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Bandyopadhyay A, Hoban KA, Jariwala AC. Surgical Management of Bilateral Triceps Muscle Rupture: A Case Report and Literature Review. J Orthop Case Rep 2023; 13:79-83. [PMID: 37654741 PMCID: PMC10465747 DOI: 10.13107/jocr.2023.v13.i08.3824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/23/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction Triceps tendon avulsion is a rare tendinous injury that can be easily overlooked. If left untreated, such injuries can lead to a weakening of a patient's elbow extension and thereby cause significant disability; therefore, early identification and appropriate surgical intervention are important. Case Report We report bilateral triceps tendon avulsion injuries in a 49-year-old, right-hand dominant airline pilot. The patient fell while running and injured both his elbows. X-rays of both elbows showed displaced olecranon avulsion fractures, confirming triceps tendon injuries. Bone tendons were repaired with the suture anchor technique, and a solid repair was achieved. 3 months post-surgery, the post-operative progress of the patient was satisfied with full function, a range of motion of 5-150° on the left arm, and 0-150° on the right arm and ability to return to work with no restrictions. Conclusion Triceps tendon avulsion is a rare injury with few reported cases. Literature suggests that the successful outcome of the patient depends on early identification and timely intervention, such as surgical repair through a trans-osseous suture technique. Our report adds to the knowledge base available in the existing medical literature for future reference by healthcare professionals.
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Affiliation(s)
- Abhijit Bandyopadhyay
- University Department of Orthopaedic and Trauma Surgery, Tort Centre, Ninewells Hospital, Dundee, Scotland
| | - Katie A Hoban
- University Department of Orthopaedic and Trauma Surgery, Tort Centre, Ninewells Hospital, Dundee, Scotland
| | - Arpit C Jariwala
- University Department of Orthopaedic and Trauma Surgery, Tort Centre, Ninewells Hospital, Dundee, Scotland
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Thompson RP, Raina P, Downie S, Jariwala AC. Acrometastasis of the Lower Limb Carries a Poorer Prognosis: A Retrospective Cohort Study. Foot Ankle Spec 2022:19386400221136373. [PMID: 36416410 DOI: 10.1177/19386400221136373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Bony metastasis distal to the knee is rare and often reported alongside metastasis distal to the elbow. We sought to provide empirical evidence of the epidemiology, presentation, and prognosis of lower limb acrometastasis, alongside investigation of the distribution of metastases present while lower limb acrometastases form. METHODS This retrospective cohort study identified 44 radiologically confirmed cases of lower limb acrometastasis from a single region. Case note review facilitated the extraction of data relating to the stated aims. Patients were grouped by extent of metastasis at primary diagnosis. Mann-Whitney U test compared metastatic burden, and Kaplan-Meier analysis compared survival. RESULTS Prostate and breast carcinoma were the most commonly diagnosed primary tumors. Sixty-eight acrometastatic lesions were identified, of which 70% presented asymptomatically. Lower limb acrometastasis was associated with metastatic disease at a significantly greater number of sites than those presenting with metastasis proximal to the knee only (P = .007) and conveyed a significantly worse survival than metastasis proximal to the knee or nil metastasis (P < .001). Median survival from diagnosis of lower limb acrometastasis was 1.0 year. CONCLUSION Lower limb acrometastasis is associated with a large metastatic burden and occurs in the terminal year of disease. Radiological identification of cases reveals a distinct cohort of acrometastatic lesions, more likely to present asymptomatically, and arises from alternate primary carcinomas than those in previous literature. LEVELS OF EVIDENCE Level IV: Case series.
