Sameer Khalid Khan - Academia.edu (original) (raw)

Papers by Sameer Khalid Khan

The bone & joint journal, 2013

In our department we use an enhanced recovery protocol for joint replacement of the lower limb. T... more In our department we use an enhanced recovery protocol for joint replacement of the lower limb. This incorporates the use of intravenous tranexamic acid (IVTA; 15 mg/kg) at the induction of anaesthesia. Recently there was a national shortage of IVTA for 18 weeks; during this period all patients received an oral preparation of tranexamic acid (OTA; 25 mg/kg). This retrospective study compares the safety (surgical and medical complications) and efficacy (reduction of transfusion requirements) of OTA and IVTA. During the study period a total of 2698 patients received IVTA and 302 received OTA. After adjusting for a range of patient and surgical factors, the odds ratio (OR) of receiving a blood transfusion was significantly higher with IVTA than with OTA (OR 0.48 (95% confidence interval 0.26 to 0.89), p = 0.019), whereas the safety profile was similar, based on length of stay, rate of readmission, return to theatre, deep infection, stroke, gastrointestinal bleeding, myocardial infarcti...

$Research paper thumbnail of Lumbar vertebral haemangioma causing pathological fracture, epidural haemorrhage, and cord compression: a case report and review of literature$

The journal of spinal cord medicine, 2011

Vertebral haemangiomas are recognized to be one of the commonest benign tumours of the vertebral ... more Vertebral haemangiomas are recognized to be one of the commonest benign tumours of the vertebral column, occurring mostly in the thoracic spine. The vast majority of these are asymptomatic. Infrequently, these can turn symptomatic and cause neurological deficit (cord compression) through any of four reported mechanisms: (1) epidural extension; (2) expansion of the involved vertebra(e) causing spinal canal stenosis; (3) spontaneous epidural haemorrhage; (4) pathological burst fracture. Thoracic haemangiomas have been reported to be more likely to produce cord compression than lumbar haemangiomas. A forty-nine year old male with acute onset spinal cord compression from a pathological fracture in a first lumbar vertebral haemangioma. An MRI delineated the haemangioma and extent of bleeding that caused the cord compression. These were confirmed during surgery and the haematoma was evacuated. The spine was instrumented from T12 to L2, and a cement vertebroplasty was performed intra-opera...

Archives of Iranian medicine, 2009

$Research paper thumbnail of The influence of process and patient factors on the recall of consent information in mentally competent patients undergoing surgery for neck of femur fractures$

The Annals of The Royal College of Surgeons of England, 2012

INTRODUCTION Informed consent is an ethical and legal prerequisite for major surgical procedures.... more INTRODUCTION Informed consent is an ethical and legal prerequisite for major surgical procedures. Recent literature has identified ‘poor consent’ as a major cause of litigation in trauma cases. We aimed to investigate the patient and process factors that influence consent information recall in mentally competent patients (abbreviated mental test score [AMTS] ≥6) presenting with neck of femur (NOF) fractures. METHODS A prospective study was conducted at a tertiary unit. Fifty NOF patients (cases) and fifty total hip replacement (THR) patients (controls) were assessed for process factors (adequacy and validity of consent) as well as patient factors (comprehension and retention) using consent forms and structured interview proformas. RESULTS The two groups were matched for ASA (American Society of Anesthesiologists) grade and AMTS. The consent forms were adequate in both groups but scored poorly for validity in the NOF group. Only 26% of NOF patients remembered correctly what surgery t...

$Research paper thumbnail of A national analysis of complications following hemiarthroplasty for hip fracture in older patients$

QJM, 2012

Background: There is emerging evidence that patients with fractured neck of femur (FNOF) aged >85... more Background: There is emerging evidence that patients with fractured neck of femur (FNOF) aged >85 years have different demands on a health-care system when compared to younger patients. Aim: We sought to better quantify this in terms of comorbidity and complication rates. Design: Retrospective review of national database. Methods: Data on all patients who underwent hip hemiarthroplasty for FNOF between January 2005 and December 2008 were extracted from the English hospital episode statistics database. Results: There were 41 770 patients aged 65-84 years and 35 321 patients aged 585 years. The older cohort was less likely to have diabetes, chronic obstructive pulmonary disease and rheumatoid arthritis. However, they exhibited a significantly higher risk of lower respiratory tract infection [odds ratio (OR) = 1.58, 95% confidence interval (CI) 1.50-1.67)], myocardial infarction (OR = 1.67, 1.52-1.83) and acute renal failure (OR = 1.54, 1.40-1.70) within 30 days of surgery with an inpatient mortality risk at 90 days, double that of the younger age group. Length of stay (LoS) was significantly longer in patients >85 years compared to younger patients (median 18 days vs. 15, P < 0.001). Conclusion: Patients aged 585 years admitted for FNOF were found to have a lower incidence of major chronic disease but exhibited a greater incidence of acute events following hemiarthroplasty and their LoS was increased. Targeted medical interventions that focus upon this susceptible patient group may help reduce morbidity and improve survival.

