syed mannan - Academia.edu (original) (raw)

Papers by syed mannan

Journal of Shoulder and Elbow Surgery, Mar 1, 2019

Background: Reverse shoulder arthroplasty has seen increased use for management of complex proxim... more Background: Reverse shoulder arthroplasty has seen increased use for management of complex proximal humeral fractures in the elderly. Recent evidence has shown that tuberosity healing leads to improved active range of motion and functional outcomes. The purpose of this study was to report on the radiographic and clinical outcomes of a consecutive series of patients having undergone reverse shoulder arthroplasty for fracture utilizing the ''black and tan'' methodda hybrid cementation-impaction grafting technique that uses autogenous cancellous bone graft to create an interface between the proximal cement mantle and the area of tuberosity repair. Methods: Twenty-five patients (average age, 77 years; range, 63-88 years) were included in the analysis with a mean follow-up of 17 months. All patients underwent reverse shoulder arthroplasty for a complex proximal humerus fracture using the black and tan technique. Results: The tuberosity healing rate was 88%. At final follow-up, mean active elevation was 117 AE 23 , mean abduction was 86 AE 16 , and mean external rotation was 29 AE 18. External rotation strength averaged 4.9 AE 0.2. The Simple Shoulder Test and Single Assessment Numeric Evaluation scores averaged 7 and 76, respectively. The mean American Shoulder and Elbow Surgeons total score was 71; visual analog scale score for pain, 2; and visual analog scale score for function, 7. Of the 25 patients, 21 (84%) rated their satisfaction with the surgery as excellent or good. Conclusions: The black and tan technique together with standard suture repair and an implant with features that support tuberosity repair results in a high tuberosity healing rate with restoration of external rotation after reverse shoulder arthroplasty for fracture.

Anaesthesia, 2021

SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...

Anaesthesia, 2021

SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critica... more SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...

WALANT technique: A possible panacea in pandemic

HAL (Le Centre pour la Communication Scientifique Directe), 2020

PubMed, Mar 28, 2019

Introduction: Intraosseous carpus ganglion cysts are very rare causes of hand and wrist pain. Iso... more Introduction: Intraosseous carpus ganglion cysts are very rare causes of hand and wrist pain. Isolated cases of lunate, scaphoid, pisiform, hamate, triquetrum, capitate, metacarpal, and phalanx cysts have no report of more than two carpal cysts, according to our knowledge. Case report: A case of simultaneous triquetrum, lunate, and capitate intraosseous ganglion cysts is presented. A 56-year-old right-handed woman presented with a 6-month history of persistent left-wrist pain. An old minor trauma was reported; however, the plain radiographs did not show any fractures. Subsequently, magnetic resonance imaging was performed, and it showed small cysticstructures in the lunate, triquetrum, and capitate which is keeping with small intraosseous ganglia. The patient did not want to go down the surgical route as the pain was to some extent manageable. Conclusion: Intraosseous carpal ganglion cysts, although rare, can cause chronic wrist pain and should be included in the differential diagnosis.

Pertrochanteric hip fracture fixation with 3 hole and 4 hole dhs side plates - A retrospective patient record review

Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria, 2022

EC Orthopaedics, Dec 31, 2020

Background: Anatomic repair is the standard of care of distal bicep brachii tendon rupture. Endob... more Background: Anatomic repair is the standard of care of distal bicep brachii tendon rupture. Endobutton fixation have demonstrable superior load to failure compared to other fixation options and in order to achieve anatomic repair, some investigators have added secondary fixation using interference screws. We questioned the relevance of this secondary fixation and we sought to evaluate the difference in the functional outcome of patients who had distal bicep brachii tendon rupture repair with endobutton with interference screws and those without interference screws. Method: A retrospective study of 48 patient who underwent distal bicep brachii tendon repair looking at biodata of patient, duration between the injury and repair, the type of fixation technique, complications and the quick dash score. We included all patient who had distal bicep tendon rupture repair with either endobutton alone or endobutton with interference screw and the following were excluded from the study ; patients who had double incision techniques, repair of chronic rupture that require a graft, background ipsilateral upper limb injury or neurologic deficit. All obtained data were analysed using the Statistical Package for Social Sciences (SPSS) version 22 (IBM SPSS Incorporated, Chicago, Illinois) and obtained values expressed in percentages. Result: All patients were male with mean age of 43.72 ± 9.12 years and average duration to surgery from the time of injury was 22.47 ± 54.78 days. There was no significant statistical difference between the treatment groups with respect to the quick dash score, complications. Injury to the lateral antebrachial nerve was the commonest complication and there was no re-rupture in both treatment groups. Conclusion: Both treatment are effective in the management of distal bicep brachii tendon rupture and addition of an interference screws was not advantageous rather would have increased the cost and duration of the surgery. 11. Grewal R., et al. "Single versus double-incision technique for the repair of acute distal biceps tendon ruptures. A randomized clinical trial".

Carpal Tunnel Decompression Under Wide Awake Local Anaesthesia No Tourniquet Technique (WALANT): A Cost Effective and Outcome Analysis

Cureus

British Journal of Surgery

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The a... more Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains...

British Journal of Surgery

British Journal of Surgery, 2021

To support the global restart of elective surgery, data from an international prospective cohort ... more To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.

Journal of bone and joint infection, May 28, 2018

Background: Incidence of infection following total elbow replacement (TER) is recognised to be hi... more Background: Incidence of infection following total elbow replacement (TER) is recognised to be higher compared to hip or knee arthroplasty. Extensive swelling following TER can complicate the wound healing which might lead to infection. Tranexamic Acid (TXA) is proven to reduce blood loss peri-operatively which might contribute to better healing outcomes. Our aim is to assess the effect of TXA in wound healing following TER. Methods: A retrospective review of a single surgeon case series. 10 patients had TER mainly for complicated elbow fractures, four of them were relatively immune-supressed. All patients had 2 grams of TXA and antibiotics intra-operatively. All were reviewed at two weeks following surgery for wound check and removal of surgical clips. Results: Seven females and three males with a mean age of 81.5 had TER and TXA. The mean level of pre-operative haemoglobin was 134.40 g/l and the mean post-operative level was 122.70g/l. No patient in this series required blood transfusion. At two weeks and six weeks follow-up, all wound healed up with no signs of infection. Conclusion: TXA has been proven to be safe an effective way of reducing peri-operative bleeding. TXA maintains haemostasis after releasing the tourniquet and therefore reduces the swelling and wound complications post-operatively

Journal of Clinical & Experimental Orthopaedics, 2020

Wide awake local anaesthesia no tourniquet (WALANT) is being employed beyond hand surgeries recen... more Wide awake local anaesthesia no tourniquet (WALANT) is being employed beyond hand surgeries recently. COVID 19 shifted many orthopaedic practices with reliance on conservative treatment and deferment of elective procedures. WALANT techniques has a tendency to minimize the risk of aerosolized droplet contamination which is important in transmission of the disease. We studied the outcome of recalcitrant tennis elbow treated with either WALANT techniques or general anaesthesia.

Pertrochanteric hip fracture fixation with 3 hole and 4 hole dhs side plates - A retrospective patient record review

Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria, 2022

Journal of Orthopaedic Case Reports, 2018

Introduction: Intraosseous carpus ganglion cysts are very rare causes of hand and wrist pain. Iso... more Introduction: Intraosseous carpus ganglion cysts are very rare causes of hand and wrist pain. Isolated cases of lunate, scaphoid, pisiform, hamate, triquetrum, capitate, metacarpal, and phalanx cysts have no report of more than two carpal cysts, according to our knowledge. Case Report: A case of simultaneous triquetrum, lunate, and capitate intraosseous ganglion cysts is presented. A 56-year-old right-handed woman presented with a 6-month history of persistent left-wrist pain. An old minor trauma was reported; however, the plain radiographs did not show any fractures. Subsequently, magnetic resonance imaging was performed, and it showed small cysticstructures in the lunate, triquetrum, and capitate which is keeping with small intraosseous ganglia. The patient did not want to go down the surgical route as the pain was to some extent manageable. Conclusion: Intraosseous carpal ganglion cysts, although rare, can cause chronic wrist pain and should be included in the differential diagno...

