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Background:  The aim of the study is to identify the potential risk factors for postoperative AKI in hip fracture patients., Design and Methods:  Using our local neck of femur (NOF) registration data, patient details were selected using inclusion and exclusion criteria. Electronic records of patients were assessed retrospectively, including blood results, radiological investigations, clinical documentation, and drug charts. The time period was from the start of January 2022 to the end of June 2022., Inclusion Criteria: All patients > 50 years old with NOF fractures underwent operative management from January 2022 to June 2022., Exclusion Criteria: 1. Pathological fractures. 2. Non-operative management. 3. Died directly postoperative., Results: Two hundred and fifty patients underwent hip fracture surgery at our hospital in 6 months (January 2022-June 2022) (Cemented procedures were 133 [53%], while fixation procedures were 117 [47%]). Female patients were 174 (70%), and male patients were 76. The average age was 83.4 years, and the number of operations done over the weekend (Friday-Sunday) = 123 (49%). The incidence of postoperative AKI was 56 (22.4%). Forty-five of the fifty-six cases were stage one (80.4%), while seven cases (12.5%) were stage 2. The studied risk factors for postoperative AKI were cemented procedures (61% of postoperative AKI incidence), female gender (66%), time from admission to operation (>24 hours = 33%), day of operation (operations done Friday/Saturday/Sunday = 55%), and postoperative antibiotics (71%)., Conclusion:  We need strategies to reduce the incidence of postoperative AKI, like AKI alert on laboratory results, IV fluid prescription preoperatively since the arrival of patients to the ED, avoiding/stopping nephrotoxic medications on admission, regular review of postoperative renal function tests and fluid balance, especially in high-risk patients, increase nursing staff and junior doctors on wards over weekends, and we need to review our policy of giving postoperative IV antibiotics., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. University hospital sussex nhs foundation trust issued approval 1876. This is a retrospective audit or quality improvement project and it was approved by the audit department of the mentioned institution and the assignment number is attached. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Metry et al.)

Background: Bennett's fracture, a fracture-dislocation of the base of the first metacarpal, poses significant challenges due to the unique biomechanics of the thumb's carpometacarpal (CMC) joint. Effective management is critical to restoring thumb function and preventing long-term complications such as arthritis and instability., Objective: This article provides a comprehensive overview of Bennett's fracture, including its mechanism of injury, diagnostic considerations, and management strategies, with a focus on conservative and surgical options., Methods: A detailed review of the current literature was conducted to outline the principles and techniques of closed reduction with percutaneous pinning (CRPP), open reduction and internal fixation (ORIF), and emerging methods such as arthroscopic-assisted fixation., Results: Conservative management is appropriate for minimally displaced fractures but is often inadequate for displaced injuries due to persistent muscle forces acting on the metacarpal. CRPP offers a minimally invasive option for fractures with moderate displacement, while ORIF provides superior stability for complex fractures. Emerging techniques, including arthroscopy and bioabsorbable implants, show promise in minimizing complications and improving outcomes., Conclusion: The management of Bennett's fractures requires a tailored approach based on fracture displacement, patient needs, and surgeon expertise. Timely diagnosis, appropriate treatment selection, and structured rehabilitation are essential for optimal recovery. Advances in imaging, surgical methods, and materials hold the potential to further refine treatment strategies and improve long-term outcomes.

