This study aimed to describe the morphology of the coracoid process and determine the frequency of commonly observed patterns. The second purpose was to determine the location of inferior tunnel exit with superior based tunnel drilling and the superior tunnel exit with inferior based tunnel drilling. A sample of 100 dry scapulae for the morphology aspect and 52 cadaveric embalmed shoulders for tunnel drilling were used. The coracoid process was described qualitatively and categorized into 6 different shapes. A transcoracoid tunnel was drilled at the centre of the base. Twenty-six shoulders were used for the superior-inferior tunnel drilling approach and 26 for the inferior-superior tunnel drilling approach. The distances to the margins of the coracoid process, from both the entry and exit points of the tunnel, were measured. Eight coracoid processes were of convex shape, 31 of hooked shape, 18 of irregular shape, 18 of narrow shape, 25 of straight shape, and 13 of wide shape. The mean difference for the distances between superior entry and inferior exit from the apex was Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation 3.65+3.51mm (p=0.002); 1.57+2.27mm for the lateral border (p=0.40) and 5.53+3.45mm for the medial border (p=0.001). The mean difference for the distances between inferior entry and superior exit from the apex was 16.95+3.11mm (p=0.0001); 6.51+3.2mm for the lateral border (p=0.40) and 1.03+2.32 mm for the medial border (p=0.045). The most common coracoid process shape observed was a hooked pattern. Both superior to inferior and inferior to superior tunnel drilling directed the tunnel from a more anterior and medial entry to a posterior-lateral exit. Superior to inferior drilling resulted in a more posteriorly angled tunnel. With inferior to superior tunnel drilling cortical breaks were observed at the inferior and medial margin of the tunnel

Introduction. External fixators are common surgical orthopaedic treatments for the management of complex fractures and in particular, the use of circular frame fixation within patients requiring limb reconstruction. It is well known that common complications relating to muscle length and patient function without rehabilitation can occur. Despite this there remains a lack of high-quality clinical trials in this area investigating the role of physiotherapy or rehabilitation in the management of these patients. We aim to complete a systematic review of rehabilitation techniques for patients undergoing external fixator treatment for Limb Reconstruction of the lower limb. Materials & Methods. A comprehensive search of AMED, CINAHL, MEDLINE and COCHRANE databases was conducted to identify relevant articles for inclusion, using a search strategy developed in collaboration with a research librarian. Inclusion criteria consisted of adults aged 18 years and over who have experienced leg trauma (open fracture, soft tissue damage), elective leg deformity corrective surgery, bone infection or fracture non-union who have been treated with the use of an external fixator for fixation. Specific exclusion criteria were patients below the age of 18 years old, patients with cancer, treatment of the injury with internal nail, patients who underwent amputation, the use of external fixators for soft tissue contracture management, editorials, comment papers, review papers, conference proceedings and non-English papers. Titles, abstracts, and full texts were screened for suitability by pairs of reviewers according to the inclusion and exclusion criteria using Rayyan QCRI online software. Any conflicts were resolved through discussion with three independent specialist senior reviewers. Following full text screening, references lists of included articles were manually searched to ensure that all relevant studies were identified. Due to lack of evidence, forward searching was also completed for studies included in the review. Data quality was assessed using the mixed methods appraisal tool and the CERT assessment tool was utilised to look at completeness of reporting of exercise interventions. Results. A total number of 832 articles were initially retrieved from our search once duplicate articles removed. After title and abstract screening, 45 articles remained for full text screening. Of these, 11 articles met our inclusion criteria and included for data extraction. Conclusions. We expect high variability of results due to our inclusion criteria and therefore plan to conduct a narrative synthesis to summarise the findings whilst measing against the mixed methods appraisal tool and CERT assessment scores to assess the data quality. We anticipate lower assessment scores within the fewer articles found and therefore poorer-quality data. We currently are in the process of finalising this data extraction. This will be completed ready for submission and potential presentation at the BLRS conference in March 2023

Using inaccurate quotations can propagate misleading information, which might affect the management of patients. The aim of this study was to determine the predictors of quotation inaccuracy in the peer-reviewed orthopaedic literature related to the scaphoid. We randomly selected 100 papers from ten orthopaedic journals. All references were retrieved in full text when available or otherwise excluded. Two observers independently rated all quotations from the selected papers by comparing the claims made by the authors with the data and expressed opinions of the reference source. A statistical analysis determined which article-related factors were predictors of quotation inaccuracy. The mean total inaccuracy rate of the 3840 verified quotes was 7.6%. There was no correlation between the rate of inaccuracy and the impact factor of the journal. Multivariable analysis identified the journal and the type of study (clinical, biomechanical, methodological, case report or review) as important predictors of the total quotation inaccuracy rate. We concluded that inaccurate quotations in the peer-reviewed orthopaedic literature related to the scaphoid were common and slightly more so for certain journals and certain study types. Authors, reviewers and editorial staff play an important role in reducing this inaccuracy

Aims

The evidence base within trauma and orthopaedics has traditionally favoured quantitative research methodologies. Qualitative research can provide unique insights which illuminate patient experiences and perceptions of care. Qualitative methods reveal the subjective narratives of patients that are not captured by quantitative data, providing a more comprehensive understanding of patient-centred care. The aim of this study is to quantify the level of qualitative research within the orthopaedic literature.

