Onur Berber - Academia.edu (original) (raw)

Papers by Onur Berber

British Journal of Surgery

Introduction We have implemented a VFC model during the COVID-19 pandemic to minimise the number ... more Introduction We have implemented a VFC model during the COVID-19 pandemic to minimise the number of face-to-face consultations and the risk of transmission. Method The VFC was implemented and assessed using 3 PDSA cycles. Initially, a paper referral system was introduced along with treatment pathways. Subsequently an electronic referral system was established. The 3rd PDSA cycle involved training A&E staff on referrals and treatment pathways. At each stage the number of VFC referrals and clinic follow-ups were measured. Patient satisfaction was assessed using a telephone survey with a random sample of 30 patients. Results There was a statistically significant reduction in face-to-face follow-ups between pre-VFC (Total:4083, Average:86.87) and post-VFC (Total:713, Average:35.65) p-value<0.0001. There was a statistically significant increase in patient satisfaction after the implementation of the electronic referral system and staff re-training(9.25) compared to paper referrals(8.2...

458 Patient Willingness to Undergo Elective Orthopaedic Surgery in Relation to the COVID-19 Outbreak

British Journal of Surgery, 2021

Objective To determine patients’ willingness to undergo elective orthopaedic surgery during the C... more Objective To determine patients’ willingness to undergo elective orthopaedic surgery during the COVID-19 pandemic. Method 4 groups of patients were chosen based on type of surgery. A telephone survey was conducted, including questions on diagnosis, symptom duration, pain severity, co-morbidities, anxiety levels for COVID-19 and surgery. Patients were given the conditions for surgery and asked whether they would undergo surgery, have the operation carried out by another consultant and any factors that would increase their confidence. Results Of 200 patients, 156 participated (78%). 78.2% were willing to undergo surgery. There was a statistically significant difference in willingness between age groups 40-49 (100%) and 80 + (58.3%). Differences in willingness between surgery types, BOA risk class, sex, symptom duration and pain scores, were not statistically significant. Patients unwilling to undergo surgery reported statistically higher anxiety scores for health (4.39) and surgery (4...

British Journal of Surgery, 2021

Introduction This study assesses whether sterile surgical helmet systems (SSHS) provide additiona... more Introduction This study assesses whether sterile surgical helmet systems (SSHS) provide additional protection from aerosol pathogens alongside protecting against splash. There has been debate on whether to use such systems in orthopaedic surgery during the COVID-19 pandemic. Method Thirty-five participants were enrolled in a double-blinded randomised controlled study investigating efficacy of the Stryker Flyte Surgical Helmet (Stryker Corporation, Kalamazoo, MI, USA) as protection against respiratory droplets. Wearing the SSHS in a fit testing hood, subjects were randomised to nebulised saccharin solution or placebo. Twenty were allocated to the saccharin group with 15 to placebo. Positive sweet taste represented test failure. Taste tests were performed with the helmet fan turned on and off. Results SSHS did not prevent saccharin taste (p < 0.0001). Within the saccharin cohort, 40% recorded a positive taste with the fan on and 100% with the fan off. There was a statistically sign...

Annales de Chirurgie Vasculaire, 2010

Le traitement d'une malformation veineuse congé nitale employant l'ablation endoveineuse par radi... more Le traitement d'une malformation veineuse congé nitale employant l'ablation endoveineuse par radiofré quence est dé crit chez un patient. Le patient a initialement deux traitements par sclé rose a la mousse avec un ré sultat modé ré. Plus tard le vaisseau d'alimentation principal de la malformation veineuse est devenu é vident a l'examen par é cho-Doppler veineux et a é té identifié comme é tant la veine grande saph ene. A ce moment, l'ablation endoveineuse par radiofré quence a é té employé e pour supprimer le vaisseau d'alimentation et pour traiter avec succ es la lé sion. La procé dure s'est dé roulé e avec succ es et sans complications, et le patient a eu des suites simples. Il est recommandé que les patients pré sentant avec de telles malformations soient considé ré s pour le traitement endoveineux aussitôt que possible.

