Surgical debridement for medial epicondylitis (ME) is indicated for patients with refractory ME. The clinical efficacy of simple debridement has not been studied sufficiently. Moreover, authors experienced surgical outcome of ME was not as good as lateral epicondylitis. In this regard, authors have combined the atelocollagen injection in the debridement surgery of ME. The purpose of study was to compare clinical outcomes between simple debridement and debridement combined with atelocollagen injection in the ME.

Twenty-five patients with refractory ME and underwent surgical debridement were included in the study. Group A (n=13) was treated with isolated debridement surgery, and group B (n=12) was treated with debridement combined with 1.0 mL of type I atelocollagen. Pain and functional improvements were assessed using visual analogue scale, Mayo Elbow Performance Score (MEPS) and quick Disabilities of the Arm, Shoulder and Hand (DASH) scale respectively before surgery, at 3, 6 months after surgery and at the final follow-up.

Demographic data did not show significant difference between two groups before surgical procedures. Both groups showed improvement in pain and functional score postoperatively. However, at the 3 months after surgery, group B showed significantly better improvement as compared to group A(VAS 3.1 / 2.0, MEPS 71/82 qDASH 29/23). At the 6 months after surgery and final follow-up, both groups did not show any difference.

Surgical debridement combined with atelocollagen is effective treatment option in refractory ME and showed better short-term outcomes compared to isolated surgery.

The Royal College of Surgeons of England (RCS) Good Surgical Practice guidance identifies essential criteria for surgical operation note documentation. The current quality improvement project aims to identify if using pre-templated operation notes for documenting fractured neck of femur surgery results in improved documentation when compared to free hand orthopaedic operation notes.

A total of fourteen categories were identified from the RCS guidance as required across all the operations identified in this study. All operations for the month of October 2021 were identified and the operation notes analysed. Pre-templated operation notes were compared to free hand operation notes.

97 cases were identified, of which 74 were free hand operation notes and 23 were pre-templated fractured neck of femur operation notes. All fourteen categories were completed in 13 (57%) of the templated operation notes vs 0 (0%) in the free hand operation notes (odds ratio 0.0052, 95% CI 0.0003 to 0.0945, p < 0.001). The median total number of completed categories was significantly higher in the templated op-note group compared to the free hand op-note group (templated median 14, range 12-14, vs. free hand median 11, range 9 to 13, p < 0.001). Logistic regression analysis of operation notes written by Registrars or Consultants identified Registrars as more likely to document the antibiotic prophylaxis given (p = 0.025).

Use of pre-templated operation notes results in significantly improved documentation. Adoption of generic pre-templated operation notes to improve surgical documentation should be considered across all operations.

Due to the presence of megakaryocytes, platelets and clotting factors, bone marrow aspirate (BMA) tends to coagulate. For the first time, starting from our previous studies on mesenchymal vertebral stem cells, it has been hypothesized that coagulated BMA represents a safe and effective autologous biological scaffold for bone regeneration in spinal surgery. The present research involved advanced preclinical in vitro models and the execution of a pilot clinical study.

Evaluation of cell morphology, growth kinetics, immunophenotyping, clonogenicity, trilineage-differentiation, growth-factors and HOX and TALE gene expression were analyzed on clotted- and un-clotted human V-BMA. In parallel, a pilot clinical study on ten patients with degenerative spine diseases submitted to instrumented posterior arthrodesis, is ongoing to assess the ability of clotted-V-BMA to improve spinal fusion at 6- and 12-months follow-up.

Results demonstrated that clotted-V-BMA have significantly higher growth-factor expression and mesenchymal stem cell (MSCs) viability, homogeneity, clonogenicity, and ability to differentiate towards the osteogenic phenotype than un-clotted-V-BMA. Clotted-V-BMA also highlighted significant reduced expression of PBX1 and of MEIS3 genes negatively involved in osteoblast maturation and differentiation. From December 2020, eight patients have already been enrolled with first promising results that will be finally evaluated in the next two months.

The application of V-BMA-clot as carrier of progenitors and cytokines and as natural scaffold with a structural texture represents a point-of-care orthobiologic product to improve spinal fusion. Clinical application seems to be efficacy, and we will confirm and strengthen these data with the final results of the pilot clinical study.

Introduction: Randomized Controlled Trials (RCT) are the golden standard in nowadays evidence based outcome assessment. Nevertheless, RCTs in surgery are associated with several concerns. The major concern focuses on ethical issues when randomization is done.

