Aims: To establish the best teaching method for medical students and ascertain the students’ preferred method of teaching. Material and Methods: 30 medical students in were picked randomly and divided into two equal groups. Group 1 received Standard bedside teaching and Group 2 watched an interactive DVD. Each group then undertook a validated OSCE and the examiners were blinded as to which teaching method the students had received. The groups then received the other method of teaching followed by another OSCE. A questionnaire was given to all the students, to assess their satisfaction of the teaching session. Results:. Conclusion: Interactive teaching method can be a useful technique for teaching medical students, however the students’ preferred method of teaching is standard bedside teaching. Efficiency of knowledge transfer can be improved if interactive teaching is followed by standard bed side teaching but not the other way around

Virtual Fracture Clinic (VFC) is a consultant-led orthopaedic trauma outpatient triage and management service. The use of VFC has recently become commonplace in the United Kingdom. It allows multiple referral sources to the orthopaedic team, with clinical information and imaging reviewed by a consultant in VFC who formulates an appropriate management plan with the patient contacted; either to attend clinic for consultation or discharged with advice over the phone. The VFC is more efficient than a traditionally delivered outpatient fracture clinic service. We have utilized VFC for 1 year at our hospital, East Kent University Hospital Foundation Trust (EKHUFT), and undertook a closed loop audit to evaluate the service and highlight potential areas of improvement. The Objective of the study was to identify whether the implementation of new re-designed VFC referral guidelines together with teaching set across one of the hospitals in EKHUFT improved the effectiveness and standards of VFC referrals. An initial audit was performed of all referrals made to VFC over a 2 weeks period in December 2018. Changes to the VFC referral pathway were implemented, and teaching sessions performed by the orthopaedic team to all referring units, including minor injury units (MIU) and the emergency department (ED). After implementation, re-audit of VFC referrals was performed in February 2019 over a similar 2 weeks period. Patient demographics, diagnosis and outcomes were collected from the online patient record with images reviewed using PACS software. Following intervention, referral rates dropped by 27.7% (136 vs 188 patients) over the 2 weeks periods. Patient demographics, injury type and severity remained the same between the 2 groups. 51.5% (70/136) did not meet VFC pathway criteria after the intervention and were considered inappropriate, compared to 70% in the original group. 15.4% (21/136) referrals could have been managed in the emergency department using the new guidelines and leaflet discharge. 5.1% (7/136) of the referrals should have been referred to orthopaedic on-call acutely and 22% (30/136) of the referrals had a soft tissue injury or no injury identified. This did not change between the 2 groups despite intervention. Referring MIU and ED units require continued support and teaching over a prolonged time period to hopefully see further improvements. Immediate hot reporting of radiographs may further benefit the service, but staffing and funding issues particularly out of hours, means this remains an aspiration

Spinal stenosis is a condition resulting in the compression of the neural elements due to narrowing of the spinal canal. Anatomical factors including enlargement of the facet joints, thickening of the ligaments, and bulging or collapse of the intervertebral discs contribute to the compression. Decompression surgery alleviates spinal stenosis through a laminectomy involving the resection of bone and ligament. Spinal decompression surgery requires appropriate planning and variable strategies depending on the specific situation. Given the potential for neural complications, there exist significant barriers to residents and fellows obtaining adequate experience performing spinal decompression in the operating room. Virtual teaching tools exist for learning instrumentation which can enhance the quality of orthopaedic training, building competency and procedural understanding. However, virtual simulation tools are lacking for decompression surgery. The aim of this work was to develop an open-source 3D virtual simulator as a teaching tool to improve orthopaedic training in spinal decompression. A custom step-wise spinal decompression simulator workflow was built using 3D Slicer, an open-source software development platform for medical image visualization and processing. The procedural steps include multimodal patient-specific loading and fusion of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) data, bone threshold-based segmentation, soft tissue segmentation, surgical planning, and a laminectomy and spinal decompression simulation. Fusion of CT and MRI elements was achieved using Fiducial-Based Registration which aligned the scans based on manually placed points allowing for the identification of the relative position of soft and hard tissues. Soft tissue segmentation of the spinal cord, the cerebrospinal fluid, the cauda equina, and the ligamentum flavum was performed using Simple Region Growing Segmentation (with manual adjustment allowed) involving the selection of structures on T1 and/or T2-weighted scans. A high-fidelity 3D model of the bony and soft tissue anatomy was generated with the resulting surgical exposure defined by labeled vertebrae simulating the central surgical incision. Bone and soft tissue resecting tools were developed by customizing manual 3D segmentation tools. Simulating a laminectomy was enabled through bone and ligamentum flavum resection at the site of compression. Elimination of the stenosis enabled decompression of the neural elements simulated by interpolation of the undeformed anatomy above and below the site of compression using Fill Between Slices to reestablish pre-compression neural tissue anatomy. The completed workflow allows patient specific simulation of decompression procedures by staff surgeons, fellows and residents. Qualitatively, good visualization was achieved of merged soft tissue and bony anatomy. Procedural accuracy, the design of resecting tools, and modeling of the impact of bone and ligament removal was found to adequately encompass important challenges in decompression surgery. This software development project has resulted in a well-characterized freely accessible tool for simulating spinal decompression surgery. Future work will integrate and evaluate the simulator within existing orthopaedic resident competency-based curriculum and fellowship training instruction. Best practices for effectively teaching decompression in tight areas of spinal stenosis using virtual simulation will also be investigated in future work