The Journal of Arthroplasty, 2011

This case report describes the successful use of a novel "conservative hip replacement" in condit... more This case report describes the successful use of a novel "conservative hip replacement" in conditions precluding the use of a standard total hip arthroplasty in a 70-year-old man. The femoral canal was occluded because of previous surgery for a bone tumor in the subtrochanteric region. The patient continues to do well at 4 years with minimal discomfort. At this interval, the Oxford Hip Score was 35. This conservative hip replacement has been developed to preserve bone stock and produce more physiologic loading of the proximal femur. Its design has been produced, using plain radiographs and computed tomography, to maximize "fit and fill" of the femur. The neck supports standard modular heads, allowing the use of any bearing surface. The prosthesis has been rigorously laboratory tested.

Dysphagia

British Journal of Hospital Medicine, 2010

The term dysphagia is defined as difficulty in swallowing and originates from the Greek words dys... more The term dysphagia is defined as difficulty in swallowing and originates from the Greek words dys, with difficulty, and phagia, to eat. Dysphagia should be distinguished from ‘odynophagia’ or painful swallowing, although both may appear together. Dysphagia is a distressing symptom and can have serious effects on a patient's health. The main concern is airway obstruction and the risk of aspiration. Suspicion of a swallowing difficulty should lead to accurate assessment and patient precautions must be taken. Furthermore, the physician should always suspect a malignant cause of dysphagia.

Acta orthopaedica Belgica, 2012

The safety of treating low-grade chondral tumours by primary surgery without a pre- operative dia... more The safety of treating low-grade chondral tumours by primary surgery without a pre- operative diagnostic needle biopsy was assessed by looking at the concordance between radiological and histological diagnoses. A retrospective review of the departmental histopathology registry from 2005 to 2009 was performed to identify cases of intramedullary chondral lesions in the appendicular skeleton. Cases with a pre-operative needle biopsy and with recurrence were excluded. Correlation between radiological and histological diagnosis was investigated with kappa analysis. Of 53 patients, bone expansion was seen in 18.4%, endosteal scalloping in 42.9% and extraosseous extension in 143%. Concordance was 100% between the radiological and histological diagnoses (Kappa score = 1.0). If a radiological diagnosis of an enchondroma or low-grade chondrosarcoma is made, then direct surgical treatment without needle biopsy is safe. A biopsy should be considered if any atypical radiological features suggest...

Knee binding as a simple adjunct to stabilising pelvic injuries in the emergency setting

Introduction Haemodynamically compromised patients with biomechanically unstable pelvic fractures... more Introduction Haemodynamically compromised patients with biomechanically unstable pelvic fractures need reduction of the pelvic volume to effect tamponade of bleeding bone and vessels. Knee binding, to help achieve this, is advocated in standard Advanced Trauma and Life Support teaching but is rarely used. There are no reports in the literature as to the benefits derived from this simple manoeuvre. The aim of this study was to investigate whether there was an effect on symphysis pubis closure by binding the knees together and to quantify this. Methods 13 consecutive patients who underwent open reduction and internal fixation of pubic symphysis diastasis +/− sacroiliac joint fixation were recruited prospectively. These patients were transferred from peripheral hospitals to this National tertiary referral level 1 trauma centre for definitive pelvic fracture management. All patients had sustained Antero-Posterior Compression (APC) type pelvic injuries. In theatre, a centred antero-poste...

Acta orthopaedica Belgica, 2011

The aim of this study was to establish whether the proximity of significant neurovascular structu... more The aim of this study was to establish whether the proximity of significant neurovascular structures around the surgical excision results in higher rates of recurrence and poorer survival outcomes. A retrospective study of all patients treated at a regional bone tumour unit for proximal fibula Ewing's tumours and osteosarcomas was conducted, and in total 17 patients were identified. The recurrence rate of all cases was 29.4% and the overall 5 year survival was 70.5%. The recurrence rate just for osteosarcoma was 50%, which compared poorly to published recurrence rates throughout the appendicular skeleton. The 5-year survival for proximal fibula osteosarcoma of 50% was also worse than generalised survivorship data reported in non-metastatic osteosarcoma. This series demonstrates that malignant proximal fibula tumours are a difficult entity to manage and recurrence rates and patient survival are poor for osteosarcoma.

