RSS 1.0UHDB Trauma and Orthopaedics
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Effect of Early Surgical Intervention on Neurological Outcomes in Acute Spinal Cord Injury: A Systematic Review and Meta-Analysis.Spinal cord injury (SCI) represents a devastating condition with profound neurological consequences, and the optimal timing of surgical decompression remains controversial. This systematic review and meta-analysis evaluated the impact of early versus late surgical intervention on neurological outcomes and mortality in patients with SCI. A comprehensive literature search was conducted across multiple databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Scopus, from 2000 to September 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing early surgical decompression (≤24 h) with delayed intervention (>24 h) in adult patients were included. Fourteen studies comprising 2,505 patients (1,115 early intervention, 1,390 delayed intervention) met the inclusion criteria, including three randomized controlled trials (RCTs) and 11 observational studies. The pooled analysis demonstrated a non-significant trend toward improved neurological recovery with early intervention, evidenced by a mean difference (MD) of 3.64 points in the American Spinal Injury Association (ASIA) Motor Score (AMS; 95% CI: -0.05 to 7.33; p = 0.05) and an OR of 1.37 for achieving at least one-grade improvement in ASIA classification (95% CI: 0.90 to 2.10; p = 0.14). Mortality rates showed no significant difference between groups (OR = 1.40, 95% CI: 0.74 to 2.68; p = 0.30). Despite not reaching statistical significance, the consistent directional trend favoring early intervention supports its consideration when medically feasible, as even modest neurological improvements may be clinically meaningful in this devastating condition. These findings suggest that early surgical decompression does not increase mortality risk and may confer neurological benefits, supporting the development of institutional protocols prioritizing expedited intervention while maintaining rigorous perioperative safety standards.
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What is the most effective treatment for basal osteoarthritis of the thumb?Basal osteoarthritis of the thumb is extremely common and causes pain and difficulty with essential 'pinching' tasks such as writing and dressing. It has been shown, in high-quality studies, that physiotherapy can result in clinically important improvements in pain and function, but the delivery of nonoperative treatment currently varies considerably throughout the NHS in the UK. Trapeziectomy is an effective, simple, and low-cost procedure, and the most common of surgical treatment for basal osteoarthritis of the thumb in the UK. However, recovery can be lengthy and complications include subsidence of the thumb metacarpal, instability, and weakness. New designs of thumb carpometacarpal joint arthroplasty (CMCJA) show promising early results with low complication rates and a quick return to function, but the implants are expensive and high-quality evidence about the outcome is lacking. The Surgery versus Conservative OsteOarthritis of Thumb Trial (SCOOTT) is a multicentre, three-arm, randomized controlled trial which is currently being undertaken, comparing the clinical outcomes and cost-effectiveness of an enhanced package of non-surgical management, trapeziectomy, and thumb CMCJA.
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Impact of Rheumatoid Arthritis on Postoperative Outcomes Following Lumbar Spine Surgery: A Systematic Review and Meta-Analysis.This systematic review and meta-analysis critically evaluated the impact of rheumatoid arthritis (RA) on postoperative outcomes following lumbar spine surgery. A comprehensive literature search was performed across multiple electronic databases from January 2010 to October 2025. Studies involving adult patients with confirmed RA undergoing lumbar spine surgery with comparator groups were included. Eight retrospective cohort studies representing diverse populations were analyzed. Pooled analysis revealed that patients with RA had a significantly higher risk of reoperation compared to non-RA patients, with a relative risk (RR) of 1.34 and a 95% confidence interval (CI) of 1.15-1.57, though high heterogeneity was noted. Surgical site infection analysis demonstrated a 45% increased risk in RA patients with an RR of 1.45 and a 95% CI of 1.28-1.65, with no heterogeneity observed. Other clinical outcomes, including mortality, pneumonia, acute kidney injury, and sepsis, showed no statistically significant differences between the groups. Patients with RA face significantly elevated risks of reoperation and surgical site infection following lumbar spine surgery, likely due to compromised bone quality, impaired healing capacity, and immunosuppressive medications. These findings have important implications for preoperative counseling and perioperative risk stratification. Future prospective research with detailed characterization of disease activity and medication use is needed to facilitate individualized risk assessment.
