of bicycles in an inner city metropolitan area.

Introduction: Rental electric scooters (e-scooters) have become more available to the UK public following amendments to legislation in 2020 affecting rideshare schemes. Existing literature from outside the UK demonstrates a worrying trend of increasing injuries related to their use and non-compliance with suggested safety precautions. An e-scooter rideshare scheme trial began in Liverpool in October 2020.

Thumbs up: Needle marker technique for preoperative localisation of radiolucent foreign bodies with ultrasonography.

Background: A 26-year-old man presented with pain and swelling after pricking his right thumb pulp with a thorn, gardening three-weeks previously.

Technique: After a thumb digital ring block with local anesthetic, a linear array ultrasound (US) transducer (frequency XX) identified a foreign body (FB) in both longitudinal and transverse planes. This was a hyperechoic FB, 5mm in length with surrounding hypoechoic shadow, denoting granulation tissue and fluid collection.

A 16-year Longitudinal Cohort Study of Incidence and Bacteriology of Necrotising Fasciitis in England.

Background: Necrotising fasciitis (NF) is a rapidly progressive, destructive soft tissue infection with high mortality. The primary aim of this study was to evaluate the incidence and mortality of NF amongst patients admitted to English National Health Service (NHS) hospitals. The secondary aims included the identification of risk factors for mortality and causative pathogens.

Acute Compartment Syndrome: Do guidelines for diagnosis and management make a difference?

Background: The best outcomes following Acute Compartment Syndrome (ACS) are attributed to early diagnosis and treatment. National guidelines were issued in the United Kingdom in 2014 (BOAST 10) to standardise and improve management. We analysed standards of diagnosis and management before and after the introduction of the guidelines.

Potential cost savings by minimisation of blood sample delays on care decision making in urgent care services.

Background: Timely availability of blood sample results for interpretation affects planning and delivery of patient care from initial assessment in Accident and Emergency (A&E) departments.

Materials And Methods: Rates of, and reasons for, rejected blood samples submitted from all clinical areas over one month were evaluated. Haemoglobin (Hb) represented haematology and potassium (K), biochemistry.

Change the habit to change the practice: Do audits really ever change anything?

Introduction: Methicillin resistant staphylococcus aureus (MRSA) eradication by nurses and pre-op induction antibiotics are mandated for emergency surgery, where true status is unknown. We assessed adherence to local MRSA guidelines for patients undergoing emergency hip fracture surgery and employed point of decision prompts to influence clinicians' behaviour.

Methods: We undertook a retrospective record review for all patients undergoing emergency hip fracture surgery at a UK major trauma centre over 3-months.

The effects of cobalt-chromium-molybdenum wear debris in vitro on serum cytokine profiles and T cell repertoire.

Cobalt-chromium-molybdenum (CoCrMo) alloy-based metal-on-metal prostheses have been the implant of choice for total hip replacement in younger patients. However 6.2% of patients require revision of their CoCrMo total hip replacement (THR) implant within five years of surgery and their use was restricted in 2013.

Do stress markers and anesthetic technique predict delirium in the elderly?

Background: Postoperative delirium (PD) is a prevalent complication of elderly surgical patients, which predisposes to worsened cognitive recovery and dementia. Risk of PD has been associated with increasing magnitude of the hypothalamic-pituitary-adrenal stress response (serum cortisol, epinephrine and norepinephrine) to surgery. Anesthetics suppress this response; however, some (total intravenous anesthesia, TIVA) more than others (anesthetic gases).

Adverse cardiovascular outcomes in relation to suboptimal antithrombotic therapy use in patients undergoing peripheral artery disease angioplasty: lost opportunities?

Introduction: Current guidelines recommend antithrombotic therapy with either aspirin or clopidogrel for all patients with peripheral arterial disease (PAD). Nevertheless, cardiovascular comorbidities and perceived bleeding risk complicate antithrombotic management of PAD patients. We studied the proportion of patients receiving optimal (guideline-recommended) antithrombotic therapy, and second, assessed the impact of suboptimal antithrombotic therapy use to long-term outcomes of PAD patients.

Dentate gyrus progenitor cell proliferation after the onset of spontaneous seizures in the tetanus toxin model of temporal lobe epilepsy.

Temporal lobe epilepsy alters adult neurogenesis. Existing experimental evidence is mainly from chronic models induced by an initial prolonged status epilepticus associated with substantial cell death. In these models, neurogenesis increases after status epilepticus.

An alternative option in the management of blunt splenic injury.

Splenic injury is a preventable cause of mortality following blunt trauma. The majority of splenic injuries can be managed conservatively. Laparotomy is indicated in the haemodynamically unstable patient, or those with other intra-abdominal injuries requiring surgery.

Influenza vaccination of future healthcare workers: a cross-sectional study of uptake, knowledge and attitudes.

Promotional campaigns recommend immunisation against influenza in healthcare workers (HCWs) but the uptake in this group remains low. We conducted a survey study during the 2008-2009 influenza vaccination period amongst future HCWs to quantify uptake and identify barriers to immunisation. Overall uptake was 8.