Background. Hospitalists have assumed an evolving role in the care of postsurgical orthopaedic patients. Literature has provided evidence to suggest improved outcomes in postsurgical hip fracture patients managed by hospitalists in nonteaching hospitals. However, the full impact of a hospitalist co-management model has not been fully investigated with regard to elective joint arthroplasty patients in a multispecialty teaching facility. We hypothesized that a hospitalist co-management model in the setting of a teaching hospital would lead to an increase in unnecessary medical workups for joint arthroplasty patients. Methods. We retrospectively evaluated 2231 patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) between May 2010 and January 2014 at one teaching facility, excluding any non-elective trauma patients. The patients were separated into a non-hospitalist (NH) cohort of 1062 patients that did not receive hospitalist co-management postsurgery, and a hospitalist (H) cohort of 1169 patients that received hospitalist co-management postsurgery. We used Student t test and significance of (P<0.05) to compare the following factors between the two patient cohorts: length of stay (LOS), readmission rates at 30 and 90 days postsurgery, number of diagnoses present on admission, and number of new diagnosis given during admission. We then compared the average number of diagnostic and laboratory studies performed per patient and the average cost per hospital stay between the two cohorts. Results. We found no significant difference in LOS between the two groups. Readmission rates for THA patients in the H group increased significantly at 90 days postsurgery (P=0.012). We found no other significant differences in readmission rates at 30 or 90 days postsurgery. No significant difference was found between the two groups with regard to number of diagnoses present on admission. However, the H group experienced a significantly higher number of new diagnoses during the admission for both THA and TKA patients (P=0.03 andP=0.002 respectively). Finally we found no significant difference in the number of studies performed or the average cost per hospital stay between the two cohorts. Conclusion. This study shows a significant increase in documented new diagnoses in postsurgical THA and TKA patients when using a hospitalist co-management model in a teaching hospital. However, LOS, and average cost per hospital stay did not show the same increase, and the readmission rate only increased significantly in THA patients in the H group at 90 days postsurgery. Therefore the H group gained a significant number of new diagnoses that seemed to remain subclinical during the postsurgical hospital stay. While hospitalists are trained to report all possible diagnoses for accurate billing purposes, some physician and hospital grading systems may view these new diagnoses as postsurgical complications resulting in penalties. Therefore, any potential benefit of a hospitalist co-management model for THAs and TKAs in a teaching hospital setting may be outweighed by the potential penalties associated with increased postsurgical subclinical diagnoses

Teaching programmes for Orthopaedic Trainees take place in every region of the UK. The aim of this study was to survey Trainees from each region to compare levels of satisfaction. A questionnaire was sent out electronically in June 2009, and was open to collect responses until December 2009. It was sent to all British Orthopaedic Trainees Association (BOTA) members to assess satisfaction and to ask for their comments and suggestions. There were 449 responses, out of a potential 1200 (37%) from across all 26 regions. Overall 71% were satisfied or highly satisfied with the organisation of their programme, and 70% were satisfied or highly satisfied with the content. However, on analysis of the data looking at individual regions, there were marked differences in satisfaction levels. In three regions over 50% of Trainees were very satisfied with their teaching, in contrast to one region where 67% were unsatisfied or very unsatisfied. 199 Trainees (44%) made comments, which fell into themes of ‘how’ the teaching is organised, ‘what’ is taught, and by ‘whom’. Topics frequently mentioned were relevance to the FRCS exam, importance of clinical case presentations and involvement of Consultants. Teaching Programmes are run differently in each region and there are contrasting levels of satisfaction amongst Trainees. The feedback from the Trainees in each region was fed back to the relevant Training Programme Director, and suggestions were made on how to improve these Teaching Programmes for the future