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Bechterew's Disease and the Risk of Spinal Fractures: Clinical Patterns, Imaging Correlation, and Outcomes.Bechterew's disease, or ankylosing spondylitis (AS), is a chronic inflammatory spondyloarthropathy that causes spinal rigidity and increases the risk of unstable fractures, often after low-energy trauma. This systematic review included seven studies encompassing 672 patients with ankylosed spines who sustained spinal fractures. Clinical presentation commonly involves sudden back or neck pain, kyphotic deformity, limited spinal mobility, and neurological deficits, which may be subtle and easily overlooked. Fractures predominantly affect the cervical spine (C5-C7) and thoracolumbar junction (T11-L2), often extending through all three spinal columns, resulting in high instability and risk of spinal cord injury. Accurate imaging is critical; computed tomography delineates bony injuries, while magnetic resonance imaging identifies spinal cord damage, ligamentous disruption, and epidural hematomas. Nonoperative management carries a high risk of secondary displacement and neurological deterioration, whereas early surgical stabilization, typically via posterior or combined anterior-posterior fixation, improves outcomes. Multidisciplinary care involving orthopedic, neurosurgical, and critical care teams is essential for optimizing recovery. Limitations of the current literature include small sample sizes and heterogeneous study designs. Future research should focus on prospective multicenter studies, standardized imaging and management protocols, and long-term functional outcomes to reduce fracture risk and improve care in this high-risk population.
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Selective Genicular Artery Embolisation for Recurrent Hemarthrosis Following Total Knee Arthroplasty: A Case ReportRecurrent hemarthrosis following total knee arthroplasty (TKA) is an uncommon complication, with an incidence of less than 1%. It can lead to pain, swelling, joint stiffness, and functional impairment. Selective genicular artery embolisation (GAE) has emerged as a minimally invasive treatment for managing such cases. We report the case of a 79-year-old female with recurrent atraumatic hemarthrosis of the left knee following TKA, complicated by long-term anticoagulation with Edoxaban for unprovoked pulmonary embolism. Despite multiple aspirations and arthroscopic washouts, symptoms persisted. Angiography revealed synovial hypervascularity, and GAE was performed to reduce bleeding. Although the procedure initially improved symptoms, recurrence occurred while the patient was maintained on full-dose Edoxaban. Following a multidisciplinary review, the anticoagulant dose was reduced, resulting in complete resolution of haemarthrosis. GAE represents an effective, minimally invasive treatment for recurrent hemarthrosis post-TKA. Anticoagulation management and multidisciplinary coordination are essential to balance bleeding risk and thromboembolic protection in such patients.
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Weighing the impact of evidence in orthopaedic trauma registries: a systematic review of national and international registry data.OBJECTIVES: Worldwide, there are 15 established trauma databases collecting data to better understand the patterns of injury and effectiveness of interventions, but interpreting the information is hampered by the varied approaches. The aim of this study was to determine the impact, practices, evolution in design and methods of analysis that are standardised and comparable within registries. DESIGN: A thematic analysis using a narrative synthesis was used to develop threads for future study and identify the limitations in current practice. DATA SOURCES: PubMed, Ovid, Scopus and EMBASE were searched on the 2 October 2025. At the same time, ChatGPT (Open artificial intelligence) identified the most cited articles in orthopaedic trauma registries, cross-referencing lists as a form of triangulation to aid in snowballing references. ELIGIBILITY CRITERIA: The review included 174 papers from trials and observational studies that analyse data from established trauma orthopaedic registries published in English. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers used standardised methods to search, screen and code included studies assessing the papers using the Strengthening the Reporting of Observational Studies in Epidemiology checklist to assess the observational and cohort studies and the Downs and Black Quality Criteria for the remaining papers. RESULTS: Outcome measures other than mortality are poorly collected, undermining the value of registries. Trauma patients reported considerable impairment 6 and 12 months after injury. Association between level of trauma care and mortality is evident for major trauma populations, but does not hold for general trauma populations. Level I trauma centres produce improved survival in severely injured, but this association could not be proven for non-fatal outcomes in general populations. There is a disparity between resources allocated to save and salvage cases within major trauma units, and hence, routine cases often have lower priority and delayed care. CONCLUSIONS: There is a need to develop a standardised and reproducible method to evaluate data quality in trauma registries. National performance guidelines and trauma centre audits are integral steps towards optimum results. Routine collection of postinjury outcome measures beyond mortality will enable the development of quality improvement metrics that better reflect patient outcomes.
