64 results on '"Peter Smitham"'
Search Results
2. Australian recommendations on perioperative use of disease‐modifying anti‐rheumatic drugs in people with inflammatory arthritis undergoing elective surgery
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Rachelle Buchbinder, Vanessa Glennon, Renea V. Johnston, Sue E. Brennan, Chris Fong, Suzie Edward May, Sean O'Neill, Peter Smitham, Lyndal Trevena, Glen Whittaker, Anita Wluka, and Samuel L. Whittle
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Internal Medicine - Published
- 2023
3. Antimicrobial‐loaded bone cement use is highly variable in joint replacement surgery: a survey of Australian arthroplasty surgeons
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Nadine T. Hillock, David Graham Campbell, Renjy Nelson, Alice Teoh, Jonathan Tan, and Peter Smitham
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Surgery ,General Medicine - Published
- 2023
4. Motivations and impact of international rotations in low- and middle-income countries for orthopaedic surgery residents: Are we on the same page?
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Heather J. Roberts, Patrick D. Albright, David W. Shearer, Nae Won, Madeline C. MacKechnie, R. Richard Coughlin, Theodore Miclau, Saam Morshed, Sanjeev Sabharwal, John Dawson, Brian Davis, Alan Daniels, Milton Little, John Garlich, Chad Coles, Ross Leighton, Michael Maceroli, Sandra Hobson, Chris Bray, Duretti Fufa, Sariah Khormaee, Brian Mullis, Roman M. Natoli, Babar Shafiq, Jimmy Mackenzie, Danny Wongworawat, Lee Zuckerman, Joshua Speirs, Charles F. Carr, Michael Mackechnie, George Dyer, Melvin Makhni, Kiran Agarwal-Harding, Brandon Yuan, Matt Beal, Danielle Chun, Andrew Furey, Brad Petrisor, Yongjung Kim, Ken Egol, Christian Pean, Blake Schultz, Darin Friess, Zach Working, Grant Sun, Henry Boateng, Michael Gardner, Malcolm DeBaun, Saquib Rehman, Eric Gokcen, J. Milo Sewards, Nicholas Bernthal, Zachary Burke, Alex Upfill Brown, Melissa Esparza, Peter O'Brien, David Stockton, Kevin Neal, Nathan O'Hara, Arun Hariharan, Peter Cole, Ann Van Heest, Patrick Horst, Brandon Kelly, Mauricio Kfuri, Karl Lalonde, Jaimo Ahn, Samir Mehta, Matt Winterton, Luke Lopas, James Kellam, Thomas Higgins, Iain Elliot, Paul Whiting, Jordan T. Shaw, Nathaniel M. Wilson, William Obremskey, Cassandra A. Lee, Keith Kenter, Joseph Weistroffer, Josh Veenstra, David Knowles, Devin Conway, Aung Thein Htay, Myat Thu Wynn, Dr Peter Smitham, Dr Dino Aguilar, Amanda J. McCoy, Kiprono Koech, Ian Orwa, Marvin Wekesa, Francis Mbugua, Daniel D. Galat, John Mandela, David Jomo, James Kinyua, Mbonisi Malaba, Felix Kuguru, Fasto Yugusuk, Pierre Woolley, Marc-Alain Pean, Billy Haonga, Edmund Eliezer, Samuel Hailu, Fre Alemseged, Linda Chokotho, Allman Tinoco, Bibek Banskota, Scott Nelson, and Francisco Alberto Hernandez Vargas
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Adult ,Male ,medicine.medical_specialty ,International Cooperation ,media_common.quotation_subject ,Developing country ,Racism ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,medicine ,Humans ,Orthopedic Procedures ,030212 general & internal medicine ,Developing Countries ,Reciprocity (cultural anthropology) ,media_common ,Surgeons ,Motivation ,business.industry ,Internship and Residency ,General Medicine ,Middle Aged ,Orthopedics ,Low and middle income countries ,Family medicine ,General partnership ,North America ,Orthopedic surgery ,Female ,Surgery ,business ,030217 neurology & neurosurgery - Abstract
Background Despite interest among North American orthopaedic residents to pursue rotations in resource-limited settings, little is known regarding resident motivations and impact on host surgeons. Methods Surveys were distributed to North American orthopaedic surgeons and trainees who participated in international rotations during residency to assess motivations for participation and to orthopaedic surgeons at partnering low- and middle-income country (LMIC) institutions to assess impact of visiting trainees. Results Responses were received from 136 North American resident rotators and 51 LMIC host surgeons and trainees. North American respondents were motivated by a desire to increase surgical capacity at the LMIC while host surgeons reported a greater impact from learning from residents than on surgical capacity. Negative aspects reported by hosts included selfishness, lack of reciprocity, racial discrimination, competition for surgical experience, and resource burdens. Conclusions The motivations and impact of orthopaedic resident rotations in LMICs need to be aligned. Host perceptions and bidirectional educational exchange should be incorporated into partnership guidelines.
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- 2021
5. Geographic variation in the frequency and potency of postoperative opioid prescriptions for extremity fracture surgery. A retrospective cohort study
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W Timothy Gardner, Sophie E. Pitts, Colin T. Patterson, Jack Richards, David Neilly, Peter Smitham, Iain Stevenson, and Stuart A. Aitken
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General Orthopaedics and Others ,Orthopedics and Sports Medicine - Abstract
INTRODUCTION: There is increasing evidence that the prescription opioid crisis is spreading internationally. However, there is scarce literature comparing contemporary prescribing practices between units in different countries, particularly in the context of this evolving international problem. We sought to determine the patterns of postoperative opioid prescribing in three hospitals from geographically distinct regions. METHODS: This is a retrospective cohort study involving patients from three hospitals: XXX, Maine, USA; XXX, Scotland; and XXX, Australia. The health records, surgical details, and frequency and potency of discharge prescriptions were analyzed for 350 patients receiving surgery for isolated wrist or ankle fractures. Regression analysis was used to identify independent predictors of prescription opioid provision. RESULTS: Following ankle fracture surgery, Aberdeen patients (OR 6.0, 95% CI 3.0–11.5) and Adelaide patients (11.8, 95% CI 4.1–39.6) were significantly more likely to receive a prescription for opioids than those in Augusta (p
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- 2022
6. Chinese Whispers: A brief history of eponymous orthopaedic examinations
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Peter Smitham, Kirsty MacLeod, Andy Goldberg, Simon Grange, Felix Allen, and Emily L Humphries
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030222 orthopedics ,medicine.medical_specialty ,Science & Technology ,business.industry ,Rehabilitation ,1103 Clinical Sciences ,Physical Therapy, Sports Therapy and Rehabilitation ,030229 sport sciences ,orthopaedic ,lcsh:RD701-811 ,Clinical ,03 medical and health sciences ,Orthopedics ,0302 clinical medicine ,lcsh:Orthopedic surgery ,Family medicine ,medicine ,Orthopedics and Sports Medicine ,eponymous ,business ,Life Sciences & Biomedicine ,examinations - Abstract
Eponymous orthopaedic examinations frequently appear in modern clinical examinations, yet their original description and cause for change are often omitted from medical education today. This is important to appreciate in order to understand their diagnostic relevance in modern medicine and subsequent interpretation of results by fellow clinicians. This article reviews the original description of these tests by their namesakes, how they have evolved over time and their relevance in orthopaedics today. An online literature review (PubMed) was conducted of the original descriptions and other published literature detailing their history, evolution, sensitivity and specificity. While elements of these tests have been lost naturally over time to the ‘Chinese Whispers’ effect, most have evolved positively secondary to a deepening anatomical and pathological understanding of their target conditions. They retain some usefulness in clinical medicine, however it is recognized that their diagnostic value is invariably supplanted by improvements in diagnostic imaging.
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- 2020
7. Does Time to Theatre Affect The Ability to Achieve Fracture Reduction in Tibial Plateau Fractures?
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Lucian B. Solomon, Jack Richards, Peter Smitham, Gerald J. Atkins, and David S. Kitchen
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Osteoarthritis ,medicine.disease ,Single surgeon ,Surgery ,Mechanism of injury ,Cohort ,medicine ,Tibial plateau fracture ,business ,Reduction (orthopedic surgery) ,Fracture reduction ,Fixation (histology) - Abstract
AimsThe primary aim of this study was to assess the effect of time to surgery on fracture reduction, assessed as residual articular step, in cases of tibial plateau fracture (TPF). The secondary aim was to assess the effect of pre-operative demographics and residual articular step on patient reported outcomes (PROMs) following TPF.MethodBetween 2006 and 2017 all surgically treated TPF patients managed by a single surgeon at our institution were prospectively consented for the study of fracture outcomes. Timing to surgical intervention, reduction of articular step, age, gender, medical background, fracture classification, mechanism of injury and PROMs (Lysholm Scores and Knee Injury and Osteoarthritis Outcome Scores (KOOS)) were recorded and analysed. Reduction of articular step, defined as ResultsOne hundred seventeen patients were enrolled, 52 with Schatzker II, four with Schatzker IV and 61 with Schatzker VI fractures. Patients were followed-up to a mean time of 3.9 years. The ability to achieve fracture reduction was negatively influenced by time to theatre with the odds of achieving reduction decreasing 17% each day post-injury (p = 0.002). An increased time to theatre was associated with reduced Lysholm scores at the one-year mark (p = 0.01). The ability to achieve fracture reduction did not influence PROMs within the study period.ConclusionDelay in surgical fixation negatively affects fracture reduction in TPF and may delay recovery. However, residual articular step did not influence the investigated PROMs in the cohort investigated over the mid-term (mean of 3.9 years).
