Trial of labour following two previous caesarean sections - A UK cohort study.

Objectives: To assess the (i) predictors of and associated rates of success and; (ii) maternal and perinatal outcomes of women undergoing trial of labour after two previous caesarean sections (TOLA2C).

Study Design: This retrospective cohort study collected data from two regional obstetric centres with 12,000 deliveries per annum collectively. The population included singleton pregnancies undergoing (i) TOLA2C, (ii) elective repeat caesarean section following two caesarean sections (ERCS) and (iii) trial of labour after one caesarean section (TOLA1C).

Expert-Based Consensus on the Principles of Pavlik Harness Management of Developmental Dysplasia of the Hip.

Unlabelled: Developmental dysplasia of the hip (DDH) is the most common orthopaedic disorder in newborns. While the Pavlik harness is one of the most frequently used treatments for DDH, there is immense variability in treatment parameters reported in the literature and in clinical practice, leading to difficulties in standardizing teaching and comparing outcomes. In the absence of definitive quantitative evidence for the optimal Pavlik harness management strategy for DDH, we addressed this problem by obtaining international expert-based consensus on the subject.

Graft-Tunnel Mismatch in Endoscopic ACL Reconstruction: Reliability of Measuring Tunnel Lengths and Intra-articular Distance.

Background: A continued technical challenge for surgeons performing bone-patellar tendon-bone anterior cruciate ligament (ACL) reconstruction with endoscopic techniques is graft-tunnel mismatch. If tibial tunnel and intra-articular distances could be reliably estimated, surgeons could adjust the length of the femoral tunnel to minimize graft-tunnel mismatch.

Purpose/hypothesis: To determine whether arthroscopic measurement of the following was reliable: femoral tunnel distance (FTD), tibial tunnel distance (TTD), intra-articular distance (IAD), and total distance (TD; sum of these 3 measurements).

Validation of a Dry Model for Assessing the Performance of Arthroscopic Hip Labral Repair.

Background: Arthroscopic hip labral repair is a technically challenging and demanding surgical technique with a steep learning curve. Arthroscopic simulation allows trainees to develop these skills in a safe environment.

Purpose: The purpose of this study was to evaluate the use of a combination of assessment ratings for the performance of arthroscopic hip labral repair on a dry model.

Avascular necrosis following closed reduction for treatment of developmental dysplasia of the hip: a systematic review.

Background: Avascular necrosis (AVN) is a significant and potentially devastating complication following the treatment of developmental dysplasia of the hip (DDH). The reported rate of AVN following closed reduction for DDH ranges from 4 to 60%, and the resultant influence on hip development remains unclear.

Purpose: A systematic review of the literature was undertaken to evaluate the frequency of AVN after more than 5 years of follow-up in children that underwent closed reduction at younger than 2-years of age for DDH.

Orthopaedic Enhanced Recovery Programme for Elective Hip and Knee Arthroplasty - Could a Regional Programme be Beneficial?

Introduction: Arthroplasty is commonplace in orthopaedic practice, and post operative pain has been shown to substantially hinder recovery and discharge from hospital.

Objectives: The current study assessed a multidisciplinary, multimodal Orthopaedic ERP in terms of its effect on patient perceived post operative pain in hip and knee arthroplasty. Secondary outcome was in the form of a cost analysis.

Education of parents in Pavlik harness application for developmental dysplasia of the hip using a validated simulated learning module.

Background: The Pavlik harness is the most common initial treatment for developmental dysplasia of the hip worldwide. During treatment, parents are required to re-apply the harness at home. Teaching parents how to apply the harness is therefore paramount to success.

Skill Acquisition and Retention Following Simulation-Based Training in Pavlik Harness Application.

Background: Simulation-based learning is increasingly prevalent in many surgical training programs, as medical education moves toward competency-based curricula. In orthopaedic surgery, developmental dysplasia of the hip is a commonly treated condition, where the standard of care for patients less than six months of age is an orthotic device such as the Pavlik harness. However, despite widespread use of the Pavlik harness and the potential complications that may arise from inappropriate application, we know of no previously described formal training curriculum for Pavlik harness application.

Novel Arthroscopic Classification of Osteochondritis Dissecans of the Knee: A Multicenter Reliability Study.

Background: Several systems have been proposed for classifying osteochondritis dissecans (OCD) of the knee during surgical evaluation. No single classification includes mutually exclusive categories that capture all of the salient features of stability, chondral fissuring, and fragment detachment. Furthermore, no study has assessed the reliability of these classification systems.

Development and Assessment of a Distal Radial Fracture Model as a Clinical Teaching Tool.

Background: Simulation-based learning is increasingly prevalent in the curricula of many surgical training programs. Newly developed simulators must undergo rigorous validity testing before they are used to assess and evaluate surgical trainees. We describe the development of a model that simulates a distal radial fracture requiring closed reduction and cast application and demonstrate its validity.

Preoperative Femoral Nerve Block for Hip Arthroscopy: A Randomized, Triple-Masked Controlled Trial.

Background: Arthroscopy has become a standard method of treatment for a variety of intra-articular hip disorders. While most arthroscopic hip procedures are performed as outpatient surgeries, patients can still experience significant postoperative pain and opioid-associated side effects.

Purpose: The potential benefits of a preoperative femoral nerve block (FNB) in hip arthroscopy were explored in a previous retrospective review.

Taking a Chance or Playing It Safe: Reframing Risk Assessment Within the Surgeon's Comfort Zone.