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Surgical margins in breast conserving surgery for ductal carcinoma in situ of the breast and clinical outcomes: a national audit with long term follow-up.BACKGROUND: Optimal surgical margin width in breast conserving surgery (BCS) for ductal carcinoma in situ (DCIS) is not established. The United Kingdom (UK) Association of Breast Surgery (ABS) recommended a 1 mm margin, whereas a minimum of 2 mm has been recommended in the United States of America (USA). This paper uses precise histological margin width data from UK national datasets to understand the impact of surgical margins on time to recurrence (TTR). METHODS: Patients were included if aged ≥45-years with a new diagnosis of DCIS alone, between 2003 and 2014, within the English National Health Service (NHS) Breast Screening Programme. Primary treatment included BCS and a minimum histological excision margin width recorded. Exclusion criteria included: prior history of DCIS; prior history of invasive cancer or its diagnosis within 3-months of initial surgical treatment for DCIS. Data was extracted from NHS England National Disease Registration Service (NDRS), ABS and Sloane Project audits. FINDINGS: 16,907 patients diagnosed with DCIS having definitive BCS surgery were identified between 2003 and 2014. TTR was found to be significantly shorter for patients with surgical margins <1 mm vs ≥ 1 mm (adjusted hazard ratio (aHR) = 1·32; 95% (confidence interval) CI:1·06-1·63; p = 0·012); <2 mm vs ≥ 2 mm (aHR = 1·19; 95% CI:1·05-1·35; p = 0·0062) and ≥1-<2 mm vs ≥ 2 mm (aHR = 1·18; 95% CI:1·01-1·38; p = 0·032). There was no evidence that increasing the surgical margin width beyond 2 mm significantly improved TTR (aHR = 0·96; 95% CI: 0·86-1·08; p = 0·52 for ≥5 mm vs ≥ 2-<5 mm). The rate of recurrence across 14 years following BCS + radiotherapy was 1·2% per annum, 2129 (13%) patients had a recurrence of which 78% were invasive breast cancers. INTERPRETATION: Patients with DCIS with histological margins of <2 mm, adjusted for other clinical factors, have significantly worse TTR compared to margins ≥2 mm. These findings may inform optimum treatment of patients with DCIS. FUNDING: An ABS grant covered the cost of data extraction by NHS England and medical writing assistance. The latter was provided by Edge Health, supervised by the co-authors.
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Surgical site infections in the head and neck: a multicentre retrospective cohort study.OBJECTIVES: Surgical site infections (SSIs) are one of the most common post-operative complications and can be associated with significant morbidity and mortality. They place a significant burden on healthcare system. Existing guidelines are based on non-head and neck procedures. This study aims to investigate factors affecting SSIs in the head and neck. METHODS: A multi-centre retrospective cohort across otolaryngology departments in Yorkshire (Bradford, Doncaster, Hull, Leeds). All patients undergoing an operation requiring a skin incision in the year 2021 were included. Electronic patient notes were used as the data source. Data on demographics, comorbidities, smoking and alcohol use, operation undertaken, diagnosis, closure material and use of antibiotic prophylaxis were recorded. RESULTS: 827 patients were included. The mean age was 51.4 years. The rate of SSI was 4.2% (n = 34/827). 30-day mortality was 0.6% (n = 5/827). There was no significant difference in development of SSI depending on antiseptic preparation choice. Diabetes significantly increased the risk of SSI. Suture choice did not affect rate of SSI. Intravenous drug use and cardiovascular disease were not significantly associated with 30-day mortality. CONCLUSION: This is the only study that assessed the rate of SSIs in the head and neck region. The NICE guidance for antiseptic preparation choice is not applicable in the head and neck. Absorbable sutures should be used when appropriate. Peri-operative comorbidities should be optimised. For more robust evidence, a larger cohort would be recommended or a randomised controlled trial assessing individual factors can be considered. LEVEL OF EVIDENCE: - Level 3.