Method: We conducted an indebt analysis on advantages and disadvantages of three types of data acquisition (Case Control Study (CCS), RCT, and Registries) where scientific impact, ability to assess changes over time, cost efficiency, time consumption, ability to provide bench marks and other variables are compared.

Results: RCTs are best regarding the scientific impact. Registers are superior in detecting changes over time (post market surveillance, early warning system), cost efficiency, time consumption, ability to provide benchmarks, local/national/international comparability and ability to let private practitioners participate. CCSs are of minor value in respect to all the assessed variables.

Conclusion: In Surgery, registries are an excellent alternative to RCTs if a great majority of the treating physicians (in respect to a therapy) participate and if all the treated patients (per physician) are included. The register increases its scientific impact if alternative therapies are included (control). In this case, the scientific impact of a register is getting nearly equivalent to RCTs.

Take home message: If ethical aspects allow an RCT, than the RCT is the study set up of choice when a new technique/implant has to be introduced in the market. Once the implant has proved its evidence, the following post market surveillance should be accompanied by registries (introduction of an implant in each country). If an RCT is not indicated (ethical or other contra indications), than registries should be used to prove evidence for an indicated therapy. CCSs are not recommended.

Aims: The purpose of our review is to evaluate results of surgical treatment in bone metastases and to relate the surgical indications to these results. Methods: 297 patients operated between 1980 and 1998 were reviewed. Main age of the patients was 60.9 (18–86). The involved bones were femur (169cases), humerus (77), spine (33), tibia (8), pelvis (4), cubitus (2)others (4). The primary tumours (of 215 reviewed diagnosis) were breast (80cases), lung (31), myeloma (21), kidney (18), intestine (8), thyroid (7), prostate (6), uterus (6), pharynx (4), sarcoma (4), bladder (2), liver (2), others (4), well differentiated unknown origin (14), undifferentiated (8). The operations performed were nailing (86cases), interlocked-nailing (59), prosthesis (58), spinal osteosynthesis (34), plating+cement (25) nailing+cement (17), resection (10), resection+cement (6), amputation (2). Minimal conditions for surgery were life expectancy of at least 60 days, possibility of a solid implant and acceptable blood parameters (wbc> 2,000, plt> 30,000). Most of the patients underwent postoperative radiotherapy. Results: The Karnofsky index at sixty days showed a mean improvement of 30pts% using nails and prosthesis, and 10pts% with plating+cement (performed in patients in better general conditions). After surgery, all of the patients reached a score over 70pts% and in every case pain was sensibly reduced. There were 3 perioperative deaths (1%) and 10 major complications (3.4%). Conclusions: An operation performed after an accurate planning leads to an improvement in the quality of life and self-sufþciency of these patients, thereby reducing the cost of care. The choice of technique must allow to obtain a quick result (no bone grafting) and a fast functional improvement, considering the limited life expectancy of the patients.

Objective: Retrospective analysis of consecutive paediatric patients treated surgically for high-grade spondylolisthesis by one of three circumferential surgical procedures with emphasis on complications and patient outcome measurements.

Methods: Between 1980 and 1998 fourty patients underwent anterior-posterior correction for Meyerding Grade 3 or 4 isthmic dysplastic spondylolisthesis. Ten patients were treated with an anterior reduction according to Louis and anterior interbody fusion followed by posterior decompression and instrumented fusion (group A). Fourteen patients underwent posterior decompression followed by anterior reposition and fusion with tricortical iliac bone crest and posterior instrumented fusion (group B). Sixteen patients underwent progressive reduction by halopelvic traction followed by anterior and posterior fusion (group C). All patients completed the North American Spine Society (NASS) outcome questionnaire and the SF-36. The cosmetic assessment was performed by means of a VAS. The mean follow-up period for group A was 13,5 years, for group B 5,5 years and for group C 15,4 years, respectively.

Results: The three groups were comparable with respect to age at operation, radiographic measurement of the slip, lumbosacral kyphosis and lumbar lordosis. The incidence of postoperative extensor hallucis longus weakness was 33% in group A, 50% in group C and 0% in group B (p< 0.001). Pearson correlation coefficient revealed a positive correlation between extensor hallucis longus weakness and the degree of correction of the lumbosacral kyphosis (P=0.56, p=0.024). Postoperative reduction of the sagittal slip (A: 64%, B: 44%, C: 50%) and lumbosacral kyphosis (A: 27°, B: 16°, C: 27°) was significant in all three groups. The incidence of pseudarthrosis was 10% in group A, 7% in group B and 6% in group C. SF-36 and NASS outcome questionnaire results have not been found statistically significant among the groups.