Abstract. Introduction. In recent years, CTA has been an effective training adjunct for orthopaedic procedures. ACLR is a complex procedure with a steep learning curve. Aim. To design a multimedia CTA learning tool for ACLR using a modified Delphi methodology. Methodology:. CTA generation: A modified Delphi method was used to generate a list of Technical Steps (TS), Decision Points (DP) and errors/solutions for an ACLR that was approved by an expert consensus amongst four, fellowship-trained knee surgeons. A technical workflow was designed to generate the audio-visual tool. Pilot study: 30 novice trainees were granted access to the CTA tool and then performed the ACLR in a cadaveric simulation workshop. A 5-point Likert scale aimed to qualitatively assess if the CTA was useful to their learning. Results:. CTA generation: 156 TS and 79 DP were included for an ACLR procedure which was divided into 7 phases. The audio-visual component was combined with the written tool to design the final CTA tool. Pilot study: 95% of trainees suggested the CTA tool would be useful before carrying out an ACLR in the operating theatre. They agreed it made their ACLR learning more effective. Conclusion:. We have designed a novel and easily accessible CTA tool to standardise teaching of ACLR surgery. Novice surgeons verify the value of the CTA as an adjunct to their apprenticeship training. Future work: A Randomised Controlled Trial (RCT) is currently being planned to evaluate whether there are any objective benefits of this CTA to train surgeons performing an ACLR

We compared the mortality of hip fracture patients treated in teaching versus community hospitals in Ontario. Hip fracture patients ≥ 50 yrs were identified from the Canadian Institute for Health Information Hospital Discharge Abstracts Database and linked to the Registered Persons Database for death information. Logistic regression analyses were done to assess the relation between hospital type and both mortality and complications after surgery. Covariates examined include sex, age, Charlson-Deyo index, time to surgery and their interactions. Although patients treated in teaching hospitals have more comorbidities and complications they have lower mortality than those treated in community hospitals. The purpose of this study was to compare the mortality of hip fracture patients treated in teaching versus urban and rural community hospitals in Ontario. Although patients treated in teaching hospitals have more comorbidities and complications they have lower mortality than those treated in community hospitals. This finding will have far-reaching implications for health policy in this province. Hip fracture (ICD-9 code 820) patients ≥ 50 yrs treated in Ontario between 1993 and 1999 were identified from the Canadian Institute for Health Information Hospital Discharge Abstracts Database. These were linked to the Registered Persons Database for death information. Logistic regression analyses were done to assess the relation between hospital type and both mortality and complications after surgery. Covariates examined include sex, age, Charlson-Deyo index, time to surgery and their interactions. Patients treated in teaching hospitals and rural community hospitals were more likely to have a major complication than those in urban community hospitals, adjusted OR (95% CI) 1.37 (1.29–1.45); 1.28 (1.06–1.55) respectively. Patients in teaching hospitals had more comordities than those in community urban or rural hospitals. Nevertheless, patients treated in teaching hospitals have lower mortality (in hospital, and at three, six and twelve months post-surgery) than those in urban community hospitals, adjusted OR (95% CI) 0.76 (0.60–0.96), 0.90 (0.85–0.96), 0.91 (0.86–0.96), 0.92 (0.88–0.96) respectively. The difference between rural and urban community hospitals was not statistically significant, however there was a trend to higher mortality in rural institutions, adjusted OR (95% CI) 0.79 (0.63–1.00), 1.13 (0.95–1.36), 1.16 (0.98–1.36), 1.13 (0.97–1.32) respectively