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- 2021
8. Intramedullary nail: the past, present and the future - a review exploring where the future may lead us
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Kishan Naidu, Noah Wong Wei Kang, Wen Po Jonathan Tan, Kandiah Umapathysivam, Peter Smitham, Yue Min Crystal Phua, and Amelia Tan Gek Min
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medicine.medical_specialty ,Mri imaging ,business.industry ,Perioperative ,law.invention ,Intramedullary rod ,Radiation exposure ,Fixation (surgical) ,law ,Orthopedic surgery ,Medicine ,Operative time ,Orthopedics and Sports Medicine ,Medical physics ,business ,Complex problems - Abstract
Background Intramedullary nails (IMNs) are the current gold standard treatment for long bone diaphyseal and selected metaphyseal fractures. The design of IMNs has undergone many revisions since its invention in the 16^th^ century, with a dramatic increase in novel designs in recent years aiming to further improve intramedullary fixation techniques. # Aims To map the evolution of IMNs in orthopedic surgery, discuss the limitations and complications of current IMNs and identify novel IMNs that may influence future design innovations. # Methods We undertook a scoping review on the status of orthopedic IMNs by reviewing Google Scholar with the following keywords. Publications and patents selected for retrieval were initially assessed on the title and abstract by five independent reviewers. 52 papers were retrieved for complete text examination, and secondary references were checked from these papers. The results were discussed within the research group and consensus was obtained describing novel IMNs. # Results Novel IMN designs include growth factor and/or antimicrobial coatings targeting fracture healing and perioperative infection risk, respectively; minimally invasive expandable IMNs to avoid the need for interlocking screws; and novel materials such as carbon fiber for their theoretically superior biomechanical properties and avoidance of artifact on CT and MRI imaging. # Conclusion The novel IMNs proposed in recent years collectively aim to improve intramedullary fixation techniques by reducing operative time and radiation exposure, improving fracture healing or monitoring bone cancer progression. However, more research and development are necessary to solve these complex problems.
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- 2021
9. A Systematic Review of Patient-reported Outcome Measures Used in Circular Frame Fixation
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Peter Smitham, Tony Antonios, I Ibrahim, Christine Scarsbrook, Amy Barker, Peter Calder, and W. David Goodier
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medicine.medical_specialty ,Hexapod type fixators ,Review Article ,Prom ,Ilizarov ,Outcome measures ,PROMs ,03 medical and health sciences ,Fixation (surgical) ,0302 clinical medicine ,Medicine ,Orthopedics and Sports Medicine ,In patient ,030212 general & internal medicine ,Patient group ,030222 orthopedics ,business.industry ,Frame (networking) ,female genital diseases and pregnancy complications ,Surgery ,Orthopedic surgery ,Systematic review ,Physical therapy ,Patient-reported outcome ,business - Abstract
Introduction Clinical studies in orthopedics are using patient-reported outcome measures (PROMs) increasingly. PROMs are often being designed for a specific disease or an area of the body with the aim of being patient centered. As yet, none exists specifically for treatment with circular ring external fixation devices. Aim The purpose of this study is to provide a comprehensive systematic review of the published literature related to the use of PROMs in patients that underwent treatment with circular frames (Ilizarov or Hexapod Type Fixators). Methods An online literature search was conducted for English language articles using the Scopus. Results There were 534 published articles identified. After initial filtering for relevance and duplication, this figure reduced to 17, with no further articles identified through searching the bibliographies. Exclusion criteria removed two articles resulting in 15 articles included in the final review. Out of the 15 studies identified, a total of 10 different scoring measures where used. The majority of studies used a combination of joint/limb-specific and generic health PROMs with an average of 2.5 per study. No paper specifically discussed all eight PROMs criteria when justifying which PROMs they used. Conclusion Our findings indicate that none of the PROMs analyzed in this systematic review are truly representative of the health outcomes specific to this patient group and, therefore, propose that a PROM specific to this patient group needs to be developed. How to cite this article Antonios T, Barker A, Ibrahim I, et al. A Systematic Review of Patient-reported Outcome Measures Used in Circular Frame Fixation. Strategies Trauma Limb Reconstr 2019;14(1):34-44.
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- 2020
10. Cemented Revision Hip Arthroplasty With Femoral Impaction Bone Grafting
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Mukai Chimutengwende-Gordon, Donald W. Howie, Jakub Jagiello, Markus P Baker, Stuart A. Callary, Lucian B. Solomon, Roumen Stamenkov, and Peter Smitham
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Reoperation ,030222 orthopedics ,medicine.medical_specialty ,Bone Transplantation ,Bone stock ,business.industry ,Impaction ,medicine.medical_treatment ,Arthroplasty, Replacement, Hip ,Bone Cements ,030229 sport sciences ,Bone grafting ,Surgery ,Prosthesis Failure ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,In patient ,Hip Prosthesis ,business ,Revision hip arthroplasty - Abstract
Long-stemmed uncemented implants are commonly used during revision hip arthroplasty but may be difficult to re-revise. Impaction bone grafting allows for the use of a shorter cemented stem during revision hip arthroplasty and may restore bone stock in patients with substantial femoral defects. Femoral impaction bone grafting is particularly beneficial in younger patients, who are more likely to require additional revision procedures in the future. The surgical technique used at our institution includes improvements to previous methods including the use of modular tamps and nonirradiated, size-profiled bone graft.
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- 2020
11. Time dependent loss of trabecular bone in human tibial plateau fractures
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Dominic Thewlis, Dongqing Yang, Masakazu Kogawa, Mark Rickman, Gerald J. Atkins, Egon Perilli, David S. Kitchen, Lucian B. Solomon, Yolandi Starczak, Paul H. Anderson, Peter Smitham, Solomon, Lucian B, Kitchen, David, Anderson, Paul H, Yang, Dongqing, Starczak, Yolandi, Kogawa, Masakazu, Perilli, Egon, Smitham, Peter J, Rickman, Mark S, Thewlis, Dominic, and Atkins, Gerald J
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Adult ,Male ,0301 basic medicine ,Time Factors ,Gene Expression ,030209 endocrinology & metabolism ,Plateau (mathematics) ,Bone remodeling ,Cohort Studies ,Fracture Fixation, Internal ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Tibial plateau fracture ,medicine ,Humans ,Orthopedics and Sports Medicine ,Bone Resorption ,micro-computed tomography ,Aged ,Aged, 80 and over ,Micro computed tomography ,X-Ray Microtomography ,Anatomy ,Middle Aged ,medicine.disease ,Tibial Fractures ,Trabecular bone ,030104 developmental biology ,Cancellous Bone ,gene expression ,Female ,tibial plateau fracture ,Biomarkers ,bone remodelling ,Geology - Abstract
We investigated if time between injury and surgery affects cancellous bone properties in patients suffering tibial plateau fractures (TPF), in terms of structural integrity and gene expression controlling bone loss. A cohort of 29 TPF, operated 1-17 days post-injury, had biopsies from the fracture and an equivalent contralateral limb site, at surgery. Samples were assessed using micro-computed tomography and real-time RT-PCR analysis for the expression of genes known to be involved in bone remodeling and fracture healing. Significant decreases in the injured vs control side were observed for bone volume fraction (BV/TV, -13.5 ± 6.0%, p = 0.011), trabecular number (Tb.N, -10.5 ± 5.9%, p = 0.041) and trabecular thickness (Tb.Th, -4.6 ± 2.5%, p = 0.033). Changes in these parameters were more evident in patients operated 5-17 days post-injury, compared to those operated in the first 4 days post-injury. A significant negative association was found between Tb.Th (r = -0.54, p 0.01) and BV/TV (r = -0.39, p 0.05) in relation to time post-injury in the injured limb. Both BV/TV and Tb.Th were negatively associated with expression of key molecular markers of bone resorption, CTSK, ACP5, and the ratio of RANKL:OPG mRNA. These structure/gene expression relationships did not exist in the contralateral tibial plateau of these patients. This study demonstrated that there is a significant early time-dependent bone loss in the proximal tibia after TPF. This bone loss was significantly associated with altered expression of genes typically involved in the process of osteoclastic bone resorption but possibly also bone resorption by osteocytes. The mechanism of early bone loss in such fractures should be a subject of further investigation. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2865-2875, 2018.
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- 2018
12. POWIFF- Prospective study of wrist internal fixation of fracture: A protocol for a single centre, superiority, randomised controlled trial to study the efficacy of the VRP (2.0) distal radius plate (Austofix) versus the VA-LCP (Depuy-Synthes) for distal radius fractures
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Viju Daniel Varghese, Suzanne Edwards, Stuart Howell, Peter Smitham, and Mark Rickman
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Adult ,Male ,medicine.medical_specialty ,lcsh:Diseases of the musculoskeletal system ,medicine.medical_treatment ,Wrist ,law.invention ,Study Protocol ,Fracture Fixation, Internal ,03 medical and health sciences ,Grip strength ,0302 clinical medicine ,Rheumatology ,Randomized controlled trial ,law ,medicine ,Humans ,Internal fixation ,Orthopedics and Sports Medicine ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Orthodontics ,030222 orthopedics ,Intention-to-treat analysis ,business.industry ,Volar plating ,Standard treatment ,Middle Aged ,Functional outcome ,Wrist Injuries ,Treatment Outcome ,medicine.anatomical_structure ,Orthopedic surgery ,Female ,lcsh:RC925-935 ,Radius Fractures ,business ,Bone Plates ,Distal radius fracture - Abstract
Background Distal radial fractures are one of the most common orthopaedic cases that present to the A&E department. Surgical intervention is warranted in displaced intraarticular fractures and fractures with more than the recommended angulation or shortening, and is most commonly treated with volarly placed fixed angle locking plates. The aim of this study is to determine and compare the efficacy of two different plates for surgical treatment of distal radius fractures. The VRP 2.0 is a new plate produced by the Austofix company and this system will be compared against the VA-LP (Variable angle-locking plate) produced by Depuy-Synthes which has been used as the standard treatment device. Methods and Design Patients between the ages of 18 and 80 presenting to the Royal Adelaide Hospital with isolated closed distal radial fractures will be invited to participate in this study. A total of 200 patients are required to provide 90% statistical power at a 5% alpha level to detect a difference of 11.5 points on the PRWE (Patient rated Wrist evaluation) score. The primary outcome measure will be the PRWE score while the secondary outcome measures will include the DASH score, EQ5D score, clinical range of movements, grip strength as well as patient perceived return of function at the wrist and time to resumption to work. These will be measured at 6 weeks, 3 months and 12 months. Radiographic indices including the radial tilt, length, volar inclination and plate prominence will also be measured. Complications will be recorded up to 12 months. Post hoc comparisons will be done using paired t tests. An intention to treat and a per protocol analysis will be done to compare the 2 groups. Discussion Distal radial fractures are increasingly being treated by internal fixation using volar locking plates. However, there is no prospective study to date comparing one plate against another in terms of outcome and complications. This study could provide more information about the best way to treat these injuries surgically. Trial registration The trial is registered with the Australia New Zealand Clinical Trials Registry (ANZCTR). Trial registration date-17/11/2016. Trial registration number-ACTRN12616001590459. Electronic supplementary material The online version of this article (10.1186/s12891-018-2052-4) contains supplementary material, which is available to authorized users.
