Consent in Limb Lengthening Surgery: Predicting the True Incidence of Material Risk.

Aim: The consent process involves supported decision-making between the surgeon and the patient. Both potential benefits and material risks of the procedure require explanation, with adequate time for reflection. The complexity of limb reconstruction surgery includes the potential for multiple types of complications.

Treating the injured: a privilege conferred by both patient and wider society.

Two discrete legal factors enable the surgeon to treat an injured patient the fully informed, autonomous consent of the adult patient with capacity via civil law; and the medical exception to the criminal law. This article discusses current concepts in consent in trauma; and also considers the perhaps less well known medical exception to the Offences against the Person Act 1861, which exempts surgeons from criminal liability as long as they provide 'proper medical treatment'.

Blacklight sintering of ceramics.

For millennia, ceramics have been densified sintering in a furnace, a time-consuming and energy-intensive process. The need to minimize environmental impact calls for new physical concepts beyond large kilns relying on thermal radiation and insulation. Here, we realize ultrarapid heating with intense blue and UV-light.

Ilizarov Method for Acute Paediatric Tibial Fractures.

Aim And Background: A systemic method for the application of Ilizarov fixators and on-table fracture reduction is described in this instructional article. This technique has been developed from the unit's practice in adult patients. The indications, underlying principles and rationale for the method are also discussed.

Thromboprophylaxis in Intramedullary Limb Lengthening Surgery.

Aim: The use of intramedullary lengthening devices is becoming increasingly popular. There are limited data regarding the incidence of venous thromboembolism following intramedullary lengthening surgery and no reports or guidance for current practice on use of thromboprophylaxis. Following a case of post-operative deep vein thrombosis in our institution, we felt that it is important to assess best practice.

A safe technique for insertion of heel wires for hindfoot external fixation frames: an anatomical study.

Aims: Anatomical atlases document classical safe corridors for the placement of transosseous fine wires through the calcaneum during circular frame external fixation. During this process, the posterior tibial neurovascular bundle (PTNVB) is placed at risk, though this has not been previously quantified. We describe a cadaveric study to investigate a safe technique for posterolateral to anteromedial fine wire insertion through the body of the calcaneum.

Treatment and functional outcomes of complex tibial fractures in children and adolescents using the Ilizarov method.

Aims: The aim of this study was to report the clinical, functional and radiological outcomes of children and adolescents with tibial fractures treated using the Ilizarov method.

Patients And Methods: Between 2013 and 2016 a total of 74 children with 75 tibial fractures underwent treatment at our major trauma centre using an Ilizarov frame. Demographic and clinical information from a prospective database was supplemented by routine functional and psychological assessment and a retrospective review of the notes and radiographs.

The treatment of segmental tibial fractures: does patient preference differ from surgeon choice?

Introduction: Segmental tibial fractures are complex injuries with a prolonged recovery time. Current definitive treatment options include intramedullary fixation or a circular external fixator. However, there is uncertainty as to which surgical option is preferable and there are no sufficiently rigorous multi-centre trials that have answered this question.

The treatment of intramedullary osteomyelitis of the femur and tibia using the Reamer-Irrigator-Aspirator system and antibiotic cement rods.

Intramedullary infection in long bones represents a complex clinical challenge, with an increasing incidence due to the increasing use of intramedullary fixation. We report a prospective case series using an intramedullary reaming device, the Reamer-Irrigator-Aspirator (RIA) system, in association with antibiotic cement rods for the treatment of lower limb long bone infections. A total of 24 such patients, 16 men and eight women, with a mean age of 44.

Ilizarov fixator pin site care: the role of crusts in the prevention of infection.

Pin site infection is one of the most common local complications after procedures using the Ilizarov fine wire fixator. In this study, the rate of infection was investigated in two groups of patients, representing two consecutive case series, undergoing fracture stabilisation or lower limb reconstruction using an Ilizarov fine wire fixator. Both groups received identical Russian-style pin site care, except in the first Group A where the crusts of dried exudate were removed at the time of pin site cleaning; while in the subsequent Group B, the adherent crusts were retained during cleaning.

The treatment of complex tibial shaft fractures by the Ilizarov method.

We report on the use of the Ilizarov method to treat 40 consecutive fractures of the tibial shaft (35 AO 42C fractures and five AO 42B3 fractures) in adults. There were 28 men and 12 women with a mean age of 43 years (19 to 81). The series included 19 open fractures (six Gustilo grade 3A and 13 grade 3B) and 21 closed injuries.

Reaming Irrigator Aspirator system: early experience of its multipurpose use.

The evolution of contemporary intramedullary reaming systems has recently generated the Reamer Irrigator Aspirator system (RIA-Synthes®), which has progressively gained in popularity as well as in indications. The preliminary results of its use over the initial period of 18 months ata single tertiary referral centre were prospectively collected and are presented. The wide spectrum of RIA's indications have been exploited, including 7 patients with polytrauma that underwent acute femoral nailing, 8 with femoral intramedullary osteomyelitis, 9 with pathological lesions of the femoral shaft, as well as 18 patients where the RIA system has been used to harvest morselised autologous bone graft in the presence of recalcitrant atrophie non-unions and bone defects.

The 'Retro-Fibular Wire': an anatomical study describing a safe corridor for placement of fine wires in the distal tibia.

Anatomical atlases document safe corridors for placement of wires when using fine-wire circular external fixation. The furthest posterolateral corridor described in the distal tibia is through the fibula. This limits the crossing angle and stability of the frame.

Changes in regional cerebral blood flow elicited by craving memories in abstinent opiate-dependent subjects.

Objective: The brain circuitry of opiate craving was investigated with positron emission tomography (PET) imaging of regional cerebral blood flow (rCBF).

Method: Twelve abstinent opiate-dependent subjects listened to audiotaped autobiographical scripts of an episode of craving and a neutral episode while undergoing a PET scan with the tracer [(15)O]H(2)O. Statistical parametric mapping was used to analyze the PET images of rCBF changes.

All basic surgical trainees should rotate through an accident and emergency post.

Unlabelled: A 6-month post in accident and emergency is no longer compulsory for basic surgical training. Meanwhile, trauma teams have emerged in many UK hospitals to receive seriously injured patients, often with no involvement of basic surgical trainees (BSTs). This may lead to the appointment of surgical specialist registrars (SpRs) who have had little exposure to the initial management of seriously injured patients.

The impact of trauma teams on basic surgical training.

An analysis of the number of trauma teams and the extent of involvement of basic surgical trainees in these teams in the South-West region is presented.

Chest wall thickness may limit adequate drainage of tension pneumothorax by needle thoracocentesis.

Tension pneumothorax in a large man was inadequately drained by needle thoracocentesis with a 4.5 cm cannula. Unsuccessful needle thoracocentesis of a clinical tension pneumothorax in a large patient should be followed immediately by chest drain insertion, without local anaesthetic, as dictated by clinical urgency.

Early (34-56 days from last menstrual period) ultrasonographic measurements in normal pregnancies.

To assess early embryonic growth and development, 361 pregnancies were studied from 34 to 56 days from last menstrual period. All pregnancies had a subsequent successful outcome. Transvaginal ultrasonography was performed using an Acuson 128 x P/10 with a 5-7.

Needle thoracocentesis in tension pneumothorax: insufficient cannula length and potential failure.

Advanced Trauma Life Support guidelines recommend the use of a cannula 3 to 6 cm long to perform needle thoracocentesis for life-threatening tension pneumothorax. The chest wall thickness in the 2nd intercostal space, mid-clavicular line, was determined by ultrasound in 54 patients aged 18 to 55 years, and ranged from 1.3 to 5.