Aims

Our primary aim was to establish the proportion of female orthopaedic consultants who perform arthroplasty via cases submitted to the National Joint Registry (NJR), which covers England, Wales, Northern Ireland, the Isle of Man, and Guernsey. Secondary aims included comparing time since specialist registration, private practice participation, and number of hospitals worked in between male and female surgeons.

Aims

Systematic reviews of randomized controlled trials (RCTs) are the highest level of evidence used to inform patient care. However, it has been suggested that the quality of randomization in RCTs in orthopaedic surgery may be low. This study aims to describe the quality of randomization in trials included in systematic reviews in orthopaedic surgery.

Duplicate publication in orthopaedic journals may further an author’s academic career but this is at the cost of both scientific integrity and knowledge. Multiple publications of the same work increase the workload of editorial boards, misguide the reader and affect the process of meta-analysis. We found that of 343 ‘original’ articles published in the Journal of Bone and Joint Surgery in 1999, 26 (7.6%) had some degree of redundancy. The prevalence of duplicate publications in the orthopaedic literature appears to be less than that in other surgical specialties but it is still a matter of concern. It is the author’s responsibility to notify the editor of any duality when submitting a paper for publication

Background. The focus on evidence-based medicine has led to calls for increased levels of evidence in surgical journals. The purpose of the present study was to review the levels of evidence in articles published in the foot and ankle literature and to assess changes in the level of evidence over a decade. Methods. All articles from the years 2000 and 2010 in Foot and Ankle International, Foot and Ankle Surgery, and all foot and ankle articles from JBJS A and JBJS B were analysed. Animal, cadaveric, basic science, editorials, surveys, letters to Editor and correspondence were excluded. Articles were ranked by a five-point level of evidence scale, according to guidelines from the Centre for Evidence Based Medicine. Results. A total of 379 articles were analysed from a total of 42 different countries. The kappa value for the inter-observer reliability showed very good agreement between the reviewers for types of evidence (κ = 0.785 (P< 0.01)) and excellent agreement for levels of evidence (κ = 0.846 (P< 0.01)). Between 2000 and 2010 the percentage of high level evidence (Levels I and II) increased (5.2% to 10.3%), and low level evidence (levels III, IV and V) decreased (94.8% to 89.7%) (p=0.09). The most frequent type of study was Therapeutic. The JBJS A produced the highest proportion of high-level evidence. The USA and UK were the highest producer of articles. The number of rest-of-world articles (non USA or UK) increased from 40.5% to 46.4% between 2000 and 2010. Conclusion. There has been a trend towards higher levels of evidence in foot and ankle surgery over a decade but the differences did not reach statistical significance

Since its introduction in 2007 the UKITE exam has been an annual event in the diary of Orthopaedic trainees. It aims to simulate the written FRCS (T&O) examination style and offers trainees practice, immediate feedback and an update of the progress they have made through their training. It also allows bench marking against their peers nationally. The editorial process has been overhauled to allow online editing of questions throughout the year, and this has streamlined the question selection process. The fifth edition of UKITE was held in December 2011. 669 trainees and 35 non-trainees sat for the examination. Consistently over the five years of UKITE we have seen a similar distribution of results showing improving performance until the final year (64.5% for 2011) and a drop in the performance in the last year (56.6% for 2011). Overall 80% of the trainees felt the exam was fair and better than last year. 80% of the trainees who had sat FRCS (T&O) previously thought that the UKITE 2011 was similar in difficulty. 98% trainees want to sit it again and 95% thought there was educational value in sitting the exam. Over 93% were satisfied with central and local provisions made for the exam. Some examining centres in NHS hospitals faced server failure issues and provision was made to sit for their trainees to sit un-invigilated from home. The mean score for the invigilated examination (53.6%) was significantly (p< 0.001) lower than that of un-invigilated examination (63.6%). UKITE continues to evolve and has become a regular feature in the post-graduate orthopaedic calendar. It is perceived as a useful way of revising and maintaining a core level of knowledge as part of the exam preparation

