Introduction. Ulnar nerve entrapment is the second most common nerve entrapment syndrome of the upper extremity. Despite this, only a few studies have assessed the outcome of ulnar nerve decompression. The objectives of the study were to review the pre-operative symptoms, nerve conduction studies, the co-morbidities, operative procedures undertaken and the post-operative outcomes; and investigate and ascertain prognostic factors particularly in cases of persistence of symptoms after the surgery. Methods. We reviewed the case notes of ulnar nerve decompressions surgery performed over a period of six year period. A structured proforma was created to document the demographics, patient complaints, method of decompression, per-operative findings and symptom status at the last follow up. Outcome grading was recorded as completely relieved, improved, unchanged or worse. Analysis of data was carried out using the SPSS software (Version 16.0; Illinois). The significance level was set at 5%. Results. 136 ulnar nerve decompressions formed the study group. Minimum follow-up was three months. Numbness and paresthesia in ulnar distribution were the two most common presenting symptoms (96%). The cause of compression was identified as idiopathic in 58.2%; flexor carpi ulnaris aponeurosis in 36.7% and Arcade of Stuthers in 5.1% extremities. The outcome was satisfactory in 85.2% of patients. No obvious association was demonstrated between the outcome of surgery and duration of symptoms, presence of co-morbidities or the type of surgery performed. Interestingly out of 12 patients who got worse or had no improvement, nine (75%) had either normal nerve conduction studies or none done pre-operatively. Conclusion. This is the largest review of outcomes after ulnar nerve decompressions at elbow. The study showed that good results (85.2%) of ulnar nerve decompression at elbow in majority of patients regardless of level of surgeon's experience or procedure undertaken

Aims. The aim of this study was to explore differences in operative autonomy by trainee gender during orthopaedic training in Ireland and the UK, and to explore differences in operative autonomy by trainee gender with regard to training year, case complexity, index procedures, and speciality area. Methods. This retrospective cohort study examined all operations recorded by orthopaedic trainees in Ireland and the UK between July 2012 and July 2022. The primary outcome was operative autonomy, which was defined as the trainee performing the case without the supervising trainer scrubbed. Results. A total of 3,533,223 operations were included for analysis. Overall, male trainees performed 5% more operations with autonomy than female trainees (30.5% vs 25.5%; 95% CI 4.85 to 5.09). Female trainees assisted for 3% more operations (35% vs 32%; 95% CI 2.91 to 3.17) and performed 2% more operations with a supervising trainer scrubbed (39% vs 37%; 95% CI 1.79 to 2.06). Male trainees performed more operations with autonomy than female trainees in every year of training, in each category of case complexity, for each orthopaedic speciality area, and for every index procedure except nerve decompression. When adjusting for year, training level, case complexity, speciality area, and urgency, male trainees had 145% (95% CI 2.18 to 2.76) increased odds of performing an operation with autonomy and 35% (95% CI 1.25 to 1.45) increased odds of performing an operation under trainer supervision, than assisting, compared to female trainees. Conclusion. Male trainees perform more operations with autonomy during orthopaedic training than female trainees. Female orthopaedic trainees assist for a greater proportion of cases than their male counterparts. A comprehensive review of trauma and orthopaedic training is needed to identify any additional differences in training opportunities between female and male trainees, particularly with regard to progression through training. Cite this article: Bone Jt Open 2025;6(1):62–73

We undertook this study to investigate the outcomes of surgical treatment for acute carpal tunnel syndrome following our protocol for concurrent nerve decompression and skeletal stabilization for bony wrist trauma to be undertaken within 48-hours. We identified all patients treated at our trauma centre following this protocol between 1 January 2014 and 31 December 2019. All patients were clinically reviewed at least 12 months following surgery and assessed using the Brief Michigan Hand Outcomes Questionnaire (bMHQ), the Boston Carpal Tunnel Questionnaire (BCTQ) and sensory assessment with Semmes-Weinstein monofilament testing. The study group was made up of 35 patients. Thirty-three patients were treated within 36-hours. Patients treated with our unit protocol for early surgery comprising nerve decompression and bony stabilization within 36-hours, report excellent outcomes at medium term follow up. We propose that nerve decompression and bony surgical stabilization should be undertaken as soon as practically possible once the diagnosis is made. This is emergent treatment to protect and preserve nerve function. In our experience, the vast majority of patients were treated within 24-hours