Acta orthopaedica Belgica, 2012

The safety of treating low-grade chondral tumours by primary surgery without a pre- operative dia... more The safety of treating low-grade chondral tumours by primary surgery without a pre- operative diagnostic needle biopsy was assessed by looking at the concordance between radiological and histological diagnoses. A retrospective review of the departmental histopathology registry from 2005 to 2009 was performed to identify cases of intramedullary chondral lesions in the appendicular skeleton. Cases with a pre-operative needle biopsy and with recurrence were excluded. Correlation between radiological and histological diagnosis was investigated with kappa analysis. Of 53 patients, bone expansion was seen in 18.4%, endosteal scalloping in 42.9% and extraosseous extension in 143%. Concordance was 100% between the radiological and histological diagnoses (Kappa score = 1.0). If a radiological diagnosis of an enchondroma or low-grade chondrosarcoma is made, then direct surgical treatment without needle biopsy is safe. A biopsy should be considered if any atypical radiological features suggest...

Fractures of the scaphoid

BMJ

Salvage of the Failed Total Wrist Arthroplasty: A Systematic Review

Journal of Wrist Surgery

Background Although the performance of total wrist arthroplasty systems has improved, failure is ... more Background Although the performance of total wrist arthroplasty systems has improved, failure is encountered and is a major challenge to manage.Questions Does physical function improve with surgical management of the failed wrist arthroplasty? Is there an improvement in secondary outcome measures including pain, grip strength, and range of motion? What are the reasons for failure in primary total wrist arthroplasty? What are the complications associated with revision of the failed total wrist arthroplasty? What are the survival profiles of the different revision strategies?Methods A systematic review of available literature was performed. Studies were systematically assessed, and data extracted from suitable studies for review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines were adhered to. The study protocol was modified from a previous protocol published on the PROSPERO database.Results Fourteen studies were identified considering ...

International Orthopaedics

Purpose This study assesses whether sterile surgical helmet systems (SSHS) provide surgeons with ... more Purpose This study assesses whether sterile surgical helmet systems (SSHS) provide surgeons with additional protection from aerosol pathogens alongside their traditional role protecting against splash. There has been debate on whether to use such systems in reopening elective orthopaedic surgery during the current COVID-19 pandemic environment. Methods Thirty-five participants were enrolled in a double-blinded randomised controlled study investigating efficacy of the Stryker Flyte Surgical Helmet (Stryker Corporation, Kalamazoo, MI, USA) as protection against respiratory droplets. Wearing the SSHS in a fit testing hood, subjects were randomised to nebulised saccharin solution or placebo. Twenty were allocated to the saccharin group with 15 to placebo. Positive sweet taste represented a failure of the test. Taste tests were performed with the helmet fan turned on and off. Results SSHS did not prevent saccharin taste (p < 0.0001). Within the saccharin cohort, 40% recorded a positive taste with the fan on and 100% with the fan off. There was a statistically significant difference in mean time-to-taste saccharin (p = 0.049) comparing fan on (123.5 s) vs. off (62.6 s). Conclusions SSHS do not protect against aerosol particulate and therefore are not efficacious in protection against COVID-19. The fan system employed may even increase risk to the surgeon by drawing in particulates as well as delay recognition of intraoperative cues, such as exhaust from diathermy, that point to respirator mask leak.

Getting it right first time: a management protocol for acute and subacute fractures of the scaphoid

Journal of Hand Surgery (European Volume)

Ankle Home Stay Programme:- A review of ankle fracture management and costs at a busy district general hospital

Annals of Medicine and Surgery

Systematic Review of Total Wrist Arthroplasty and Arthrodesis in Wrist Arthritis

Journal of Wrist Surgery

Background End-stage wrist arthritis has traditionally been treated with a total wrist fusion. Th... more Background End-stage wrist arthritis has traditionally been treated with a total wrist fusion. There is a recent trend toward motion preserving surgery in the form of total wrist replacement. Questions Is there a functional benefit to performing a total wrist replacement instead of a total wrist fusion in patients with end-stage wrist arthritis? Is there any difference in secondary outcome measures including pain, grip strength, and range of motion? Does the risk of adverse events and treatment failure differ between the two techniques? Methods A systematic literature search was performed to identify studies reporting either total wrist arthrodesis or arthroplasty for end-stage wrist arthritis. Studies were systematically screened and assessed for risk of bias and quality. Data were extracted and reviewed. Results A total of 43 studies were included in the review: 17 on arthrodesis, 24 on arthroplasty, and 2 matched cohort studies. This represented 669 index arthrodesis operations i...