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Affiliation(s)
- Rory P Thompson
- Department of Orthopaedics, Ninewells Hospital and Medical School, Dundee, UK
| | - Prince Raina
- University Department of Trauma and Orthopaedics, University of Dundee, Dundee, UK
| | - Samantha Downie
- Department of Orthopaedics, Ninewells Hospital and Medical School, Dundee, UK
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Arpit C Jariwala
- Department of Orthopaedics, Ninewells Hospital and Medical School, Dundee, UK
- University Department of Trauma and Orthopaedics, University of Dundee, Dundee, UK
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Hoban KA, Downie S, Adamson DJ, MacLean JG, Cool P, Jariwala AC. Mirels’ Score for upper limb metastatic lesions: Do we need a different cut-off for recommending prophylactic fixation? JSES Int 2022; 6:675-681. [PMID: 35813136 PMCID: PMC9264023 DOI: 10.1016/j.jseint.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Katie A. Hoban
- NHS Tayside, Ninewells Hospital & Medical School, Dundee, United Kingdom
- Corresponding author: Katie A. Hoban, BSc (Hons), MBChB, MSc, MRCS (Glasg), Department of Trauma and Orthopaedics, NHS Tayside, Ninewells Hospital & Medical School, Dundee DD1 9SY, United Kingdom.
| | - Samantha Downie
- NHS Tayside, Ninewells Hospital & Medical School, Dundee, United Kingdom
| | | | | | - Paul Cool
- The Robert Jones and Agnus Hunt Orthopaedic Hospital, Gobowen, Oswestry, United Kingdom
- Keele University, Keele, Staffordshire, United Kingdom
| | - Arpit C. Jariwala
- University Department of Orthopaedics and Trauma Surgery, Ninewells Hospital & Medical School, University of Dundee, Dundee, United Kingdom
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Abstract
OBJECTIVES Identify the proportion of patients attending fracture clinics who had suffered intimate partner violence (IPV) within the past year. DESIGN Powered cross-sectional study using validated participant self-reported questionnaires. SETTING AND PARTICIPANTS Adult trauma patients (no gender/age exclusions) attending one of three Scottish adult fracture clinics over 16-month period (from October 2016 to January 2018). PRIMARY OUTCOME MEASURE Number of participants answering 'yes' to the Woman Abuse Screening Tool question: 'In your current relationship over the past twelve months, has your partner ever abused you physically/emotionally/sexually?' RESULTS Of 336 respondents, 46% (156/336 known) were women with 65% aged over 40 (212/328 known). The overall prevalence of IPV within the preceding 12 months was 12% 39/336) for both male and female patients. The lifetime prevalence of IPV among respondents was 20% (68/336). 38% of patients who had experienced IPV within the past 12 months had been physically abused (11/29). None of the patients were being seen for an injury caused by abuse. Two-thirds of respondents thought that staff should ask routinely about IPV (55%, 217/336), but only 5% had previously been asked about abuse (18/336). CONCLUSIONS This is the first study worldwide investigating the prevalence of IPV in fracture clinics for both male and female patients. 12-month prevalence of IPV in fracture clinic patients is significant and not affected by gender in this study. Patients appear willing to disclose abuse within this setting and are supportive of staff asking about abuse. This presents an opportunity to identify those at risk within this vulnerable population.
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Affiliation(s)
- Samantha Downie
- Orthopaedics Department, NHS Tayside, Dundee, UK
- University Department of Orthopaedics and Trauma Surgery, University of Dundee, Dundee, UK
| | | | - Kim Madden
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Arpit C Jariwala
- Orthopaedics Department, NHS Tayside, Dundee, UK
- University Department of Orthopaedics and Trauma Surgery, University of Dundee, Dundee, UK
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Faulkner A, MacDonald DRW, Neilly DW, Davies PSE, Ha TT, Stevenson IM, Jariwala AC. Cycling injuries requiring orthopaedic intervention during the first COVID-19 lockdown period: A multi-centre SCottish Orthopaedic Research collaborativE (SCORE) study. Surgeon 2021; 20:252-257. [PMID: 34183264 PMCID: PMC9451541 DOI: 10.1016/j.surge.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/20/2021] [Accepted: 05/06/2021] [Indexed: 12/23/2022]