Background. The UKITE was started nationally as a yearly, online, curriculum-based, self-assessment examination in 2007 for the orthopaedic trainees. It remains free if trainees contribute questions. The examination has matured, expanded its services and established over 3 years. The UKITE is funded by DePuy. Methods. The data for the last 3 years of UKITE examinations were collected and analysed using Microsoft Excel. Results. Over the last 3 years the number of trainees increased from 450 to 705. The performance of trainees over the training period up to SpR5/StR7 improves, but falls away in the fional training year. The majority of the trainees prefer a yearly exam and cite improved ease of use over the 3 year period. The quality of questions has also improved over the time with an expanded editorial board of 30 trainees and consultants. Consistently over 90% of trainees felt that there was educational benefit in preparing questions for submission and taking the examination. Although it is not validated, consistently over 3 years over 70% the post-FRCS trainees felt the exam was similar to the official FRCS. The central and local organisation has improved acceptability from the trainees from 80% to nearly 95%. The IT systems and access have improved (97%). Over 99% trainees would like to take the exam again. Conclusion. The UKITE aims to improve access and will be working with the BOA and the Intercollegiate Specialty Board to improve quality and usability over the next year. Future progress will be aimed at expanding the role of UKITE for all levels of trainees working with local educational leads and nationally with other educational bodies and internationally

Since its introduction in 2007 the UKITE exam has been an annual event in the diary of Orthopaedic trainees. It aims to simulate the written FRCS (T&O) examination style and offers trainees practice, immediate feedback and an update of the progress they have made through their training. It also allows bench marking against their peers nationally. UKITE 2010 has made further progress and for the first time trainees from all the deaneries in UK participated. A total of 645 trainees appeared for the examination that was held in December 2010. We introduced remote access from home for trainees (N=171, 26.5%) who could not appear in an “examination centre”. An online editorial process was also introduced, which made the work of the question editing team easier. The scores ranged from 25.5 to 93.4% with a mean of 54.2% (sd=11.8). The score consistently improved from ST1 (41.8%) to ST7 (64.3%) level and then declined at ST8 (54.7%) level. The mean score for candidates sitting at home (53.3%, sd=11.4) was similar (p=0.23) to those sitting at an invigilated examination venue (54.6%, sd=11.9). The extreme low and high scores were more frequent invigilated exam. The feedback suggested that 95% trainees felt that UKITE has educational benefit and 98% wish to sit again. 75% want it as an annual self-assessment tool. 80% feel that it was better than last year and of those who had sat FRCS (T&O) nearly 80% felt it was very similar. UKITE continues to evolve and has become a regular feature in the post-graduate orthopaedic calendar. It is perceived as a useful way of revising and maintaining a core level of knowledge as part of the exam preparation

Introduction. Electrolyte imbalance in the elderly is a clinical problem faced by both elderly care physicians and orthopaedic surgeons alike. Hyponatraemia is a common condition with a vague clinical profile and severe consequences if untreated. Recent medical editorials have criticised orthopaedic handling of this problem. We therefore sought to establish the incidence of hyponatraemia within our orthopaedic population and a similar age-matched elderly care population in the light of changing attitudes to fluid management. Methods. Retrospective, consecutive analysis of the serum sodium concentrations and fluid regimes of all patients admitted with a fractured neck of femur during a three-month period. An age-matched control group of elderly care patients was used for comparison. Data was analysed using paired t-test and independent t-test as appropriate. Results. 200 patients were identified, 100 in each group. There was no loss to follow-up. The mean admission serum sodium of all patients studied was 135.7mmol/L (SD=5.4). Comparison of two groups showed no statistical significant difference between them (t(198)=0.70, p=0.49). The mean follow-up sodium was 136.6mmol/L (SD=4.5). Comparison of two groups again showed no difference (t(198)=0.64, p=0.52). While the mean levels were greater than 135.0mmol/L in both groups the actual percentage of cases presenting to hospital with hyponatraemia were 29% in the hip fracture group and 33% in the elderly care group. This compared poorly with previously quoted levels of approximately 15% elderly admissions in other studies. We also noted that of those patients that were hyponatraemic on admission, the majority remained hyponatraemic during their hospital stay. Discussion. This study underlines the high incidence of hyponatraemia within the elderly orthopaedic population. It also demonstrates that there is no statistically significant difference in the incidence of hyponatraemia between the elderly orthopaedic population and the general elderly population, both before operative intervention and thereafter

Aims

COVID-19-related patient care delays have resulted in an unprecedented patient care backlog in the field of orthopaedics. The objective of this study is to examine orthopaedic provider preferences regarding the patient care backlog and financial recovery initiatives in response to the COVID-19 pandemic.

Aims

To describe the incidence of adverse clinical outcomes related to COVID-19 infection following corticosteroid injections (CSI) during the COVID-19 pandemic. To describe the incidence of positive SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) testing, positive SARS-COV2 IgG antibody testing or positive imaging findings following CSI at our institution during the COVID-19 pandemic.

This paper offers a summary of the ethical guide for the European orthopaedic community; the full report will be published in the EFORT Journal.

Cite this article: Bone Joint J 2014;96-B:1130–2.