- Published
- 2018
13. Plaster of Paris–Short History of Casting and Injured Limb Immobilzation
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B Szostakowski, Wasim S. Khan, and Peter Smitham
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030222 orthopedics ,Complications ,business.industry ,Non-operative management ,Dentistry ,Article ,03 medical and health sciences ,0302 clinical medicine ,Plaster of Paris ,Casting (metalworking) ,Immobilisation ,Medicine ,030212 general & internal medicine ,business ,Fractures - Abstract
Various materials have been used since ancient times to help immobilise fractures. In this review, we discuss the history and developments of these materials as well as plaster of Paris. There has been a recent trend away from non-operative management of fractures, and skills in the use of plaster of Paris are declining. For the successful treatment of patients, it is important to appreciate how plaster works, how it should be used, and what can go wrong. In this review, we also discuss principles of applications and complications of plaster of Paris.
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- 2017
14. Characterization of Bespoke Force Sensors for Tailored Applications
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Maria del Pilar Garcia Souto, Benjamin M. Oldfrey, Catherine Holloway, Mark Miodownik, Dafne Zuleima Morgado Ramirez, and Peter Smitham
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0209 industrial biotechnology ,Engineering ,business.industry ,010401 analytical chemistry ,Composite number ,Electrical engineering ,02 engineering and technology ,Thread (computing) ,Epoxy ,5S ,01 natural sciences ,0104 chemical sciences ,Exponential function ,020901 industrial engineering & automation ,Transducer ,Dynamic loading ,visual_art ,visual_art.visual_art_medium ,Electrical and Electronic Engineering ,Composite material ,business ,Instrumentation ,Bespoke - Abstract
Bespoke force sensors made with active polymer composites are inexpensive, thin and flexible, hence popular in wearable electronics, however their wider application is limited due to the lack of literature studying their voltage response related errors. We present the voltage response characterization of bespoke force sensors made with an active polymer composite, silver coated fabric, stainless steel thread, and silver epoxy. Characterization of the effects of static and dynamic loading was completed with a mechanical testing machine. Static tests consisted of loading and unloading at 0.01, 0.1, 0.5 and 1 N/s, and drift tests for 120 minutes up to 10 N every 1 N. Dynamic tests consisted of a sinusoidal load of 5 N ±1 N applied at 0.05, 0.1, and 0.5 Hz for 60 min. The force-voltage relationships were modeled using an exponential function. Maximum mean drift error was observed when applying different static loads for 120 minutes each. Drift error is minimal at 5 s (
- Published
- 2017
15. Biomechanical Study Comparing Cut-out Resistance of the X-Bolt® and Dynamic Hip Screw at Various Tip-Apex Distances
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Steven, Kahane, Kalpesh R, Vaghela, John, Stammers, Andy, Goldberg, and Peter, Smitham
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Fracture Fixation, Internal ,Hip Fractures ,Bone Screws ,Humans ,Femur Head ,Orthopedic Procedures ,Biomechanical Phenomena - Abstract
Bone quality in hip fractures is poor and there is a need to not only correctly position metalwork within the femoral head, but also for implants to resist cut-out. New implant designs may help to reduce metalwork cut-out, leading to fewer failures of fixation. This study compared the cut-out strength of a Dynamic Hip Screw (DHS) to that of an X-Bolt® (X-Bolt Orthopaedics, Dublin, Ireland) implant in an osteoporotic Sawbones® (Sawbones, Vashon Island, WA) model.An unstable fracture model (AO 31-A2) was created using low-density 5 pound per cubic foot (pcf) Sawbones®. The DHS and X-Bolts® were inserted into the Sawbones® femoral head at Tip-Apex Distances (TAD) of 10mm, 15mm, 20mm, 25mm, 30mm and 40mm. A cyclic-loading Instron® machine (Instron Corp., Norwood, MA) pushed the bone at a compression rate of 5mm per minute at a 20-degree angle to the axis of the implant with an upper force limit of 4000N. Maximum force reached and load to failure, defined as movement of the implant by 5mm, were recorded. Four implants were used per group to give a total of 48 tests between the two groups.The X-Bolt® demonstrated a superior average maximum total load push-out force compared to the DHS group for all of the TAD configurations tested. The maximum force reached in the X-Bolt® group was significantly higher than that in the DHS group at a TAD of 10mm (X-Bolt® 3299.25N vs. DHS 2843.75N, P0.029) and 30mm (X-Bolt® 2908.25N vs. DHS 2030N, P0.029). The X-Bolt® also had a higher load to failure than the DHS group at all of the TAD values tested.The X-Bolt® implant gave superior performance compared to the standard DHS, as reflected by a greater push-out force in an osteoporotic Sawbones® model.
- Published
- 2019
16. Surgical Technique to Manage Periprosthetic Fractures of the Knee in Patients with Infected Leg Ulcers: A Report of Two Cases
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Ashray Vohora, Donald W. Howie, Gerald J. Atkins, Peter Smitham, and Lucian B. Solomon
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Aged, 80 and over ,medicine.medical_specialty ,Percutaneous ,business.industry ,medicine.medical_treatment ,Leg Ulcer ,Periprosthetic ,Knee Injuries ,Baseline level ,Infections ,Prosthesis ,Surgery ,Fracture Fixation, Internal ,Fracture fixation ,Surgical site ,medicine ,Internal fixation ,Humans ,Orthopedics and Sports Medicine ,In patient ,Female ,Periprosthetic Fractures ,business - Abstract
Cases We describe 2 cases of nonagenarians with periprosthetic knee fractures that were not amenable to either standard internal fixation nor prosthesis revision because of infected leg ulcers in the same limb. The fractures were internally fixed by percutaneous insertion of medial and lateral plates that spanned the knee. Both patients returned to their baseline level of activity without developing surgical site infections. Conclusions Percutaneous bridging plates that span the knee are a useful option for treating these difficult cases.
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- 2019
17. Identifying key experience-related differences in over-ground manual wheelchair propulsion biomechanics
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Peter Smitham, S.J.G. Taylor, Tatsuto Suzuki, Andrew Symonds, Angela Gall, and Catherine Holloway
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Special Collection: Affordable Rehabilitation and Assistive Technologies ,030506 rehabilitation ,medicine.medical_specialty ,Computer science ,Biomechanics ,Spinal cord injury ,Propulsion ,technique ,biomechanics ,Transport engineering ,Manual wheelchair ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Wheelchair ,experience ,medicine ,Key (cryptography) ,0305 other medical science ,030217 neurology & neurosurgery ,manual wheelchair propulsion - Abstract
Objectives The purpose of this study was to investigate technique differences between expert and novice manual wheelchair users during over-ground wheelchair propulsion. Method Seven experts (spinal cord injury level between T5 and L1) and six novices (non-wheelchair users) pushed a manual wheelchair over level ground, a 2.5% cross slope and up a 6.5% incline (7.2 m length) and 12% incline (1.5 m length). Push rim kinetics, trunk and shoulder kinematics and muscle activity level were measured. Results During the level and cross slope tasks, the experts completed the tasks with fewer pushes by applying a similar push rim moment over a greater push arc, demonstrating lower muscle activity. During the incline tasks, the experts required fewer pushes and maintained a greater average velocity, generating greater power by applying a similar push rim moment over a greater push arc with greater angular velocity, demonstrating greater trunk flexion and higher shoulder muscle activity. Conclusions This study identifies experience-related differences during over-ground manual wheelchair propulsion. These differences are particularly evident during incline propulsion, with the experts generating significantly greater power to maintain a higher velocity.
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- 2019
18. A Deep Learning Approach to Non-linearity in Wearable Stretch Sensors
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Ben Oldfrey, Richard Jackson, Peter Smitham, and Mark Miodownik
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Robotics and AI ,Resistive touchscreen ,long short term memory neural network ,Artificial neural network ,Computer science ,business.industry ,lcsh:Mechanical engineering and machinery ,Wearable computer ,real-time ,deep learning ,Strain rate ,sensors ,Viscoelasticity ,lcsh:QA75.5-76.95 ,Computer Science Applications ,Artificial Intelligence ,Electronic engineering ,Calibration ,lcsh:TJ1-1570 ,Electronics ,lcsh:Electronic computers. Computer science ,flexible ,business ,Wearable technology ,Original Research - Abstract
There is a growing need for flexible stretch sensors to monitor real time stress and strain in wearable technology. However, developing stretch sensors with linear responses is difficult due to viscoelastic and strain rate dependent effects. Instead of trying to engineer the perfect linear sensor we take a deep learning approach which can cope with non-linearity and yet still deliver reliable results. We present a general method for calibrating highly hysteretic resistive stretch sensors. We show results for textile and elastomeric stretch sensors however we believe the method is directly applicable to any physical choice of sensor material and fabrication, and easily adaptable to other sensing methods, such as those based on capacitance. Our algorithm does not require any a priori knowledge of the physical attributes or geometry of the sensor to be calibrated, which is a key advantage as stretchable sensors are generally applicable to highly complex geometries with integrated electronics requiring bespoke manufacture. The method involves three-stages. The first stage requires a calibration step in which the strain of the sensor material is measured using a webcam while the electrical response is measured via a set of arduino-based electronics. During this data collection stage, the strain is applied manually by pulling the sensor over a range of strains and strain rates corresponding to the realistic in-use strain and strain rates. The correlated data between electrical resistance and measured strain and strain rate are stored. In the second stage the data is passed to a Long Short Term Memory Neural Network (LSTM) which is trained using part of the data set. The ability of the LSTM to predict the strain state given a stream of unseen electrical resistance data is then assessed and the maximum errors established. In the third stage the sensor is removed from the webcam calibration set-up and embedded in the wearable application where the live stream of electrical resistance is the only measure of strain-this corresponds to the proposed use case. Highly accurate stretch topology mapping is achieved for the three commercially available flexible sensor materials tested.
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- 2019
19. A lightweight wheelchair propulsion dynamometer for improving user energy efficiency and mobility
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J Gorjon, Catherine Holloway, Peter Smitham, Andrew Symonds, and Sjg Taylor
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education.field_of_study ,Wheelchair ,Dynamometer ,Computer science ,Population ,Instrumentation (computer programming) ,Propulsion ,education ,Load cell ,Automotive engineering ,Wheelchair propulsion ,Efficient energy use - Abstract
The population of manual wheelchair users is growing; the vast majority of users are due to spinal cord injury, often presenting in young adults. Propulsion forces must be produced by the upper body only; such repetitive forces impact the shoulder and elbow joints, leading to long term pain and injury. This also has an effect on mobility, with consequential socio-economic implications. Training in the style of propulsion, especially from an early age, may lead to more efficient propulsion and reduced injury and pain. To measure the forces of propulsion and calculate energy expenditure, the connecting pins between a wheelchair pushrim and drivewheel were replaced with three multi-axis load cells able to measure the real time forces due to pushing. This paper reports the development of the Sensewheel Mk1 propulsion dynamometer: concept, load cell design and modelling, strain gauging and instrumentation, assembly, calibration and sample recorded data.