Background: Anatomic repair is the standard of care of distal bicep brachii tendon rupture. Endob... more Background: Anatomic repair is the standard of care of distal bicep brachii tendon rupture. Endobutton fixation have demonstrable superior load to failure compared to other fixation options and in order to achieve anatomic repair, some investigators have added secondary fixation using interference screws. We questioned the relevance of this secondary fixation and we sought to evaluate the difference in the functional outcome of patients who had distal bicep brachii tendon rupture repair with endobutton with interference screws and those without interference screws. Method: A retrospective study of 48 patient who underwent distal bicep brachii tendon repair looking at biodata of patient, duration between the injury and repair, the type of fixation technique, complications and the quick dash score. We included all patient who had distal bicep tendon rupture repair with either endobutton alone or endobutton with interference screw and the following were excluded from the study ; patients who had double incision techniques, repair of chronic rupture that require a graft, background ipsilateral upper limb injury or neurologic deficit. All obtained data were analysed using the Statistical Package for Social Sciences (SPSS) version 22 (IBM SPSS Incorporated, Chicago, Illinois) and obtained values expressed in percentages. Result: All patients were male with mean age of 43.72 ± 9.12 years and average duration to surgery from the time of injury was 22.47 ± 54.78 days. There was no significant statistical difference between the treatment groups with respect to the quick dash score, complications. Injury to the lateral antebrachial nerve was the commonest complication and there was no re-rupture in both treatment groups. Conclusion: Both treatment are effective in the management of distal bicep brachii tendon rupture and addition of an interference screws was not advantageous rather would have increased the cost and duration of the surgery. 11. Grewal R., et al. "Single versus double-incision technique for the repair of acute distal biceps tendon ruptures. A randomized clinical trial".

British Journal of Surgery, 2021

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numb... more Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst ...

The Lancet, 2020

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in Engli... more Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre -including this research content -immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Journal of Ultrasonography, 2018

Background: Ultrasonography is widely utilized by emergency physicians and radiologists to diagno... more Background: Ultrasonography is widely utilized by emergency physicians and radiologists to diagnose various orthopaedic diseases, including fractures. We aim to derive a definitive estimate of the diagnostic accuracy of ultrasonography in clinically suspected scaphoid fractures. Methods: We undertook a systematic review and meta-analysis of included diagnostic cohort studies that discussed the use of ultrasonography in the diagnosis of occult scaphoid fractures. We searched the National Institute for Health and Care Excellence database using the Healthcare Databases Advanced Search tool. In addition, we utilized the PubMed database to search the Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, Cumulative Index of Nursing and Allied Health and Allied and Complimentary Medicine databases. Studies were included if they discuss the role of ultrasound imaging in the diagnosis of scaphoid fractures based on cortical interruption, radio-carpal effusion and scapho-trapezium-trapezoid effusion. Quality assessment was performed using the methodological index for non-randomized studies scoring system. Results: 6 non-randomized control studies met the inclusion criteria. Collectively, these included 236 patients with a mean age ranging from 18 to 41.2 years. The quality of these articles ranged between moderate and high based on the methodological index for nonrandomized studies score. The mean sensitivity was 88.95% (standard deviation 10.03) and mean specificity was 89.50% (standard deviation 12.21). Conclusion: The current literature reveals high sensitivity and specificity in the use of ultrasonography in scaphoid fracture diagnosis. However, multiple factors including technical differences in ultrasound machines and probes, small sample sizes and variability of subsequent confirmatory tests have created a challenge in determining the ultimate reliability of ultrasonography in the diagnosis of occult scaphoid fractures. Considering these factors and limitations, large-sample and high-quality clinical trials are needed to adequately assess its reliability for this purpose. One stop clinics, in the authors' opinion, would be an ideal setting for its introduction as well as for future trials.