Ankle Home Stay Programme: A Prospective Cohort of Ankle Fracture Management and Costs at A Busy District General Hospital

Journal of Surgery

MOJ Gerontology & Geriatrics

Background: The objective of this study was to evaluate the proportion of patients presenting wit... more Background: The objective of this study was to evaluate the proportion of patients presenting with a fall also having a coexisting diagnosis of an overactive bladder (OAB). Methodology: This was a prospective case series study of patients over 65 years of age. Of a 137 patients presenting to the hospital during a 6-month period, 33 patients had a urinary tract infection and therefore 104 patients (average age: 79.3 years) were included for further analysis. Results: In this cohort, 61% patients had a diagnosis of OAB. Only 1.9% of these had any investigations or treatment. The falls risk was multifactorial in 42 cases (40%). A fracture was diagnosed in 73% of patients, 39% of which was a fracture neck of femur. The relative risk of sustaining a fracture and having OAB was 0.67 (95% confidence interval, 0.42, 1.05). A significant relationship was seen between a hip fracture and OAB diagnosis (p=0.0152). Conclusion: An overactive bladder is an important risk factor in patients presenting with falls. Falls in patients with an overactive bladder can have significant consequences such as a neck of femur fracture.

Hip international : the journal of clinical and experimental research on hip pathology and therapy, Jan 4, 2017

Intravenous tranexamic acid (IV TXA) is a recognised pharmaceutical intervention utilised to mini... more Intravenous tranexamic acid (IV TXA) is a recognised pharmaceutical intervention utilised to minimise blood loss and allogenic blood transfusion. However, the use of IV TXA in hip fracture surgery remains inconclusive. We conducted a meta-analysis to investigate the role of TXA in operative hip fracture management on operative and total blood loss, allogenic blood transfusion requirements and impact on venous thromboembolic (VTE) event incidence. A systematic computerised literature search of PubMed, Medline, Embase, Ovid, The Cochrane Controlled Trials Register, Trip and Google was conducted. We reviewed the efficacy of IV TXA on perioperative blood loss, total blood loss, pre- and postoperative haemoglobin differences, duration of surgery, allogenic blood transfusion requirements and VTE events. 8 studies were eligible including 6 randomised control trials and 2 cohort studies. Patients receiving IV TXA had reduced mean total blood loss of 442.9 mls (95% CI, 426.5-459.3; p<0.00...

British Journal of Surgery

Introduction We have implemented a VFC model during the COVID-19 pandemic to minimise the number ... more Introduction We have implemented a VFC model during the COVID-19 pandemic to minimise the number of face-to-face consultations and the risk of transmission. Method The VFC was implemented and assessed using 3 PDSA cycles. Initially, a paper referral system was introduced along with treatment pathways. Subsequently an electronic referral system was established. The 3rd PDSA cycle involved training A&E staff on referrals and treatment pathways. At each stage the number of VFC referrals and clinic follow-ups were measured. Patient satisfaction was assessed using a telephone survey with a random sample of 30 patients. Results There was a statistically significant reduction in face-to-face follow-ups between pre-VFC (Total:4083, Average:86.87) and post-VFC (Total:713, Average:35.65) p-value<0.0001. There was a statistically significant increase in patient satisfaction after the implementation of the electronic referral system and staff re-training(9.25) compared to paper referrals(8.2...

458 Patient Willingness to Undergo Elective Orthopaedic Surgery in Relation to the COVID-19 Outbreak

British Journal of Surgery, 2021

Objective To determine patients’ willingness to undergo elective orthopaedic surgery during the C... more Objective To determine patients’ willingness to undergo elective orthopaedic surgery during the COVID-19 pandemic. Method 4 groups of patients were chosen based on type of surgery. A telephone survey was conducted, including questions on diagnosis, symptom duration, pain severity, co-morbidities, anxiety levels for COVID-19 and surgery. Patients were given the conditions for surgery and asked whether they would undergo surgery, have the operation carried out by another consultant and any factors that would increase their confidence. Results Of 200 patients, 156 participated (78%). 78.2% were willing to undergo surgery. There was a statistically significant difference in willingness between age groups 40-49 (100%) and 80 + (58.3%). Differences in willingness between surgery types, BOA risk class, sex, symptom duration and pain scores, were not statistically significant. Patients unwilling to undergo surgery reported statistically higher anxiety scores for health (4.39) and surgery (4...