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- 2019
20. Scoping review of priority setting of research topics for musculoskeletal conditions
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Chung-Wei Christine Lin, Allison Bourne, Renea V Johnston, Ian A. Harris, Steven J. Kamper, Claire E. Hiller, Andrew M. Briggs, Jane Latimer, William J. Taylor, Christopher G. Maher, Peter Smitham, Sheila Cyril, Christopher Hill, Bethan Richards, Ornella Clavisi, Andrew Lawson, Diana M. Perriman, Rachelle Buchbinder, Samuel L Whittle, and Gustavo Duque
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medicine.medical_specialty ,Future studies ,Biomedical Research ,Population ,MEDLINE ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Systems research ,medicine ,Back pain ,Humans ,030212 general & internal medicine ,Musculoskeletal Diseases ,education ,030203 arthritis & rheumatology ,education.field_of_study ,Priority setting ,business.industry ,Research ,General Medicine ,Low back pain ,Family medicine ,scoping review ,medicine.symptom ,musculoskeletal disorders ,business ,Inclusion (education) - Abstract
ObjectiveDescribe research methods used in priority-setting exercises for musculoskeletal conditions and synthesise the priorities identified.DesignScoping review.Setting and populationStudies that elicited the research priorities of patients/consumers, clinicians, researchers, policy-makers and/or funders for any musculoskeletal condition were included.Methods and analysisWe searched MEDLINE and EMBASE from inception to November 2017 and the James Lind Alliance top 10 priorities, Cochrane Priority Setting Methods Group, and Cochrane Musculoskeletal and Back Groups review priority lists. The reported methods and research topics/questions identified were extracted, and a descriptive synthesis conducted.ResultsForty-nine articles fulfilled our inclusion criteria. Methodologies and stakeholders varied widely (26 included a mix of clinicians, consumers and others, 16 included only clinicians, 6 included only consumers or patients and in 1 participants were unclear). Only two (4%) reported any explicit inclusion criteria for priorities. We identified 294 broad research priorities from 37 articles and 246 specific research questions from 17 articles, although only four (24%) of the latter listed questions in an actionable format. Research priorities for osteoarthritis were identified most often (n=7), followed by rheumatoid arthritis (n=4), osteoporosis (n=4) and back pain (n=4). Nearly half of both broad and specific research priorities were focused on treatment interventions (n=116 and 111, respectively), while few were economic (n=8, 2.7% broad and n=1, 0.4% specific), implementation (n=6, 2% broad and n=4, 1.6% specific) or health services and systems research (n=15, 5.1% broad and n=9, 3.7% specific) priorities.ConclusionsWhile many research priority-setting studies in the musculoskeletal field have been performed, methodological limitations and lack of actionable research questions limit their usefulness. Future studies should ensure they conform to good priority-setting practice to ensure that the generated priorities are of maximum value.PROSPERO registration numberCRD42017059250.
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- 2018
21. Surgical trainees' experience of pregnancy, maternity and paternity leave: a cross-sectional study
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Vimal J. Gokani, Oroog Ali, Rhiannon L Harries, Helen Mohan, Peter Smitham, J Edward Fitzgerald, and Ciara McGoldrick
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Adult ,Male ,medicine.medical_specialty ,Cross-sectional study ,Attitude of Health Personnel ,Personnel Staffing and Scheduling ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Surveys and Questionnaires ,medicine ,Humans ,Maternal health ,030212 general & internal medicine ,Parental status ,business.industry ,Internship and Residency ,Normal level ,General Medicine ,medicine.disease ,Surgical training ,Organizational Policy ,United Kingdom ,Parental Leave ,Cross-Sectional Studies ,Maternity leave ,Family medicine ,Female ,Surgical education ,business ,Ireland - Abstract
Background Internationally, supporting surgical trainees during pregnancy, maternity and paternity leave is essential for trainee well-being and for retention of high-calibre surgeons, regardless of their parental status. This study sought to determine the current experience of surgical trainees regarding pregnancy, maternity and paternity leave. Methods A cross-sectional anonymised electronic voluntary survey of all surgical trainees working in the UK and Ireland was distributed via the Association of Surgeons in Training and the British Orthopaedic Trainees’ Association. Results There were 876 complete responses, of whom 61.4% (n=555) were female. 46.5% (258/555) had been pregnant during surgical training. The majority (51.9%, n=134/258) stopped night on-call shifts by 30 weeks’ gestation. The most common reason for this was concerns related to tiredness and maternal health. 41% did not have rest facilities available on night shifts. 27.1% (n=70/258) of trainees did not feel supported by their department during pregnancy, and 17.1% (n=50/258) found the process of arranging maternity leave difficult or very difficult. 61% (n=118/193) of trainees felt they had returned to their normal level of working within 6 months of returning to work after maternity leave, while a significant minority took longer. 25% (n=33/135) of trainees found arranging paternity leave difficult or very difficult, and the most common source of information regarding paternity leave was other trainees. Conclusion Over a quarter of surgical trainees felt unsupported by their department during pregnancy, while a quarter of male trainees experience difficulty in arranging paternity leave. Efforts must be made to ensure support is available in pregnancy and maternity/paternity leave.
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- 2018
22. Vancouver B2 Peri-Prosthetic Fractures in Cemented Femoral Implants can be Treated With Open Reduction and Internal Fixation Alone Without Revision
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Donald W. Howie, Stuart A. Callary, Jacob T. Munro, Tania A. Carbone, Lucian B. Solomon, Kerry Costi, Young Sig Kim, Peter Smitham, and Scott M. Bolam
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Adult ,Male ,Reoperation ,medicine.medical_specialty ,medicine.medical_treatment ,Arthroplasty, Replacement, Hip ,Bone healing ,Femoral stem ,03 medical and health sciences ,Fixation (surgical) ,Fracture Fixation, Internal ,0302 clinical medicine ,Medicine ,Internal fixation ,Humans ,Orthopedics and Sports Medicine ,Femur ,Frail elderly ,Aged ,Retrospective Studies ,Aged, 80 and over ,Fracture Healing ,030222 orthopedics ,business.industry ,Bone Cements ,Retrospective cohort study ,Middle Aged ,Surgery ,Female ,Implant ,Hip Prosthesis ,Periprosthetic Fractures ,business ,Femoral Fractures - Abstract
Background The aim of this study is to assess the outcomes of 52 consecutive Vancouver B2 peri-prosthetic fractures around cemented polished double-tapered stems treated by open reduction and internal fixation in 2 trauma centers in 2 countries. Methods Outcomes included modified Harris Hip Score (mHHS), Harris Pain Score, and return to pre-injury mobility. Fracture healing was assessed; implant subsidence measured and complications including re-operations reported. Results No patient was lost to follow-up. Median patient age at operation was 82 years (range 43-98); Harris pain scores showed minimal pain (median 42, range 10-44) at latest follow-up. Median total subsidence at 1 year was 1.1 mm (range 0-5.4), the majority of which occurred within the cement mantle. No subsequent femoral stem revision was required (median 2.9 years, 0-10); however, there were 3 re-operations: 1 re-operation for pre-existing recurrent dislocation involving head liner exchange and 2 for repeat fixation due to metal fatigue. Two additional fractures occurred below the new plating, requiring further plating whilst still retaining the original stems. Conclusion Anatomical reduction and open reduction and internal fixation of Vancouver B2 peri-prosthetic fractures should be considered as an appropriate treatment solution for frail elderly patients with a peri-prosthetic fracture around cemented polished double-tapered stems.
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- 2018
23. Bilateral Neck of Femur Fractures in a Bilateral Below-Knee Amputee: A Unique Case
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Hannah Lancer, Pinak Ray, and Peter Smitham
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musculoskeletal diseases ,030222 orthopedics ,Hip fracture ,medicine.medical_specialty ,Activities of daily living ,business.industry ,Bilateral hip pain ,Case Report ,General Medicine ,Emergency department ,Northern ireland ,medicine.disease ,Surgery ,lcsh:RD701-811 ,03 medical and health sciences ,0302 clinical medicine ,lcsh:Orthopedic surgery ,Full recovery ,Radiological weapon ,medicine ,Femur ,business ,030217 neurology & neurosurgery - Abstract
According to the National Hip Fracture Database, over 64,000 patients were admitted with a hip fracture across England, Wales, and Northern Ireland in 2013, but very few are bilateral, and there are no current cases in the literature of bilateral neck of femur fractures in a patient with bilateral below-knee amputations. We present a case of a 69-year-old bilateral below-knee amputee male admitted to the emergency department with bilateral hip pain and radiological evidence of bilateral displaced neck of femur fractures. The patient subsequently underwent synchronous bilateral total hip replacements under general anaesthetic and an epidural and then went on to make a full recovery. He was discharged 27 days after arrival in hospital. Outpatient follow-up at 3 months has shown that the patient has returned to a similar level of preinjury function and is still able to carry out his daily activities with walking aids and bilateral leg prostheses.