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Comparative Effectiveness of the Proximal Femoral Nail and Dynamic Hip Screw Fixation in Intertrochanteric Femur Fractures: A Systematic Review and Meta-Analysis.This systematic review and meta-analysis compared the clinical effectiveness of proximal femoral nail (PFN) versus dynamic hip screw (DHS) fixation in patients with intertrochanteric femur fractures. A comprehensive literature search was conducted across multiple databases from January 2010 to September 2025, identifying studies that directly compared PFN and DHS fixation outcomes. Thirty-three studies met the inclusion criteria, comprising randomized controlled trials, prospective cohorts, and retrospective comparative studies from diverse geographic regions. The pooled analysis demonstrated several significant advantages favoring PFN fixation. Operative time was significantly shorter with PFN compared to DHS (mean difference (MD): -12.30 minutes, 95% confidence interval (CI): -17.33 to -7.28), while intraoperative blood loss was substantially lower (MD: -115.01 mL, 95% CI: -132.05 to -97.98). Patients treated with PFN achieved full weight-bearing significantly earlier than those receiving DHS. Safety outcomes showed PFN was associated with significantly lower total complication rates (risk ratio (RR): 0.46, 95% CI: 0.31-0.68) and reduced infection risk. However, no significant differences were observed between groups regarding implant failure rates, mortality, or long-term functional outcomes, as measured by the Harris Hip Score. High heterogeneity was noted across most outcomes, reflecting variations in study populations and methodologies. These findings suggest that PFN offers superior perioperative outcomes and early recovery advantages compared to DHS, while maintaining comparable long-term functional results and survival rates in patients with intertrochanteric femur fractures
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Tailored performance of additively manufactured titanium TPMS bone scaffoldTriply periodic minimal surfaces (TPMS), exemplified by the Schwarz geometry, provide an optimal platform for bone scaffolds due to their high surface-to-volume ratio, continuous porosity, and bone-analogous mechanical response. Here, titanium TPMS scaffolds were additively manufactured via laser powder bed fusion (L-PBF) with precise control over geometric parameters. A data-driven surrogate model, informed by experimental and numerical analyses, was developed to map the relationship between design variables and mechanical performance. The model enabled the design of scaffolds with tailored stiffness matching that of native bone, while revealing the dominant roles of wall thickness and cell size. Porosity varied from 47 % to 68 %, governed inversely by wall thickness, while elastic modulus scaled from 6 to 24 GPa, driven primarily by wall thickness and secondarily by cell size. Yield and ultimate strengths exhibited strong positive correlations with wall thickness, spanning 240–655 MPa and 320–784 MPa, respectively. This study provides a predictive framework for engineering 3D printed titanium scaffolds with targeted mechanical properties, offering a basis for next-generation load-bearing orthopaedic implants.
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Efficacy of Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Systematic Review and Meta-Analysis.The study was conducted to evaluate the safety and effectiveness of platelet-rich plasma (PRP) injections for knee osteoarthritis. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches were performed in PubMed, Scopus, Web of Science, and the Cochrane Database for studies published between January 2015 and June 2025. Only randomized controlled trials (RCTs) published in the English language were included, while reviews, case reports, and non-randomized studies were excluded. Six high-quality RCTs were identified, including a total of 1,162 patients with mild-to-moderate knee osteoarthritis. PRP injections were compared with hyaluronic acid, corticosteroid injections, or placebo. Pain and function were assessed using standardized tools such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the International Knee Documentation Committee (IKDC) score, the Knee Injury and Osteoarthritis Outcome Score, and the Visual Analog Scale. Significant improvements with PRP were observed at 6 and 12 months. The WOMAC pain score was reduced by an average of -8.5 points, and the IKDC score increased by +6.2 points. Both results were statistically significant. Moderate variability was found between studies, but sensitivity analyses confirmed stability of the results. Subgroup analysis did not show consistent differences between leukocyte-rich PRP and leukocyte-poor PRP. Reported side effects were minor and self-limiting. Overall, PRP demonstrated significant improvements at 6 and 12 months. Pooled analysis indicated moderate pain reduction (standardized mean difference (SMD) = -0.32, 95% confidence interval (CI) = -0.48 to -0.15; I² = 46%) and functional improvement (SMD = -0.28, 95% CI = -0.44 to -0.12; I² = 52%) compared with control groups. However, long-term structural improvement was not demonstrated. Larger trials are still needed to confirm benefits, optimize preparation methods, and assess cost-effectiveness.