Introduction. Only a few studies have assessed the outcome of ulnar nerve decompression, most comparing various forms of decompression. A review of the case notes of patients undergone ulnar nerve decompressions was undertaken looking at the pre-op symptoms, nerve conduction studies, the co-morbidities, operative procedures and the post-operative outcomes. Material/methods. We reviewed the case notes of ulnar nerve decompressions surgery performed over a period of six year period. Outcome grading was recorded as completely relieved, improved, unchanged or worse. The significance level was set at 5%. Results. A total of 136 ulnar nerve decompressions formed the study group. Numbness and paraesthesia in ulnar distribution were the two most common presenting symptoms (96%). Majority (68%) had symptoms for over a year before surgery. Simple decompression was done in 110 extremities and rest of the cases required additional anterior subcutaneous transposition. The cause of compression was identified as idiopathic in 58.2%; flexor carpi ulnaris aponeurosis in 36.7% and Arcade of Struthers in 5.1% extremities. The outcome was satisfactory in 85.2% of patients. No obvious association was demonstrated between the outcome of surgery and duration of symptoms, presence of co-morbidities or the type of surgery performed. Interestingly out of 12 patients who got worse or had no improvement, nine (75%) had either normal nerve conduction studies or none done pre-operatively. Conclusions. This is the largest review of outcomes after ulnar nerve decompressions at elbow. The study showed that good results (85.2%) in majority of patients regardless of level of surgeon's experience or procedure undertaken

Aims. We aim to objectively assess the impact of COVID-19 on mean total operative cases for all indicative procedures (as outlined by the Joint Committee on Surgical Training (JCST)) experienced by orthopaedic trainees in the deanery of the Republic of Ireland. Subjective experiences were reported for each trainee using questionnaires. Methods. During the first four weeks of the nationwide lockdown due to COVID-19, the objective impact of the pandemic on each trainee’s surgical caseload exposure was assessed using data from individual trainee logbook profiles in the deanery of the Republic of Ireland. Independent predictor variables included the trainee grade (ST 3 to 8), the individual trainee, the unit that the logbook was reported from, and the year in which the logbook was recorded. We used the analysis of variance (ANOVA) test to assess for any statistically significant predictor variables. The subjective experience of each trainee was captured using an electronic questionnaire. Results. The mean number of total procedures per trainee over four weeks was 36.8 (7 to 99; standard deviation (SD) 19.67) in 2018, 40.6 (6 to 81; SD 17.90) in 2019, and 18.3 (3 to 65; SD 11.70) during the pandemic of 2020 (p = 0.043). Significant reductions were noted for all elective indicative procedures, including arthroplasty (p = 0.019), osteotomy (p = 0.045), nerve decompression (p = 0.024) and arthroscopy (p = 0.024). In contrast, none of the nine indicative procedures for trauma were reduced. There was a significant inter-unit difference in the mean number of total cases (p = 0.029) and indicative cases (p = 0.0005) per trainee. We noted that 7.69% (n = 3) of trainees contracted COVID-19. Conclusion. During the COVID-19 pandemic, the mean number of operative cases per trainee has been significantly reduced for four of the 13 indicative procedures, as outlined by the JCST. Reassignment of trainees to high-volume institutions in the future may be a plausible approach to mitigate significant training deficits in those trainees worst impacted by the reduction in operative exposure

Thermal injury to the radial nerve caused by cement leakage is a rare complication after revision elbow arthroplasty. Several reports have described nerve palsy caused by cement leakage after hip arthroplasty. However, little information is available regarding whether radial nerve injury due to cement leakage after humeral stem revision will recover. In a recent study, radial nerve palsy occurred in 2 of 7 patients who had thermal injury from leaked cement during humeral component revisions. These patients did not regain function of the radial nerve after observation. We present a case of functional recovery from a radial nerve palsy caused by cement leakage after immediate nerve decompression in revision elbow arthroplasty[Fig. 1.2]

Aims

As an alternative to external fixators, intramedullary lengthening nails (ILNs) can be employed for distraction osteogenesis. While previous studies have demonstrated that typical complications of external devices, such as soft-tissue tethering, and pin site infection can be avoided with ILNs, there is a lack of studies that exclusively investigated tibial distraction osteogenesis with motorized ILNs inserted via an antegrade approach.

