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Papers by Kevin Newman

$Research paper thumbnail of Neck of femur fractures in the elderly: Does every hour to surgery count?$

Injury, 2017

To determine if early surgery before 12 h confers a survival or length of stay benefit for patien... more To determine if early surgery before 12 h confers a survival or length of stay benefit for patients with neck of femur (NOF) fractures. Design: Retrospective review of prospectively collected data. Setting: District general hospital. Patients: 1913 patients aged over 60 admitted with a fractured NOF who underwent surgery between 2011 and 2015. Mean age was 83.9 years. 73.7% were female. Intervention: Patients had surgery for fractured NOF with data collected on demographics, mortality and length of stay. Main outcome measurements: Data collected included gender, age, ASA grade, fracture anatomy, surgery, time to surgery, days spent in acute hospital and rehabilitation settings and 30-day mortality. Statistical analysis was used to identify independent predictors of mortality and length of stay. Results: 30-day mortality was 6.1% and the mean hospitalisation time was 13 AE 11.3 days for the acute hospital and 20.2 AE 17.2 days for the trust. Operations were performed at a mean of 23.8 AE 14.8 h after presentation. Age, gender, ASA grade and type of fracture were independent predictors of either mortality or length of stay. Timing of surgery had an association with mortality but this only reached statistical significance at 24 h. In line with previous studies we analysed time to surgery in 12 h blocks. We also used logistic regression, recognizing time as a continuous variable, which revealed that every hour of delay to surgery increased the mortality risk by 1.8%. Conclusions: While every hour of delay increased mortality risk, the association with mortality only became statistically significant when delaying over 24 h. This supports a pragmatic approach, with surgery as soon as medically possible without a race to theatre. Level of evidence: Level III retrospective cohort study.

$Research paper thumbnail of Displaced intracapsular neck of femur fractures: Outcome of 810 hydroxyapetite coated (HAC) uncemented hemiarthroplasties$

Injury-international Journal of The Care of The Injured, Apr 1, 2017

A Cochrane review influenced new NICE guidelines, which recommended surgeons: 'Offer cemented imp... more A Cochrane review influenced new NICE guidelines, which recommended surgeons: 'Offer cemented implants to patients undergoing surgery with arthroplasty. However our trust routinely uses HAC uncemented stem (Taperloc®, Biomet) hemiarthroplasties. A review of a consecutive series of uncemented HAC stem hemiarthroplasties including measures such as intro-operative complications, mortality and revision surgery.

$Research paper thumbnail of The Chertsey classification of tibial plateau fractures and a comparison of the outcome of treatment with internal fixation or an Ilizarov fine wire circular frame$

Injury Extra, Dec 1, 2010

Aim: To assess mid to long-term functional and symptomatic outcome after internal fixation of the... more Aim: To assess mid to long-term functional and symptomatic outcome after internal fixation of the distal radius.Methods: All patients operated upon between June 2004 and October 2007 were retrospectively assessed using the ‘Disabilities of arm, shoulder and hand’ (DASH, range 0–100), and Mayo wrist (range 0–100) functional scoring systems. Fractures were classified according to the AO system. All patients were treated in one unit by the same group of surgeons using standard accepted techniques. Revision operations and patients treated at greater than four weeks after injury were excluded. Radiographic analysis of time to union was also performed.Results: 201 patients underwent surgical fixation of which, 183 patients were contactable for follow up (9% loss). Only these patients were included in the study. Mean age was 62.5 years. Mean follow up time was 30 months. Mean time to surgery was eight days. 74% had good/excellent Mayo and 75% good/excellent DASH scores. 2% of patients had ...