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Consensus on long-term follow-up and surveillance of elective primary shoulder arthroplasty using a real-time Delphi technique.BACKGROUND: Long-term follow-up of elective primary shoulder arthroplasty remains contentious. A real-time Delphi technique allows a single survey to obtain a consensus from experts on the optimum surveillance protocol. METHODS: A real-time Delphi consensus study was delivered using Surveylet. Delphi statements surveyed whether a type of shoulder arthroplasty requires follow-up in the initial 10 postoperative years and beyond 10 postoperative years. Further statements related to surveillance episode format were included. British Elbow and Shoulder Society members were invited to participate. Participants rated agreement with statements using a 5-point Likert scale. Study results were used to produce expert-opinion recommendations that were presented to a patient group. RESULTS: The study received 37 responses of which 31 were complete. 78% of respondents were orthopaedic surgeons and 19% were physiotherapists. Mean survey visits per participant was 3.8 (total 140). The patient group included 13 patients. Consensus agreement was reached on surveillance requirement for numerous shoulder arthroplasty types and aspects of surveillance format, including requirement for radiological assessment and completion of a patient-reported outcome measure. All patients expressed agreement with the resulting expert-opinion recommendations. DISCUSSION: A real-time Delphi among expert clinicians identified areas of consensus in long-term surveillance of elective primary shoulder arthroplasty.
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Operative Versus Nonoperative Outcomes: A Cohort Study on Distal Biceps Tendon Rupture.Background Distal biceps tendon ruptures typically occur in middle-aged men following eccentric loading activities. While surgical repair is common, comparative data on operative versus nonoperative outcomes remain limited. We conducted a retrospective study to compare the outcomes of operative versus nonoperative management in Queen's Hospital Burton. Methods We reviewed the records of 72 patients (52 operative, 20 nonoperative) treated during the period of 2016-2023 for complete distal biceps tendon ruptures. All diagnoses were confirmed clinically and radiologically. Operative management was via a single anterior incision or a modified two-incision technique using cortical button fixation. Complications, range of motion, and return to activity were abstracted from clinical records documented at the time of care. Validated outcome measures, such as the Disabilities of the Arm, Shoulder, and Hand (DASH) and the Mayo Elbow Performance Score (MEPS), were not collected as part of routine care. Results Operative management was associated with a higher rate of complications, including nerve injuries and wound issues, though most patients ultimately regained a full range of motion and function. Nonoperative management resulted in minimal complications, with patients reporting return to their previous activity levels and only minor subjective strength deficits. Overall, operative repair offered greater strength recovery, particularly in supination, but at the cost of increased morbidity, whereas nonoperative management provided excellent functional outcomes with lower risk. Conclusion Nonoperative management appeared to be a reasonable option for selected patients in this cohort. Operative repair is effective but associated with a higher complication rate. Treatment should be individualised, balancing patient activity level, expectations, and risk profile.