Tuberosity healing after reverse shoulder arthroplasty for complex proximal humeral fractures in elderly patients—does it improve outcomes? A systematic review and meta-analysis

Journal of Shoulder and Elbow Surgery, 2018

BACKGROUND Reverse shoulder arthroplasty (RSA) is being increasingly used for complex, displaced ... more BACKGROUND Reverse shoulder arthroplasty (RSA) is being increasingly used for complex, displaced fractures of the proximal humerus in older patients. Anatomic tuberosity healing in RSA has been recognized to restore better shoulder function. We compared the reported clinical and functional outcomes of RSA in proximal humeral fractures with and without tuberosity healing. METHODS We performed a systematic review of literature based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched MEDLINE, CINAHL, Embase, and Cochrane Central Register of Controlled Trials. We included all studies with RSA for proximal humeral fractures in patients older than 60 years and compared outcomes based on tuberosity healing with minimum follow-up of 12 months. RESULTS Seven studies met the inclusion criteria. A total of 381 patients (382 shoulders) were identified. There were 53 men (18.3%) and 236 women (81.7%), with mean age of 76.83 years (range, 74-81 years). Mean follow-up duration was 29.84 months (range, 24-90 months), and the mean rate of greater tuberosity healing was 70.5%. Patients with healed tuberosity had significantly better active forward flexion (134.1° vs. 112.5°, P < .05), abduction (114.8° vs. 95.1°, P < .05), external rotation with elbow by the side (27.8° vs. 7.6°), and mean Constant score (63.5 vs. 56.6, P < .05) than with those with nonhealed tuberosity. CONCLUSION The RSA group with healed greater tuberosity showed better range of motion, especially forward flexion and external rotation and Constant scores, compared with the nonhealed greater tuberosity group. Tuberosity healing may influence overall shoulder function after RSA for proximal humeral fractures in the elderly, and this needs verification with future prospective studies.

Journal of Shoulder and Elbow Surgery, Mar 1, 2019

Background: Reverse shoulder arthroplasty has seen increased use for management of complex proxim... more Background: Reverse shoulder arthroplasty has seen increased use for management of complex proximal humeral fractures in the elderly. Recent evidence has shown that tuberosity healing leads to improved active range of motion and functional outcomes. The purpose of this study was to report on the radiographic and clinical outcomes of a consecutive series of patients having undergone reverse shoulder arthroplasty for fracture utilizing the ''black and tan'' methodda hybrid cementation-impaction grafting technique that uses autogenous cancellous bone graft to create an interface between the proximal cement mantle and the area of tuberosity repair. Methods: Twenty-five patients (average age, 77 years; range, 63-88 years) were included in the analysis with a mean follow-up of 17 months. All patients underwent reverse shoulder arthroplasty for a complex proximal humerus fracture using the black and tan technique. Results: The tuberosity healing rate was 88%. At final follow-up, mean active elevation was 117 AE 23 , mean abduction was 86 AE 16 , and mean external rotation was 29 AE 18. External rotation strength averaged 4.9 AE 0.2. The Simple Shoulder Test and Single Assessment Numeric Evaluation scores averaged 7 and 76, respectively. The mean American Shoulder and Elbow Surgeons total score was 71; visual analog scale score for pain, 2; and visual analog scale score for function, 7. Of the 25 patients, 21 (84%) rated their satisfaction with the surgery as excellent or good. Conclusions: The black and tan technique together with standard suture repair and an implant with features that support tuberosity repair results in a high tuberosity healing rate with restoration of external rotation after reverse shoulder arthroplasty for fracture.

Anaesthesia, 2021

SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...

Anaesthesia, 2021

SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critica... more SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...