- Published
- 2016
24. An audit of clinical training exposure amongst junior doctors working in Trauma & Orthopaedic Surgery in 101 hospitals in the United Kingdom
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Jimmy Ng, Rupert Wharton, Aaron Rooney, Tarek Boutefnouchet, Nomaan Sheikh, Michalis Panteli, Alexander Durst, Guy Morris, Simon Fleming, Steven Kahane, Moez Zeiton, Mustafa Saad Rashid, Peter Smitham, Peter Davies, Peter Cay, Daniel Burchette, Liam Yapp, Ali Abdulkarim, Ashley Brian Scrimshire, Daniel Shaerf, and Christopher Buckle
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medicine.medical_specialty ,Evening ,020205 medical informatics ,education ,Specialty ,lcsh:Medicine ,02 engineering and technology ,Audit ,Trauma ,Exposure ,Education ,03 medical and health sciences ,0302 clinical medicine ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,Training ,Outpatient clinic ,030212 general & internal medicine ,Surgeons ,lcsh:LC8-6691 ,Medical education ,lcsh:Special aspects of education ,business.industry ,lcsh:R ,Orthopaedic ,General Medicine ,National health service ,Surgical training ,Clinical training ,Family medicine ,Orthopedic surgery ,Surgery ,business - Abstract
BackgroundThere are concerns regarding early years' training for junior doctors in Trauma & Orthopaedic Surgery (T&O) in the United Kingdom. Our primary objective was to audit the clinical activities undertaken by junior doctors working in Trauma & Orthopaedic (T&O) surgery in the National Health Service (NHS) in a typical workweek. A secondary objective was to audit the clinical exposure of junior surgeons in training to the Joint Committee on Surgical Training (JCST) standards for minimum weekly clinical exposure in T&O surgery.MethodsWe recruited collaborators in 101 T&O surgery departments in NHS hospitals to participate in this study. Clinical activity diaries from 935 doctors working in T&O surgery in the 101 participating NHS hospitals were involved. All junior doctors covering the junior on call tier were included. Collaborators collected clinical activity data from 08:00 18/01/2015 to 20:00 22/01/2015. Clinical activities recorded in sessions (morning, afternoon, evening) depending on what activity that doctor undertook for the majority of that session. Clinical activities were grouped into operating theatre/room, outpatient clinic, on call, "not in work" (i.e. leave, sickness), teaching, and ward cover sessions. The weekly clinical activity of Core Surgical Trainees (CSTs) were analyzed in accordance to two JCST standards for minimum weekly clinical exposure.ResultsOverall, junior doctors working in T&O surgery attended a theatre list session 8.5% of the time, an outpatient clinic 3.2%, were on call 14.8%, a teaching session 1.7%, providing ward cover 34.6%, and on a zero session 20.7% of the time. Only 5% of core surgical trainees (n = 200) met both the JCST standards for minimum weekly clinical exposure in the specialty.ConclusionsJunior surgeons in training, working in Trauma & Orthopaedic surgery in the United Kingdom are not meeting the minimum weekly clinical sessions laid out by the JCST. Further work to develop models allowing for enhanced training experiences and improved clinical exposure to operating lists and outpatient clinics would be beneficial.
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- 2018
25. Exposure of the Superior Gluteal Neurovascular Bundle for the Safe Application of Acetabular Reinforcement Cages in Complex Revisions
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Peter Smitham, Lucian B. Solomon, Donald W. Howie, and Dennis Kosuge
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Reoperation ,0301 basic medicine ,medicine.medical_specialty ,Arthroplasty, Replacement, Hip ,medicine.medical_treatment ,Risk Assessment ,Posterior approach ,Prosthesis Implantation ,Superior gluteal nerve ,medicine.nerve ,03 medical and health sciences ,0302 clinical medicine ,Superior gluteal artery ,medicine.artery ,medicine ,Humans ,Orthopedics and Sports Medicine ,Intraoperative Complications ,Reinforcement ,Fixation (histology) ,030222 orthopedics ,Hip Fractures ,business.industry ,Acetabulum ,Anatomy ,Neurovascular bundle ,Arthroplasty ,Surgery ,Buttocks ,Hip Prosthesis ,Patient Safety ,030101 anatomy & morphology ,business - Abstract
The posterior approach to the hip is the most common extensile approach used, however exposure is limited superiorly by the superior gluteal neurovascular bundle (SGNB). The extra-pelvic course of the SGNB demonstrates variability between individuals, occasionally located only 1 cm from the acetabular rim. In complex acetabular reconstructions where the application of a reinforcement cage maybe required protecting the SGNB is challenging. The flanges of these cages are designed to sit on the ilium superior to the acetabular rim and to receive screws for fixation. The application of such cages may result in iatrogenic injury to the SGNB by way of forceful retraction or entrapment. We describe a technique that involves exposure and release of the SGNB such that the flanges of cage constructs may be safely applied.
- Published
- 2016
26. WHAT ARE USER PERSPECTIVES OF EXOSKELETON TECHNOLOGY? A LITERATURE REVIEW
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Deborah Hill, Dafne Zuleima Morgado Ramirez, Catherine Holloway, Yannis Pappas, and Peter Smitham
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030506 rehabilitation ,Bionics ,Inclusion (disability rights) ,Computer science ,business.industry ,Health Policy ,Robotics ,Walking ,USable ,Exoskeleton Device ,Exoskeleton ,03 medical and health sciences ,0302 clinical medicine ,Ranking ,Human–computer interaction ,Health care ,Humans ,Paralysis ,Artificial intelligence ,0305 other medical science ,business ,030217 neurology & neurosurgery ,Functional movement - Abstract
Objectives: Exoskeletons are electromechanical devices that are worn by a human operator to increase their physical performance. Several exoskeletons have been developed to restore functional movements, such as walking, for those with paralysis due to neurological impairment. However, existing exoskeletons have limitations with respect to affordability, size, weight, speed, and efficiency, which may reduce their functional application. Therefore, the aim of this scoping review is to collect and narratively synthesize the perspectives of users of exoskeleton technology.Methods: A systematic literature search was conducted across several healthcare related online databases.Results: A total of 4,619 articles were identified, of which 51 were selected for full review. Only three studies were identified that met the inclusion criteria. Of these, one showed an incongruence between users’ expectations and experiences of device use; another reported perspectives on potential rather than actual device use, ranking design features in order of perceived importance; and the other reported ratings of ease of device use in training.Conclusions: The heterogeneity of studies included within this review, leave the authors unable to suggest consensus as to user perspectives of exoskeleton technology. However, it is apparent that users are able to suggest priorities for exoskeleton design and that users’ perspectives of exoskeleton technology might change in response to experience of use. The authors, therefore, suggest that exoskeleton design should be an iterative process, whereby user perspectives are sought, incorporated and refined by tangible experience, to ensure that devices developed are acceptable to and usable by the populations they seek to re-enable.
- Published
- 2017
27. A cross sectional study of pregnancy and maternity and paternity leave among surgical trainees in the United Kingdom and Republic of Ireland
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Helen Mohan, J.E.F. Fitzgerald, Ciara McGoldrick, Peter Smitham, R.L. Harries, and Vimal J. Gokani
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Pregnancy ,Nursing ,business.industry ,Cross-sectional study ,education ,medicine ,Surgery ,General Medicine ,medicine.disease ,business - Published
- 2016
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28. Screw fixation of medial malleolar fractures
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L. Parker, N. Garlick, Wolfgang Grechenig, I. McCarthy, Stephan Grechenig, and Peter Smitham
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Bone Screws ,Ankle Fractures ,Prosthesis Design ,Screw fixation ,Fracture Fixation, Internal ,Fixation (surgical) ,Bone Density ,Cadaver ,Fracture fixation ,Humans ,Medicine ,Internal fixation ,Orthopedics and Sports Medicine ,Tibia ,Aged ,Aged, 80 and over ,Orthodontics ,business.industry ,Middle Aged ,Biomechanical Phenomena ,Surgery ,Radiography ,Orthopedic surgery ,Female ,Stress, Mechanical ,business ,Cadaveric spasm ,Ankle Joint - Abstract
The AO Foundation advocates the use of partially threaded lag screws in the fixation of fractures of the medial malleolus. However, their threads often bypass the radiodense physeal scar of the distal tibia, possibly failing to obtain more secure purchase and better compression of the fracture. We therefore hypothesised that the partially threaded screws commonly used to fix a medial malleolar fracture often provide suboptimal compression as a result of bypassing the physeal scar, and proposed that better compression of the fracture may be achieved with shorter partially threaded screws or fully threaded screws whose threads engage the physeal scar. We analysed compression at the fracture site in human cadaver medial malleoli treated with either 30 mm or 45 mm long partially threaded screws or 45 mm fully threaded screws. The median compression at the fracture site achieved with 30 mm partially threaded screws (0.95 kg/cm2 (interquartile range (IQR) 0.8 to 1.2) and 45 mm fully threaded screws (1.0 kg/cm2 (IQR 0.7 to 2.8)) was significantly higher than that achieved with 45 mm partially threaded screws (0.6 kg/cm2 (IQR 0.2 to 0.9)) (p = 0.04 and p < 0.001, respectively). The fully threaded screws and the 30mm partially threaded screws were seen to engage the physeal scar under an image intensifier in each case. The results support the use of 30 mm partially threaded or 45 mm fully threaded screws that engage the physeal scar rather than longer partially threaded screws that do not. A 45 mm fully threaded screw may in practice offer additional benefit over 30 mm partially threaded screws in increasing the thread count in the denser paraphyseal region. Cite this article: Bone Joint J 2013;95-B:1662–6.
- Published
- 2013
29. The anti-diabetic drug metformin does not affect bone mass in vivo or fracture healing
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M. Pierre, Peter Smitham, C. Bardin, S A Ellis, Allen E. Goodship, Chantal Chenu, Benoit Viollet, Jean-Paul Roux, Gul Zaman, J Jeyabalan, and University of London [London]
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Bone density ,endocrine system diseases ,Endocrinology, Diabetes and Metabolism ,[SDV]Life Sciences [q-bio] ,Osteoporosis ,Bone architecture ,AMP-Activated Protein Kinases ,Bone remodeling ,Mice ,0302 clinical medicine ,Bone Density ,Femur ,Bony Callus ,Fracture Healing ,0303 health sciences ,digestive, oral, and skin physiology ,Metformin ,3. Good health ,Original Article ,Female ,Bone Remodeling ,Rosiglitazone ,Femoral Fractures ,medicine.drug ,Micro-CT ,medicine.medical_specialty ,Ovariectomy ,030209 endocrinology & metabolism ,Bone healing ,03 medical and health sciences ,In vivo ,Internal medicine ,medicine ,Animals ,Hypoglycemic Agents ,Rats, Wistar ,Adverse effect ,030304 developmental biology ,Histomorphometry ,Tibia ,business.industry ,nutritional and metabolic diseases ,X-Ray Microtomography ,medicine.disease ,Rats ,Enzyme Activation ,Mice, Inbred C57BL ,Endocrinology ,business - Abstract
WOS:000324536200013; International audience; The present study shows no adverse effects of the anti-diabetic drug metformin on bone mass and fracture healing in rodents but demonstrates that metformin is not osteogenic in vivo, as previously proposed. Introduction In view of the increased incidence of fractures in patients with type 2 diabetes mellitus (T2DM), we investigated the effects of metformin, a widely used T2DM therapy, on bone mass and fracture healing in vivo using two different rodent models and modes of metformin administration. Methods We first subjected 12-week-old female C57BL/6 mice to ovariectomy (OVX). Four weeks after OVX, mice received either saline or metformin administered by gavage (100 mg/kg/daily). After 4 weeks of treatment, bone micro-architecture and cellular activity were determined in tibia by micro-CT and bone histomorphometry. In another experiment, female Wistar rats aged 3 months were given only water or metformin for 8 weeks via the drinking water (2 mg/ml). After 4 weeks of treatment, a mid-diaphyseal osteotomy was performed in the left femur. Rats were sacrificed 4 weeks after osteotomy and bone architecture analysed by micro-CT in the right tibia while fracture healing and callus volume were determined in the left femur by X-ray analysis and micro-CT, respectively. Results In both models, our results show no significant differences in cortical and trabecular bone architecture in metformin-treated rodents compared to saline. Metformin had no effect on bone resorption but reduced bone formation rate in trabecular bone. Mean X-ray scores assessed on control and metformin fractures showed no significant differences of healing between the groups. Fracture callus volume and mineral content after 4 weeks were similar in both groups. Conclusions Our results indicate that metformin has no effect on bone mass in vivo or fracture healing in rodents.