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Improving surgical outcomes through non-technical skills: the case for better training and national evaluationEffective communication and teamwork are as crucial as technical proficiency for achieving positive surgical outcomes. Non-technical skills (NTS)-including communication, leadership, decision-making, and situational awareness— enhance surgical performance by fostering awareness and capability among both trainees and experienced surgeons. Despite growing recognition of its importance, NTS training is not uniformly implemented in surgical education, leaving a significant gap. This study examines opportunities to expand NTS training within surgical practice. A survey at a local hospital assessed the availability of NTS training and perceived needs among 38 surgical trainees and professionals. The majority acknowledged the value of NTS in improving clinical performance but reported limited focus on human factors in daily practice. Complementing the survey, a literature review was conducted across Medline, EMBASE, and PsycINFO databases, identifying 414 relevant articles, 114 of which focused on clinical or educational contexts. Of these, 61 studies emphasized psychomotor skill assessment via direct observation, patient outcomes, and peer feedback, underscoring the critical role of effective evaluation methods. Findings indicate that while NTS training is appreciated, its effectiveness depends heavily on feedback quality and team dynamics, particularly in addressing challenging behaviors. The study highlights the need for enhanced training design and robust feedback mechanisms. Although current evidence linking NTS training to improved patient outcomes is largely anecdotal, there is strong professional support for broader implementation. The authors advocate for a systematic, nationwide evaluation to determine the true impact of NTS training on surgical performance and outcomes
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Improving surgical outcomes through non-technical skills: the case for better training and national evaluationAbstract: Effective communication and teamwork are as crucial as technical proficiency for achieving positive surgical outcomes. Non-technical skills (NTS)-including communication, leadership, decision-making, and situational awareness—enhance surgical performance by fostering awareness and capability among both trainees and experienced surgeons. Despite growing recognition of its importance, NTS training is not uniformly implemented in surgical education, leaving a significant gap. This study examines opportunities to expand NTS training within surgical practice. A survey at a local hospital assessed the availability of NTS training and perceived needs among 38 surgical trainees and professionals. The majority acknowledged the value of NTS in improving clinical performance but reported limited focus on human factors in daily practice. Complementing the survey, a literature review was conducted across Medline, EMBASE, and PsycINFO databases, identifying 414 relevant articles, 114 of which focused on clinical or educational contexts. Of these, 61 studies emphasized psychomotor skill assessment via direct observation, patient outcomes, and peer feedback, underscoring the critical role of effective evaluation methods. Findings indicate that while NTS training is appreciated, its effectiveness depends heavily on feedback quality and team dynamics, particularly in addressing challenging behaviors. The study highlights the need for enhanced training design and robust feedback mechanisms. Although current evidence linking NTS training to improved patient outcomes is largely anecdotal, there is strong professional support for broader implementation. The authors advocate for a systematic, nationwide evaluation to determine the true impact of NTS training on surgical performance and outcomes.
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Musculoskeletal trauma readmissions and reoperations at a level 3 trauma unit in the UKAbstract: Background This study explores patterns of readmissions to a trauma service in the United Kingdom (UK), where expansion of the national trauma database to include all levels of trauma unit has been underway since early in 2024 and is in the pilot phase of redevelopment. Patterns of readmissions have not been clearly defined in the UK especially for level 3 units and these can proactively be managed by institutions if recognised. Early signposting of those at risk may avoid prolonged treatment and is an opportunity to enhance patient care and recovery within the UK but also further afield. The 5535 readmissions over the last 16 years presenting to the level three trauma unit were identified from the 24, 162 presentations kept prospectively on a local trauma database. Patients were identified as having further injuries, staged operations, and complications of elective and trauma care. Descriptive statistics and univariate analysis were examined to look at factors that predict readmission and the type of cases affected with any modifications to the care pathway to improve care. Results The proportion of cases admitted once was 72.5 %, 5 % further injury in an unrelated area, 10 % had staged care and 12.5 % had complications. In those that presented with complications of care 34 % had the index operation in another hospital and 46 % were in patients who had an elective operation, mainly arthroplasty surgery. Osteoporotic refracture accounted for 15 % of the readmissions. Only 491 trauma cases (2 % of the total) had a complication of care. Conclusion Whilst improved surgical delivery and aftercare in trauma cases maybe important to prevent readmission and improve the patient's journey, it also appears equal consideration is needed in prevention of reinjury, improved definitive care rates through resource development in trauma care and enhanced elective aftercare pathways to reduce the readmissions rates into the trauma service within the UK.
