Search

Females remain under-represented in surgery in the United Kingdom and around the globe. Gender representation on journal editorial boards is one of the key metrics of gender representation within academic surgery. The aim of this study was to quantify gender representation within the editorial leadership of journals affiliated with UK surgical specialties. A web-based search for each of the UK surgical specialty associations was conducted, followed by identification of the endorsed journals for each one. As of August 2022, data on the gender of the editor-in-chief and other journal leadership positions, including associate, section, and deputy editors, were collated. Gender classification was completed using first-name recognition, verified by a web search using the name and institution provided. Managing editors without clinical backgrounds were excluded. Ten journals were identified for the following surgical specialties: General Surgery, Trauma and Orthopaedics, Neurosurgery, Cardiothoracic, Urology, Paediatric Surgery, Ear Nose and Throat, Oral and Maxillofacial, Plastic and Reconstructive Surgery, and Vascular Surgery. In total, 242 editorial positions were identified: 207 were held by males (82.8%) and 35 by females (17.2%). There were no female editors-in-chief. The average female proportion of editorial leadership per journal was 18.8%. One journal had no female editorial leadership representation. Overall, the number of females in editorial leadership positions is comparable to the current proportion of UK female consultant surgeons (13.7%). Journals with an under-representation of females in senior editorial leadership positions compared with the parent specialty should consider initiatives that will encourage diversity, promote greater gender parity, and champion female representation. [ABSTRACT FROM AUTHOR]

Background Congenital indifference to pain with anhidrosis (CIPA) is a rare hereditary neuropathy, which is associated with defective sensation to noxious stimuli and autonomic dysfunction. The objective of the study was to report on the orthopaedic manifestations of this condition and provide an evidence-based approach for management. Methods Retrospective review of 14 consecutive patients with CIPA referred to a single tertiary centre. Mean age of diagnosis was 2.5 years (range 0.5 to 11 years). Results Patients presented with a range of orthopaedic problems including fractures, infections, growth disturbance, joint subluxation and Charcot joints affecting the limbs and spine. Conservative treatment with closed reduction and cast immobilisation was satisfactory for stress fractures of the lower extremity and Charcot joints. Posterior instrumented correction of scoliosis was associated with a high-risk of infection requiring reoperation for debridement and removal of posterior instrumentation. Growth disturbance leading to leg-length discrepancies were managed with shoe raises and corrective osteotomies. Aspiration and cultures may be used to differentiate between acute fracture and infection. Conclusions Preventative treatment strategies with appropriately padded shoe-wear, gait and posture modification, parental education regarding environmental thermoregulation, and behavioural support are essential for improving prognosis and reducing long-term complications. [ABSTRACT FROM AUTHOR]

Abstract: Normal development is not an exact science. Children progress in a variety of ways without falling outside the normal range. This applies to the shape of their legs and feet, as well as the onset and development of their gait pattern. Deviation from parents' expectations may lead to considerable anxiety and medical consultation. It is essential to identify the important pathological diagnoses amongst the array of normal variants to facilitate early intervention and optimise outcomes. [Copyright &y& Elsevier]

Abstract: The paediatric skeleton differs from that of an adult in that the bones are more elastic and they contain growth plates (physes). Physeal injuries affect the growth plates of children and adolescents. A basic understanding of the anatomy and physiology of the physis is mandatory in order that injuries to the growth plate can be managed effectively. Salter and Harris described a classification for physeal injuries based on radiographic findings. The system predicts the prognosis for any given injury and guides treatment choice. The goal of treatment is to achieve and maintain an acceptable reduction of the fracture without compromising the germinal layer of the growth plate. A comprehensive understanding of remodelling potential related to patient age and site of injury is essential and influences treatment. Occasionally, malunion and growth arrest can occur. The management of these complications ranges from simple observation to complex deformity correction. The clinician should know how to avoid such complications but also know how to recognize them should they occur. [Copyright &y& Elsevier]