$Research paper thumbnail of Union of an intra-articular distal radius fracture after successive failures of three locking plates: a case report$

Strategies in Trauma and Limb Reconstruction, 2012

We report a case of a 30-year old male, who presented with a right distal radius intra-articular ... more We report a case of a 30-year old male, who presented with a right distal radius intra-articular fracture complicated by compartment syndrome. He was treated with fasciotomies and fracture fixation with a 3.5 mm LCP (Synthes TM), followed 7 days later by skin graft. Repeat radiographs 8 weeks later showed a break across the plate at the level of an unfilled screw hole over the fracture. He underwent exchange plating with a 2.4 mm LCP Distal Radius Plate (Synthes TM). This revision was complicated by an infected wound dehiscence 2 weeks later requiring multiple procedures. Radiographs at 20 weeks showed broken distal screws. A second revision was performed. At 12 months, the fracture had healed clinically and radiologically, but the three distal screws had broken. We discuss the multifactorial failures of the these three attempts at osteosynthesis, and which factors helped achieve osseous union. We also discuss the literature on volar locking plate breakage and conclude with the recommendations to avoid this rare complication.

Journal of The Royal Naval Medical Service, 2009

$Research paper thumbnail of Atraumatic intracapsular neck of femur fractures after prolonged bisphosphonate treatment: a new atypical variant?$

Clinical cases in mineral and bone metabolism : the official journal of the Italian Society of Osteoporosis, Mineral Metabolism, and Skeletal Diseases

We present 2 cases of elderly females presenting with atraumatic, near-vertical (Pauwells grade 3... more We present 2 cases of elderly females presenting with atraumatic, near-vertical (Pauwells grade 3), intracapsular neck of femur fractures. Following diagnosis of osteoporosis on DEXA scans, they had received alendronic acid for 7 and 10 years respectively. Routine blood tests and serum estimations of calcium, vitamin-D and thyroid-stimulating hormone, done at admission, were within the normal ranges. These patients were managed with a hemiarthroplasty and a dynamic hip screw (DHS) respectively, following discontinuation of bisphosphonates. We present these 2 cases in light of emerging evidence that associates long-term bisphosphonate use with atypical low energy femoral fractures. Only subtrochanteric/diaphyseal fractures have been reported to date. We present a new variant of atypical femoral neck fractures in metaphyseal bone related to prolonged bisphosphonate therapy.

$Research paper thumbnail of Achieving Best Practice Tariff does not reflect improved outcome after hip fracture treatment$

Nuclear medicine review. Central & Eastern Europe, 2007

Metastases from bladder cancer to the bones of the hands or feet are rare and usually present aft... more Metastases from bladder cancer to the bones of the hands or feet are rare and usually present after the diagnosis of the primary lesion has been made. This case report describes a 76-year-old man presenting with initial signs of infection of the right foot. Subsequent bone scan revealed multiple bony metastases and hydronephrosis raising the possibility of a primary bladder tumour that was later confirmed by urine cytology and fine needle aspiration of the foot.

Journal of telemedicine and telecare, 2011

Circular frame treatment for limb reconstruction involves repeated follow-up visits, and a substa... more Circular frame treatment for limb reconstruction involves repeated follow-up visits, and a substantial number of these appointments are for pin site review only. We have encouraged our frame patients to take photographs of their pin sites when they carry out their weekly dressing changes. The photographs are taken with mobile phones or digital cameras by the patients themselves, and the images sent to us by email. We reply within 24 hours, with either reassurance or appropriate instructions as indicated. In the past 12 months, five patients have had their pin sites reviewed remotely using this method, and have expressed a high level of satisfaction. These early results are encouraging.

$Research paper thumbnail of Does the place of fall influence the time to specialist treatment in patients sustaining hip fractures? A study of 4917 patients falling in four different settings$

Acta orthopaedica Belgica, 2011

Delay to treatment is a multifactorial issue for patients sustaining hip fractures. The place of ... more Delay to treatment is a multifactorial issue for patients sustaining hip fractures. The place of fall could possibly impact on the time to specialist care. We aimed to investigate the correlation between the place where a hip fracture occurs, and the time to initiation of specialist fracture-specific treatment. We retrospectively analysed data that had been collected on 4917 consecutive hip fracture admissions to our unit. The recorded places of fall were divided into four groups, including those falling 'outside home', 'at home', 'residential or nursing home', and 'hospital inpatients' respectively. A 24-hour scale was used to record times of fall and of initiation of treatment. The latter was the time of admission to Accident & Emergency for groups 1-3, and the time of referral to the Orthopaedic team for group 4.23.5% patients fell outside their own home (group 1), and presented at only 2 hours post-injury. Patients in both group 2 (47.7%) and grou...