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Randomized Control Trial Comparing Effects of Tourniquets on Neurology and Functional Outcomes after Total Knee ArthoplastyAbstract: Introduction: Total knee arthroplasty (TKA) often uses a tourniquet to enhance surgical visualization and reduce intraoperative blood loss. Despite its benefits, tourniquet use is associated with several complications such as skin blistering, nerve palsy, and deep vein thrombosis. The literature reveals a divided opinion on whether TKA should be performed with or without a tourniquet, with conflicting results on post-operative pain, blood loss, and functional outcomes. Materials and Methods: This study included patients aged 65 to 90 years undergoing elective unilateral TKA for osteoarthritis. Exclusion criteria included patients with a Body mass index ≥35, rheumatoid arthritis, peripheral vascular disease, diabetes, prior knee surgery, and on anticoagulation medication. The study focused on comparing the neurology through nerve conduction studies and functional outcomes of TKA performed with and without a tourniquet. Some key metrics included intraoperative blood loss, surgical duration, post-operative pain, analgesic use, and range of motion (ROM). Results:The study recruited 55 patients aged ranging from 65 to 90 years who were randomized into two groups.22 patients were excluded, and the final analysis involved 23 patients. Tourniquet use resulted in lower blood loss (140 mL vs. 215 mL) and shorter operative times (87 min vs. 95 min) compared to the non-tourniquet group. However, the tourniquet group had higher incidences of nerve palsy in the immediate post-operative period as compared to the other group. Both the groups showed significant improvements in post-operative ROM, but the tourniquet group had higher post-operative pain and analgesic requirements, and this was statistically significant. Conclusion: Tourniquet use in TKA reduces intraoperative blood loss and operative time but is associated with a higher risk of nerve-related complications and increased post-operative pain. The findings suggest that avoiding tourniquet use may lead to better overall clinical outcomes and early post-operative ROM.
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The Impact of Near-Peer Teaching Methods in Undergraduate and Postgraduate Surgical Education Using the Kirkpatrick Evaluation Model: A Systematic Review.OBJECTIVES: The aim of this study was to use the Kirkpatrick evaluation model (levels 1-4) to analyze the impacts of NPT programmes on learners and tutors within surgical education. METHODS: This study was registered prospectively on the international platform of registered systematic reviews and meta-analysis protocols (INPLASY)- INPLASY202450037. The study was conducted following the PRISMA guidelines. A search of PubMed, Medline, Embase, PsycINFO and CINAHL was performed from inception till March 30, 2024. Quality appraisal of the included studies was performed using the mixed methods appraisal tool (MMAT). RESULTS: 22 studies were included in the final analysis. The results showed that NPT was better or at least comparable to senior faculty-led teaching for improved satisfaction ratings for most clinical and nonclinical parameters; improved learners' knowledge and basic surgical skills; and improved clinical practice for leading ward rounds (Kirkpatrick model, levels 1-3). NPT did not improve learners' interest in pursuing a surgical career. No evidence was reported for the impact of NPT on healthcare/educational organizations (Kirkpatrick model, level 4). For tutors, there was evidence that showed that NPT had positive impacts on their basic surgical, mentoring and teaching skills. Quality appraisal showed that the included studies had high to moderate quality. CONCLUSION: This study has shown that there is high to moderate quality evidence for the impact of NPT in undergraduate and postgraduate surgical education for levels 1 and 2 of the Kirkpatrick models, with some evidence for its impact on learners at level 3 of the Kirkpatrick model within postgraduate surgical education. Future research should be focused on the impact of NPT on real-life behavioral changes and on organizations (levels 3 and 4 of the Kirkpatrick models, respectively) within a surgical educational context.
