Author(s): Hill, Daniel S.; Marynissen, Hans
Source: Spine (03622436); Oct 2018; vol. 43 (no. 20)
Publication Date: Oct 2018
Publication Type(s): Academic Journal
Abstract:
Study Design: A retrospective cross-sectional analysis.

Objective: The aim of this study was to describe the provision of a spinal service using an electronic platform to direct management from an external spinal unit, and to quantify the time taken to obtain definitive management plans while under prescribed spinal immobilization.

Summary Of Background Data: Most attending district general hospitals following spinal trauma will have stable injuries and normal neurology, with only a small proportion requiring urgent transfer to a specialist center.

Methods: A retrospective review of 104 patients admitted following vertebral trauma during a 12-month period. The British Orthopaedic Association Standards for Trauma consensus that "spinal immobilisation is not recommended for more than 48 hours" was the standard of care measured against.

​Results: One hundred patients occupied a total of 975 hospital inpatient bed days. One hundred and seventeen radiological investigations were requested after the point of external referral [47 computed tomography (CT)-scans, 37 magnetic resonance imaging (MRI)-scans, and 33 weight-bearing radiographs]. The period between initial referral to the regional spinal service and then receiving a definitive final management plan had a median value of 72 hours and a range of 0 and 33 days. Patients will have been under some form of prescribed spinal immobilization until the definitive management plan was communicated. Thirty-four patients (34% of the overall cohort) had a definitive management plan in place within 48 hours. Eighty patients had vertebral injuries (73 stable, six unstable), three patients had prolapsed intervertebral disks, one had metastatic disease, and 17 did not have evidence of an acute injury following evaluation.

​Conclusion: Patients are being placed under prescribed immobilization for longer than is recommended. Delays in obtaining radiological imaging were an important factor, together with the time taken to receive a definitive management plan. Limitations in social care provision and delays in arranging this were additional barriers to hospital discharge following the final management plan.
Database: CINAHL

​Author(s): Honnenahalli Chandrappa M.; Hajibandeh S.
Source: Journal of Clinical Orthopaedics and Trauma; Nov 2017; vol. 8
Publication Date: Nov 2017
Publication Type(s): Review
Abstract:Objectives Our objective was to perform a systematic review of the literature and conduct a meta-analysis to investigate the outcomes of open versus arthroscopic methods of ankle fusion. Methods In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards, we performed a systematic review. Electronic databases MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify randomised and non-randomised studies comparing outcomes of arthroscopic and open ankle arthrodesis. The Newcastle-Ottawa scale was used to assess the methodological quality and risk of bias of the selected studies. Fixed-effect or random-effects models were applied to calculate pooled outcome data. Results We identified one prospective cohort study and 5 retrospective cohort studies, enrolling a total of 286 patients with ankle arthritis. Our analysis showed that open ankle fusion was associated with a lower fusion rate (OR 0.26, 95% CI 0.13-0.52, P = 0.0002), longer tourniquet time (MD 16.49, 95% CI 9.46-23.41, P Copyright © 2017
Database: EMBASE

​Author(s): Nie K.; Rymaruk S.; Paton R.W.
Source: Bone and Joint Journal; Nov 2017 (no. 11); p. 1533-1536
Publication Date: Nov 2017
Publication Type(s): Article
Abstract:Aims A clicky hip is a common referral for clinical and sonographic screening for developmental dysplasia of the hip (DDH). There is controversy regarding whether it represents a true risk factor for pathological DDH. Therefore a 20-year prospective, longitudinal, observational study was undertaken to assess the relationship between the presence of a neonatal clicky hip and pathological DDH. Patients and Methods A total of 362 infants from 1997 to 2016 were referred with clicky hips to our 'one-stop' paediatric hip screening clinic. Hips were assessed clinically for instability and by ultrasound imaging using a simplified Graf/Harcke classification. Dislocated or dislocatable hips were classified as Graf Type IV hips. Results The mean age at presentation was 13.8 weeks (12.8 to 14.7). In all 351 out of 362 children (97.0%) had Graf Type I hips (normal) that required no treatment. Nine children (2.5%) had Graf Type II hips but all resolved to Graf Type I hips on follow-up scans. One child (0.3%) had Graf Type III hip dysplasia and one child (0.3%) had an irreducible hip dislocation. The two pathological hips were associated with unilateral limited hip abduction. Mean referrals increased from 12.9 to 23.3 each year (p = 0.002) from the first decade of the study to the second, driven by increasing primary care referrals (5.5 versus 16.7 per year, p < 0.001). Conclusion Most clicky hips required no treatment other than reassurance to parents. Clicky hips with a normal hip examination should be considered a variant of normal childhood and not a risk factor for DDH. However, an abnormal hip examination including unilateral limited hip abduction should prompt urgent further investigations.
Database: EMBASE

