Lisfranc Injury: a Comprehensive Analysis of LongTerm Outcomes - the Oswestry Experience.

Purpose Of The Study: Lisfranc is a challenging injury both diagnostically and surgically, with sparse long-term literature evidence of surgical practice. We aim to review our long-term specialist orthopaedic institutional experience of Lisfranc injuries and the surgical management of this complex injury, specifically considering surgical outcomes as per radiological and clinical assessment.

Material And Methods: We present data from a prospectively maintained institutional database, reviewing patients who underwent operative fixation for Lisfranc injury between April 2014 and August 2020.

Early Screening for Confusion and Vitamin D Deficiency in Elderly Hip Fracture Patients: A Quality Improvement Initiative to Mitigate the Risk of Postoperative Delirium.

Background Postoperative delirium (POD) is a common and debilitating complication in elderly hip fracture patients, associated with significant clinical and functional consequences. Early identification of risk factors, such as cognitive impairment and vitamin D deficiency, is essential to mitigate its impact. However, preoperative screening practices are often inconsistent.

Functional Outcomes and Complications After Open Reduction and Internal Fixation of Mid-shaft Clavicle Fractures: A Retrospective Study.

Introduction: Clavicle fractures are routinely encountered in orthopedic clinical practice and have often been the subject of debate when it comes to optimal treatment. Clavicle fracture surgery has come a long way with excellent pre-contoured superior locking plates available for fixation. This study aimed to evaluate a cohort of patients operated for displaced mid-shaft clavicle fractures by open reduction and internal fixation using superior clavicle locking plates.

Functional Outcomes in the Distal End of Radius Fracture: A Prospective Study in a Tertiary Care Center.

Objectives: The objectives of this study are to determine the functional outcomes and compare them between conservative and surgical management in patients managed for closed-type intra-articular distal end of radius fractures.

Methods: A prospective observational study was done on 150 patients who underwent treatment for closed-type intra-articular distal end of radius fractures. As per Frykman Classification, they were type III.

Evaluation of Patient-Initiated Follow-Up (PIFU) Service in a Fracture Clinic: A Comprehensive Service Evaluation and Patient Satisfaction Audit.

Background Outpatient clinics are increasingly challenged by high patient volumes and rising "did not attend" (DNA) rates, leading to extended wait times and declines in patient satisfaction. Traditional follow-up (FU) models with routinely scheduled appointments contribute to inefficiencies, as stable patients may attend unnecessary visits, thus straining clinic resources. The patient-initiated follow-up (PIFU) model offers an alternative where patients schedule appointments only when necessary.

Proximal Humerus Fractures: A Review of Anatomy, Classification, Management Strategies, and Complications.

Proximal humerus fractures are prevalent in older adults, particularly women, primarily due to osteoporosis and increased fall risk. These fractures often result from low-energy falls in elderly patients, while in younger individuals, they are more likely to occur with high-energy trauma, which may involve additional injuries to soft tissue and neurovascular structures. Proper anatomical understanding, including key structures and blood supply, is crucial for effective management and to prevent complications.

Labelling of Fluids in the Sterile Field During Orthopaedic Surgery: A Quality Improvement Initiative.

Background Intraoperative safety protocols, including proper labelling of syringes, are critical to patient safety in surgical settings. While the Royal Pharmaceutical Society and the Royal College of Anaesthetists provide clear guidelines to prevent medication errors, ensuring consistent compliance with labelling protocols in the fast-paced and complex environment of orthopaedic surgery can still present practical challenges. The absence of proper labelling, combined with the use of multiple fluids such as normal saline, disinfectants, and local anaesthetics, increases the risk of adverse outcomes due to fluid misidentification.

An overview of cell salvage in orthopaedic hip and knee arthroplasty surgery.

Blood management is a critical aspect of patient care during surgical procedures. In the United Kingdom, there is a growing recognition of the need to integrate intraoperative cell salvage into blood management protocols, especially for invasive surgeries where significant blood loss is anticipated. While donated blood (allogeneic blood) is traditionally used in such cases, it carries risks and potential complications.