- Published
- 2013
30. 'When can I return to driving?'
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K. MacLeod, A. Lingham, H. Chatha, Andrew Parkes, Simon Grange, J. Lewis, and Peter Smitham
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Automobile Driving ,medicine.medical_specialty ,Joint replacement ,Deceleration ,medicine.medical_treatment ,MEDLINE ,Poison control ,Occupational safety and health ,Arthroplasty ,Brake ,Injury prevention ,Reaction Time ,medicine ,Humans ,Orthopedics and Sports Medicine ,Rehabilitation ,business.industry ,Human factors and ergonomics ,body regions ,Practice Guidelines as Topic ,Physical therapy ,Surgery ,Safety ,business ,human activities ,Leg Injuries - Abstract
Clinicians are often asked by patients, “When can I drive again?” after lower limb injury or surgery. This question is difficult to answer in the absence of any guidelines. This review aims to collate the currently available evidence and discuss the factors that influence the decision to allow a patient to return to driving. Medline, Web of Science, Scopus, and EMBASE were searched using the following terms: ‘brake reaction time’, ‘brake response time’, ‘braking force’, ‘brake pedal force’, ‘resume driving’, ‘rate of application of force’, ‘driving after injury’, ‘joint replacement and driving’, and ‘fracture and driving’. Of the relevant literature identified, most studies used the brake reaction time and total brake time as the outcome measures. Varying recovery periods were proposed based on the type and severity of injury or surgery. Surveys of the Driver and Vehicle Licensing Agency, the Police, insurance companies in the United Kingdom and Orthopaedic Surgeons offered a variety of opinions. There is currently insufficient evidence for any authoritative body to determine fitness to drive. The lack of guidance could result in patients being withheld from driving for longer than is necessary, or returning to driving while still unsafe. Cite this article: Bone Joint J 2013;95-B:290–4.
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- 2013
31. Sclerostin does not play a major role in the pathogenesis of skeletal complications in type 2 diabetes mellitus
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Ines Reichert, Jean-Paul Roux, N. Lund, Delphine Farlay, A. Hvid, Stephanie Gohin, Peter Smitham, Marie Pereira, M. J. Oddy, Chantal Chenu, Mark E. Cleasby, and University of London [London]
- Subjects
Blood Glucose ,Male ,0301 basic medicine ,HIGH GLUCOSE ,endocrine system diseases ,Endocrinology, Diabetes and Metabolism ,[SDV]Life Sciences [q-bio] ,Type 2 diabetes ,Pathogenesis ,chemistry.chemical_compound ,0302 clinical medicine ,Bone Density ,RAT MODEL ,STRENGTH ,Adipocytes ,Cells, Cultured ,Zucker rats ,Bone Morphogenetic Proteins ,Cancellous Bone ,High glucose ,Original Article ,Bone Remodeling ,BONE-MINERAL DENSITY ,GLYCATION END-PRODUCTS ,Life Sciences & Biomedicine ,Genetic Markers ,medicine.medical_specialty ,ECOSIS_ACL\₂012\₂017_WOS ,Sclerostin ,Rat model ,INHIBITION ,030209 endocrinology & metabolism ,MASS ,Osteocytes ,Diabetes Mellitus, Experimental ,Endocrinology & Metabolism ,03 medical and health sciences ,Hardness ,Internal medicine ,Cortical Bone ,medicine ,Animals ,RNA, Messenger ,Bone ,Science & Technology ,business.industry ,Body Weight ,Type 2 Diabetes Mellitus ,nutritional and metabolic diseases ,1103 Clinical Sciences ,X-Ray Microtomography ,IN-VITRO ,medicine.disease ,Zdf rats ,Rheumatology ,Rats, Zucker ,MICE ,030104 developmental biology ,Endocrinology ,Diabetes Mellitus, Type 2 ,chemistry ,CELLS ,business - Abstract
Summary: In contrast to previously reported elevations in serum sclerostin levels in diabetic patients, the present study shows that the impaired bone microarchitecture and cellular turnover associated with type 2 diabetes mellitus (T2DM)-like conditions in ZDF rats are not correlated with changes in serum and bone sclerostin expression. Introduction: T2DM is associated with impaired skeletal structure and a higher prevalence of bone fractures. Sclerostin, a negative regulator of bone formation, is elevated in serum of diabetic patients. We aimed to relate changes in bone architecture and cellular activities to sclerostin production in the Zucker diabetic fatty (ZDF) rat. Methods: Bone density and architecture were measured by micro-CT and bone remodelling by histomorphometry in tibiae and femurs of 14-week-old male ZDF rats and lean Zucker controls (n = 6/group). Results: ZDF rats showed lower trabecular bone mineral density and bone mass compared to controls, due to decreases in bone volume and thickness, along with impaired bone connectivity and cortical bone geometry. Bone remodelling was impaired in diabetic rats, demonstrated by decreased bone formation rate and increased percentage of tartrate-resistant acid phosphatase-positive osteoclastic surfaces. Serum sclerostin levels (ELISA) were higher in ZDF compared to lean rats at 9 weeks (+40 %, p
- Published
- 2016
32. Linking wheelchair kinetics to glenohumeral joint demand during everyday accessibility activities
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Peter Smitham, Tatsuto Suzuki, Angela Gall, Stephen Taylor, Catherine Holloway, and Andrew Symonds
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Engineering ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Electromyography ,Shoulder Joint ,Biomechanics ,Biomedical Engineering ,Cross slope ,Kinematics ,Trunk ,Biomechanical Phenomena ,medicine.anatomical_structure ,Physical medicine and rehabilitation ,Wheelchair ,Wheelchairs ,medicine ,Physical therapy ,Upper limb ,Humans ,Shoulder joint ,business ,Muscle, Skeletal - Abstract
The aim of the study was to investigate if push-rim kinetics could be used as markers of glenohumeral joint demand during manual wheelchair accessibility activities; demonstrating a method of biomechanical analysis that could be used away from the laboratory. Propulsion forces, trunk and upper limb kinematics and surface electromyography were recorded during four propulsion tasks (level, 2.5% cross slope, 6.5% incline and 12% incline). Kinetic and kinematic data were applied to an OpenSim musculoskeletal model of the trunk and upper limb, to enable calculation of glenohumeral joint contact force. Results demonstrated a positive correlation between propulsion forces and glenohumeral joint contact forces. Both propulsion forces and joint contact forces increased as the task became more challenging. Participants demonstrated increases in trunk flexion angle as the requirement for force application increased, significantly so in the 12% incline. There were significant increases in both resultant glenohumeral joint contact forces and peak and mean normalized muscle activity levels during the incline tasks. This study demonstrated the high demand placed on the glenohumeral joint during accessibility tasks, especially as the gradient of incline increases. A lightweight instrumented wheelchair wheel has potential to guide the user to minimize upper limb demand during daily activity.
- Published
- 2016
33. Relationship of Surgical Accuracy and Clinical Outcomes in Charitè Lumbar Disc Replacement
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Christopher W. Jones, Peter Smitham, and William R. Walsh
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Radiography ,Retrospective cohort study ,Lumbar vertebrae ,medicine.disease ,Arthroplasty ,Surgery ,Lumbar disc ,Intervertebral disk ,medicine.anatomical_structure ,medicine ,Orthopedics and Sports Medicine ,Heterotopic ossification ,business ,Reduction (orthopedic surgery) - Abstract
Objective To retrospectively assess the clinical and functional outcomes of a group of patients receiving Charite lumbar disc replacement and to compare those outcomes to the corresponding surgical technical accuracy. Methods A retrospective study of all patients treated over a 3-year period was undertaken. Objective pain scores were quantified from 1 to 10. Short Form 36-Health Survey (SF-36v2) scores were compared to Australian population norms. Surgical placements were radiographically classified. Heterotopic ossification, disc height restoration and angle-defined instability were assessed using established protocols. Results Twenty-five patients were identified with three patients lost to follow-up. Average follow-up was 34 months. Ideal surgical placement was achieved in five (33%) single-level and three (37.5%) dual-level disc replacements. Sub-optimal surgical placement was seen in nine (60%) single-level and five (62.5%) dual-level disc replacements. Poor surgical placement was observed in a single-level disc replacement. All patients demonstrated a reduction in objective pain score (P < 0.05). SF-36v2 outcomes were superior in single-level compared to dual-level and ideal compared to sub-optimal replacements (P < 0.05). Conclusion The hypothesis that ideal surgical placements are associated with improved clinical and functional outcomes in total lumbar disc replacement was confirmed.