​Author(s): Javed S.; Sadozai Z.; Javed A.; Din A.; Schmitgen G.
Source: Journal of Orthopaedic Surgery; 2017; vol. 25 (no. 3)
Publication Date: 2017
Publication Type(s): Article
Available  at Journal of orthopaedic surgery (Hong Kong) -  from EBSCO (MEDLINE Complete)
Abstract:Introduction: Steroid and local anaesthetic injection to the acromioclavicular joint (ACJ) is a very common diagnostic and therapeutic procedure, which is often performed in the outpatient department. However, it can be difficult to localize this joint because of its small size, presence of osteophytes and variable morphology in the population. We performed a study to determine whether the use of an image intensifier (X-ray guidance), in theatre, improves the accuracy of this injection. Methods: This was a prospective study carried out between March 2014 and March 2015. The injections were performed by two senior orthopaedic surgeons. First, we clinically palpated the ACJ and marked the area over this point as A. Then, with the use of a needle and an image intensifier in a single plane, we identified the actual location of the ACJ and marked this point as B. We measured the distance between A and B in millimetres (mm) and determined the accuracy of the injections. Further analysis taking into account the ACJ capsular attachments was also performed. Results: In total, 45 patients and 50 injections were included in the study; five patients had repeated injections at different times. We found that only 12 injections (24%) were palpated to be correct with no discrepancies between A and B (95% confidence interval: 14-37%). For the remaining 38 injections (76%), the use of an image intensifier had significantly improved the accuracy of ACJ location (p Copyright © The Author(s) 2017.
Database: EMBASE

Author(s): Dwan K.; Kirkham J.; Paton R.W.; Morely E.; Newton A.W.; Perry D.C.

Source: Cochrane Database of Systematic Reviews; Jul 2017; vol. 2017 (no. 7)

Publication Date: Jul 2017

Publication Type(s): Article

Abstract:This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To determine the role of splinting and the optimal treatment strategy for the non-operative management of DDH in children under six months of age. To identify if there are particular subgroups of patients for whom the optimal management strategy may differ.Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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Database: EMBASE

Author(s): Choudry, Qaisar; Paton, Robin W

Source: Journal of pediatric orthopedics. Part B; Mar 2017

Publication Type(s): Journal Article

Abstract:In the UK, the Pavlik harness is generally the accepted treatment technique for the treatment of neonatal and infant pathological developmental dysplasia of the hip. In 2013, the success rate of the Pavlik harness became an outcome measure from the British Society of Children's Orthopaedic Surgery for appraisal and revalidation with the GMC for paediatric orthopaedic surgery. The standard set requires an 80% success rate, with less than 20% requiring surgery. This study evaluated the outcomes of Pavlik harness treatment in neonates/infants with 'pathological hips' diagnosed by ultrasound imaging in a district general hospital setting. In a 10-year prospective observational longitudinal cohort study, modified Graf type III and IV hips (excluding those presenting with irreducible hip dislocation) were classified as pathological and splinted. A total of 2826 neonates/infants underwent ultrasound assessment in the paediatric orthopaedic 'screening clinic'. Neonates and infants were referred as 'at-risk' or as clinically unstable by the Paediatric Department and by general practitioners. Thirty-one Graf type III and 95 Graf type IV hips were identified and treated with a Pavlik harness. One Graf type III (30/31=success rate 96.8%) and three clinically unstable Graf type IV hips progressed to irreducible hip dislocations (92/95=96.8%). The success rate of the Pavlik harness in Graf type III and IV dysplasia was 96.8%, with 3.2% requiring surgery because of progression of the condition, confirming acceptable results for this technique in a district general hospital setting.
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Database: Medline

Author(s): Honnenahalli Chandrappa M.; Hajibandeh S.

Source: Journal of Clinical Orthopaedics and Trauma; Jan 2017

Publication Date: Jan 2017

Abstract:Objectives: Our objective was to perform a systematic review of the literature and conduct a meta-analysis to investigate the outcomes of open versus arthroscopic methods of ankle fusion. Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards, we performed a systematic review. Electronic databases MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify randomised and non-randomised studies comparing outcomes of arthroscopic and open ankle arthrodesis. The Newcastle-Ottawa scale was used to assess the methodological quality and risk of bias of the selected studies. Fixed-effect or random-effects models were applied to calculate pooled outcome data. Results: We identified one prospective cohort study and 5 retrospective cohort studies, enrolling a total of 286 patients with ankle arthritis. Our analysis showed that open ankle fusion was associated with a lower fusion rate (OR 0.26, 95% CI 0.13-0.52, P = 0.0002), longer tourniquet time (MD 16.49, 95% CI 9.46-23.41, P. <. 0.00001), and longer length of stay (MD 1.60,95% CI 1.10-2.10, P. <. 0.00001) compared to arthroscopic ankle fusion; however, there was no significant difference between two groups in terms of infection rate (OR 2.41, 95% CI 0.76-7.64, P = 0.14), overall complication rate (OR: 1.54, 95% CI 0.80-2.96, P = 0.20), and operation time (MD 4.09, 95% CI -2.49-10.66, P = 0.22). The between-study heterogeneity was high for tourniquet time but low or moderate for other outcomes. The direction of the effect sizes remains unchanged throughout sensitivity analyses. Conclusions: The best available evidence demonstrates that arthroscopic ankle fusion may be associated with a higher fusion rate, shorter tourniquet time, and shorter length of stay compared to open ankle fusion. We found no significant difference between two groups in terms of infection rate, overall complication rate, and operation time. The best available evidence is not adequately robust to make definitive conclusions. Long-term results of the comparative efficacy of arthroscopic ankle fusion over open ankle fusion are not currently available. Further high quality randomised controlled trials that are adequately powered are required.Copyright © 2017.