Conclusion: Outcomes of function, satisfaction and cosmesis are satisfactory in all three surgical groups. Posterior decompression followed by anterior reduction and fusion using tricortical iliac crest bone graft and posterior instrumented fusion lack neurogenic complications. Therefore it is the standard surgical procedure for severe isthmic dysplastic spondylolisthesis at our department.

Introduction

The transition from resident to registrar constitutes a steep learning curve in most medical practitioners’ careers, regardless of speciality. We aimed to determine whether a six-week orthopaedic surgical skills course could increase resident skills and confidence prior to transitioning to orthopaedic registrar within the Gold Coast University Hospital, Queensland, Australia.

Change in forearm muscle length can be used to predict muscle function during pronosupination. In ten fresh cadaveric specimens, markers were placed at fifteen muscle origins and insertions. The forearm was positioned at 10° increments from 80° of pronation to 90° of supination with the elbow flexed at 90°. An electromagnetic tracking system was used to digitally collect 3D origin and insertion coordinates. These coordinates were used to create a vector representing muscle length as a straight line from the muscle origin to the muscle insertion. To normalize the data, all lengths were normalized as a percentage of the maximum muscle length for each specimen. Differences in the data were determined through paired t-test analysis. The muscles which exhibited a significant decrease in length from pronation to supination throughout the entire range were the biceps brachii and the palmaris longus. Muscles exhibiting a significant increase over the range were the pronator teres at both the humeral and ulnar origins as well as the pronator quadratus. The brachialis also exhibited an increase, though not as pronounced. The supinator, extensor indicis and the extensor carpi ulnaris all exhibited maximum length at the neutral position while length decreased in both pronation and supination directions. The only muscle to exhibit minimal length at neutral with increasing length in each direction was the brachioradialis. The extensor carpi radialis longus kept a consistent length during pronation and increased during supination. Muscles that remained consistent during pronation but decreased their length during supination included the extensor policis longus, the flexor carpi ulnaris, and the radial and ulnar origins of the abductor policis longus. The extensor carpi radialis brevis and the flexor carpi radialis exhibited no significant change in muscle length during forearm rotation. Forearm Rotation involves a complex interaction between the Radius and Ulna. Multiple muscles traverse the forearm en route to the hand. Many muscles change significantly in length during pronosupination. These muscles. Must adapt to this change in length to allow coordinated Upper Extremity function. Produce a force vector stressing the Distal and Proximal Radioulnar joints. Assist with Forearm Motion. Clinical Relevance- Rehabilitation following Injury needs to take into account the effect of forearm rotation, Splint position may vary depending on which Muscle or Tendon is injured, Surgical Procedures and Implants need to be designed to take into account transverse and longitudinal forces on the forearm

Aims

Pneumatic tourniquets are often used during the surgical treatment of unstable traumatic ankle fractures. The aim of this study was to assess the risk of reoperation after open reduction and internal fixation of ankle fractures with and without the use of pneumatic tourniquets.

Aims

Few studies have investigated potential consequences of strained surgical resources. The aim of this cohort study was to assess whether a high proportion of concurrent acute surgical admissions, tying up hospital surgical capacity, may lead to delayed surgery and affect mortality for hip fracture patients.

Aims

The aims of this study were to determine the rates of surgical complications, reoperations, and readmissions following herniated lumbar disc surgery, and to investigate the impact of sociodemographic factors and comorbidity on the rate of such unfavourable events.

Aims

This study assessed the association of classes of body mass index in kg/m² (classified as normal weight 18.5 kg/m² to 24.9 kg/m², overweight 25.0 kg/m² to 29.9 kg/m², and obese ≥ 30.0 kg/m²) with short-term complications and functional outcomes three to six years post-operatively for closed ankle fractures.

Previous studies from single centres or single-surgeon series report good early and mid-term results for high tibial osteotomy (HTO) in the treatment of osteoarthritis of the knee. However, the survivorship of HTO at a national level is unknown. This registry-based study included 3195 high HTOs performed between 1987 and 2008. Kaplan-Meier analysis revealed an overall survivorship of 89% (95% confidence interval (CI) 88 to 90) at five years and 73% (95% CI 72 to 75) at ten years, when conversion to total knee replacement was taken as the endpoint. Females and patients aged > 50 years had worse survivorship than males or patients aged ≤ 50 years (hazard ratio (HR) 1.26 (95% CI 1.11 to 1.43) and HR 1.41 (95% CI 1.23 to 1.64), respectively). The survivorship of HTOs performed between 1998 to 2008 was worse than for those performed between 1987 and 1997.