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Does earlier investigation of first-time traumatic shoulder dislocation lead to a reduction in the rate of recurrent dislocations?BACKGROUND: The British Elbow and Shoulder Society (BESS) introduced national guidance for first-time traumatic shoulder instability in 2015. The aim of this case-control study was to evaluate the effect on re-dislocation rate following adoption of their imaging protocol in our department in 2016. METHOD: We included patients >16 years old with first traumatic shoulder dislocations between: January 2013 to December 2013 and January 2016 to September 2016 (pre-guidance) and October 2016 to December 2019 (post-guidance). Clinical records were analysed to determine imaging and surgery rates, respective lag times and re-dislocation rates. Follow-up was set at 4 years. RESULTS: The study comprised 144 pre-guidance and 342 post-guidance patients. MRI arthrograms performed in < 25 s increased from 26.2% to 68.2% (p < 0.001), with lag times reduced (p = 0.061). Ultrasound scans performed in > 40 s increased from 42.6% to 60.1% (p < 0.05), with a significant lag time reduction (p < 0.001). Time to surgery decreased from 432 to 249 days. Overall re-dislocations decreased from 14.6% to 8.5% (p < 0.05), and mean dislocations from 1.33 to 1.14 (p = 0.028). In < 25 s, percentage of ≥3 dislocations decreased from 19.0% to 3.03% (p = 0.005). CONCLUSIONS: BESS guideline implementation has resulted in increased rates of imaging and reduced lag times to imaging and surgery. Re-dislocations rates have significantly decreased.
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Effectiveness of a community-based rehabilitation programme following hip fracture: results from the Fracture in the Elderly Multidisciplinary Rehabilitation phase III (FEMuR III) randomised controlled trial.OBJECTIVE: To determine whether an enhanced community rehabilitation intervention (the Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR) intervention) was more effective than usual National Health Service care, following surgical repair of hip fracture, in terms of the recovery of activities of daily living (ADLs). DESIGN: Definitive, pragmatic, multisite, parallel-group, two-armed, superiority randomised controlled trial with 1:1 allocation ratio. SETTING: Participant recruitment in 13 hospitals across England and Wales, with the FEMuR intervention delivered in the community. PARTICIPANTS: Patients aged over 60 years, with mental capacity, recovering from surgical treatment for hip fracture and living in their own home prior to fracture. INTERVENTIONS: Usual rehabilitation care (control) was compared with usual rehabilitation care plus the FEMuR intervention, which comprised a patient-held workbook and goal-setting diary to improve self-efficacy, and six additional therapy sessions delivered in-person in the community, or remotely during COVID-19 restrictions (intervention), to increase the practice of exercise and ADL. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome was the Nottingham Extended Activities of Daily Living (NEADL) scale at 12 months. Secondary outcomes included: Hospital Anxiety and Depression Scale, Falls Self-Efficacy-International scale, hip pain intensity, fear of falling, grip strength and Short Physical Performance Battery. Outcomes were collected by research assistants in participants' homes, whenever possible, but had to be collected remotely during COVID-19 restrictions. RESULTS: In total, 205 participants were randomised (n=104 experimental; n=101 control). Trial processes were adversely affected by the COVID-19 pandemic. There were 20 deaths, 34 withdrawals and three lost to follow-up. At 52 weeks, there was no significant difference in NEADL score between the FEMuR intervention and control groups. Joint modelling analysis testing for difference in longitudinal outcome adjusted for missing values also found no significant difference with a mean difference of 0.1 (95% CI -1.1, 1.3). There were no significant between-group differences in secondary outcomes. Sensitivity analyses, examining the impact of COVID-19 restrictions, produced similar results. A median of 4.5 extra rehabilitation sessions were delivered to the FEMuR intervention group, with a median of two sessions delivered in-person. Instrumental variable regression did not find any effect of the amount of rehabilitation on the main outcome. There were 53 unrelated serious adverse events (SAEs) including 11 deaths in the control group: 41 SAEs including nine deaths in the FEMuR intervention group. CONCLUSIONS: The FEMuR intervention was not more effective than usual rehabilitation care. The trial was severely impacted by COVID-19. Possible reasons for lack of effect included limited intervention fidelity (fewer sessions than planned and remote delivery), lack of usual levels of support from health professionals and families, and change in recovery beliefs and behaviours during the pandemic. TRIAL REGISTRATION NUMBER: ISRCTN28376407.