Background: Adolescent posteriorly displaced physeal injuries of the medial clavicle are uncommon. Up to 50% of conservatively treated patients remain symptomatic, and late surgery is hazardous. Stability is rarely achieved with closed or open reduction alone, and internal fixation is usually required. Previously described options for fixation achieve stability of the medial clavicle by securing it to the intact epiphysis. Because the epiphyseal fragment is small, fixation is achieved using sutures or wires. This relies on the size and structural integrity of the medial fragment, which in our experience can be variable. We hypothesized that a novel technique of operative stabilization of these injuries, which does not require fixation to the epiphyseal fragment and uses no metalwork, is safe and effective in treating these injuries. Materials and methods: The operative technique involves suturing the medial clavicle to the anterior platysmal and periosteal layer using absorbable sutures passed through drill holes in the medial clavicle. Patients were assessed clinically an average of 9 months after surgery. Results: We treated 7 patients with this method. There were no intraoperative complications. All patients were pain-free and symptom-free and had a full range of movement at follow-up. All patients had returned to their preinjury level of sports. Conclusions: We recommend this technique for treating these uncommon injuries. It is simple, safe, and reproducible and it produces good results. [ABSTRACT FROM AUTHOR]

Abstract: The paediatric skeleton differs from that of an adult in that the bones are more elastic and they contain growth plates (physes). Physeal injuries affect the growth plates of children and adolescents. A basic understanding of the anatomy and physiology of the physis is mandatory in order that injuries to the growth plate can be managed effectively. Salter and Harris described a classification for physeal injuries based on radiographic findings. The system predicts the prognosis for any given injury and guides treatment choice. The goal of treatment is to achieve and maintain an acceptable reduction of the fracture without compromising the germinal layer of the growth plate. A comprehensive understanding of remodelling potential related to patient age and site of injury is essential and influences treatment. Occasionally, malunion and growth arrest can occur. The management of these complications ranges from simple observation to complex deformity correction. The clinician should know how to avoid such complications, but also know how to recognize them should they occur. [Copyright &y& Elsevier]

Abstract: Harrison TP, Sadnicka A, Eastwood DM. Motor points for the neuromuscular blockade of the subscapularis muscle. Objective: To locate the motor points of the subscapularis muscle in relation to palpable anatomic landmarks and hence suggest a technique for botulinum toxin injection into subscapularis applicable to patients of all ages. Design: Anatomic dissection of the innervation of 20 subscapular muscles. Setting: University dissecting room. Cadavers: Ten formalin-preserved cadavers. Interventions: Not applicable. Main Outcome Measure: The location of motor points in relation to anatomic landmarks. Results: The median number of motor points for the subscapularis was 5 (range, 3−6). All motor point measurements were related to surface points and converted into proportional values along reference lines. Motor points from the 20 dissections showed clustering in a band. A line of best fit was calculated (y=1.48x–0.743). Conclusions: We describe an injection technique that would deliver botulinum toxin close to the motor points of the subscapularis, a surrogate marker of the motor endplate zones. By using proportional distances, this technique is applicable to an adult and pediatric population. This should lead to an increased efficacy and decreased side-effect profile in clinical practice, although clinical trials will need to confirm this. [Copyright &y& Elsevier]

A pre-meeting workshop on Long Bone Pathology in Children with Achondroplasia was held in Salzburg, Austria at the 11th International Conference on Children's Bone Health (ICCBH) 22–25 June 2024. There remains poor understanding and awareness amongst physicians managing achondroplasia of the underlying pathophysiology, radiology, natural history and orthopaedic procedures available for long bone deformities and restrictions. The structure of the workshop consisted of presentation of the results of a multinational patient survey on views of leg lengthening in achondroplasia, lectures, a debate and an interactive round table discussion. In total 150 attendees from 71 different cities and 31 countries were in attendance. • Long-limb surgery in achondroplasia is contentious with wide global variations in practices, outcomes and patient opinions. • Patients expressed concerns about timing and complications of surgery alongside benefits e.g. driving access and selfcare. • A balanced focus on corrective deformity correction verses limb lengthening is important when professionals speak to families. • Risks and benefits of orthopaedic options in achondroplasia are ideally discussed with families prior to an acute situation. • Less invasive: precision drug therapy; guided growth and telescopic intramedullary nails are becoming more available. [ABSTRACT FROM AUTHOR]