Identifying Research Priorities in Limb Reconstruction Surgery in the United Kingdom.

Introduction: Limb reconstruction surgery (LRS) has a wide range of clinical applications within orthopaedic and trauma surgery. We sought a consensus view from limb reconstruction healthcare practitioners across the United Kingdom to help guide research priorities within LRS. Our aim is to guide future clinical research in LRS, and assist healthcare practitioners, clinical academics, and funding bodies in identifying key research priorities to improve patient care.

Optimising the Orthopaedic Trauma Society Open Fracture Classification system: a proposal for modification in the context of high civilian gunshot fractures.

Objectives: Uniformly classifying long bone open fractures is challenging. The purpose of this study was to propose a modified Orthopaedic Trauma Society (OTS) Open Fracture Classification System, developed in a setting with a high incidence of civilian gunshot fractures.

Methods: From our prospectively collected database, we identified all patients with open tibia and femur fractures treated with intramedullary nailing over a 4 year period.

Circular External Fixator Removal in the Outpatient Clinic Using Regional Anaesthesia: A Pilot Study of a Novel Approach.

Introduction: External fixator (EF) devices are commonly used in the management of complex skeletal trauma, as well as in elective limb reconstruction surgery for the management of congenital and acquired pathology. The subsequent removal of an EF is commonly performed under general anaesthesia in an operating theatre. This practice is resource-intensive and limits the amount of time available for other surgical cases in the operating theatre.

Penthrox (Methoxyflurane) as an Analgesic for Removal of Circular External Fixators and Minor Procedures during the COVID-19 Pandemic.

Introduction: Methoxyflurane has excellent analgesic properties and is approved for use in the United Kingdom and Ireland since 2015. It is currently used in emergency departments for analgesia during fracture reductions. During the COVID-19 pandemic, with theatre access severely restricted, Penthrox® had the potential to provide adequate pain relief to aid frame and wire removal in the clinic setting.

Is human immunodeficiency virus a risk factor for the development of nonunion?-a case-control study.

Objective: Human immunodeficiency virus (HIV) infection has been suggested to be associated with an increased risk of the development of nonunion after a fracture. This prospective matched case-control study in South Africa investigated common risk factors, including HIV status, that influence the development of a nonunion after a femur or tibia fracture.

Methods: Adult participants (cases) with established nonunions of the femur or tibia shaft were recruited over a 16-month period, between December 2017 and April 2019.

Establishing Consensus on Essential Resources for Musculoskeletal Trauma Care Worldwide: A Modified Delphi Study.

Background: Despite evidence that formalized trauma systems enhance patient functional outcomes and decrease mortality rates, there remains a lack of such systems globally. Critical to trauma systems are the equipment, materials, and supplies needed to support care, which vary in availability regionally. The purpose of the present study was to identify essential resources for musculoskeletal trauma care across diverse resource settings worldwide.

Return to Work Following Intramedullary Nailing of Lower-Limb Long-Bone Fractures in South Africa.

Background: Injuries are one of the leading causes of global death and disability and commonly have substantial economic implications. The economic impact of injuries is particularly pronounced in low- and middle-income countries, where 90% of injuries occur. In this study, we aimed to assess return-to-work rates of individuals who sustained a lower-limb long-bone fracture in South Africa and to identify factors that influence the ability to return to employment.

Establishing a consensus on research priorities in orthopaedic trauma within South Africa.

Background: Musculoskeletal (MSK) injuries are one of the leading causes of disability worldwide. Despite improvements in trauma-related morbidity and mortality in high-income countries over recent years, outcomes following MSK injuries in low- and middle-income countries, such as South Africa (SA), have not. Despite governmental recognition that this is required, funding and research into this significant health burden are limited within SA.

Clinical outcomes of ankle fractures in sub-Saharan Africa: a systematic review.

Purpose: Ankle fractures may cause disability and socioeconomic challenges, even when managed in a high-resource setting. The outcomes of ankle fractures in sub-Saharan Africa are not widely reported. We present a systematic review of the patient-reported outcomes and complications of patients treated for ankle fractures in sub-Saharan Africa.

The effect of anti-retroviral therapy on fracture healing : an in vivo animal model.

Aims: A number of anti-retroviral therapies (ART) have been implicated in potentially contributing to HIV-associated bone disease. The aim of this study was to evaluate the effect of combination ART on the fracture healing process.

Methods: A total of 16 adult male Wistar rats were randomly divided into two groups (n = eight each): Group 1 was given a combination of Tenfovir 30 mg, Lamivudine 30 mg, and Efavirenz 60 mg per day orally, whereas Group 2 was used as a control.

The reuse of circular external fixator components: an assessment of safety and potential savings.

Purpose: Cost-saving strategies are important, especially in a resource-constrained environment. One such strategy well supported in the literature is the reuse of temporary monolateral external fixator components, a strategy we utilize at our institution. The aim of the study was to determine the safety and cost saving associated with the reuse of definitive circular external fixator components in a resource-constrained environment.

Total Joint Arthroplasty in HIV-Positive Patients in Malawi: Outcomes from the National Arthroplasty Registry of the Malawi Orthopaedic Association.

Unlabelled: In this observational study, we describe the medium-term outcomes of total joint arthroplasty (TJA) in human immunodeficiency virus (HIV)-positive patients in Malawi, a low-income country. With a high prevalence of HIV and increasing arthroplasty rates in low and middle-income countries, understanding the outcomes of TJA in this unique cohort of patients is essential to ensure that surgical practice is evidence-based.