WALANT technique: A possible panacea in pandemic

HAL (Le Centre pour la Communication Scientifique Directe), 2020

PubMed, Mar 28, 2019

Introduction: Intraosseous carpus ganglion cysts are very rare causes of hand and wrist pain. Iso... more Introduction: Intraosseous carpus ganglion cysts are very rare causes of hand and wrist pain. Isolated cases of lunate, scaphoid, pisiform, hamate, triquetrum, capitate, metacarpal, and phalanx cysts have no report of more than two carpal cysts, according to our knowledge. Case report: A case of simultaneous triquetrum, lunate, and capitate intraosseous ganglion cysts is presented. A 56-year-old right-handed woman presented with a 6-month history of persistent left-wrist pain. An old minor trauma was reported; however, the plain radiographs did not show any fractures. Subsequently, magnetic resonance imaging was performed, and it showed small cysticstructures in the lunate, triquetrum, and capitate which is keeping with small intraosseous ganglia. The patient did not want to go down the surgical route as the pain was to some extent manageable. Conclusion: Intraosseous carpal ganglion cysts, although rare, can cause chronic wrist pain and should be included in the differential diagnosis.

Pertrochanteric hip fracture fixation with 3 hole and 4 hole dhs side plates - A retrospective patient record review

Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria, 2022

EC Orthopaedics, Dec 31, 2020

Background: Anatomic repair is the standard of care of distal bicep brachii tendon rupture. Endob... more Background: Anatomic repair is the standard of care of distal bicep brachii tendon rupture. Endobutton fixation have demonstrable superior load to failure compared to other fixation options and in order to achieve anatomic repair, some investigators have added secondary fixation using interference screws. We questioned the relevance of this secondary fixation and we sought to evaluate the difference in the functional outcome of patients who had distal bicep brachii tendon rupture repair with endobutton with interference screws and those without interference screws. Method: A retrospective study of 48 patient who underwent distal bicep brachii tendon repair looking at biodata of patient, duration between the injury and repair, the type of fixation technique, complications and the quick dash score. We included all patient who had distal bicep tendon rupture repair with either endobutton alone or endobutton with interference screw and the following were excluded from the study ; patients who had double incision techniques, repair of chronic rupture that require a graft, background ipsilateral upper limb injury or neurologic deficit. All obtained data were analysed using the Statistical Package for Social Sciences (SPSS) version 22 (IBM SPSS Incorporated, Chicago, Illinois) and obtained values expressed in percentages. Result: All patients were male with mean age of 43.72 ± 9.12 years and average duration to surgery from the time of injury was 22.47 ± 54.78 days. There was no significant statistical difference between the treatment groups with respect to the quick dash score, complications. Injury to the lateral antebrachial nerve was the commonest complication and there was no re-rupture in both treatment groups. Conclusion: Both treatment are effective in the management of distal bicep brachii tendon rupture and addition of an interference screws was not advantageous rather would have increased the cost and duration of the surgery. 11. Grewal R., et al. "Single versus double-incision technique for the repair of acute distal biceps tendon ruptures. A randomized clinical trial".

Carpal Tunnel Decompression Under Wide Awake Local Anaesthesia No Tourniquet Technique (WALANT): A Cost Effective and Outcome Analysis

Cureus

British Journal of Surgery

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The a... more Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains...

British Journal of Surgery

British Journal of Surgery, 2021

To support the global restart of elective surgery, data from an international prospective cohort ... more To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.

Journal of bone and joint infection, May 28, 2018

Background: Incidence of infection following total elbow replacement (TER) is recognised to be hi... more Background: Incidence of infection following total elbow replacement (TER) is recognised to be higher compared to hip or knee arthroplasty. Extensive swelling following TER can complicate the wound healing which might lead to infection. Tranexamic Acid (TXA) is proven to reduce blood loss peri-operatively which might contribute to better healing outcomes. Our aim is to assess the effect of TXA in wound healing following TER. Methods: A retrospective review of a single surgeon case series. 10 patients had TER mainly for complicated elbow fractures, four of them were relatively immune-supressed. All patients had 2 grams of TXA and antibiotics intra-operatively. All were reviewed at two weeks following surgery for wound check and removal of surgical clips. Results: Seven females and three males with a mean age of 81.5 had TER and TXA. The mean level of pre-operative haemoglobin was 134.40 g/l and the mean post-operative level was 122.70g/l. No patient in this series required blood transfusion. At two weeks and six weeks follow-up, all wound healed up with no signs of infection. Conclusion: TXA has been proven to be safe an effective way of reducing peri-operative bleeding. TXA maintains haemostasis after releasing the tourniquet and therefore reduces the swelling and wound complications post-operatively