We compared the mortality of hip fracture patients treated in teaching versus community hospitals in Ontario. Hip fracture patients ≥ 50 yrs were identified from the Canadian Institute for Health Information Hospital Discharge Abstracts Database and linked to the Registered Persons Database for death information. Logistic regression analyses were done to assess the relation between hospital type and both mortality and complications after surgery. Covariates examined include sex, age, Charlson-Deyo index, time to surgery and their interactions. Although patients treated in teaching hospitals have more comorbidities and complications they have lower mortality than those treated in community hospitals. To compare the mortality of hip fracture patients treated in teaching versus urban and rural community hospitals in Ontario. Although patients treated in teaching hospitals have more comorbidities and complications they have lower mortality than those treated in community hospitals. This finding will have far-reaching implications for health policy in this province. Hip fracture (ICD-9 code 820) patients ≥ 50 yrs treated in Ontario between 1993 and 1999 were identified from the Canadian Institute for Health Information Hospital Discharge Abstracts Database. These were linked to the Registered Persons Database for death information. Logistic regression analyses were done to assess the relation between hospital type and both mortality and complications after surgery. Covariates examined include sex, age, Charlson-Deyo index, time to surgery and their interactions. Patients treated in teaching hospitals and rural community hospitals were more likely to have a major complication than those in urban community hospitals, adjusted OR (95% CI) 1.37 (1.29–1.45); 1.28 (1.06–1.55) respectively. Patients in teaching hospitals had more comordities than those in community urban or rural hospitals. Nevertheless, patients treated in teaching hospitals have lower mortality (in hospital, and at three, six and twelve months post-surgery) than those in urban community hospitals, adjusted OR (95% CI) 0.76 (0.60–0.96), 0.90 (0.85–0.96), 0.91 (0.86–0.96), 0.92 (0.88–0.96) respectively. The difference between rural and urban community hospitals was not statistically significant, however there was a trend to higher mortality in rural institutions, adjusted OR (95% CI) 0.79 (0.63–1.00), 1.13 (0.95–1.36), 1.16 (0.98–1.36), 1.13 (0.97–1.32) respectively

Aims. Sickle cell disease (SCD) is an autosomal recessive inherited condition that presents with a number of clinical manifestations that include musculoskeletal manifestations (MM). MM may present differently in different individuals and settings and the predictors are not well known. Herein, we aimed at determining the predictors of MM in patients with SCD at the University Teaching Hospital, Lusaka, Zambia. Methods. An unmatched case-control study was conducted between January and May 2019 in children below the age of 16 years. In all, 57 cases and 114 controls were obtained by systematic sampling method. A structured questionnaire was used to collect data. The different MM were identified, staged, and classified according to the Standard Orthopaedic Classification Systems using radiological and laboratory investigations. The data was entered in Epidata version 3.1 and exported to STATA 15 for analysis. Multiple logistic regression was used to determine predictors and predictive margins were used to determine the probability of MM. Results. The cases were older median age 9.5 (interquartile range (IQR) 7 to 12) years compared to controls 7 (IQR 4 to 11) years; p = 0.003. After multivariate logistic regression, increase in age (adjusted odds ratio (AOR) = 1.2, 95% confidence interval (CI) 1.04 to 1.45; p = 0.043), increase in the frequency of vaso-occlusive crisis (VOC) (AOR = 1.3, 95% CI 1.09 to 1.52; p = 0.009) and increase in percentage of haemoglobin S (HbS) (AOR = 1.18, 95% CI 1.09 to 1.29; p < 0.001) were significant predictors of MM. Predictive margins showed that for a 16-year-old the average probability of having MM would be 51 percentage points higher than that of a two-year-old. Conclusion. Increase in age, frequency of VOC, and an increase in the percentage of HbS were significant predictors of MM. These predictors maybe useful to clinicians in determining children who are at risk. Cite this article: Bone Joint Open 2020;1-6:175–181

At least 10% of consultations in General Practice are for musculoskeletal problems. It would seem appropriate that the diagnosis and management of common musculoskeletal problems should form an important part of the “core” curriculum of any undergraduate medical training. Time is always short in an undergraduate teaching program and the pressures not to overload the curriculum are constant. The planned increased in student numbers is likely to stretch the ability of most teaching departments to provide a high level of undergraduate training in musculoskeletal disease. A postal survey of the provision of undergraduate teaching in T& O was performed in the UK. All 23 medical schools in England, Scotland, Wales and Northern Ireland were. To gain further insight into non-specialist general training in T& O after qualification a survey of the Vocational Training Schemes (VTS) for General practitioners in the Northern Deanery was performed. Ninety-one percent of Medical Schools replied. The average length of the orthopaedic attachments (all years combined) was five weeks. However, all but two programs were combined with other clinical subjects. The dilutional effect of these other subjects resulted in the average duration of the T& O attachment being reduced to 2.7 weeks (range 1.5 – 6). All the modules in orthopaedic surgery except one included trauma within the curriculum. There are four VTSs in the Northern Deanery. All of these had schemes that included A& E but not for every trainee. No scheme had either a rheumatology or orthopaedic surgery placement, although some exposure to rheumatology occurred during attachments in general medicine. This study shows that there is a significant discrepancy between the amount of time, within the curriculum (4%), devoted to musculoskeletal/orthopaedic teaching and the number of consultations in General Practice (10%); this discrepancy is not made up during VTS placements. In addition, such short exposure to a large subject may encourage superficial learning which medical education is specifically trying to avoid