Objectives: The purpose of this study was to explore how risk is perceived and experienced by the surgeon and how risk is actively managed in individual practice.

Background: Risk in surgery has been examined from system-wide and personality perspectives. Although these are important, little is known about the perspective of the individual surgeon.

A Qualitative Investigation of Return to Sport After Arthroscopic Bankart Repair: Beyond Stability.

Background: Arthroscopic shoulder stabilization is known to have excellent functional results, but many patients do not return to their preinjury level of sport, with return to play rates reported between 48% and 100% despite good outcome scores.

Purpose: To understand specific subjective psychosocial factors influencing a patient's decision to return to sport after arthroscopic shoulder stabilization.

Study Design: Case series; Level of evidence, 4.

A Reliable and Valid Objective Structured Assessment of Technical Skill for the Application of a Pavlik Harness Based on International Expert Consensus.

Background: The use of competency-based training is increasing in medical education as it offers individualized learning opportunities to master required skills. Inherent to this method of teaching is the need for standardized and objective assessments of skill mastery. In orthopaedic surgery, educational programs have focused on surgical skills with lesser emphasis on nonoperative techniques.

Coaching Surgeons: Is Culture Limiting Our Ability to Improve?

Objective: To explore surgeons' perceptions of and potential concerns about coaching.

Background: There is growing recognition that the traditional model of continuing professional development is suboptimal. This has led to increasing interest in alternative strategies that take place within the actual practice environment such as coaching.

Using a mobile app for monitoring post-operative quality of recovery of patients at home: a feasibility study.

Background: Mobile apps are being viewed as a new solution for post-operative monitoring of surgical patients. Mobile phone monitoring of patients in the post-operative period can allow expedited discharge and may allow early detection of complications.

Objective: The objective of the current study was to assess the feasibility of using a mobile app for the monitoring of post-operative quality of recovery at home following surgery in an ambulatory setting.

Juvenile Osteochondritis Dissecans in a 13-year-old male athlete: A case report.

Objective: To present the clinical management of juvenile osteochondritis dissecans (OCD) of the knee and highlight the importance of a timely diagnosis to optimize the time needed for less invasive, non-operative therapy.

Clinical Features: A 13-year-old provincial level male soccer player presenting with recurrent anterior knee pain despite ongoing manual therapy.

Intervention And Outcome: A multidisciplinary, non-operative treatment approach was utilized to promote natural healing of the osteochondral lesion.

Can neonatal pelvic osteotomies permanently change pelvic shape in patients with exstrophy? Understanding late rediastasis.

Background: Pelvic osteotomies are frequently used as part of the surgical management of bladder exstrophy. The outcomes are often measured on the basis of the residual symphyseal diastasis. The aims of this study were to evaluate and validate a more reliable radiographic measure of ischiopubic rotation, to utilize this measure in analyzing pelves from patients with exstrophy and controls, and to propose a model for rediastasis in a pelvis with exstrophy.

How to assess communication, professionalism, collaboration and the other intrinsic CanMEDS roles in orthopedic residents: use of an objective structured clinical examination (OSCE).

Background: Assessing residents' understanding and application of the 6 intrinsic CanMEDS roles (communicator, professional, manager, collaborator, health advocate, scholar) is challenging for postgraduate medical educators. We hypothesized that an objective structured clinical examination (OSCE) designed to assess multiple intrinsic CanMEDS roles would be sufficiently reliable and valid.

Methods: The OSCE comprised 6 10-minute stations, each testing 2 intrinsic roles using case-based scenarios (with or without the use of standardized patients).

Development of a cast application simulator and evaluation of objective measures of performance.

Background: Surgical simulation offers a low-risk learning environment with repetitive practice opportunities for orthopaedic residents. It is increasingly prevalent in many training programs, as acquisition of technical skills in the face of educational demands and reduced work hours becomes more challenging. In addition to surgical skills, orthopaedic residents must also learn the technique of cast application.

Drilling techniques for osteochondritis dissecans.

Although the advanced stages of osteochondritis dissecans remain challenging to treat, most early-stage lesions in skeletally immature patients, if managed appropriately, can be stimulated to heal. For stable lesions that do not demonstrate adequate healing with nonoperative measures, such as activity modification, weight-bearing protection, or bracing, drilling of the subchondral bone has emerged as the gold standard of management. Several techniques of drilling exist, including transarticular drilling, retroarticular drilling, and notch drilling.

The sizing of hamstring grafts for anterior cruciate reconstruction: intra- and inter-observer reliability.

Purpose: The objective of this study was to establish the intra- and inter-observer reliability of hamstring graft measurement using cylindrical sizing tubes.

Methods: Hamstring tendons (gracilis and semitendinosus) were harvested from ten cadavers by a single surgeon and whip stitched together to create ten 4-strand hamstring grafts. Ten sports medicine surgeons and fellows sized each graft independently using either hollow cylindrical sizers or block sizers in 0.

A qualitative investigation of the decision to return to sport after anterior cruciate ligament reconstruction: to play or not to play.

Background: Primary anterior cruciate ligament (ACL) reconstruction is known to have excellent outcomes, but many patients do not return to their preinjury level of sport participation. Previous studies have used subjective outcome scores to evaluate this discrepancy, but none to date has used qualitative, in-depth patient interviews.

Purpose: To understand the factors influencing a patient's decision to return to his or her preinjury level of sport after ACL reconstruction.