Management of Cervical Spine Fractures and Injuries: A Literature Review.

Cervical spine injuries are one of the most common injuries of the spine that are encountered in the emergency department (ED). More than half of all spinal injuries presenting to the ED involve the cervical spine, with nearly half of them resulting from road traffic accidents. The majority of spinal cord injuries are found to occur in males of younger age groups, with almost half of them resulting in incomplete spinal cord injuries.

Optimizing Achilles Tendon Rupture Care: The Efficacy of Physiotherapy-Led Conservative Management in a District General Hospital.

Introduction Achilles tendon rupture (ATR) represents a significant musculoskeletal injury that can affect many patients' mobility and quality of life. Treatment of ATR consists of both conservative and surgical options, with the traditional belief being that surgical intervention reduces the risk of re-rupture. However, with the introduction of physiotherapy-led functional rehabilitation strategies with early mobilization, it has been shown that re-rupture rates are equal among surgical and non-surgical patients.

Impact of Timing Surgical Fixation on Complications and Functional Outcomes in Ankle Fractures.

Introduction: This study aimed to assess whether adherence to the British Orthopaedic Association Standards for Trauma (BOAST) and National Institute for Health and Care Excellence (NICE) guidelines for ankle fractures is associated with reduced complication rates and improved functional outcomes.  Methods: A retrospective analysis was conducted of all patients who underwent surgical fixation for ankle fractures in August 2023 to January 2024 from an acute hospital. Statistical analyses were performed using IBM SPSS Statistics software, version 29 (IBM Corp.

Musculoskeletal Computed Tomography: How to Add Value When Reporting Adult Lower Limb Trauma.

Computed tomography plays an ever-increasing role in the management of fractures and dislocations due to its capability in efficiently providing multiplanar reformats and 3-dimensional volume rendered images. It can reveal findings that are occult on plain radiography and therefore allow for more accurate decision making with regard to fracture classification and management. Clinical radiologists play a critical role in facilitating the processing of imaging to provide adequate image reformats in the desired planes, producing 3 dimensional images but most crucially identifying pertinent findings, which will contribute between the selection of nonoperative and operative management and potentially influence surgical technique.

DREAM: an adaptive, randomised, placebo-controlled trial of duloxetine for reducing leg pain in people with chronic sciatica-trial protocol.

Introduction: Sciatica is a debilitating condition that often becomes chronic, and for which there are few effective treatment options. Treatments such as the anti-depressant duloxetine have shown promise, but the evidence is inconclusive. We are describing a high quality, definitive trial to investigate the efficacy, safety and cost-effectiveness of duloxetine in chronic sciatica.

Do patients with minimally displaced distal radial fractures need a plaster cast?

Traditionally, patients with a fracture of the distal radius are treated in a cast if they do not require surgery. If the fracture requires manipulation, the cast is moulded to hold the reduction and maintain normal anatomical alignment during healing. However, is a cast necessary for patients whose fracture does not require manipulation? Removable splints are an alternative treatment option.

Microscopic changes in the multifidus muscle in people with low back pain associated with lumbar disc herniation.

Lumbar disc herniation (LDH) is a common degenerative condition causing low back pain (LBP) due to nerve compression. Previous studies show conflicting findings regarding the multifidus (MF) muscle's microscopic changes in LDH patients. So, this study aimed to compare the affected MF to the adjacent MF on the ipsilateral and contralateral sides in LDH patients and examined correlations with clinical features of LBP.

Limb Salvage Versus Amputation: A Review of Variables Influencing the Assessment and Decision-Making in Complex Limb Fracture Management.

Complex limb injuries are combination injuries that involve all components of a limb's tissue, such as skin, bone with its surrounding soft tissue cover, and neurovascular elements. Complex limb trauma often has a background of a significant mechanism of injuries such as high-velocity road traffic accidents, ballistic injuries, industrial accidents, and other major mechanisms of injuries which involve high amounts of energy transfer through these tissue layers. These injuries pose a major challenge to trauma and orthopaedic surgeons.

Bridging Distances and Enhancing Care: A Comprehensive Review of Telemedicine in Surgery.

Telemedicine in surgical care has undergone rapid advancements in recent years, leveraging technologies such as telerobotics, artificial intelligence (AI) diagnostics, and wearable devices to facilitate remote evaluation and monitoring of patients. These innovations have improved access to care, reduced costs, and enhanced patient satisfaction. However, significant challenges remain, including technical barriers, limited tactile feedback in telesurgery, and inequities arising from digital literacy and infrastructure gaps.

Current and future perspectives on pregnancy and lactation-associated osteoporosis.

Normal pregnancy and lactation have a marked physiological impact on maternal bone metabolism. This impact is usually temporary and reversible, but some women sustain fragility fractures whilst pregnant or lactating, termed pregnancy and lactation-associated osteoporosis (PLO). These fractures have severe negative consequences on their quality of life, at what is a crucial stage in a mother's life.

Clinical Value of Routine Follow-Up Radiographs in Total Joint Arthroplasty.

