Search

Purpose. Non-weight bearing is often recommended after humeral fractures. This review aims to summarise the extent and nature of the evidence for the feasibility, acceptability, safety, and effects of early weight bearing (EWB) in people with humeral fractures, treated operatively or non-operatively. Methods. Data sources identified published (PUBMED, EMBASE, CINAHL) and unpublished (ClinicalTrials.gov, CENTRAL, NIHR Open Research, OpenGrey) literature. Independent data extraction was conducted by two reviewers. Results. 13 901 records were retrieved. Ten studies, involving 515 post-operative patients and 351 healthcare professionals, were included. EWB was found to be feasible in nine studies. There was limited evidence regarding adherence to EWB. Trauma and orthopaedic surgeons reported that EWB was acceptable. This depended on surgery type and whether it was a post-operative polytrauma case. No acceptability data was reported from patients’ perspectives. Only one study reported two patients who developed unsatisfactory outcomes from excessive post-operative EWB. Positive effects of EWB were reported on disability level, pain, shoulder and elbow motion, and union. Conclusion. There is some evidence for the feasibility, safety, and effectiveness of post-operative EWB after humeral fractures. There was limited data on the acceptability of EWB. Heterogeneous study designs, and variations in EWB protocols limit conclusions.

Glen Wilson,1 Alexander Zargaran,2 Ilya Kokotkin,1 Jared Bhaskar,3 David Zargaran,3 Alex Trompeter4 1Department of Medicine, St George’s, University of London, London, UK; 2Department of Medicine, King’s College London, London, UK; 3Department of Medicine, Imperial College London, London, UK; 4Department of Trauma & Orthopaedic Surgery, St George’s Hospital, London, UKCorrespondence: Alexander ZargaranKing’s College London, Guy’s Campus, Great Maze Pond, London SE1 1UL, UKTel +44 2071887188Email alexander.zargaran@kcl.ac.ukBackground: Orthopaedic surgery is underrepresented in the United Kingdom medical school curriculum, with an average of less than 3 weeks of exposure over the five-year degree. This study evaluates the effectiveness of high-fidelity virtual reality (VR) and physical model simulation in teaching undergraduate orthopaedic concepts.Methods: A modified randomised crossover trial was used. Forty-nine students were randomly allocated to two groups, with thirty-three finishing the six-week follow-up assessment. All undergraduate medical students were eligible for inclusion. Both groups were given introductory lectures, before completing a pre-test with questions on the principles of fracture fixation and osteotomy. Each group then received a lecture on these topics with the same content, but one was delivered with VR and the other with physical models. Both groups completed the post-course assessments. Knowledge was assessed by way of questionnaire immediately before, immediately after, and six-weeks after.Results: In the VR group, participants improved their post-training score by 192.1% (U=32; p< 0.00001). In the physical models group, participants improved their post-training scores by 163.1% (U=8.5; p< 0.00001). Overall, there was no statistically significant difference in the total means of post-training test scores between the VR and the physical models study groups (U=260.5; p

Glen Wilson,1 Alexander Zargaran,2 Ilya Kokotkin,1 Jared Bhaskar,3 David Zargaran,3 Alex Trompeter4 1Department of Medicine, St George’s, University of London, London, UK; 2Department of Medicine, King’s College London, London, UK; 3Department of Medicine, Imperial College London, London, UK; 4Department of Trauma & Orthopaedic Surgery, St George’s Hospital, London, UKCorrespondence: Alexander ZargaranKing’s College London, Guy’s Campus, Great Maze Pond, London SE1 1UL, UKTel +44 2071887188Email alexander.zargaran@kcl.ac.ukBackground: Orthopaedic surgery is underrepresented in the United Kingdom medical school curriculum, with an average of less than 3 weeks of exposure over the five-year degree. This study evaluates the effectiveness of high-fidelity virtual reality (VR) and physical model simulation in teaching undergraduate orthopaedic concepts.Methods: A modified randomised crossover trial was used. Forty-nine students were randomly allocated to two groups, with thirty-three finishing the six-week follow-up assessment. All undergraduate medical students were eligible for inclusion. Both groups were given introductory lectures, before completing a pre-test with questions on the principles of fracture fixation and osteotomy. Each group then received a lecture on these topics with the same content, but one was delivered with VR and the other with physical models. Both groups completed the post-course assessments. Knowledge was assessed by way of questionnaire immediately before, immediately after, and six-weeks after.Results: In the VR group, participants improved their post-training score by 192.1% (U=32; p< 0.00001). In the physical models group, participants improved their post-training scores by 163.1% (U=8.5; p< 0.00001). Overall, there was no statistically significant difference in the total means of post-training test scores between the VR and the physical models study groups (U=260.5; p

Alexander Zargaran,1 David Zargaran,2 Alex Trompeter3 1Department of Medicine, King’s College London, Guy’s Campus, London SE1 1UL, UK; 2Department of Medicine, Imperial College London, London SW7 2BU, UK; 3Department of Orthopaedic Surgery, St George’s Hospital, London SW17 0QT, UKCorrespondence: Alexander ZargaranDepartment of Medicine, Kings College London, Guy’s Campus, Great Maze Pond, London SE1 1UL, UKEmail alexander.zargaran@kcl.ac.ukBackground: An estimated one in two healthy adults in the United Kingdom suffer from low levels of 25[OH]D. Vitamin D is involved in modulating immune response, but there is less clarity over its role in orthopaedic infection. This study assesses the relationship between serum 25[OH]D concentration and orthopaedic infection.Methods: A total of 205 patients in a tertiary referral centre for orthopaedic infection were included in the study. They were divided into groups based on their infection status, matched by age and gender. Data were statistically analysed to determine presence and direction of relationship.Results: A total of 114 patients had an infection. There was no statistically significant difference in age or gender between the two groups. Mean serum 25[OH]D concentration was 39 nmol/L in the group with infection and 59 nmol/L in the group without an infection (p< 0.01). Overall mean serum 25[OH]D concentration was 48 nmol/L. There was a correlation between low serum 25[OH]D concentration and rate of infection (odds ratio, 5.94; 95% confidence interval [CI], 3.24 to 10.92) with a bivariate correlation of − 0.338 (p< 0.01).Conclusion: This study demonstrates an association between low levels of serum 25[OH]D and increased orthopaedic infection. Orthopaedic inpatients suffered from vitamin D insufficiency, and there was a correlation between higher levels of serum 25[OH]D and lower rates of infection. This suggests that prophylactic supplementation of 25[OH]