Introduction and Aims: There is significant mortality during the first year after hip fracture. US studies indicate that mortality is lower in teaching than non-teaching hospitals for hip fracture patients. Our aim was to compare the mortality of hip fracture patients treated in teaching versus urban and rural community hospitals in Ontario. Method: Hip fracture (ICD-9 code 820) patients ³ 50 yrs treated in Ontario between 1993 and 1999 were identified from the Canadian Institute for Health Information Hospital Discharge Abstracts Database. These were linked to the Registered Persons Database for death information. Logistic regression analyses were done to assess the relation between hospital type and both mortality and complications after surgery. Covariates examined include sex, age, Charlson-Deyo index, time to surgery and their interactions. Results: Patients treated in teaching hospitals and rural community hospitals were more likely to have a major complication than those in urban community hospitals, adjusted OR (95% CI) 1.37 (1.29–1.45); 1.28 (1.06–1.55) respectively. Patients in teaching hospitals had more comordities than those in community urban or rural hospitals. Nevertheless, patients treated in teaching hospitals have lower mortality (in hospital, and at three, six and 12 months post-surgery) than those in urban community hospitals, adjusted OR (95% CI) 0.76 (0.60–0.96), 0.90 (0.85–0.96), 0.91 (0.86–0.96), 0.92 (0.88–0.96) respectively. The difference between rural and urban community hospitals was not statistically significant, however there was a trend to higher mortality in rural institutions, adjusted OR (95% CI) 0.79 (0.63–1.00), 1.13 (0.95–1.36), 1.16 (0.98–1.36), 1.13 (0.97–1.32) respectively. Conclusion: Although patients treated in teaching hospitals have more comorbidities and complications they have lower mortality than those treated in community hospitals. These findings have enormous implications for healthcare providers and health policy-makers

Objectives. To determine the morbidity and mortality outcomes of patients presenting with a fractured neck of femur in an Australian context. Peri-operative variables related to unfavourable outcomes were identified to allow planning of intervention strategies for improving peri-operative care. Methods. We performed a retrospective observational study of 185 consecutive adult patients admitted to an Australian metropolitan teaching hospital with fractured neck of femur between 2009 and 2010. The main outcome measures were 30-day and one-year mortality rates, major complications and factors influencing mortality. . Results. The majority of patients were elderly, female and had multiple comorbidities. Multiple peri-operative medical complications were observed, including pre-operative hypoxia (17%), post-operative delirium (25%), anaemia requiring blood transfusion (28%), representation within 30 days of discharge (18%), congestive cardiac failure (14%), acute renal impairment (12%) and myocardial infarction (4%). Mortality rates were 8.1% at 30 days and 21.6% at one year. Factors predictive of one-year mortality were American Society of Anesthesiologists (ASA) score (odds ratio (OR) 4.2 (95% confidence interval (CI) 1.5 to 12.2)), general anaesthesia (OR 3.1 (95% CI 1.1 to 8.5)), age > 90 years (OR 4.5 (95% CI 1.5 to 13.1)) and post-operative oliguria (OR 3.6 (95% CI 1.1 to 11.7)). Conclusions. Results from an Australian metropolitan teaching hospital confirm the persistently high morbidity and mortality in patients presenting with a fractured neck of femur. Efforts should be aimed at medically optimising patients pre-operatively and correction of pre-operative hypoxia. This study provides planning data for future interventional studies. Cite this article: Bone Joint Res 2013;2:162–8