- Published
- 2012
34. A comparison of two elbow crutch designs on functional performance in elite football (soccer) players with amputation
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Adam West, Richard Weiler, and Peter Smitham
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medicine.medical_specialty ,Engineering ,biology ,Athletes ,business.industry ,medicine.medical_treatment ,Crutch ,Physical Therapy, Sports Therapy and Rehabilitation ,Human Factors and Ergonomics ,Perceived exertion ,biology.organism_classification ,Elbow crutch ,Test (assessment) ,Amputation ,Football soccer ,Physical therapy ,medicine ,Orthopedics and Sports Medicine ,business ,Engineering (miscellaneous) ,Simulation ,Mobility aid - Abstract
This study compares different measures of performance and participant preferences using two different crutch designs with elite footballers with amputation; a traditional elbow crutch and spring-assisted crutch. Seven male international athletes were randomly assigned to one of the crutch designs. Tests of speed and agility were performed one week apart. Participants completed a questionnaire regarding perceived pain, stability, fatigue, ease of use and crutch design preferences. Participants using the traditional elbow crutch were significantly (p
- Published
- 2012
35. The Role of Perioperative Care in Reducing Rates of Methicillin Resistant Staphylococcus Aureus
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Clare Byrne, Wasim S. Khan, Peter Smitham, and Alexandra Hazlerigg
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Methicillin-Resistant Staphylococcus aureus ,medicine.medical_specialty ,Septic shock ,business.industry ,Perioperative ,Staphylococcal Infections ,biochemical phenomena, metabolism, and nutrition ,bacterial infections and mycoses ,medicine.disease ,Staphylococcal infections ,medicine.disease_cause ,Methicillin-resistant Staphylococcus aureus ,Perioperative Care ,Medical–Surgical Nursing ,Anesthesiology and Pain Medicine ,Antibiotic resistance ,Staphylococcus aureus ,medicine ,Humans ,Endocarditis ,Surgery ,Septic arthritis ,Intensive care medicine ,business - Abstract
Methicillin resistant Staphylococcus aureus (MRSA) is defined as any strain of Staphylococcus aureus resistant to beta-lactam antibiotics, including the penicillins and cephalosporins. Over the past ten years the UK has seen a dramatic increase in MRSA prevalence in healthcare facilities and the community, with an estimated 30–50% of healthy adults thought to be colonised with MRSA. Surgical patients are among those at highest risk. With potential sequelae including septicaemia, septic shock, septic arthritis, osteomyelitis, meningitis, pneumonia or endocarditis, it is vital that all care facilities have up to date evidence-based guidelines to tackle this problem. The purpose of this review is to highlight the current evidence supporting some of the key perioperative measures which may be implemented in preventing MRSA.
- Published
- 2011
36. Bone Cement: Perioperative Issues, Orthopaedic Applications and Future Developments
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Christopher John O'Dowd-Booth, Peter Smitham, Wasim S. Khan, Jonathan J E White, and David Marsh
- Subjects
musculoskeletal diseases ,Cement ,Engineering ,medicine.medical_specialty ,Polymethyl methacrylate ,business.industry ,Bone Cements ,technology, industry, and agriculture ,Total hip replacement ,Dentistry ,General Medicine ,Perioperative ,equipment and supplies ,Bone cement ,surgical procedures, operative ,Orthopedic surgery ,Orthopaedic procedures ,medicine ,Humans ,Polymethyl Methacrylate ,Arthroplasty, Replacement ,business ,Cementation - Abstract
Bone cement has been increasingly used in orthopaedic surgery over the last 50 years. Since Sir John Charnley pioneered the use of polymethylmethacrylate cement in total hip replacements, there have been developments in cementing techniques and an expansion in the number of orthopaedic procedures that use cement. This review covers the perioperative issues surrounding bone cement including storage, cementing techniques and complications. It also discusses specific orthopaedic applications of bone cement and future developments.
- Published
- 2011
37. Dupuytren's Disease: Review of the Current Literature
- Author
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Morsi Khashan, Peter Smitham, Nicholas J. Goddard, and Wasim S. Khan
- Subjects
medicine.medical_specialty ,Pathology ,Contracture ,hand ,business.industry ,MEDLINE ,Disease ,Hand surgeons ,Article ,Review article ,body regions ,Dupuytren’s disease ,Dupuytren’s nodules ,fasciectomy ,medicine ,Etiology ,medicine.symptom ,Intensive care medicine ,business ,Loss function - Abstract
Dupuytren's disease is one of the most common condition seen by hand surgeons. It is not only prevalent but can also be a most debilitating condition resulting in significant loss of function of the fingers involved. The cause of this disease, however still remains largely unknown although some recent evidence suggests a stem cell etiology. This review article summarizes the current known knowledge of Dupuytren's as well as the clinical findings, investigations and treatments available.
- Published
- 2011
38. Perioperative Implications of Surgery in Elderly Patients with Hip Fractures: An Evidence-Based Review
- Author
-
Wasim S. Khan, Jonathan J E White, and Peter Smitham
- Subjects
medicine.medical_specialty ,Standard of care ,Population ,Comorbidity ,Perioperative Care ,Postoperative Complications ,Humans ,Medicine ,education ,Geriatric Assessment ,Aged ,Pressure Ulcer ,Older person ,Pain, Postoperative ,education.field_of_study ,Hip fracture ,Hip Fractures ,business.industry ,Delirium ,Venous Thromboembolism ,General Medicine ,Perioperative ,Evidence based review ,medicine.disease ,United Kingdom ,Surgery ,Physical therapy ,medicine.symptom ,business - Abstract
Hip fracture is a major cause of morbidity, mortality and loss of independence for the elderly. Surgical fixation of the fractured hip remains the standard of care to allow for early mobilisation and a return to independence. Operative management in this population carries its own set of problems. The altered physiological state of the older person, often coupled with significant co-morbidity, can present challenges for the anaesthetist, the surgeon and the rest of the perioperative team. This article provides an evidence-based review of the important perioperative factors associated with hip fractures in the older person and their management.
- Published
- 2011
39. A Modified Technique of Using the S-Quattro External Finger Fixation System- A Case Report
- Author
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Nabil R M Fahmy, Peter Smitham, and Wasim S. Khan
- Subjects
Orthodontics ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,education ,Rehabilitation ,Intraarticular fracture ,Modified technique ,Soft tissue ,Metacarpophalangeal joint ,Surgery ,Fixation (surgical) ,medicine.anatomical_structure ,Fracture fixation ,medicine ,Internal fixation ,Orthopedics and Sports Medicine ,Kirschner wire ,business - Abstract
Fractures of the phalangeal joints of the hand present a challenging problem because of the small size of the fracture fragments, limiting internal fixation, and their articular nature necessitating early mobilisation to ensure good results. We present a case of a patient presenting with an open displaced intraarticular fracture of the metacarpophalangeal joint that was managed with limited internal fixation with a Kirschner wire along with the S-Quattro. The fracture united and the patient returned to his previous occupation with no limitations in his activities of daily living. This is the first instance of S-Quattro being described for the management of an open fracture with the additional use of limited internal fixation. The additional use of limited internal fixation ensured adequate fracture reduction and stabilisation. The S-Quattro application does not require significant soft tissue dissection, making it particularly suited to open fractures.
- Published
- 2011
40. What shape do UK surgical trainees want their training to be?
- Author
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A. Vesey, Richard J. McGregor, Peter Smitham, Vimal J. Gokani, M. Rashid, and R.L. Harries
- Subjects
Medical education ,business.industry ,education ,Medicine ,Surgery ,General Medicine ,business ,Training (civil) ,humanities - Published
- 2016
- Full Text
- View/download PDF
41. The Compressive Properties of Bone Cements Containing Large Doses of Antibiotics
- Author
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Peter Smitham, Lawrie Malisano, Matthew H. Pelletier, Koji Okamoto, and William R. Walsh
- Subjects
medicine.medical_specialty ,Compressive Strength ,medicine.drug_class ,medicine.medical_treatment ,Antibiotics ,Methylmethacrylate ,Floxacillin ,Vancomycin ,Materials Testing ,medicine ,Polymethyl Methacrylate ,Drug Interactions ,Orthopedics and Sports Medicine ,Saline ,Curing (chemistry) ,Cement ,business.industry ,Bone Cements ,Bone cement ,Anti-Bacterial Agents ,Surgery ,Compressive strength ,Flucloxacillin ,business ,Biomedical engineering ,medicine.drug - Abstract
The addition of large amounts of antibiotics to bone cement provides a convenient local delivery, but may influence the compressive properties of the cement. Flucloxacillin and vancomycin were added to Simplex P (Stryker, Limerick, Ireland) and VersaBond (Smith & Nephew) cements. Tripling the antibiotic dose from 2 to 6 g had little effect on the static compressive properties 24 hours after curing. After 4 weeks in phosphate-buffered saline, there was marked decrease in properties with the addition of antibiotics. Compressive strength of cements with 6 g of antibiotic was reduced to near or below the ASTM and ISO minimum of 70 MPa after 4 weeks in phosphate-buffered saline. Microcomputer tomography revealed increased porosity and clumping of the radiopacifier with the addition of antibiotics.
- Published
- 2009
42. Biomechanical Influence of the Vincula Tendinum on Digital Motion After Isolated Flexor Tendon Injury: A Cadaveric Study
- Author
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Peter Smitham, Mark P. Gianoutsos, William R. Walsh, and David A. Stewart
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,Movement ,Tendons ,Weight-Bearing ,Tendon Injuries ,Finger Injuries ,Cadaver ,medicine ,Humans ,Orthopedics and Sports Medicine ,Aged ,Aged, 80 and over ,Flexor tendon ,business.industry ,Biomechanics ,Metacarpophalangeal joint ,Anatomy ,musculoskeletal system ,Numerical digit ,Tendon ,body regions ,medicine.anatomical_structure ,Orthopedic surgery ,Surgery ,Cadaveric spasm ,business ,Interphalangeal Joint - Abstract
Purpose The vincula are specialized mesotendinous structures attaching to the flexor tendons of the hand. In addition to providing vascular supply to the tendons, the vincula can be mechanically important. The purpose of this study was to quantify the influence of intact vincula on digital flexion after flexor tendon laceration and to assess the ultimate strength and stiffness of the vincula. Methods The index, middle, and ring fingers of 12 fresh-frozen cadaveric fingers were dissected free at the level of the metacarpophalangeal joint, preserving at least 10 cm of the flexor and extensor tendons. A 9.8-N load was applied to each flexor tendon, and using digital photography and image analysis software, the degree of flexion at the proximal and distal interphalangeal joints and excursion of tendons proximal to the metacarpophalangeal joint was recorded before and after division of the flexor digitorum profundus and flexor digitorum superficialis tendons at their insertions. Load to failure and stiffness of the vincula were measured via a uniaxial material testing apparatus. Analysis of means was performed with a paired t -test. Results After division of the flexor digitorum superficialis tendon, proximal interphalangeal joint flexion secondary to the influence of the intact vincula was 93% of that compared with the uninjured digit. Distal interphalangeal joint flexion after flexor digitorum profundus transection was 69% of normal. The increased excursion of transected tendons compared with testing before division was 4 mm for flexor digitorum superficialis and 2 mm for flexor digitorum profundus. Load to failure was 27 N, and stiffness was 6 N/mm. Conclusions The vincula breve can facilitate digital flexion after distal tendon transection, allowing tendons to act indirectly across the interphalangeal joints. The intact vincula breve can facilitate an almost normal range of motion across the interphalangeal joints, making the diagnosis of a flexor tendon injury difficult. In the immediate postinjury period, the vincula breve can hold a divided tendon within a few millimeters of its insertion. Testing against resistance is important to avoid missing the diagnosis of a tendon injury.