Background Due to the increased use of e-scooters in the UK, associated injuries have increased, and its cost has increased as well. Worldwide data on injuries related to e-scooter use are relatively limited, owing to the short duration since their first introduction to the public.  Aim There has been an increase in using e-scooters as a method of transport recently. It was noticed that the severity and frequency of its injuries are increasing as well. This study focuses on the frequency of e-scooter-associated injuries, especially open fractures, and to evaluate its burden on the health system. Methods Data on e-scooter injuries were extracted from our trauma database from November 2017 to July 2022. Patients' notes and images were reviewed. Outcome measures were the type of injuries: site of bony fractures, closed vs. open fracture (using Anderson and Gustilo classification), number of operations, complications, and length of hospital stay. Results The number of patients enrolled was 104. The mean age was 34.3 years, and 78.8% (n = 82) were male. The main mechanism of injury was riding (91%, n = 95) vs. hitting by an e-scooter (9%, n = 9). Injured patients were more likely not to wear helmets (82% of total injured patients). Patients with bony injuries were 65.4% (n = 68), with 22.1% (n = 15) of them being open fractures. The most common bony injuries were lower limb-only fractures at 45.6% (n = 31), then upper limb-only injuries at 39.7% (n = 27). Combined upper and lower limb cases were 8.8% (n = 6), and pelvic injuries were 5.9% (n = 4). Head and neck injuries composed 23.1% (n = 24) of the reported injuries, including intracranial haemorrhages (9.6%, n = 10), extensive traumatic brain injury (3.8%, n = 4), haematoma/lacerations (3.8%, n = 4), cervical spine fractures (1.9%, n = 2), and skull fractures (1.9%, n = 2). The mean duration of hospital stay was 8.6 days, and 9.6% (n = 10) of patients needed intensive therapy unit (ITU) admission. The number of patients presented as trauma calls was 55.8% (n = 58). Patients who needed surgical intervention either under orthopaedics or other specialties were 52.9% (n = 55) and 21.2% (n = 22) of total patients had complications either due to surgical intervention or a long hospital stay.  Conclusion E-scooter riding can lead to serious injuries that can end with limb- or life-threatening conditions. The most common demographic characteristics were adults in their early 30s. There should be more emphasis on wearing protective gear like wrist and elbow guards in addition to helmets. Future prospective studies with larger cohorts across multiple regions and hospitals are necessary to truly characterize the nature and cost of e-scooter injuries., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Metry et al.)

Tantalum, known for its superior mechanical properties and biocompatibility, has revolutionized the field of acetabular reconstruction, especially in revision total hip arthroplasty (rTHA). This review explores the clinical indications, biomechanical and biological properties, benefits, risks, and outcomes associated with tantalum acetabular components, particularly in managing complex cases of acetabular deficiencies. Extensive research has highlighted tantalum's ability to promote osseointegration, provide high survivorship rates, and maintain mechanical stability even in the most challenging cases, such as pelvic discontinuity and severe bone loss. However, challenges remain, including high costs and the need for long-term studies in primary total hip arthroplasty (THA). This article aims to provide a comprehensive overview of tantalum's current role in THA, discussing the potential for broader applications in primary surgeries and the implications of its high cost on healthcare systems.

Ankle fractures are common injuries treated in accident and emergency (A&E) departments, often requiring prompt reduction to restore joint alignment. Traditional pain management methods, including intravenous sedation and general anaesthesia, carry risks of systemic complications. The ankle block, a form of regional anaesthesia, is increasingly used for ankle fracture reduction due to its ability to provide localized pain relief while minimizing systemic side effects. This article reviews the techniques, recent trends, advantages, and disadvantages of ankle blocks in A&E settings. Ultrasound guidance has enhanced the precision and success of the procedure, leading to improved outcomes. Despite challenges, such as the need for specialized training and occasional incomplete analgesia, the ankle block is emerging as a preferred opioid-sparing alternative. Continued advancements in regional anaesthesia and training programs are expected to broaden its use in emergency care. Further research may focus on optimizing techniques to ensure consistent results.

Intraoperative blood loss management is a critical concern in orthopaedic surgeries, particularly in trauma and complex elective procedures. Traditionally, allogeneic blood transfusions have been used to manage significant blood loss, but they carry risks such as transfusion reactions, infections, and increased healthcare costs. Cell salvage, or autotransfusion, offers a safer alternative by collecting, processing, and reinfusing the patient's own blood during surgery. This article explores recent trends in the use of cell salvage in orthopaedic trauma and elective surgeries, highlighting its growing adoption in high-blood-loss procedures such as pelvic fractures, long bone injuries, and revision arthroplasties. We discuss the indications, including use in patients with rare blood types, religious objections to donor blood, and pre-existing anaemia. The advantages of cell salvage, such as reducing dependency on allogeneic transfusions, minimizing transfusion reactions, and providing cost-effectiveness, are weighed against its limitations, including high initial costs, contraindications in certain procedures, and the need for specialized training. Recent advances in cell salvage technology, which enhance the safety and efficiency of the process, are also examined. As orthopaedic practices evolve toward more patient-centered, cost-effective care, the role of cell salvage is expected to grow, making it a valuable tool in modern blood management strategies.

