Search

BACKGROUND The purpose of this study was to compare total blood loss and the risk of receiving a blood transfusion in robotic-assisted total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) against conventional jig-based techniques. METHODS Robotic TKA (n = 50) and UKA (n = 50) patients were matched to contemporary controls for TKA (n = 50) and UKA (n = 50) and retrospectively analysed. RESULTS Robotic TKA patients experienced 23.7% less blood loss compared to conventional TKA patients (911.0 ml vs 1193.7 ml, p

Virtual fracture clinics (VFCs) have become widely adopted, aiming to improve efficiency, standardise patient care and reduce clinic appointments for injuries that can be managed conservatively. A variety of means exist to manage VFC referrals and assessment, including paper-based and digital methods. This study assesses VFC referral quality and outcomes before and after implementation of a digital VFC referral and management system. A retrospective analysis was conducted of all VFC referrals and assessments from July 2017–March 2020 in a large UK district general hospital. All referrals and assessments were analysed for quality and completeness of referral information, grade of assessor, outcome of assessment, referral-to-assessment time, and assessment-to-surgery time (for those requiring operative management). 3038 paper and 9,228 digital referrals were analysed by 2 separate reviewers. Quality and completeness of referral information showed significant improvement in 11 predetermined key data points with the digital referral system (p

The case we present suggests that it might be possible to overcompress the syndesmosis, causing subluxation of the talus within the ankle mortise. A 26-year-old female patient had had a Weber Type C ankle fracture internally fixed with a lateral plate and syndesmosis screws. Despite the fibula appearing well reduced and computed tomography imaging showing a well-aligned fibula within the fibular notch, anteromedial subluxation of the talus was present in the ankle mortise. Examination with the patient under anesthesia revealed a stable syndesmosis fixation; however, talar malpositioning was not affected by the foot position. The syndesmosis fixation was revised sequentially. As the fixation was relaxed sequentially, the talus appeared to reduce within the ankle mortise, with restoration of the previously obliterated medial clear space. The syndesmosis was stabilized with a single 3.5-mm cortical screw in a reduced position. The patient had made a full recovery at the 12-month follow-up examination, having undergone elective syndesmosis screw removal at 12 weeks postoperatively. Several studies have suggested that it might not be possible to overcompress the syndesmosis and have even advocated the use of a lag screw technique for syndesmosis fixation. Based on the present case, we would advise a degree of caution with this approach, because it might be possible to overcompress the syndesmosis and cause significant subluxation of the tibiotalar articulation.

Trauma meetings constitute the majority of clinical decision-making for new referrals and also act as a crucial tool to coordinate the trauma theatre list. Incorporation of electronic technology has been shown to improve the quality of patient handover. eTrauma is a recently developed cloud-based patient management platform which we planned to implement at our hospital. The aim of our project was to evaluate the quality of our current trauma meeting and subsequently the effect of implementing a modern trauma management platform. In order to identify the key concerns of staff members with the trauma meeting handover, a questionnaire was given to 20 members of the team. A review of effective handover guidelines published from the Royal College of Surgeons and the Royal College of Physicians was undertaken. We combined information from these guidelines to identify two key sets of data points for an effective trauma referral: patient demographics and referral details. Questionnaires were distributed at three separate time periods providing assessment of implementation of changes. The questionnaire results indicated progressive improvement in the morning trauma meeting with increased clarity for the anaesthetic team, better communication of operation to be performed, better documentation and clarity of management plans. A total of 150 referrals using the existing system (TIGER) were compared with 100 eTrauma referrals at two separate time intervals. Our analysis showed significant improvements in 12 (57%) of the 21 key data points indicating improved data entry for referrals using the new platform. Three PDSA (Plan, Do, Study, Act) cycles were completed with relevant adjustments within this process. Introduction of a new cloud-based trauma management platform has had a positive impact overall within our trust. Modern electronic trauma systems have the ability to improve our trauma management, this must go hand in hand, however, with a structured and effectively communicated trauma meeting.

Tarsal coalitions represent a cohort of conditions characterized by bony, cartilaginous, or fibrous union of two or more tarsal bones. These disorders are often poorly understood by medical professionals, often leading to delays in diagnosis and treatment. They may be asymptomatic or cause hindfoot pain, stiffness, decreased range of motion, and foot deformities. Coalitions can be investigated by an ascending sequence of imaging including radiography, computed tomography, and magnetic resonance imaging. They may be managed conservatively with orthoses, activity modification, physiotherapy, anti-inflammatory medications, or definitive surgical intervention. To our knowledge, cuboid-lateral cuneiform coalition has not been reported in the orthopedic literature. We describe a 40-year-old woman with this condition who reported a 1-year history of left foot pain and stiffness. She was definitively diagnosed with magnetic resonance imaging and was managed conservatively with an aircast boot and hydrocortisone injection.

Open ankle arthrodesis is one of the primary operations for disabling ankle arthrosis. The transfibular lateral approach to ankle fusion is a common approach for open ankle arthrodesis. Autologous bone graft can be harvested from the osteotomised fibula. We describe a safe technique of taking graduated slices of fibula bone graft, which allows optimal fibula length excision and are suitable in shape to pack into defects at the fusion site.

sion approach was used and repaired with anchor sutures. Results: Time to surgery, mean of 13.6 days, follow up mean 13.5 weeks, range 9 26 weeks. 2 patients lost to follow up at 9 weeks. Full range of movement in 15/17 patients. Pre-injury strength regained in 12/17 patients. 2 patients had reasonable power at 12 weeks. Slow improvement in 2 patients at week 12. 2 patients had complications, 1 had injury to lateral cutaneous nerve of the forearm, and 1 had a superficial blister proximal to the wound. Conclusions: Single incision approach has a low complication rate and a high satisfaction outcome. It provides acceptable functional recovery of elbow and forearm mechanics and we believe it a safe repair for distal biceps tendon injuries.