Journal of Clinical & Experimental Orthopaedics, 2020

Wide awake local anaesthesia no tourniquet (WALANT) is being employed beyond hand surgeries recen... more Wide awake local anaesthesia no tourniquet (WALANT) is being employed beyond hand surgeries recently. COVID 19 shifted many orthopaedic practices with reliance on conservative treatment and deferment of elective procedures. WALANT techniques has a tendency to minimize the risk of aerosolized droplet contamination which is important in transmission of the disease. We studied the outcome of recalcitrant tennis elbow treated with either WALANT techniques or general anaesthesia.

Pertrochanteric hip fracture fixation with 3 hole and 4 hole dhs side plates - A retrospective patient record review

Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria, 2022

Journal of Orthopaedic Case Reports, 2018

Introduction: Intraosseous carpus ganglion cysts are very rare causes of hand and wrist pain. Iso... more Introduction: Intraosseous carpus ganglion cysts are very rare causes of hand and wrist pain. Isolated cases of lunate, scaphoid, pisiform, hamate, triquetrum, capitate, metacarpal, and phalanx cysts have no report of more than two carpal cysts, according to our knowledge. Case Report: A case of simultaneous triquetrum, lunate, and capitate intraosseous ganglion cysts is presented. A 56-year-old right-handed woman presented with a 6-month history of persistent left-wrist pain. An old minor trauma was reported; however, the plain radiographs did not show any fractures. Subsequently, magnetic resonance imaging was performed, and it showed small cysticstructures in the lunate, triquetrum, and capitate which is keeping with small intraosseous ganglia. The patient did not want to go down the surgical route as the pain was to some extent manageable. Conclusion: Intraosseous carpal ganglion cysts, although rare, can cause chronic wrist pain and should be included in the differential diagno...

Background: Anatomic repair is the standard of care of distal bicep brachii tendon rupture. Endob... more Background: Anatomic repair is the standard of care of distal bicep brachii tendon rupture. Endobutton fixation have demonstrable superior load to failure compared to other fixation options and in order to achieve anatomic repair, some investigators have added secondary fixation using interference screws. We questioned the relevance of this secondary fixation and we sought to evaluate the difference in the functional outcome of patients who had distal bicep brachii tendon rupture repair with endobutton with interference screws and those without interference screws. Method: A retrospective study of 48 patient who underwent distal bicep brachii tendon repair looking at biodata of patient, duration between the injury and repair, the type of fixation technique, complications and the quick dash score. We included all patient who had distal bicep tendon rupture repair with either endobutton alone or endobutton with interference screw and the following were excluded from the study ; patients who had double incision techniques, repair of chronic rupture that require a graft, background ipsilateral upper limb injury or neurologic deficit. All obtained data were analysed using the Statistical Package for Social Sciences (SPSS) version 22 (IBM SPSS Incorporated, Chicago, Illinois) and obtained values expressed in percentages. Result: All patients were male with mean age of 43.72 ± 9.12 years and average duration to surgery from the time of injury was 22.47 ± 54.78 days. There was no significant statistical difference between the treatment groups with respect to the quick dash score, complications. Injury to the lateral antebrachial nerve was the commonest complication and there was no re-rupture in both treatment groups. Conclusion: Both treatment are effective in the management of distal bicep brachii tendon rupture and addition of an interference screws was not advantageous rather would have increased the cost and duration of the surgery. 11. Grewal R., et al. "Single versus double-incision technique for the repair of acute distal biceps tendon ruptures. A randomized clinical trial".