Background: Performing routine radiographs after total joint arthroplasty (TJA) in post-operative follow-up, typically at four weeks and 12 months, in addition to baseline radiographs obtained immediately post-operatively, is common practice in many institutions. Despite research indicating it may not alter management, it is associated with substantial financial, resource, and time costs. This study aimed to assess the impact of routine radiographs on the management of TJA patients in a UK district general hospital.

The London Regional Major Trauma System: A Literature Review of Epidemiology and Current and Future Challenges.

Trauma has been one of the world's most common causes of death among younger age groups. In the UK, a lack of an organized and streamlined approach was reported in the management of traumatic injuries and patients involved in trauma cases in the UK. Therefore, a major trauma network system was devised to address these issues in line with other trauma systems around the world.

A deep learning framework deploying segment anything to detect pan-cancer mitotic figures from haematoxylin and eosin-stained slides.

Mitotic activity is an important feature for grading several cancer types. However, counting mitotic figures (cells in division) is a time-consuming and laborious task prone to inter-observer variation. Inaccurate recognition of MFs can lead to incorrect grading and hence potential suboptimal treatment.

Staff education compared with active real-time waste segregation to reduce the environmental impact of hip and knee arthroplasty.

Aims: Arthroplasty has been shown to generate the most waste among all orthopaedic subspecialties, and it is estimated that hip and knee arthroplasty generate in excess of three million kg of waste annually in the UK. Infectious waste generates up to ten times more CO2 compared with recycled waste, and previous studies have shown that over 90% of waste in the infectious stream is misallocated. We assessed the effect of real-time waste segregation by an unscrubbed team member on waste generation in knee and hip arthroplasty cases, and compared this with a simple educational intervention during the 'team brief' at the start of the operating list across two sites.

Structured tailored rehabilitation after hip fragility fracture: The 'Stratify' feasibility and pilot randomised controlled trial protocol.

Background: Rehabilitation in hospital is effective in reducing mortality after hip fracture. However, there is uncertainty over optimal in-hospital rehabilitation treatment ingredients, and the generalizability of trial findings to subgroups of patients systematically excluded from previous trials. The aim of this study is to determine the feasibility of a randomized controlled trial which aims to assess the clinical- and cost-effectiveness of adding a stratified care intervention to usual care designed to improve outcomes of acute rehabilitation for all older adults after hip fracture.

Efficacy, safety, and quality of life 4 years after valoctocogene roxaparvovec gene transfer for severe hemophilia A in the phase 3 GENEr8-1 trial.

Background: Valoctocogene roxaparvovec, an adeno-associated virus-mediated gene therapy for severe hemophilia A, enables endogenous factor (F)VIII expression and provides bleed protection.

Objectives: Determine valoctocogene roxaparvovec durability, efficacy, and safety 4 years after treatment.

Methods: In the phase 3 GENEr8-1 trial, 134 adult male persons with severe hemophilia A without inhibitors and previously using FVIII prophylaxis received a 6 × 10 vg/kg infusion of valoctocogene roxaparvovec.

Feasibility of embedding orthopaedic clinical trials into national registries: a pilot quality improvement study for the UK Non-Arthroplasty Hip Registry (UK-NAHR).

The integration of 'Registry-based Randomised Control Trials' (RRCT) into national registries has the potential to catalyse prospective research, enhancing the evidence base for practice. The aim of this study was to assess the feasibility of embedding a trial within the UK Non-Arthroplasty Hip Registry. This was a national observational, multi-centre study.

Artificial intelligence (AI) for paediatric fracture detection: a multireader multicase (MRMC) study protocol.

Introduction: Paediatric fractures are common but can be easily missed on radiography leading to potentially serious implications including long-term pain, disability and missed opportunities for safeguarding in cases of inflicted injury. Artificial intelligence (AI) tools to assist fracture detection in adult patients exist, although their efficacy in children is less well known. This study aims to evaluate whether a commercially available AI tool (certified for paediatric use) improves healthcare professionals (HCPs) detection of fractures, and how this may impact patient care in a retrospective simulated study design.

Collagenase injection versus limited fasciectomy surgery to treat Dupuytren's contracture in adult patients in the UK: DISC, a non-inferiority RCT and economic evaluation.

Background: Dupuytren's contracture is caused by nodules and cords which pull the fingers towards the palm of the hand. Treatments include limited fasciectomy surgery, collagenase injection and needle fasciotomy. There is limited evidence comparing limited fasciectomy with collagenase injection.

A comparison of postoperative microbiological and histological test results with the indication for revision as listed at the time of surgery in the National Joint Registry: a single-centre cohort study of metal-on-metal total hip replacement and hip resurfacing revision procedures.

Introduction: Surgeons allocate an indication(s) for revision surgery on NJR Minimum Data Set forms in the immediate perioperative period, when results from intraoperative histology and microbiology samples are not available. We evaluated to what extent the postoperative diagnostics obtained for patients undergoing metal-on-metal hip arthroplasty (MoMHA) revision surgery align with the indication for revision listed in the NJR.

Methods: NJR data for MoMHA revision patients (2004-2015) at a single centre were linked to hospital records of microbiology and histology testing for prosthetic joint infection (PJI) and adverse reaction to metal debris (ARMD).