Percivall Pott (1713-1788): Father of Orthopaedics and Pioneer of Occupational Medicine.

Percivall Pott was an eighteenth-century English surgeon best known for three eponymous diseases: Pott's fracture, Pott's puffy tumour and Pott's disease of the spine. He wrote extensively, with treatises covering a wide range of surgical subjects, including cataracts, cranial trauma, hernias and neurology. Pott's practice came at a time when surgery was being transformed from the work of barbers into a scientific study.

iCan, Empowering Recovery: Evaluating a Patient-Centred Cancer Rehabilitation Programme across the Cancer Care Continuum.

Background/objectives: The adverse effects of cancer and the long-term sequelae of associated treatments result in reduced quality of life and increased mortality for patients. Supporting patients with cancer to mitigate adverse outcomes is an important aspect of oncology care and the primary purpose of cancer rehabilitation. A retrospective service evaluation was conducted to evaluate the effectiveness of the core iCan patient-centred cancer rehabilitation service.

Enhancing Junior Doctors' Preparedness and Satisfaction in Trauma and Orthopaedics: A Quality Improvement Project With the Development of a Comprehensive Guidebook.

Background: Junior doctors often feel underprepared for their trauma and orthopaedics (T&O) rotation due to limited exposure during medical school and inadequate support. This project aimed to enhance junior doctors' preparedness and satisfaction during their T&O rotation by developing a comprehensive guidebook that addresses key orthopaedic knowledge and logistical challenges.

Methods: A quality improvement project (QIP) was conducted at Ysbyty Gwynedd Hospital.

Hypoxia-Associated Gene Signatures Are Not Prognostic in High-Risk Localized Prostate Cancers Undergoing Androgen Deprivation Therapy With Radiation Therapy.

Purpose: Men with high-risk prostate cancer (PCa) are treated with androgen deprivation therapy (ADT) and radiation therapy, but the disease reoccurs in 30% of patients. Biochemical recurrence of PCa after treatment is influenced by tumor hypoxia. Tumors with high levels of hypoxia are aggressive, resistant to treatment, and have increased metastatic capacity.

A literature review assessing the perioperative efficacy and safety of tranexamic acid in elective total hip and knee arthroplasty in UK practice.

Hip and knee arthroplasty are frequently associated with significant blood loss, often necessitating blood transfusions. A variety of methods are employed to minimise blood loss and consequently mitigate the necessity for transfusions. This review explores the incidence of blood loss in hip and knee arthroplasty alongside perioperative strategies aimed at its reduction in UK practice.

Identification and optimisation of perioperative factors for patients with von Willebrand disease undergoing elective total hip and knee arthroplasty.

Von Willebrand disease stands as the most prevalent bleeding disorder seen in both medical and surgical practice. Due to recurrent bleeding episodes within the joints, many patients endure arthropathy, leading to substantial pain and restricted function. Total joint arthroplasty emerges as a final option for managing such cases.

Pulmonary Embolism Presenting As Shoulder and Back Pain: A Case Report.

Pulmonary embolism (PE) is a common but life-threatening condition, and diagnosis can be challenging. Diagnosis is even more difficult in those patients with atypical presentations such as the absence of pleuritic chest pain, dyspnoea, tachycardia, or symptoms of deep vein thrombosis. We have delineated shoulder and back pain as an atypical sign of PE.

Effect of Alvimopan on Postoperative Ileus and Length of Hospital Stay in Patients Undergoing Bowel Resection: A Systematic Review and Meta-Analysis.

Aims: The aim is to investigate the effect of alvimopan on postoperative ileus and length of hospital stay in patients undergoing bowel resection.

Methods: The PRISMA statement standards were followed to conduct a systematic review and meta-analysis. The available literature was searched to identify all studies comparing alvimopan with no alvimopan in patients undergoing bowel resection.