The aim of this study is to compare functional, clinical and radiological outcomes in K-wire fixation versus volar fixed-angle plate fixation in unstable, dorsally angulated distal radius fractures. Fifty-four adult patients with an isolated closed, unilateral, unstable, distal radius fracture were recruited to participate in the study. Only dorsally displaced fractures with no articular comminution were included. Patients were randomised to have their fracture treated with either closed reduction and K-wire fixation (3 wires) or fixed-angle volar plating. Both groups were immobilised in a below elbow cast for six weeks. The wires removed in the outpatients at six weeks and both groups were referred for physiotherapy. Independent clinical review was performed at three and six months post injury. Functional scoring was performed using the DASH and Gartland and Werley scoring systems. Radiographs were evaluated by an independent orthopaedic surgeon. Twenty-five patients were treated with a plate and twenty-nine with wires. There were no complications in the plate group. There were 9 complications in the K-wire group with 3 patients requiring a second operation (1 corrective osteotomy for malunion, 1 median nerve decompression and 1 retrieval of a migrated wire). The remaining complications included: 5 pin site infections (3 treated with early pin removal and 2 with oral antibiotics only), and 1 superficial radial nerve palsy. There were no tendon ruptures. Both groups scored satisfactory functional results with no statistical difference. There was a statistically significant difference in the radiological outcomes with the plate group achieving better results. We conclude that in unstable dorsally angulated distal radius fractures volar fixed-angle plate fixation is able to achieve comparable functional results to K-wire fixation with better radiological results and fewer complications. This has resulted in a change in our clinical practice

Purpose. Pain and stiffness from elbow arthritides can be reliably improved with arthroscopic osteocapsular ulnohumeral arthroplasty (OUA) in selected patients. Post-operative continuous passive motion (CPM) may be helpful in reducing hemarthrosis, improving soft-tissue compliance and maintaining the range of motion (ROM) established intra-operatively. There is only one published series of arthroscopic OUA and CPM was used in a minority of those patients. We hypothesized that a standardized surgical and post-operative CPM protocol would lead to rapid recovery and sustained improvement in ROM. Method. Thirty patients with painful elbow contractures underwent limited open ulnar nerve decompression and arthroscopic OUA at our institution by a single fellowship trained upper limb reconstruction surgeon. All patients underwent CPM for three days in-hospital with a continuous peripheral nerve block, followed by gradual weaning of CPM at home over two weeks. ROM using a goniometer was assessed at discharge, cessation of CPM (2 weeks) and final follow-up. The main outcome was elbow flexion, extension and total arc of motion. Paired students t-test was used to compare pre and post-operative ROM. Results. The median age was 45 (14–68) years, 77% were male, 73% had the dominant side affected and the most common pre-operative diagnosis was arthritis (50% post-traumatic, 30% primary osteoarthritis). Mean last follow-up was 7 months (range 2 weeks to 2 years). The mean pre-operative range of motion was 119 flexion, −32 extension and a total arc of 8719. At cessation of CPM, the mean flexion was 135, extension −7 and total arc 12711. At last follow-up flexion was maintained at a mean of 134 (p=0.6) but some extension was lost (mean −15, p<0.05) and total arc of motion decreased to 11820 (p<0.05). However, only two patients failed to maintain a functional arc of >100 and the amount of pre-operative contracture was correlated (r=0.73) with final arc of motion. Complications included only two transient ulnar neuropraxias. Only three patients required post-CPM bracing or physiotherapy. Conclusion. We present excellent improvement in short-term ROM following arthroscopic OUA using a standardized post-operative CPM protocol. These results are equal or better than open and non-CPM results published in the literature and alleviate the need for lengthy post-operative physiotherapy and splinting protocols in the majority of patients. A comparative study of CPM and non-CPM post-operative regimens after arthroscopic OUA is warranted to determine the true influence of CPM