British Journal of Surgery, 2021

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numb... more Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst ...

The Lancet, 2020

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in Engli... more Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre -including this research content -immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Journal of Ultrasonography, 2018

Background: Ultrasonography is widely utilized by emergency physicians and radiologists to diagno... more Background: Ultrasonography is widely utilized by emergency physicians and radiologists to diagnose various orthopaedic diseases, including fractures. We aim to derive a definitive estimate of the diagnostic accuracy of ultrasonography in clinically suspected scaphoid fractures. Methods: We undertook a systematic review and meta-analysis of included diagnostic cohort studies that discussed the use of ultrasonography in the diagnosis of occult scaphoid fractures. We searched the National Institute for Health and Care Excellence database using the Healthcare Databases Advanced Search tool. In addition, we utilized the PubMed database to search the Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, Cumulative Index of Nursing and Allied Health and Allied and Complimentary Medicine databases. Studies were included if they discuss the role of ultrasound imaging in the diagnosis of scaphoid fractures based on cortical interruption, radio-carpal effusion and scapho-trapezium-trapezoid effusion. Quality assessment was performed using the methodological index for non-randomized studies scoring system. Results: 6 non-randomized control studies met the inclusion criteria. Collectively, these included 236 patients with a mean age ranging from 18 to 41.2 years. The quality of these articles ranged between moderate and high based on the methodological index for nonrandomized studies score. The mean sensitivity was 88.95% (standard deviation 10.03) and mean specificity was 89.50% (standard deviation 12.21). Conclusion: The current literature reveals high sensitivity and specificity in the use of ultrasonography in scaphoid fracture diagnosis. However, multiple factors including technical differences in ultrasound machines and probes, small sample sizes and variability of subsequent confirmatory tests have created a challenge in determining the ultimate reliability of ultrasonography in the diagnosis of occult scaphoid fractures. Considering these factors and limitations, large-sample and high-quality clinical trials are needed to adequately assess its reliability for this purpose. One stop clinics, in the authors' opinion, would be an ideal setting for its introduction as well as for future trials.

Tuberosity healing after reverse shoulder arthroplasty for complex proximal humeral fractures in elderly patients—does it improve outcomes? A systematic review and meta-analysis

Journal of Shoulder and Elbow Surgery, 2018

BACKGROUND Reverse shoulder arthroplasty (RSA) is being increasingly used for complex, displaced ... more BACKGROUND Reverse shoulder arthroplasty (RSA) is being increasingly used for complex, displaced fractures of the proximal humerus in older patients. Anatomic tuberosity healing in RSA has been recognized to restore better shoulder function. We compared the reported clinical and functional outcomes of RSA in proximal humeral fractures with and without tuberosity healing. METHODS We performed a systematic review of literature based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched MEDLINE, CINAHL, Embase, and Cochrane Central Register of Controlled Trials. We included all studies with RSA for proximal humeral fractures in patients older than 60 years and compared outcomes based on tuberosity healing with minimum follow-up of 12 months. RESULTS Seven studies met the inclusion criteria. A total of 381 patients (382 shoulders) were identified. There were 53 men (18.3%) and 236 women (81.7%), with mean age of 76.83 years (range, 74-81 years). Mean follow-up duration was 29.84 months (range, 24-90 months), and the mean rate of greater tuberosity healing was 70.5%. Patients with healed tuberosity had significantly better active forward flexion (134.1° vs. 112.5°, P < .05), abduction (114.8° vs. 95.1°, P < .05), external rotation with elbow by the side (27.8° vs. 7.6°), and mean Constant score (63.5 vs. 56.6, P < .05) than with those with nonhealed tuberosity. CONCLUSION The RSA group with healed greater tuberosity showed better range of motion, especially forward flexion and external rotation and Constant scores, compared with the nonhealed greater tuberosity group. Tuberosity healing may influence overall shoulder function after RSA for proximal humeral fractures in the elderly, and this needs verification with future prospective studies.