British Journal of Surgery, 2021

Introduction This study assesses whether sterile surgical helmet systems (SSHS) provide additiona... more Introduction This study assesses whether sterile surgical helmet systems (SSHS) provide additional protection from aerosol pathogens alongside protecting against splash. There has been debate on whether to use such systems in orthopaedic surgery during the COVID-19 pandemic. Method Thirty-five participants were enrolled in a double-blinded randomised controlled study investigating efficacy of the Stryker Flyte Surgical Helmet (Stryker Corporation, Kalamazoo, MI, USA) as protection against respiratory droplets. Wearing the SSHS in a fit testing hood, subjects were randomised to nebulised saccharin solution or placebo. Twenty were allocated to the saccharin group with 15 to placebo. Positive sweet taste represented test failure. Taste tests were performed with the helmet fan turned on and off. Results SSHS did not prevent saccharin taste (p < 0.0001). Within the saccharin cohort, 40% recorded a positive taste with the fan on and 100% with the fan off. There was a statistically sign...

Annales de Chirurgie Vasculaire, 2010

Le traitement d'une malformation veineuse congé nitale employant l'ablation endoveineuse par radi... more Le traitement d'une malformation veineuse congé nitale employant l'ablation endoveineuse par radiofré quence est dé crit chez un patient. Le patient a initialement deux traitements par sclé rose a la mousse avec un ré sultat modé ré. Plus tard le vaisseau d'alimentation principal de la malformation veineuse est devenu é vident a l'examen par é cho-Doppler veineux et a é té identifié comme é tant la veine grande saph ene. A ce moment, l'ablation endoveineuse par radiofré quence a é té employé e pour supprimer le vaisseau d'alimentation et pour traiter avec succ es la lé sion. La procé dure s'est dé roulé e avec succ es et sans complications, et le patient a eu des suites simples. Il est recommandé que les patients pré sentant avec de telles malformations soient considé ré s pour le traitement endoveineux aussitôt que possible.

The Journal of Arthroplasty, 2011

This case report describes the successful use of a novel "conservative hip replacement" in condit... more This case report describes the successful use of a novel "conservative hip replacement" in conditions precluding the use of a standard total hip arthroplasty in a 70-year-old man. The femoral canal was occluded because of previous surgery for a bone tumor in the subtrochanteric region. The patient continues to do well at 4 years with minimal discomfort. At this interval, the Oxford Hip Score was 35. This conservative hip replacement has been developed to preserve bone stock and produce more physiologic loading of the proximal femur. Its design has been produced, using plain radiographs and computed tomography, to maximize "fit and fill" of the femur. The neck supports standard modular heads, allowing the use of any bearing surface. The prosthesis has been rigorously laboratory tested.

Dysphagia

British Journal of Hospital Medicine, 2010

The term dysphagia is defined as difficulty in swallowing and originates from the Greek words dys... more The term dysphagia is defined as difficulty in swallowing and originates from the Greek words dys, with difficulty, and phagia, to eat. Dysphagia should be distinguished from ‘odynophagia’ or painful swallowing, although both may appear together. Dysphagia is a distressing symptom and can have serious effects on a patient's health. The main concern is airway obstruction and the risk of aspiration. Suspicion of a swallowing difficulty should lead to accurate assessment and patient precautions must be taken. Furthermore, the physician should always suspect a malignant cause of dysphagia.

Acta orthopaedica Belgica, 2012

The safety of treating low-grade chondral tumours by primary surgery without a pre- operative dia... more The safety of treating low-grade chondral tumours by primary surgery without a pre- operative diagnostic needle biopsy was assessed by looking at the concordance between radiological and histological diagnoses. A retrospective review of the departmental histopathology registry from 2005 to 2009 was performed to identify cases of intramedullary chondral lesions in the appendicular skeleton. Cases with a pre-operative needle biopsy and with recurrence were excluded. Correlation between radiological and histological diagnosis was investigated with kappa analysis. Of 53 patients, bone expansion was seen in 18.4%, endosteal scalloping in 42.9% and extraosseous extension in 143%. Concordance was 100% between the radiological and histological diagnoses (Kappa score = 1.0). If a radiological diagnosis of an enchondroma or low-grade chondrosarcoma is made, then direct surgical treatment without needle biopsy is safe. A biopsy should be considered if any atypical radiological features suggest...