Background: Sarcopenia has a negative impact on the number of populations. The frequency of sarcopenia in polytrauma patients, however, is little understood. Knowing how many people face a bad outcome will raise awareness and help stop additional muscle mass loss., Aim: This pilot study's objectives included determining prevalence of the low mass of muscle in the aged patients of poly-trauma and examining the links between complications, low muscle mass, death, and the inflammatory response., Method: All polytrauma patients who were seen between 2017 and 2021 at the level-I trauma centre were included in the data from the regional perspective registry of trauma. The computed tomography (CT) of the abdomen's availability and the height in the subjects was screened to determine the skeletal mass index (SMI), which is utilised to calculate the sarcopenia. Additionally, factors of clinical outcome were evaluated. A multivariate regression analysis was conducted if parameters related to a poor result were found through a univariate analysis., Results: Sarcopenia was prevalent in 33.5 percent of the population overall, but in older age groups (60-79 years), it was significantly more prevalent, reaching to 82 percent in the individuals over the 80 years old. The ISS (Injury severity score) where the p=0.026, age where the p<0.0001, the CCI (Charlson comorbidity index) where the p=0.001, injury severity score, and the 30-day or the in-hospital mortality were all associated with sarcopenia. The Injury Severity Score (ISS) is a medical scoring system to assess trauma severity based on the extent of injuries in various body regions. Sarcopenia was discovered to be a predictor of the 30-day mortality by log rank analysis (p=0.032)., Conclusion: In conclusion, we found that polytrauma patients had a significant prevalence of sarcopenia, which increased with age. Additionally, sarcopenia was found to be the predictor of the 30-day death, highlighting clinical importance of finding the low muscle mass on the CT-scan, which was already regularly performed on the majority of patients of trauma.

The use of tourniquet is common in orthopaedic surgeries as it reduces blood loss, enhances visualization of the operating field, and leads to quicker procedures. However, the use of tourniquet has certain risks which can be avoided by following guidelines like British Orthopaedic Association Standards for Trauma (BOAST) guidelines for safe use of tourniquet. This audit study was done in a District general hospital to check the compliance of two trauma theatres with BOAST guidelines. The audit found that there was poor documentation of tourniquet details in the operation notes (10%). Regarding tourniquet time and pressure, the compliance in the two theatres was 95 % & 97.5 %. The recommendations of this audit were to use a template to improve documentation of tourniquet details in the operation notes and training of theatre staff on BOAST guidelines for safe use of tourniquet.

The restoration of the joint line is important for a good functional outcome after a Total Knee Arthroplasty(TKA). Knee joint biomechanics need to be restored as near normal as possible. Joint line elevation leads to anterior knee pain, decrease in range of motion, patella baja ,mid-flexion instability and impingement of patellar tendon. Joint line depression on the other hand leads to patella alta, risk of patellar subluxation and mid-flexion instability of the knee. Various studies have demonstrated various range of acceptable joint line variation but there is no clear acceptable range of joint line variation. More studies are required for establishing the acceptable range of joint line variation and standard practices should be established for arthroplasty surgeons for preventing variation of joint line.

Fractures of the metacarpal particularly the 5th metacarpal is quite common among all hand fractures and has a high incidence in male adult population. Proper management of these fractures plays a key role in rehabilitation and early return to work thus reducing the economic burden. Treatment of these injuries depends on the type of injury: whether it is a closed/open fracture, degree of angulation at the fracture site and also mal-rotation and shortening of the finger. Non-operative management is suitable for fractures which are closed, non-displaced and without angulation or rotation. Open fractures, fractures with angulation and/or mal-rotation and fractures with neuro-vascular injury are more suitable for operative management. The acceptable angulation for conservative management for most studies is 70 degrees. Buddy strapping with a Futura splint provides good functional results. In fractures requiring operative intervention, K-wire fixation is a minimally invasive method of fixation, which in most cases has good functional results. Plate and screw fixation, however, is preferred for cases with significant comminution or multiple metacarpal fractures.

Traditionally, it was believed that both proximal and distal locking are essential for achieving stability during intra-medullary fixation for extra-capsular hip fractures. However, recent literature has presented varying perspectives on the necessity of distal locking. Distal locking plays a significant role in managing hip fractures with uncertainties regarding longitudinal and rotational stability. This includes cases of comminuted intertrochanteric fractures with subtrochanteric extension, reverse oblique and high oblique fractures, broad medullary canals, comminution of the lateral wall, diaphyseal fractures, and large posteromedial fragments extending below the level of the lesser trochanter. In stable pertrochanteric fractures, with the lag screw passing through the lateral cortex of the distal fragment, may not require a distal locking screw. Distal locking has been associated with potential complications, including irritation of the fascia lata, prolonged operation time, increased radiation exposure, greater blood loss, implant loosening, secondary femoral stress fractures, and damage to the femoral artery. Thus, although distal locking is of doubtful significance in stable pertrochanteric fractures it is essential in unstable fracture patterns.

