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Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_1 | Pages 21 - 21
1 Jan 2022
Mehta M Soni A Munshi S Talawadekar G
Full Access

Abstract

Introduction

Clinic letters to the general practitioner (GP) form an essential part of communication in a patient's care. One essential variable requiring 100% compliance is the laterality/side of the diagnosis. Rationale of this audit was to check compliance of the same in clinic letters, to implement changes within the department initially followed by trust wide change in policy to improve the same.

Material and Methods

Clinic letters over a period of time were read through in retrospect to see for mention of side. The exclusion criteria were COVID consenting letters over phone, “did not attend” letters and letters for spinal pathology.

After 1st limb of audit following actions were taken: doctor education, secretaries to remind the dictating doctor to mention side in the letter and putting up of laminated prompters in all T&O clinic rooms to remind doctors. Following this a 2nd limb was conducted with similar parameters.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_19 | Pages 10 - 10
1 Apr 2013
Elnikety S El-Husseiny M Kamal T Gregoras M Talawadekar G Jeer P
Full Access

Introduction

The transtibial approach is widely used for femoral tunnel positioning in ACL reconstruction. Controversy exists over the superiority of this approach over others. Few studies reflected on the reproducibility rates of the femoral tunnel position in relation to the approach used.

Methods

We reviewed AP and Lat X-ray radiographs post isolated ACL reconstruction for 180 patients for femoral tunnel position, tibial tunnel position and graft inclination angle. All patients had their operations performed by one surgeon in one hospital between March 2006 and Sep 2010. All operations were performed using one standard technique using transtibial approach for femoral tunnel positioning. Two orthopaedic fellows, with similar experiences, reviewed blinded radiographs. A second reading was done 8 weeks later. Pearson inter-observer and intra-observer correlation analyses were done using SPSS. Mean age was 29 years (range 16–54).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XLII | Pages 3 - 3
1 Sep 2012
Elnikety S El-Husseiny M Kamal T Gregoras M Talawadekar G Jeer PJS
Full Access

The transtibial approach is widely used for femoral tunnel positioning in ACL reconstruction. Controversy exists over the superiority of this approach over others. Few studies reflected on the reproducibility rates of the femoral tunnel position in relation to the approach used.

We reviewed AP and Lat X-ray radiographs post isolated ACL reconstruction for 180 patients for femoral tunnel position, tibial tunnel position and graft inclination angle. All patients had their operations performed by one surgeon in one hospital between March 2006 and Sep 2010. All operations were performed using one standard technique using transtibial approach for femoral tunnel positioning.

Two orthopaedic fellows, with similar experiences, reviewed blinded radiographs. A second reading was done 8 weeks later. Pearson inter-observer, intra-observer correlation and Bland-Altman agreements plots statistical analyses were done.

Mean age was 29 years (range 16–54), Pearson intra-observer correlation shows substantial to perfect agreement while Pearson's inter-observer correlation shows moderate to substantial agreement.

Previous literature proved that optimal femoral tunnel position for the best clinical and biomechanical outcome is for the centre of the tunnel to be at 43% from the lateral end of the width of the femoral condyles on the AP view and at 86% from the anterior end of the Blumensaat's line on the lateral view. In our study 85% of the femoral tunnels were within +/− 5% of the optimal tunnel position on the AP views, and more than 70% of the femoral tunnels were within +/−5% of the optimal tunnel position on the Lateral view. Interobserver and intraobserver corelations show moderate to substantial agreement, Bland-Altman agreement plots show substantial agreements for interobserver and intraobserver measurements. These results were found to be statistically significant at 0.01

Based on our results we conclude that using one standardised transtibial technique for ACL reconstruction can result in high reproducibility rates of optimal femoral tunnel position. Further studies are needed to validate our results and to study the reproducibility rates for different approaches and techniques.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 135 - 135
1 Sep 2012
Elnikety S El-Husseiny M Kamal T Talawadekar G Triggs N Richards H Smith A
Full Access

Introduction

“No routine post-operative follow up appointments” policy has been implemented in NHS hospitals in different specialties for uncomplicated surgical procedures. In trauma and orthopaedics few studies to date reviewed this practice and reflected on the patients' opinions.

Methods

A total of 121 patients were recruited over 2 years, each patient had post operative follow up by the hand therapist for 3 months. 50 patients post Trapeziectomy and 71 patients post single digit Dupuytren's fasciectomy were prospectively surveyed for their opinion on their post operative care and whether they would have liked to be reviewed by the surgeon in a routine post operative follow up appointment or not. All operations were done by one surgeon in one hospital. All patients were reviewed by a hand therapist within 2 weeks post operatively and treatment protocols were followed with all the patients. During their final appointment with the hand therapist all patients completed a questionnaire.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIX | Pages 78 - 78
1 Jul 2012
Talawadekar G Rose B Elnikety S Grigoras I Jeer P
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Introduction

As intra-operative fluoroscopic identification of the isometric MPFL attachment to the femur can be imprecise and laborious in a surgical setting, we used clinical criteria to identify the isometric point and then studied post-operative radiographs to find out whether it was achieved and compared it with functional outcome.

Materials and Methods

Sixteen patients underwent 17 MPFL reconstructions using autologous semi-tendinosis tendon graft. Clinical judgement was used to identify the optimal point for femoral attachment of the MPFL without fluoroscopy control. Post-operative radiographs at 2 weeks were analysed to confirm whether an isometric point for the reconstructed MPFL was achieved by dividing the distal femur into 4 quadrants by 2 lines on the lateral radiograph. Telephonic interview was conducted to assess functional scores using the Kujala score at a mean follow-up of 13 months.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XIII | Pages 20 - 20
1 Apr 2012
Talawadekar G Sathyamurthy S
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Queen Elizabeth the Queen Mother Hospital, Margate, East Kent Hospitals NHS University Trust, UK.

PURPOSE

Surfaces of supports used to position patients for hip replacement are usually are in direct contact with the patient skin around the groin/buttock areas & repeated use of same supports, in trauma & elective surgeries, can be a source of cross-infection & wound contamination.

MATERIALS AND RESULTS

Swab samples from 12 supports, employed interchangeably for elective & trauma surgery. Cultured & incubated at 37 0 C in Columbia Blood Agar. 2 random supports cleaned using Sani Cloth Detergent non-alcoholic wipes & 2 samples were obtained from each support, 5 min later.

71% sampled supports were contaminated, with Coagulase-negative Staphylococcus, including Staph Epidermidis, being the most commonly grown organism with average of 5.3 colony forming units (CFU) (0-38) per swab. 5 min after cleaning 2 of above supports there was a 100% reduction in their contamination with no growth from the 4 swabs.