Aim: To describe a radiographic biomechanical classification of tibial plateau fractures which di... more Aim: To describe a radiographic biomechanical classification of tibial plateau fractures which dictates treatment. To compare the intra- and interobserver reliability and reproducibility of this, the Chertsey (C1-3) classification, and the Schatzker (SK1-6) classification. Method: This classification system has been used at this institution for 8 years by the orthopaedic trauma consultants and consists of C1 – valgus fractures, C2 – Varus fractures and C3 axial fractures. Our treatment regime is based on this classification and results presented in a sperate study. These consultants were excluded from the study on reliability and reproducibility. 2 Orthopaedic consultants, 2 orthopaedic registrars and 2 radiologists were selected randomly to classify 30 sets of AP and Lateral radiographs, of randomly selected patients treated in this institution with tibial plateau fractures, consisting of 9 SK1-3/C1, 8 SK4/C2 and 13 SK5,6/C3 fractures, and again with the same radiographs in a rando...

$Research paper thumbnail of Mid-term functional outcome after the internal fixation of distal radius fractures$

Journal of Orthopaedic Surgery and Research, 2012

Background: Distal radius fracture is a common injury with a variety of operative and non-operati... more Background: Distal radius fracture is a common injury with a variety of operative and non-operative management options. There remains debate as to the optimal treatment for a given patient and fracture. Despite the popularity of volar locking plate fixation, there are few large cohort or long term follow up studies to justify this modality. Our aim was to report the functional outcome of a large number of patients at a significant follow up time after fixation of their distal radius with a volar locking plate. Methods: 180 patients with 183 fractures and a mean age of 62.4 years were followed up retrospectively at a mean of 30 months (Standard deviation = 10.4). Functional assessment was performed using the Disabilities of the Arm, Shoulder and Hand (DASH) and modified MAYO wrist scores. Statistical analysis was performed to identify possible variables affecting outcome and radiographs were assessed to determine time to fracture union. Results: The median DASH score was 2.3 and median MAYO score was 90 for the whole group. Overall, 133 patients (74%) had a good or excellent DASH and MAYO score. Statistical analysis showed that no specific variable including gender, age, fracture type, post-operative immobilisation or surgeon grade significantly affected outcome. Complications occurred in 27 patients (15%) and in 11 patients were major (6%). Conclusion: This single centre large population series demonstrates good to excellent results in the majority of patients after volar locking plate fixation of the distal radius, with complication rates comparable to other nonoperative and operative treatment modalities. On this basis we recommend this mode of fixation for distal radius fractures requiting operative intervention.

$Research paper thumbnail of Volar locking plate for distal radial fractures$

Injury Extra, Apr 1, 2007

The archives of bone and joint surgery, 2018

There is a general consensus on the management of femoral fractures in children younger than two ... more There is a general consensus on the management of femoral fractures in children younger than two years and adolescents older than sixteen years. The best treatment for patients younger than sixteen years of age is still debatable. Titanium Elastic Nails (TEN), is widely used with some evidence, nonetheless, we undertook a systematic meta-analysis to assess the efficacy of TEN compared to Spica cast for the management of femoral shaft fracture in children aged between 2 to 16 years old. A computer literature search of PubMed, Scopus, Web of Science, CINAHL and Cochrane Central was conducted using relevant keywords. We included clinical trials and observational studies that compared TEN versus Spica cast; Records were screened for eligible studies and data were extracted and synthesized using Review Manager version 5.3 for Windows. Our search found 573 unique articles. After screening the abstract and relevant full text, 12 studies with a total of 1012 patients were suitable for the f...

European journal of orthopaedic surgery & traumatology : orthopédie traumatologie, 2014

Intramedullary nailing of tibial fractures is commonplace, and freehand operative techniques are ... more Intramedullary nailing of tibial fractures is commonplace, and freehand operative techniques are increasingly popular. The standard freehand method has the knee of the injured leg flexed over a radiolucent bolster. This requires the theatre fluoroscope to swing from antero-posterior to lateral position several times. Furthermore, guide wire placement, reaming and nail insertion are all performed well above most surgeons' shoulder height. Alternatively the leg is hung over the edge of the table, and the assistant must crouch and hold the leg until the nail is passed beyond the fracture. We describe a freehand figure 4 position technique for tibial nailing which is easier both for the surgeons and the radiographer, and present a series of 87 consecutive cases utilising this method.

