Environmental and financial impacts of perioperative paracetamol use: a multicentre international life-cycle assessment.

Background: Pharmaceuticals account for 19-32% of healthcare greenhouse gas (GHG) emissions. Paracetamol is a common perioperative analgesic agent. We estimated GHG emissions associated with i.

Use of a non-anatomic mini-fragment fixation system for foot fractures.

Background: Plating techniques for the fixation of foot fractures can utilize pre-contoured region-specific plates or non-anatomic non-specific mini-fragment plating systems, however there is limited published data describing complication rates.

Methods: This study reviewed the complication rates and performed a cost analysis of 45 foot fractures that had fixation with the use of mini-fragment non-anatomic implants, comparing them to a series from the same centre fixed using anatomic implants and the published literature.

Results: Complication rates seemed equivalent.

Gustilo-Anderson type III tibial fractures have poor functional outcomes in patients over 75 years.

Background: Previous outcome studies in open tibial fractures have commonly assessed young patients and there is a paucity of data regarding outcomes in the elderly. The aim of this study is to assess functional outcomes for patients over 75 years with Gustilo-Anderson Grade III open tibial fractures, including mobility and residential status.

Methods: Outcomes for all patients over 75 years admitted with grade III open tibial fractures to a UK level 1 trauma centre during a 5-year period (January 2010-May 2015) were analysed.

Midterm Outcomes of a Synthetic Cartilage Implant for the First Metatarsophalangeal Joint in Advanced Hallux Rigidus.

Background:: A prospective, randomized, noninferiority clinical trial of synthetic cartilage implant hemiarthroplasty for hallux rigidus demonstrated functional outcomes and safety equivalent to first metatarsophalangeal (MTP) joint arthrodesis at 24 months. We prospectively assessed safety and efficacy outcomes for synthetic cartilage implant hemiarthroplasty at a minimum of 5 years.

Methods:: Of 135 eligible patients from the original trial, 112 (83.

Traumatic brain injured patients: primum non nocere.

Purpose Of Review: Traumatic brain injury (TBI) remains an unfortunately common disease with potentially devastating consequences for patients and their families. However, it is important to remember that it is a spectrum of disease and thus, a one 'treatment fits all' approach is not appropriate to achieve optimal outcomes. This review aims to inform readers about recent updates in prehospital and neurocritical care management of patients with TBI.

Treatment of first metatarsophalangeal joint arthritis using hemiarthroplasty with a synthetic cartilage implant or arthrodesis: A comparison of operative and recovery time.

Background: First metatarsophalangeal joint (MTPJ1) hemiarthroplasty using a novel synthetic cartilage implant was as effective and safe as MTPJ1 arthrodesis in a randomized clinical trial. We retrospectively evaluated operative time and recovery period for implant hemiarthroplasty (n=152) and MTPJ1 arthrodesis (n=50).

Methods: Perioperative data were assessed for operative and anaesthesia times.

Correlation of Hallux Rigidus Grade With Motion, VAS Pain, Intraoperative Cartilage Loss, and Treatment Success for First MTP Joint Arthrodesis and Synthetic Cartilage Implant.

Background: Grading systems are used to assess severity of any condition and as an aid in guiding treatment. This study examined the relationship of baseline motion, pain, and observed intraoperative cartilage loss with hallux rigidus grade.

Methods: A prospective, randomized study examining outcomes of arthrodesis compared to synthetic cartilage implant was performed.

Association Between Patient Factors and Outcome of Synthetic Cartilage Implant Hemiarthroplasty vs First Metatarsophalangeal Joint Arthrodesis in Advanced Hallux Rigidus.

Background: We evaluated data from a clinical trial of first metatarsophalangeal joint (MTPJ1) implant hemiarthroplasty and arthrodesis to determine the association between patient factors and clinical outcomes.

Methods: Patients ≥18 years with hallux rigidus grade 2, 3, or 4 were treated with synthetic cartilage implant MTPJ1 hemiarthroplasty or arthrodesis. Pain visual analog scale (VAS), Foot and Ankle Ability Measure (FAAM) sports and activities of daily living (ADL) scores, and Short Form-36 Physical Function (SF-36 PF) subscore were obtained preoperatively, and at 2, 6, 12, 24, 52, and 104 weeks postoperatively.