Introduction: The Boyd approach allows excellent access to the elbow and is used to treat complex elbow injuries using a single incision approach., Materials and Methods: In this study, we retrospectively evaluated 16 patients with complex elbow injuries treated with open reduction and internal fixation using the Boyd approach between 2016 and 2018., Results: All fractures were well united in anatomical position. Postoperatively, the range of motion was not significantly different between the affected and unaffected elbows. The mean Mayo Elbow Performance Index score was 95 ± 5 (range 90 to 100). All study participants had satisfactory results and recovered to full activity. There was no incidence of posttraumatic arthritis of the elbow joint or synostosis of the radius and ulna., Conclusion: Thus, according to our study, the Boyd elbow approach is a safe and effective method of treating elbow injuries., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Sain et al.)

Fluoroscopy is an indispensable tool that forms a significant part of the standard practice in many trauma and orthopaedic (T&O) procedures, as it facilitates dynamic assessment and aids intraoperative visualization and decision-making. It exposes patients and theatre staff to the potential hazards of ionizing radiation. Thus, the awareness of these hazards and proper use of personal protective equipment (PPE) will help mitigate increased exposure. This audit aimed to assess awareness regarding the safe use of fluoroscopy in T&O theatres, evaluate the level of PPE use and the knowledge of relevant guidelines, such as the British Orthopaedic Association (BOA) recommendations and local trust policy.A prospective audit was performed between June and July 2023 using an online survey sent to healthcare professionals working in T&O theatres across two hospital sites. Data were collected using an online questionnaire and responses kept anonymous and thus implied consent was applied. Standards followed the local trust policy at the University Hospitals Sussex NHS Trust and the BOA guidelines.Of the 49 respondents, 59% were fully aware of radiation hazards, and only the theatre radiographers were all fully aware. Surgeons (56%) and anaesthetists (46%) considered themselves to have adequate knowledge of these hazards. Just over half of the respondents (69%) could identify the major source of radiation, while only 37% understood the effect of distance on dose exposure. Of those surveyed, 49% knew the local trust policy, while 39.6% knew the BOA guidelines; less than half had formal training (40.8%). The results showed that less than half of the participants used the full PPE highlighted in the guidelines. Statistical analysis showed that only 46% of participants used a protective lead apron/lead skirt with a coat and thyroid shield. Of the survey participants, 84% never used eye protection during fluoroscopy procedures, and 58% had never received any formal training on radiation safety.The findings from this audit highlight the lack of awareness of the guidelines, resulting in suboptimal use of PPE in procedures with fluoroscopy. Recommendations for improvement include mandatory training for all theatre personnel. Methods of increasing awareness include using posters, performing regular audits to monitor the usage of PPE, and discussing the results in clinical governance meetings.

Orthopaedic surgeries pose various risks to the health of orthopaedic surgeons: radiation, noise, infection, chemical exposure, and musculoskeletal injury. These are associated with short and long-term health problems including malignancy and teratogenicity. Orthopaedic surgeons' health is critical to ensure optimal patient care. Most of these hazards can be obviated or minimized by adopting rigorous prevention protocols and raising awareness. Further related research is warranted and guidelines regarding prevention need to be framed by regulatory bodies.

Lisfranc injury refers to a group of bony or ligamentous injuries in which one or more of the metatarsals are displaced with respect to the tarsus. These injuries can occur as a result of either high-energy trauma like motor vehicle accidents and falls from height, or low-energy trauma from sports activities. A significant proportion of Lisfranc injuries are missed initially. The effects of delayed and missed diagnosed cases can be devastating as patients may develop progressive midfoot instability, collapse of arch, abduction of forefoot, and post-traumatic osteoarthritis, which can cause chronic pain, stiffness, and foot and ankle complex dysfunction. Favourable outcomes are associated with early diagnosis and prompt treatment. Open reduction and internal fixation (ORIF) with arthrodesis has better results than ORIF alone in functional outcomes. Dorsal bridge plates are currently the preferred mode of fixation due to advantages over trans-articular screws., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Sain et al.)