Orthopaedics and Trauma, 2014

Diaphyseal tibial fractures are the most common long bone fracture. There are a variety of treatm... more Diaphyseal tibial fractures are the most common long bone fracture. There are a variety of treatment options, both operative and nonoperative, and satisfactory outcomes are reliant on a thorough understanding of the strengths and weaknesses of the different treatment modalities, and their most useful applications. Certain fracture patterns present particular difficulties and these must be recognized pre-operatively so that an appropriate surgical strategy can be planned. Compartment syndrome can be a devastating complication, and must be kept in mind at all times.

Southern Medical Journal, 1988

We tested the clinical utility and predictive value of graded exercise testing in the diagnosis o... more We tested the clinical utility and predictive value of graded exercise testing in the diagnosis of coronary artery disease in 153 patients aged 65 years or more. Based on changes of the ST segment from baseline, the test was considered positive with 1 mm of depression lasting 0.08 seconds, negative with no changes despite 85% of predicted maximal heart rate, probably positive with 1 mm of depression at rest becoming 2 mm with exercise, probably negative with no changes at maximal heart rate (within 10 beats per minute of 85% of predicted maximal), and uninterpretable with baseline electrocardiographic changes (eg, digitalis effect, left bundle branch block, left ventricular hypertrophy, etc). A test was considered inadequate when the exercise tolerance was less than or equal to 5 METs (metabolic equivalent of the task) and/or maximal heart rate was less than 100 beats per minute. The 153 patients had 163 tests. Only 33 (20%) were considered inadequate or uninterpretable, and there were no complications requiring medical intervention. Of 82 patients who had coronary angiography, 52 (63%) had 50% stenosis of at least one major epicardial artery; 44 of these patients had positive results of exercise testing. Nine patients with negative exercise tests had negative angiograms. There were eight false-negative and seven false-positive results. These results revealed a sensitivity of 85%, a specificity of 56%, and a predictive value of 86% for a positive test.

Southern Medical Journal, 1987

$Research paper thumbnail of Femoral shaft fractures in adults$

Orthopaedics and Trauma, 2013

Diaphyseal femoral fractures are common and can present as isolated injuries or as part of a poly... more Diaphyseal femoral fractures are common and can present as isolated injuries or as part of a polytrauma situation. Management of these fractures requires an understanding of the timing of definitive surgery in systemically unwell patients, as well as the physiologic effects of reaming and instrumentation of the femoral canal. An appreciation of biomechanics of femoral nails, along with other implants, and the nuances of their application is essential in achieving a satisfactory outcome.

Annals of The Royal College of Surgeons of England, 2011

Figure 1 Adhesive strips are applied over the edges of this pre-tibial laceration Figure 2 Skin e... more Figure 1 Adhesive strips are applied over the edges of this pre-tibial laceration Figure 2 Skin edges are opposed in this pre-tibial laceration by suturing through skin and adhesive strips

The American Journal of Cardiology, 1993

We reviewed our results and complications of using a pre-bent 1.6mm Kirschner wire (K-wire) for e... more We reviewed our results and complications of using a pre-bent 1.6mm Kirschner wire (K-wire) for extra-articular metacarpal fractures. The surgical procedure was indicated for angulation at the fracture site in a true lateral radiograph of at least 30 degrees and/or in the presence of a rotatory deformity. A single K-wire is pre-bent in a lazy-S fashion with a sharp bend at approximately 5 millimetres and a longer smooth curve bent in the opposite direction. An initial entry point is made at the base of the metacarpal using a 2.5mm drill by hand. The K-wire is inserted blunt end first in an antegrade manner and the fracture reduced as the wire is passed across the fracture site. With the wire acting as three-point fixation, early mobilisation is commenced at the metacarpo-phalangeal joint in a Futuro hand splint. The wire is usually removed with pliers post-operatively at four weeks in the fracture clinic. We studied internal fixation of 18 little finger and 2 ring finger metacarpal ...