Dedicated anticoagulation management protocols in fragility femoral fracture care - a source of significant variance and limited effectiveness in improving time to surgery: The hip and femoral fracture anticoagulation surgical timing evaluation (HASTE) study.

Introduction: Approximately 20 % of femoral fragility fracture patients take anticoagulants, typically warfarin or Direct Oral AntiCoagulant (DOAC). These can impact timing of surgery affecting patient survival. Due to several possible approaches and numerous factors to consider in the preoperative workup of anticoagulated patients, potential for variations in clinical practice exist.

Patients' Preferences for Cytoreductive Treatments in Newly Diagnosed Metastatic Prostate Cancer: The IP5-MATTER Study.

Background And Objective: Cytoreductive treatments for patients diagnosed with de novo synchronous metastatic hormone-sensitive prostate cancer (mHSPC) confer incremental survival benefits over systemic therapy, but these may lead to added toxicity and morbidity. Our objective was to determine patients' preferences for, and trade-offs between, additional cytoreductive prostate and metastasis-directed interventions.

Methods: A prospective multicentre discrete choice experiment trial was conducted at 30 hospitals in the UK between December 3, 2020 and January 25, 2023 (NCT04590976).

A Systematic Review and Meta-Analysis of the Outcomes of Reconstruction with Vascularised vs Non-Vascularised Bone Graft after Surgical Resection of Primary Malignant and Non-Malignant Bone Tumors.

Purpose Of The Study: Vascularised bone grafting (VBG) and non-vascularised bone grafting (NVBG) are crucial biological reconstructive procedures extensively employed in the management of bone tumours. The principal aim of this study is to conduct a comparative analysis of the post-resection outcomes associated with the utilisation of vascularised and non-vascularised bone grafts.

Material And Methods: A comprehensive and systematic literature review spanning the years 2013 to 2023 was meticulously executed, utilising prominent online databases including PubMed/Medline, Google Scholar, and Cochrane Library.

Global 30-day morbidity and mortality of surgery for perforated peptic ulcer: GRACE study.

Background: There is little international data on morbidity and mortality of surgery for perforated peptic ulcer (PPU). This study aimed to understand the global 30-day morbidity and mortality of patients undergoing surgery for PPU and to identify variables associated with these.

Method: We performed an international study of adults (≥ 18 years) who underwent surgery for PPU from 1st January 2022 to 30th June 2022.

Viscosupplementation with High Molecular Weight Hyaluronic Acid for Hip Osteoarthritis: a Systematic Review and Meta-Analysis of Randomised Control Trials of the Efficacy on Pain, Functional Disability, and the Occurrence of Adverse Events.

Purpose Of The Study: Hip osteoarthritis (OA) has a prevalence of around 6.4% and is the second most commonly affected joint. This review aims to assess the clinical outcomes of intra-articular high molecular weight hyaluronic acid (HMWHA) in the management of hip osteoarthritis.

A Systemic Review of Primary Malignant Long Bone Tumors in Children and Adolescents.

Purpose Of The Study: Managing bone tumours is complex, relying on limited evidence, expert opinions, and retrospective reviews. Multidisciplinary approaches and early diagnosis are crucial for better outcomes, especially in young patients with growing skeletons. The aim of this systemic review and meta-analysis is to give a comprehensive review of common malignant tumors affecting long bones in children and adolescents.

The diagnosis and management of systemic autoimmune rheumatic disease-related interstitial lung disease: British Society for Rheumatology guideline scope.

Interstitial lung disease (ILD) is a significant complication of many systemic autoimmune rheumatic diseases (SARDs), although the clinical presentation, severity and outlook may vary widely between individuals. Despite the prevalence, there are no specific guidelines addressing the issue of screening, diagnosis and management of ILD across this diverse group. Guidelines from the ACR and EULAR are expected, but there is a need for UK-specific guidelines that consider the framework of the UK National Health Service, local licensing and funding strategies.