Problem-based learning medical courses are now in the majority in the UK. This type of teaching, based on research by Barrow in the 1960s, seeks to integrate basic sciences and clinical teaching, leading to the acquisition of an integrated knowledge base that is readily recalled and applied to the analysis and solution of problems. We noticed an apparent difference in the core anatomical knowledge in a group of 4th year medical students during their orthopaedic placement, some of whom had been taught a traditional course and some a PBL course. We set out to quantify this difference. 60 simple anatomy questions were asked, with 30 minutes allowed, and no negative marking. 33 students were PBL taught, and 27 by a traditional course, with a roughly equal male: female ratio. The average score in the PBL group was 39.2% (range 11–52%), whereas the traditional group averaged 73.7% (range 63–79%). A second study was undertaken on two groups of 80 second year medical students, at 2 different UK universities with comparable teaching standards and entry requirements, both being well-established courses. Again, a simple 50-question anatomy paper was used, without negative marking. The traditional course students scored a mean of 37.5 (25–46), and the PBL group scored a mean of 32.3 (18–45). The results were statistically significant (p< 0.0001). Our results suggest that the difference between the two groups with regard to core anatomical knowledge increases with progression through training. This has significant implications due to PBL courses being in the majority. During the usually short orthopaedic attachment, it will become increasingly difficult for clinicians to teach effectively due to the lack of this knowledge

This paper will focus on the use and including a demonstration of Digital photography for the purpose of clinical documentation, audit, teaching and research. Digital photography is particularly suitable in upper & lower limb surgery because of the discrete regional anatomy and radiology. Digital images once created and stored do not deteriorate, unlike pictures or slides. Digital camera that uses a single floppy disc has an added advantage of simplicity and ease of storage. Pre-op, intra-op, and post-op images of patients undergoing hand surgery and treatment are easily documented with the camera. The information can be archived using commercially available filing software such as File MakerPro. The information can be retrieved at a later stage to be used in audit, teaching and research, with the images retained in their original, unmodified condition. Existing clinical, historical and teaching library slides, pictures or images can be archived to ensure the quality of the images do not deteriorate further, and for ease of retrieval and subsequent application. Archiving in this manner would require a slide scanner. The ease of file retrieval, reliability and accuracy of this imaging system has been tested using a minimum of 2000 patient files, using both PC and Macintosh systems, with no computer error and minimal operator errors found. The software used has “auto save” feature built in, hence computer “crash resistance.” The only limitation of the technology is the set up costs, and the resolution of the images. Fortunately, both these limitations are improving rapidly

Simulation in surgical training has become a key component of surgical training curricula, mandated by the GMC, however commercial tools are often expensive. As training budgets become increasingly pressurised, low-cost innovative simulation tools become desirable. We present the results of a low-cost, high-fidelity simulator developed in-house for teaching fluoroscopic guidewire insertion. A guidewire is placed in a 3d-printed plastic bone using simulated fluoroscopy. Custom software enables two inexpensive web cameras and an infra-red led marker to function as an accurate computer navigation system. This enables high quality simulated fluoroscopic images to be generated from the original CT scan from which the bone model is derived and measured guidewire position. Data including time taken, number of simulated radiographs required and final measurements such as tip apex distance (TAD) are collected. The simulator was validated using a DHS model and integrated assessment tool. TAD improved from 16.8mm to 6.6mm (p=0.001, n=9) in inexperienced trainees, and time taken from 4:25s to 2m59s (p=0.011). A control group of experienced surgeons showed no improvement but better starting points in TAD, time taken and number of radiographs. We have also simulated cannulated hip screws, femoral nail entry point and SUFE, but the system has potential for simulating any procedure requiring fluoroscopic guidewire placement e.g. pedicle screws or pelvic fixation. The low cost and 3D-printable nature have enabled multiple copies to be built. The software is open source allowing replication by any interested party. The simulator has been incorporated successfully into a higher orthopaedic surgical training program

Introduction. We performed a longitudinal outcome study involving the operative management of ankle fractures at two university teaching hospitals. This was a retrospective review of the quality of reduction and a prospective study into the functional outcome. Methods. All patients undergoing open reduction internal fixation of the ankle between November 2006 and November 2007 at one centre, and January to December 2009 at the other were included. Adequacy of reduction was assessed on the initial post-operative radiographs using Pettrone's criterion. The post-operative functional outcome was recorded using the Lower Extremity Functional Scale (LEFS), completed by postal or telephone follow-up at 64 months post injury (60–74 months). Results. There were 261 patients in the cohort, with a mean age of 47 years (17–91). Weber B fractures were sustained in 193 patients compared to 68 Weber C fractures. The medial malleolus was fractured in 43 cases, and a large posterior malleolar fragment (>20%) was found in 13 cases. Malreduction of the Weber B cohort was identified in 61 ankles (31%): Malreduction of the Weber C cohort was identified in 25 cases (37%): At time of follow-up 26 patients were not traceable or had died. Of the surviving 235 patients, 139 responded to the LEFS questionnaire (60%). The mean LEFS was 58 (out of 80) in the Weber B cohort and 61 in the Weber C cohort. Significantly lower LEFS were found in patients who had a malreduction in 2 or more criteria. Conclusion. Our study shows that there is high incidence of malreduction in the operative treatment of ankle fractures which leads to a significantly poorer functional outcome. We strongly recommend that adequate care and supervision are used in theatre together with post-operative independent review of intra-operative fluoroscopy images