Knee binding as a simple adjunct to stabilising pelvic injuries in the emergency setting

Introduction Haemodynamically compromised patients with biomechanically unstable pelvic fractures... more Introduction Haemodynamically compromised patients with biomechanically unstable pelvic fractures need reduction of the pelvic volume to effect tamponade of bleeding bone and vessels. Knee binding, to help achieve this, is advocated in standard Advanced Trauma and Life Support teaching but is rarely used. There are no reports in the literature as to the benefits derived from this simple manoeuvre. The aim of this study was to investigate whether there was an effect on symphysis pubis closure by binding the knees together and to quantify this. Methods 13 consecutive patients who underwent open reduction and internal fixation of pubic symphysis diastasis +/− sacroiliac joint fixation were recruited prospectively. These patients were transferred from peripheral hospitals to this National tertiary referral level 1 trauma centre for definitive pelvic fracture management. All patients had sustained Antero-Posterior Compression (APC) type pelvic injuries. In theatre, a centred antero-poste...

Acta orthopaedica Belgica, 2011

The aim of this study was to establish whether the proximity of significant neurovascular structu... more The aim of this study was to establish whether the proximity of significant neurovascular structures around the surgical excision results in higher rates of recurrence and poorer survival outcomes. A retrospective study of all patients treated at a regional bone tumour unit for proximal fibula Ewing's tumours and osteosarcomas was conducted, and in total 17 patients were identified. The recurrence rate of all cases was 29.4% and the overall 5 year survival was 70.5%. The recurrence rate just for osteosarcoma was 50%, which compared poorly to published recurrence rates throughout the appendicular skeleton. The 5-year survival for proximal fibula osteosarcoma of 50% was also worse than generalised survivorship data reported in non-metastatic osteosarcoma. This series demonstrates that malignant proximal fibula tumours are a difficult entity to manage and recurrence rates and patient survival are poor for osteosarcoma.

Acta orthopaedica Belgica, 2012

The safety of treating low-grade chondral tumours by primary surgery without a pre- operative dia... more The safety of treating low-grade chondral tumours by primary surgery without a pre- operative diagnostic needle biopsy was assessed by looking at the concordance between radiological and histological diagnoses. A retrospective review of the departmental histopathology registry from 2005 to 2009 was performed to identify cases of intramedullary chondral lesions in the appendicular skeleton. Cases with a pre-operative needle biopsy and with recurrence were excluded. Correlation between radiological and histological diagnosis was investigated with kappa analysis. Of 53 patients, bone expansion was seen in 18.4%, endosteal scalloping in 42.9% and extraosseous extension in 143%. Concordance was 100% between the radiological and histological diagnoses (Kappa score = 1.0). If a radiological diagnosis of an enchondroma or low-grade chondrosarcoma is made, then direct surgical treatment without needle biopsy is safe. A biopsy should be considered if any atypical radiological features suggest...

Fractures of the scaphoid

BMJ

Salvage of the Failed Total Wrist Arthroplasty: A Systematic Review

Journal of Wrist Surgery

Background Although the performance of total wrist arthroplasty systems has improved, failure is ... more Background Although the performance of total wrist arthroplasty systems has improved, failure is encountered and is a major challenge to manage.Questions Does physical function improve with surgical management of the failed wrist arthroplasty? Is there an improvement in secondary outcome measures including pain, grip strength, and range of motion? What are the reasons for failure in primary total wrist arthroplasty? What are the complications associated with revision of the failed total wrist arthroplasty? What are the survival profiles of the different revision strategies?Methods A systematic review of available literature was performed. Studies were systematically assessed, and data extracted from suitable studies for review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines were adhered to. The study protocol was modified from a previous protocol published on the PROSPERO database.Results Fourteen studies were identified considering ...

International Orthopaedics

Purpose This study assesses whether sterile surgical helmet systems (SSHS) provide surgeons with ... more Purpose This study assesses whether sterile surgical helmet systems (SSHS) provide surgeons with additional protection from aerosol pathogens alongside their traditional role protecting against splash. There has been debate on whether to use such systems in reopening elective orthopaedic surgery during the current COVID-19 pandemic environment. Methods Thirty-five participants were enrolled in a double-blinded randomised controlled study investigating efficacy of the Stryker Flyte Surgical Helmet (Stryker Corporation, Kalamazoo, MI, USA) as protection against respiratory droplets. Wearing the SSHS in a fit testing hood, subjects were randomised to nebulised saccharin solution or placebo. Twenty were allocated to the saccharin group with 15 to placebo. Positive sweet taste represented a failure of the test. Taste tests were performed with the helmet fan turned on and off. Results SSHS did not prevent saccharin taste (p < 0.0001). Within the saccharin cohort, 40% recorded a positive taste with the fan on and 100% with the fan off. There was a statistically significant difference in mean time-to-taste saccharin (p = 0.049) comparing fan on (123.5 s) vs. off (62.6 s). Conclusions SSHS do not protect against aerosol particulate and therefore are not efficacious in protection against COVID-19. The fan system employed may even increase risk to the surgeon by drawing in particulates as well as delay recognition of intraoperative cues, such as exhaust from diathermy, that point to respirator mask leak.