- Published
- 2007
43. Influence of surgical preparation on the in-vivo response of osteochondral defects
- Author
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Yan Yu, T. Gothelf, William R. Walsh, Rema A. Oliver, Frank Vizesi, and Peter Smitham
- Subjects
Cartilage, Articular ,Male ,Fractures, Cartilage ,Wound Healing ,medicine.medical_specialty ,Sheep ,business.industry ,Mechanical Engineering ,Cartilage ,Inflammatory response ,General Medicine ,Surgery ,Disease Models, Animal ,medicine.anatomical_structure ,Tissue engineering ,In vivo ,medicine ,Animals ,Surgical preparation ,business - Abstract
Cartilage has an extremely poor capacity to heal, which has lead to intensive research into biomaterials and tissue engineering for the purpose of regenerating cartilage in vivo. Many of these techniques have shown great promise in vitro; however, the results do not always carry across to the in-vivo scenario. Healthy cartilage autografts often do not integrate with the adjacent cartilage, suggesting that cartilage is rarely capable of healing even under ideal conditions. It is hypothesized in this study that the surgical creation of defects in cartilage causes significant damage to the adjacent tissues, leading to further degradation of the cartilage and poor outcome for the repair in general. This study compares the healing response of osteochondral defects created with either a punch or a drill in the weight-bearing region of the sheep knee at 4 and 26 weeks following surgery. The use of a drill to create the defect creates a more aggressive inflammatory response at 4 weeks compared with a punch. However, by 26 weeks, defects created with a punch scored higher on the O'Driscoll cartilage grading scale. Tissue damage at the time of surgery plays an important part in the sequence of events for healing of cartilage defects. This knowledge will help to characterize and refine the ovine model for cartilage regeneration and may have an influence on surgical technique and instrumentation for clinical cartilage repair.
- Published
- 2007
44. Increased circulating sclerostin levels in type 2 diabetic rats are not associated with changes in bone sclerostin production
- Author
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Chantal Chenu, Stephanie Gohin, Michael Oddy, Nina Lund, Peter Smitham, Ines Reichert, Marie Pereira, and Anne Hvid
- Subjects
medicine.medical_specialty ,chemistry.chemical_compound ,Endocrinology ,chemistry ,business.industry ,Internal medicine ,medicine ,Sclerostin ,business - Published
- 2015
45. Validation of a modified FRAX® tool for improving outpatient efficiency—part of the 'Catch Before a Fall' initiative
- Author
-
Maria Ciaccio, Simon Parker, Simon Grange, Graham Davenport, Peter Smitham, A Cooper, and Erica Cook
- Subjects
Male ,Self-assessment ,medicine.medical_specialty ,FRAX ,Concordance ,Poison control ,Risk Assessment ,Sensitivity and Specificity ,Quality of life (healthcare) ,Ambulatory care ,Bone Density ,Risk Factors ,Outpatients ,medicine ,Humans ,Outpatient clinic ,Orthopedics and Sports Medicine ,Aged ,Aged, 80 and over ,business.industry ,Body Weight ,Middle Aged ,Decision Support Systems, Clinical ,medicine.disease ,Body Height ,Physical therapy ,Female ,Self Report ,Medical emergency ,business ,Risk assessment ,Osteoporotic Fractures - Abstract
We have validated our touch-screen-modified FRAX® tool against the traditional healthcare professional-led questionnaire, demonstrating strong concordance between doctor- and patient-derived results. We will use this in outpatient clinics and general practice to increase our capture rate of at-risk patients, making valuable use of otherwise wasted patient waiting times.Outpatient clinics offer an opportunity to collect valuable health information from a captive population. We have previously developed a modified fracture risk assessment (FRAX®) tool, enabling patients to self-assess their osteoporotic fracture risk in a touch-screen computer format and demonstrated its acceptability with patients. We aim to validate the accuracy of our tool against the traditional questionnaire.Fifty patients over 50 years of age within the fracture clinic independently completed a paper equivalent of our touch-screen-modified FRAX® questionnaire. Responses were analysed against the traditional healthcare professional (HCP)-led questionnaire which was carried out afterwards. Correlation was assessed by sensitivity, specificity, Cohen's kappa statistic and Fisher's exact test for each potential FRAX® outcome of "treat", "measure BMD" and "lifestyle advice".Age range was 51-98 years. The FRAX® tool was completed by 88 % of patients; six patients lacked confidence in estimating either their height or weight. Following question adjustment according to patient response and feedback, our tool achieved95 % sensitivity and specificity for the "treat" and "lifestyle advice" groups, and 79 % sensitivity and 100 % specificity in the "measure BMD" group. Cohen's kappa value ranged from 0.823 to 0.995 across all groups, demonstrating "very good" agreement for all. Fisher's exact test demonstrated significant concordance between doctor and patient decisions.Our modified tool provides a simple, accurate and reliable method for patients to self-report their own FRAX® score outside the clinical contact period, thus releasing the HCP from the time required to complete the questionnaire and potentially increasing our capture rate of at-risk patients.
- Published
- 2015
46. How I got into orthopaedics – Peter Smitham
- Author
-
Peter Smitham
- Subjects
business.industry ,Medicine ,Orthopedics and Sports Medicine ,business ,Classics - Published
- 2015
47. Less than full-time training in surgery: A cross sectional study of surgical trainees
- Author
-
J.E.F. Fitzgerald, Peter Smitham, R.L. Harries, and Vimal J. Gokani
- Subjects
medicine.medical_specialty ,Less than full time ,Cross-sectional study ,business.industry ,education ,Physical therapy ,medicine ,Training (meteorology) ,Surgery ,General Medicine ,business - Published
- 2016
48. Use of inertial measurement units to assess age-related changes in gait kinematics in an active population
- Author
-
Andy Goldberg, M. Thornton, Peter Smitham, Ian McCarthy, and Maureen Monda
- Subjects
Adult ,Male ,medicine.medical_specialty ,Aging ,Adolescent ,Population ,STRIDE ,Physical Therapy, Sports Therapy and Rehabilitation ,Thigh ,Units of measurement ,Young Adult ,Physical medicine and rehabilitation ,medicine ,Humans ,education ,Gait ,Aged ,Aged, 80 and over ,education.field_of_study ,business.industry ,Rehabilitation ,Swing ,Middle Aged ,Biomechanical Phenomena ,body regions ,medicine.anatomical_structure ,Lower Extremity ,Duration (music) ,Gait analysis ,Female ,Geriatrics and Gerontology ,business ,human activities ,Gerontology - Abstract
To study mobility in older populations it can be advantageous to use portable gait analysis systems, such as inertial measurement units (IMUs), which can be used in the community. To define a normal range, 136 active subjects were recruited with an age range of 18 to 97. Four IMUs were attached to the subjects, one on each thigh and shank. Subjects were asked to walk 10 m at their own self-selected speed. The ranges of motion of thigh, shank, and knee in both swing and stance phase were calculated, in addition to stride duration. Thigh, shank, and knee range of movement in swing and stance were significantly different only in the > 80 age group. Regressions of angle against age showed a cubic relationship. Stride duration showed a weak linear relationship with age, increasing by approximately 0.1% per year.
- Published
- 2013
49. What shape do UK trainees want their training to be? Results of a cross-sectional study
- Author
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Richard J. McGregor, Alex Vesey, Jonathan Frost, Gana Kugathasan, Walid Al-Deeb, Mustafa Rashid, Matthew Prior, Karl Scheeres, Peter Smitham, Jon Bailey, Syed Mohammed Afzal Sohaib, Rhiannon L Harries, and Vimal J. Gokani
- Subjects
Male ,Consultants ,Cross-sectional study ,shape of training ,Credentialing ,MEDICAL EDUCATION & TRAINING ,0302 clinical medicine ,Surveys and Questionnaires ,postgraduate training ,Medicine ,Prospective Studies ,030212 general & internal medicine ,Medicine(all) ,education.field_of_study ,Education, Medical ,General Medicine ,HOSPITAL VOLUME ,030220 oncology & carcinogenesis ,Female ,Clinical Competence ,Curriculum ,Life Sciences & Biomedicine ,Specialization ,Attitude of Health Personnel ,education ,Population ,Specialty ,Training (civil) ,03 medical and health sciences ,Medicine, General & Internal ,Nursing ,General & Internal Medicine ,Greenaway review ,Physicians ,Humans ,Social media ,Government ,Science & Technology ,business.industry ,Research ,MORTALITY ,Medical Education and Training ,United Kingdom ,Cross-Sectional Studies ,business - Abstract
Objectives The British Government is acting on recommendations to overhaul postgraduate training to meet the needs of the changing population, to produce generalist doctors undergoing shorter broad-based training (Greenaway Review). Only 45 doctors in training were involved in the consultation process. This study aims to obtain a focused perspective on the proposed reforms by doctors in training from across specialities. Design Prospective, questionnaire-based cross-sectional study. Setting/participants Following validation, a 31-item electronic questionnaire was distributed via trainee organisations and Postgraduate Local Education and Training Board (LETB) mailing lists. Throughout the 10-week study period, the survey was publicised on several social media platforms. Results Of the 3603 demographically representative respondents, 69% knew about proposed changes. Of the respondents, 73% expressed a desire to specialise, with 54% keen to provide general emergency cover. A small proportion (12%) stated that current training pathway length is too long, although 86% felt that it is impossible to achieve independent practitioner-level proficiency in a shorter period of time than is currently required. Opinions regarding credentialing were mixed, but tended towards disagreement. The vast majority (97%) felt credentialing should not be funded by doctors in training. Respondents preferred longer placement lengths with increasing career progression. Doctors in training value early generalised training (65%), with suggestions for further improvement. Conclusions This is the first large-scale cross-specialty study regarding the Shape of Training Review. Although there are recommendations which trainees support, it is clear that one size does not fit all. Most trainees are keen to provide a specialist service on an emergency generalist background. Credentialing is a contentious issue; however, we believe removing aspects from curricula into post-Certificate of Completion of Training (CCT) credentialing programmes with shortened specialty training routes only degrades the current consultant expertise, and does not serve the population. Educational needs, not political winds, should drive changes in postgraduate medical education and all stakeholders should be involved.
- Published
- 2016
50. The development and validation of a test for core stability
- Author
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Andy Goldberg, Peter Smitham, Ian McCarthy, Tony Betts, and Syed Aftab
- Subjects
business.industry ,Medicine ,Core stability ,Surgery ,Orthopedics and Sports Medicine ,Neurology (clinical) ,business ,Reliability engineering ,Test (assessment) - Published
- 2016
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