Introduction

Ankle fractures represent approximately 10% of the fracture workload and are projected to increase due to ageing population. We present our 5 years outcome review post-surgical management of ankle fractures in a large UK Trauma unit.

Background and Purpose. Most information regarding adverse events (AEs) following osteopathic treatment is anecdotal; empirical data are limited. We explored the feasibility of online questionnaires to capture AEs prospectively within an osteopathic teaching clinic, and explored associations between a priori selected variables and reporting AEs. Methods and Results. We piloted a prospective patient-completed online questionnaire rating (‘none’/‘mild’/‘moderate’/‘severe’/‘don't know’) 14 symptoms (e.g. ‘pain’, ‘headaches’, ‘dizziness’, ‘nausea’, ‘tingling’) at five time-points within one week post-treatment. We recruited patients presenting with a new complaint. Additional data on concomitant symptoms, demographics, and treatment approach were obtained. Using logistic regression we explored associations between reporting an event at 24 hours and age, gender, high-velocity-low-amplitude-thrust and smoking status. ‘Pain’ (82%), ‘stiffness’ (40%) and ‘lack of mobility’ (28%) were the main presenting complaints, and ‘lower back’ (39%), ‘head/neck’ (26%) and ‘upper limb’ (14%) the commonest regions affected. AEs were reported by 83% of patients; ‘pain’ (74%), ‘stiffness’ (58%) and ‘unexpected tiredness’ (10%) were the most frequently reported. These peaked at 24, 48 and 24 hours respectively and were commonly rated as ‘mild’. There was no evidence for age, gender, HVLAT in crude or adjusted models; there were very weak/weak suggestions smoking cessation may be associated with reporting AEs; adjusted OR for ex-smokers versus never-smokers was 3.50 (0.66–18.40; P=0.14); ex-smokers versus smokers was 5.67 (0.85–37.80; P=0.07)). Conclusion. Using online questionnaire is feasible within a teaching clinic. Over 80% of patients reported one or more mild adverse events post-treatment. A larger study may be warranted testing the hypothesis smoking status predicts reporting of adverse events. No conflicts of interest. Sources of funding: The European School of Osteopathy. This abstract has not been previously published in whole or substantial part nor has it been presented previously at a national meeting

Background. PROMs have become an integral assessment tool of clinical effectiveness and patient satisfaction. To date, PROMs for lumbar discectomy are not an NHS requirement, although voluntary collection via the British Spine Registry is encouraged. Despite this, PROMs for day case microdiscectomy is scarcely reported. We present PROMs for day case microdiscectomy at Lancashire Teaching Hospitals. Aims. 1). To review PROMs to quantify leg pain, back pain, EQ5D and ODI scores. 2). Evaluate PROMs data collection compliance. Methods. We studied PROMs data, taken prospectively as part of routine clinical care for all patients who underwent single level day case microdiscectomy between January 2013 to December 2015. PROMs included VAS for back and leg pain, EQ5D and ODI scores. Preoperative PROMs were compared to all available postoperative PROMs at 3 months, 6 months, 12 months and 24 months. Paired student T-tests were used to compare preoperative to postoperative scores. Results. Preoperative PROMs were recorded for 132 patients. Postoperative PROMs were recorded for 48 patients at 3 months, 51 patients at 6 months, 37 patients at 12 months and 15 patients at 24 months. Significant postoperative improvements (p<0.05) were found at all time points for back pain, leg pain, EQ5D and ODI, with the exception EQ5D at 24 months (p = 0.10). Conclusion. There was significant improvement in VAS back and leg scores, as well as ODI scores over 24 months. Further work is needed to improve compliance with postoperative PROMs and to optimise the benefit of these health assessment tools. No conflicts of interest. No funding obtained

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.