Author(s): Chandrappa M.H.; Hajibandeh S.

Source: Journal of Clinical Orthopaedics and Trauma; Jan 2017; vol. 8 (no. 1); p. 14-20

Publication Date: Jan 2017

Publication Type(s): Review

Abstract:Objectives Our objective was to perform a systematic review of the literature and conduct a meta-analysis to investigate the effect of initial varus or valgus displacement of proximal humerus on the outcomes of patients with proximal humerus fractures treated with open reduction and internal fixation. Methods In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards, we performed a systematic review. Electronic databases MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify randomised and non-randomised studies comparing postoperative outcomes associated with initial varus versus initial valgus displacement of proximal humerus fracture. The Newcastle-Ottawa scale was used to assess the methodological quality and risk of bias of the selected studies. Fixed-effect or random-effects models were applied to calculate pooled outcome data. Results We identified two retrospective cohort studies and one retrospective analysis of a prospective database, enrolling a total of 243 patients with proximal humerus fractures. Our analysis showed that initial varus displacement was associated with a higher risk of overall complication (RR 2.28, 95% CI 1.12-4.64, P = 0.02), screw penetration (RR 2.30, 95% CI 1.06-5.02, P = 0.04), varus displacement (RR 4.38, 95% CI 2.22-8.65, P < 0.0001), and reoperation (RR 3.01, 95% CI 1.80-5.03, P < 0.0001) compared to valgus displacement. There was no significant difference in avascular necrosis (RR 1.43, 95% CI 0.62-3.27, P = 0.40), infection (RR 1.49, 95% CI 0.46-4.84, P = 0.51), and non-union or malunion (RR 1.37, 95% CI 0.37-5.04, P = 0.64). Conclusions The best available evidence demonstrates that initial varus displacement of proximal humerus fractures is associated with higher risk of overall complication, screw penetration, varus displacement, and reoperation compared to initial valgus displacement. The best available evidence is not adequately robust to make definitive conclusions. Further high quality studies, that are adequately powered, are required to investigate the outcomes of initial varus and valgus displacement in specific fracture types. Level of evidence Level II.Copyright © 2016
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Database: EMBASE

​Author(s): Paton, Robin W.; Choudry, Qaisar

Source: Orthopaedics & Trauma; Dec 2016; vol. 30 (no. 6); p. 453-460

Publication Date: Dec 2016

Publication Type(s): Academic Journal
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Database: CINAHL

Source: Journal of Pediatric Orthopaedics Part B; Nov 2016; vol. 25 (no. 6); p. 489-492

Publication Type(s): Journal: Article

Author(s): Barkatali B.M.; Imalingat H.; Paton R.; Childs J.; Baumann A.

Abstract:Following surgical reduction of an irreducible hip in developmental dysplasia of the hip, imaging is required to ascertain successful reduction. Recent studies have compared MRI versus computed tomography (CT) in terms of cost, time, sensitivity and specificity. This is the first study to compare intraobserver and interobserver reliability for both modalities.

Nineteen CT scans of 38 hips in 10 patients and nine MRI scans of 18 hips in six patients were reviewed on two separate occasions by three clinicians. Image clarity, confidence of diagnosis, time taken to perform the scan as well as radiation dose for CT were recorded. Intraobserver and interobserver reliability kappa values were calculated. There were 14 female patients and one male patient. The mean age at the time of the scan was 12 months (range 3-25 months). Intraobserver reliability was greater than 0.8 (both CT and MRI). Interobserver reliability was greater than 0.8 (both CT and MRI). Image clarity was higher for CT for two out of the three clinicians (9.47 vs. 6.33 P0.05).

​The mean radiation dose for CT was 91.75 DLP (dose length product, mGyxcm) (95% confidence interval+/-26.95). Our results show that MRI is equal to CT as an imaging modality in the assessment of postreduction hips in developmental dysplasia of the hip. Intraobserver and interobserver reliability was excellent for both. The image clarity was higher for CT, but this method of imaging carries a significant risk of radiation exposure. We recommend that MRI should supersede CT as an imaging modality for this clinical situation. Copyright © 2016 Wolters Kluwer Health, Inc.