Prospective, Randomized, Multi-centered Clinical Trial Assessing Safety and Efficacy of a Synthetic Cartilage Implant Versus First Metatarsophalangeal Arthrodesis in Advanced Hallux Rigidus.

Background: Although a variety of great toe implants have been tried in an attempt to maintain toe motion, the majority have failed with loosening, malalignment/dislocation, implant fragmentation and bone loss. In these cases, salvage to arthrodesis is more complicated and results in shortening of the ray or requires structural bone graft to reestablish length. This prospective study compared the efficacy and safety of this small (8/10 mm) hydrogel implant to the gold standard of a great toe arthrodesis for advanced-stage hallux rigidus.

Surgical fixation methods for tibial plateau fractures.

Background: Fractures of the tibial plateau, which are intra-articular injuries of the knee joint, are often difficult to treat and have a high complication rate, including early-onset osteoarthritis. Surgical fixation is usually used for more complex tibial plateau fractures. Additionally, bone void fillers are often used to address bone defects caused by the injury.

Expandable intramedullary nails in lower limb trauma: a systematic review of clinical and radiological outcomes.

This study systematically reviews the evidence-base for the use of expandable nails in the treatment of acute diaphyseal fractures of the lower limb. Both electronic and hand searches were undertaken of the published and grey literature to 1 December 2011. A total of 154 citations were identified, of which 15 were deemed suitable and assessed with the Critical Appraisals Skills Programme tool.

Expandable intramedullary nails for humeral fractures: a systematic review of clinical and radiological outcomes.

The Fixion(™) system (Disc-O-Tech Medical Technologies, Herzeliya, Israel), which is currently the only expandable nailing system available for use in the humerus, has a number of purported advantages over the standard locked humeral nail, including a reduction in operating and fluoroscopy time since locking screws are not required. A systematic review was undertaken of all published (AMED, CINAHL, EMBASE and Medline via the Ovid platform) and unpublished or grey literature research databases from inception until 1st December 2010. Demographic data, clinical and radiological outcomes, and complications were extracted from each study by two independent investigators, and each study underwent independent critical appraisal using the CASP appraisal tool.

Minimally invasive paratenon release for non-insertional Achilles tendinopathy.

Background: Non-insertional Achilles tendinopathy is an increasing, perhaps secondary to an increase in sporting activities. Traditional open surgical procedures have been associated with a significant rate of complications. We describe a minimally invasive technique involving the release of the adherent paratenon with a peritendinous infusion of corticosteroids and present the results in a cohort of patients.

Arthroscopic visualization of the posterior horn of the medial meniscus.

We present a method of visualizing the posterior horn of the medial meniscus through the anterolateral portal that has not been previously described in the literature. It allows easy visualization and instrumentation of the posterior horn, an area that commonly has pathology that can be difficult to identify and treat. The technique involves allowing the knee to flex to 60 degrees to 90 degrees over the side of the bed and applying a varus force to the tibia, opening up the posteromedial part of the joint.

Short-listing for orthopaedic specialist registrar posts--what is important?

Introduction: Competition for specialist registrar (SpR) posts in orthopaedics is high. The aim of the current study was to provide evidence-based advice for applicants applying for SpR posts in orthopaedics.

Methods: The short-listing forms of 273 applicants for orthopaedic SpR posts in South Thames (West) were reviewed.

Where to split plaster casts.

Plaster casts are often split to accommodate swelling following injury. This is not influenced by the axis of the split. The aim of this study was to compare the mechanical properties of plasters split along different axes.

Satisfaction levels in orthopaedic out-patients.

Introduction: It is important that patients are satisfied with an out-patient consultation. This ensures compliance with treatment and attendance for follow-up. The aim of this study was to identify factors regarding out-patient consultation associated with patient satisfaction.

Keeping plaster casts dry: what works?

Plaster casts are commonly used in the management of fractures. The mechanical properties of plasters are adversely affected by water. There are a number of commercial products available to allow patients to continue to shower and swim by protecting the plaster.