Getting it right first time: a management protocol for acute and subacute fractures of the scaphoid

Journal of Hand Surgery (European Volume)

Ankle Home Stay Programme:- A review of ankle fracture management and costs at a busy district general hospital

Annals of Medicine and Surgery

Systematic Review of Total Wrist Arthroplasty and Arthrodesis in Wrist Arthritis

Journal of Wrist Surgery

Background End-stage wrist arthritis has traditionally been treated with a total wrist fusion. Th... more Background End-stage wrist arthritis has traditionally been treated with a total wrist fusion. There is a recent trend toward motion preserving surgery in the form of total wrist replacement. Questions Is there a functional benefit to performing a total wrist replacement instead of a total wrist fusion in patients with end-stage wrist arthritis? Is there any difference in secondary outcome measures including pain, grip strength, and range of motion? Does the risk of adverse events and treatment failure differ between the two techniques? Methods A systematic literature search was performed to identify studies reporting either total wrist arthrodesis or arthroplasty for end-stage wrist arthritis. Studies were systematically screened and assessed for risk of bias and quality. Data were extracted and reviewed. Results A total of 43 studies were included in the review: 17 on arthrodesis, 24 on arthroplasty, and 2 matched cohort studies. This represented 669 index arthrodesis operations i...

Ankle Home Stay Programme: A Prospective Cohort of Ankle Fracture Management and Costs at A Busy District General Hospital

Journal of Surgery

MOJ Gerontology & Geriatrics

Background: The objective of this study was to evaluate the proportion of patients presenting wit... more Background: The objective of this study was to evaluate the proportion of patients presenting with a fall also having a coexisting diagnosis of an overactive bladder (OAB). Methodology: This was a prospective case series study of patients over 65 years of age. Of a 137 patients presenting to the hospital during a 6-month period, 33 patients had a urinary tract infection and therefore 104 patients (average age: 79.3 years) were included for further analysis. Results: In this cohort, 61% patients had a diagnosis of OAB. Only 1.9% of these had any investigations or treatment. The falls risk was multifactorial in 42 cases (40%). A fracture was diagnosed in 73% of patients, 39% of which was a fracture neck of femur. The relative risk of sustaining a fracture and having OAB was 0.67 (95% confidence interval, 0.42, 1.05). A significant relationship was seen between a hip fracture and OAB diagnosis (p=0.0152). Conclusion: An overactive bladder is an important risk factor in patients presenting with falls. Falls in patients with an overactive bladder can have significant consequences such as a neck of femur fracture.

Hip international : the journal of clinical and experimental research on hip pathology and therapy, Jan 4, 2017

Intravenous tranexamic acid (IV TXA) is a recognised pharmaceutical intervention utilised to mini... more Intravenous tranexamic acid (IV TXA) is a recognised pharmaceutical intervention utilised to minimise blood loss and allogenic blood transfusion. However, the use of IV TXA in hip fracture surgery remains inconclusive. We conducted a meta-analysis to investigate the role of TXA in operative hip fracture management on operative and total blood loss, allogenic blood transfusion requirements and impact on venous thromboembolic (VTE) event incidence. A systematic computerised literature search of PubMed, Medline, Embase, Ovid, The Cochrane Controlled Trials Register, Trip and Google was conducted. We reviewed the efficacy of IV TXA on perioperative blood loss, total blood loss, pre- and postoperative haemoglobin differences, duration of surgery, allogenic blood transfusion requirements and VTE events. 8 studies were eligible including 6 randomised control trials and 2 cohort studies. Patients receiving IV TXA had reduced mean total blood loss of 442.9 mls (95% CI, 426.5-459.3; p<0.00...