Methods: Data for all HIV-positive patients who had TJA from January 2005 to March 2020 were extracted from the National Arthroplasty Registry of the Malawi Orthopaedic Association (NARMOA).

Radiographic union score for tibia (RUST) scoring system in adult diaphyseal femoral fractures treated with intramedullary nailing: an assessment of interobserver and intraobserver reliability.

Objectives: The Radiographic Union Score for Tibia (RUST) scoring system has been validated in multiple studies assessing the healing of tibial fractures. Our objective was to assess the interobserver and intraobserver reliability for the RUST in diaphyseal femoral fractures treated with intramedullary (IM) nailing.

Patients And Methods: A total of 60 sets of anteroposterior (AP) and lateral radiographs of diaphyseal femoral fractures treated by reamed IM nailing were randomly selected from a prospectively collected database.

Epidemiology of fractures and their treatment in Malawi: Results of a multicentre prospective registry study to guide orthopaedic care planning.

Importance: Injuries cause 30% more deaths than HIV, TB and malaria combined, and a prospective fracture care registry was established to investigate the fracture burden and treatment in Malawi to inform evidence-based improvements.

Objective: To use the analysis of prospectively-collected fracture data to develop evidence-based strategies to improve fracture care in Malawi and other similar settings.

Design: Multicentre prospective registry study.

A tale of three pandemics: Shining a light on a hidden problem.

An "epidemic" is an event in which a disease, infectious or non-infectious, is actively spreading within a population and designated area. The term "pandemic" is defined as "an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people". The global response to the COVID-19 pandemic has not been seen since the outbreak of Human Immunodeficiency Virus in the early eighties.

Fracture Healing in Patients With HIV in South Africa: A Prospective Cohort Study.

Background: HIV reduces bone mineral density, mineralization, and turnover and may impair fracture healing.

Setting: This prospective cohort study in South Africa investigated whether HIV infection was associated with impaired fracture healing after trauma.

Methods: All adults with acute tibia and femur fractures who underwent intermedullary (IM) nailing for fracture fixation between September 2017 and December 2018, at 2 tertiary hospitals, were followed up for a minimum of 12 months postoperatively.

Bibliometric analysis of research on the effects of human immunodeficiency virus in orthopaedic and trauma surgery.

Background: There is little research investigating how human immunodeficiency virus (HIV) affects outcomes in orthopaedic surgery. With advances in treatment, HIV has become a chronic health problem and the chance of orthopaedic surgeons encountering it in clinical practice is increasing.

Aim: To ascertain the quantity and quality of peer-reviewed publications in orthopaedic journals about HIV.

Civilian gunshot injuries in orthopaedics: a narrative review of ballistics, current concepts, and the South African experience.

The incidence of civilian gunshot injuries is on the rise worldwide.Unfortunately, there is a lack of high-level evidence guiding management. The treatment of orthopaedic injuries from gunshots is complex and requires consideration of multiple aspects, including energy transfer to the tissue, severity of the wound, possible contamination, presence of fractures and associated injuries.

Total Hip Arthroplasty in a Low-Income Country: Ten-Year Outcomes from the National Joint Registry of the Malawi Orthopaedic Association.

Unlabelled: We describe our 10-year experience performing total hip arthroplasty (THA) in patients enrolled in the National Joint Registry of the Malawi Orthopaedic Association.

Methods: Eighty-three THAs were performed in 70 patients (40 male and 30 female) with a mean age of 52 years (range, 18 to 77 years). The cohort included 24 patients (14 male and 10 female; mean age, 52 years [range, 35 to 78 years]) who were human immunodeficiency virus (HIV)-positive.

Orthopaedic research in low-income countries: A bibliometric analysis of the current literature.

Background: To perform a bibliometric analysis and quantify the amount of orthopaedic and trauma literature published from low-income countries (LICs).

Methods And Methods: The Web of Science database was utilised to identify all indexed orthopaedic journals. All articles published in the 76 orthopaedics journals over the last 10 years were reviewed, to determine their geographic origin.

Topics, Skills, and Cases for an Undergraduate Musculoskeletal Curriculum in Southern Africa: A Consensus from Local and International Experts.

Background: Most patients with orthopaedic pathology in low to middle-income countries are treated by nonspecialists. A curriculum to prepare undergraduate medical students for this duty should reflect the local pathology and skills that are required to manage patients in a resource-restricted environment. The aim of this study was to establish and prioritize a list of core orthopaedic-related knowledge topics, clinical cases, and skills that are relevant to medical students in southern Africa and areas with a similar clinical context.

Total joint replacement in sub-Saharan Africa: a systematic review.

Outcomes of arthroplasty in sub-Saharan Africa are not widely reported. To our knowledge, this systematic review is the first to explore this topic. Scopus, EMBASE, Medline and PubMed databases were searched, utilising MeSH headings and Boolean search strategies.

Implant-related sepsis in lower limb fractures following gunshot injuries in the civilian population: A systematic review.

Introduction: The management of long bone lower limb fractures secondary to gunshot wounds (GSWs) in the civilian setting are complex and there is currently no consensus regarding the optimal approach to managing such fractures. This study aims to address the relationship of implant related sepsis in fractures secondary to GSWs.

Methods: A systematic review of the literature was performed on both Pubmed and Scopus databases that look at fractures caused by GSWs in the lower limb.