The western journal of emergency medicine, 2011

A young man presented with a painful and swollen thigh, without any history of trauma, illness, c... more A young man presented with a painful and swollen thigh, without any history of trauma, illness, coagulopathic medication or recent exertional exercise. Preliminary imaging delineated a haematoma in the anterior thigh, without any fractures or muscle trauma. Emergent fasciotomies were performed. No pathology could be identified intra-operatively, or on follow-up imaging. A review of thigh compartment syndromes described in literature is presented in a table. Emergency physicians and traumatologists should be cognisant of spontaneous atraumatic presentations of thigh compartment syndrome, to ensure prompt referral and definitive management of this limb-threatening condition.

Hand Surgery, 2013

We present results of four-corner carpal arthrodesis with the Acumed® HubcapTM circular plate per... more We present results of four-corner carpal arthrodesis with the Acumed® HubcapTM circular plate performed at our unit. Eight patients underwent eight procedures over five years, for scapholunate advanced collapse (five wrists) and scaphoid non-union advanced collapse (three wrists). Outcomes included range of motion, quickDASH scores, and visual analogue scores for satisfaction. At final follow-up, mean flexion-extension arc was 56°, mean radial-ulnar deviation 29° and mean quickDASH score was 23/100. Mean score for satisfaction was 7.7/10 (77%). Seven out of eight (87.5%) patients said they would have it done again, and would also recommend it to others. Radiological union was achieved in all cases. One screw broke in one arthrodesis without causing symptoms. The functional outcomes with our use of the HubcapTM are comparable to those reported in literature to date with other circular plates (e.g. Spider plate). There were no non-unions, which is the main reported complication with t...

$Research paper thumbnail of Achieving best practice tariff may not reflect improved survival after hip fracture treatment$

Clinical Interventions in Aging, 2014

The best practice tariff (BPT) incentivizes hospitals in the England and Wales National Health Se... more The best practice tariff (BPT) incentivizes hospitals in the England and Wales National Health Service to provide multiprofessional care to patients with hip fractures. The initial six targets included: 1) admission under consultant-led joint orthopedic-geriatric care, 2) multidisciplinary assessment protocol on admission, 3) surgery within 36 hours, 4) geriatrician review within 72 hours, 5) multiprofessional rehabilitation, and 6) assessment for falls and bone protection. We aimed to examine the relationship between BPT achievement and important patient outcomes and whether the BPT could predict these independently of other validated predictors. Materials and methods: A retrospective review was conducted on 516 patient episodes. Four outcomes were defined: 1) 30-day mortality, 2) 365-day mortality, 3) postoperative length of stay on trauma ward (LOS-T), and 4) total post-operative hospital LOS (LOS-H). Patient episodes were grouped as follows: 1) group 1, pre-BPT, 2) group 2, BPT achievers, 3) group 3, BPT fails. These were compared for mortality (χ 2 test) and for LOS (Kruskal-Wallis test). Event analysis was done for groups 2 and 3 using generalized linear modeling, with age, sex, American Society of Anesthesiologists grade, hemoglobin, albumin, creatinine, and BPT achievement evaluated as predictors. Results: The three groups did not differ significantly in baseline characteristics or outcomes. In the event analysis, the risk of 30-day mortality was related only to abnormal creatinine (P=0.025); mortality at 365 days was related significantly to low albumin (P=0.023) and weakly to abnormal creatinine (P=0.089). The risks of both increased LOST and LOS-H were related to age only (P=0.052, P0.001, respectively). Conclusion: Achieving BPT does not predict any outcome of interest on its own.

$Research paper thumbnail of Partial evacuation of the fracture haematoma does not potentiate the analgesic effect of infiltrated local anaesthetic in the manipulation of distal radius fractures$

Trauma, 2013

Wrist haematoma blocks increase the volume of the fracture-soft tissue envelope and the resulting... more Wrist haematoma blocks increase the volume of the fracture-soft tissue envelope and the resulting compartment pressures. We hypothesised that evacuating the haematoma before infiltrating with local anaesthetic would reduce the risk of undue swelling and produce a more effective block as measured by changes in a visual analogue score for pain. A total of 100 patients (100 fractures) were recruited; 77 had the haematoma partially evacuated (Group 1) and 23 did not (Group 2). The volumes of infiltrated anaesthetic, timing of manipulation, rates of re-manipulation and splitting of cast were not different between the two groups. The mean visual analogue score before manipulation in the two groups were 7.8 and 7.5, respectively, which declined to 3.2 and 2.5 at 5 min and to 2.8 and 2.4 at 10 min. The differences in change in visual analogue score were not significant at 5 and 10 min ( p = 0.42, p = 0.55). This suggests that evacuation of the haematoma does not influence the analgesic effe...

$Research paper thumbnail of The risk of cardiorespiratory deaths persists beyond 30 days after proximal femoral fracture surgery$

$Research paper thumbnail of Comments on ‘Concurrent fractures of the hip and wrist: A matched analysis of elderly patients’$

Injury, 2010

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$Research paper thumbnail of Posterior multifragmentation of the femoral neck: Does it portend a poor outcome in internally fixed intracapsular hip fractures?$