The causes of a stiff elbow are numerous including: post-traumatic elbow, burns, head injury, osteoarthritis, inflammatory joint disease and congenital. Types of stiffness include: loss of elbow flexion, loss of elbow extension and loss of forearm rotation. All three have different prognoses in terms of the timing of surgery and the likelihood of restoration of function. Contractures can be classified into extrinsic and intrinsic (all intrinsic develop some extrinsic component). Functional impairment can be assessed medicolegally; however, in clinical practice the patient puts an individual value on the arc of motion. Objectively most functions can be undertaken with an arc of 30 to 130 degrees. The commonest cause of a Post-traumatic Stiff elbow is a radial head fracture or a complex fracture dislocation. Risk factors for stiffness include length of immobilisation, associated fracture with dislocation, intra-articular derangement, delayed surgical treatment, associated head injury, heterotopic ossification. Early restoration of bony columns and joint stability to allow early mobilisation reduces incidence of joint stiffness. Heterotopic ossification (HO) is common in fracture dislocation of the elbow. Neural Axis trauma alone causes HO in elbows in 5%. However, combined neural trauma and elbow trauma the incidence is 89%. Stiffness due to thermal injury is usually related to the degree rather than the site. The majority of patients have greater than 20% total body area involved. Extrinsic contractures are usually managed with a sequential release of soft tissues commencing with a capsular excision (retaining LCL/MCL), posterior bundle of the MCL +/− ulna nerve decompression (if there is loss of flexion to 100 degrees). This reliably achieved via a posterior incision, a lateral column exposure +/− ulna nerve mobilisation. A medial column exposure is a viable alternative. Arthroscopic capsular release although associated with a quicker easier rehabilitation is associated with increased neural injury. Timing of release is specific to the type of contracture, i.e. flexion contractures after approx. six months, extension contractures ASAP but after four months, loss of forearm rotation less 6 to 24 months. The use of Hinged Elbow Fixators is increasing. The indications include reconstructions that require protection whilst allowing early movement, persistent instability or recurrent/late instability or interposition arthroplasty. Post-operative rehabilitation requires good analgesia, joint stability and early movement. The role of CPM is often helpful but still being evaluated

Aims

Restarting planned surgery during the COVID-19 pandemic is a clinical and societal priority, but it is unknown whether it can be done safely and include high-risk or complex cases. We developed a Surgical Prioritization and Allocation Guide (SPAG). Here, we validate its effectiveness and safety in COVID-free sites.

Aims

Now that we are in the deceleration phase of the COVID-19 pandemic, the focus has shifted to how to safely reinstate elective operating. Regional and speciality specific data is important to guide this decision-making process. This study aimed to review 30-day mortality for all patients undergoing orthopaedic surgery during the peak of the pandemic within our region.

A total of 38 patients with leprosy and localised nerve damage (11 median at the wrist and 37 posterior tibial at the ankle) were treated by 48 freeze-thawed skeletal muscle autografts ranging between 2.5 cm and 14 cm in length. Sensory recovery was noted in 34 patients (89%) and was maintained during a mean period of follow-up of 12.6 years (4 to 14). After grafting the median nerve all patients remained free of ulcers and blisters, ten demonstrated perception of texture and eight recognised weighted pins. In the posterior tibial nerve group, 24 of 30 repairs (80%) resulted in improved healing of the ulcers and 26 (87%) demonstrated discrimination of texture. Quality of life and hand and foot questionnaires showed improvement; the activities of daily living scores improved in six of seven after operations on the hand, and in 14 of 22 after procedures on the foot. Another benefit was subjective improvement in the opposite limb, probably because of the protective effect of better function in the operated side. This study demonstrates that nerve/muscle interposition grafting in leprosy results in consistent sensory recovery and high levels of patient satisfaction. Ten of 11 patients with hand operations and 22 of 25 with procedures to the foot showed sensory recovery in at least one modality.