Abstract
Introduction The COVID-19 lockdown resulted in decreased vehicle use and an increased uptake in cycling. This study investigated the trends in cycling-related injuries requiring orthopaedic intervention during the COVID-19 lockdown period compared with similar time periods in 2018 and 2019. Methods Data were collected prospectively for patients in 2020 and collected retrospectively for 2019 and 2018, from hospitals within four NHS Scotland Health Boards encompassing three major trauma centres. All patients who sustained an injury as a result of cycling requiring orthopaedic intervention were included. Patient age, sex, mechanism of injury, diagnosis and treatment outcome from electronic patient records. Results Number of injuries requiring surgery 2020: 77 (mean age/years – 42.7); 2019: 47 (mean age/years - 42.7); 2018: 32 (mean age/years – 31.3). Overall incidence of cycling injuries 2020: 6.7%; 2019: 3.0%; 2018: 2.1%. Commonest mechanism of injury: fall from bike 2020 n = 54 (70.1%); 2019 n = 41 (65.1%); 2018 n = 25 (67.6%). Commonest injury type: fracture 2020 n = 68 (79.1%); 2019 n = 33 (70.2%); 2018 n = 20 (62.5%). Commonest areas affected: Upper extremity: 2020 n = 45 (58.5%); 2019 n = 25 (53.2%); 2018 n = 25 (78.1%). Lower extremity: 2020 n = 23 (29.9%); 2019 n = 14 (29.7%); 2018 n = 7 (21.8%). Conclusion A significant increase in the number of cycling related injuries requiring orthopaedic intervention, a greater proportion of female cyclists and an older mean age of patients affected was observed during the COVID-19 lockdown period compared with previous years. The most common types of injury were fractures followed by lacerations and fracture-dislocations. The upper extremity was the commonest area affected.
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Affiliation(s)
- Alastair Faulkner
- Department of Trauma and Orthopaedics, Ninewells Hospital, James Arrott Dr, Dundee, DD2 1SG, UK.
| | - David R W MacDonald
- Department of Trauma and Orthopaedics, Aberdeen Royal Infirmary, Foresterhill Rd, Aberdeen, AB25 2ZN, UK
| | - David W Neilly
- Department of Trauma and Orthopaedics, Aberdeen Royal Infirmary, Foresterhill Rd, Aberdeen, AB25 2ZN, UK
| | - Peter S E Davies
- Department of Trauma and Orthopaedics, Ninewells Hospital, James Arrott Dr, Dundee, DD2 1SG, UK
| | - Taegyeong T Ha
- Department of Trauma and Orthopaedics Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, UK
| | - Iain M Stevenson
- Department of Trauma and Orthopaedics, Aberdeen Royal Infirmary, Foresterhill Rd, Aberdeen, AB25 2ZN, UK
| | - Arpit C Jariwala
- Department of Trauma and Orthopaedics, Ninewells Hospital, James Arrott Dr, Dundee, DD2 1SG, UK
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MacDonald DRW, Neilly DW, Davies PSE, Crome CR, Jamal B, Gill SL, Jariwala AC, Stevenson IM, Ashcroft GP. Effects of the COVID-19 lockdown on orthopaedic trauma: a multicentre study across Scotland. Bone Jt Open 2020; 1:541-548. [PMID: 33215152 PMCID: PMC7659679 DOI: 10.1302/2633-1462.19.bjo-2020-0114.r1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
AIMS The UK government declared a national lockdown on 23 March 2020 to reduce transmission of COVID-19. This study aims to identify the effect of lockdown on the rates, types, mechanisms, and mortality of musculoskeletal trauma across Scotland. METHODS Data for all musculoskeletal trauma requiring operative treatment were collected prospectively from five key orthopaedic units across Scotland during lockdown (23 March 2020 to 28 May 2020). This was compared with data for the same timeframe in 2019 and 2018. Data collected included all cases requiring surgery, injury type, mechanism of injury, and inpatient mortality. RESULTS A total of 1,315 patients received operative treatment from 23 March 2020 to 28 May 2020 compared with 1,791 in 2019 and 1,719 in 2018. The numbers of all injury types decreased, but the relative frequency of hip fractures increased (36.3% in 2020 vs 30.2% in 2019, p < 0.0001 and 30.7% in 2018, p < 0.0001). Significant increases were seen in the proportion of DIY-related injuries (3.1% in 2020 vs 1.7% in 2019, p = 0.012 and 1.6% in 2018, p < 0.005) and injuries caused by falls (65.6% in 2020 vs 62.6% in 2019, p = 0.082 and 61.9% in 2018, p = 0.047). Significant decreases were seen in the proportion of road traffic collisions (2.6% in 2020 vs 5.4% in 2019, p < 0.0001 and 4.2% in 2018, p = 0.016), occupational injuries (1.8% in 2020 vs 3.0% in 2019, p = 0.025 and 2.3% in 2018, p = 0.012) and infections (6.8% in 2020 vs 7.8% in 2019, p = 0.268 and 10.3% in 2018, p < 0.012). Cycling injuries increased (78 in 2020 vs 64 in 2019 vs 42 in 2018). A significant increase in the proportion of self-harm injuries was seen (1.7% in 2020 vs 1.1% in 2019, p = 0.185 and 0.5% in 2018, p < 0.0001). Mortality of trauma patients was significantly higher in 2020 (5.0%) than in 2019 (2.8%, p = 0.002) and 2018 (1.8%, p < 0.0001). CONCLUSION The UK COVID-19 lockdown has resulted in a marked reduction in musculoskeletal trauma patients undergoing surgery in Scotland. There have been significant changes in types and mechanisms of injury and, concerningly, mortality of trauma patients has risen significantly.Cite this article: Bone Joint Open 2020;1-9:541-548.
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Affiliation(s)
| | - David W. Neilly
- Department of Trauma and Orthopaedics, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - Christopher R. Crome
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Bilal Jamal
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Sarah L. Gill
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Arpit C. Jariwala
- Department of Trauma and Orthopaedics, Ninewells Hospital, Dundee, UK
| | - Iain M. Stevenson
- Department of Trauma and Orthopaedics, Aberdeen Royal Infirmary, Aberdeen, UK
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Abstract
Aims The early mortality in patients with hip fractures from bony metastases is unknown. The objectives of this study were to quantify 30- and 90-day mortality in patients with proximal femoral metastases, and to create a mortality prediction tool based on biomarkers associated with early death. Methods This was a retrospective cohort study of consecutive patients referred to the orthopaedic department at a UK trauma centre with a proximal femoral metastasis (PFM) over a seven-year period (2010 to 2016). The study group were compared to a matched control group of non-metastatic hip fractures. Minimum follow-up was one year. Results There was a 90-day mortality of 46% in patients with metastatic hip fractures versus 12% in controls (89/195 and 24/192, respectively; p < 0.001). Mean time to surgery was longer in symptomatic metastases versus complete fractures (9.5 days (SD 19.8) and 3.4 days (SD 11.4), respectively; p < 0.05). Albumin, urea, and corrected calcium were all independent predictors of early mortality and were used to generate a simple tool for predicting 90-day mortality, titled the Metastatic Early Prognostic (MEP) score. An MEP score of 0 was associated with the lowest risk of death at 30 days (14%, 3/21), 90 days (19%, 4/21), and one year (62%, 13/21). MEP scores of 3/4 were associated with the highest risk of death at 30 days (56%, 5/9), 90 days (100%, 9/9), and one year (100%, 9/9). Neither age nor primary cancer diagnosis was an independent predictor of mortality at 30 and 90 days. Conclusion This score could be used to predict early mortality and guide perioperative counselling. The delay to surgery identifies a potential window to intervene and correct these abnormalities with the aim of improving survival. Cite this article: Bone Joint J. 2020;102-B(1):72–81
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Affiliation(s)
- Samantha Downie
- NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
| | - Florence Y. Lai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Judith Joss
- NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
| | - Douglas Adamson
- NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
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Sangram BS, Mayne AIW, Jariwala AC. Can we accurately predict nerve conduction study outcome using a carpal tunnel syndrome questionnaire? Surgeon 2019; 17:156-159. [PMID: 30935878 DOI: 10.1016/j.surge.2019.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/28/2018] [Accepted: 02/25/2019] [Indexed: 11/30/2022]
Abstract
NCS are often routinely performed for CTS despite recommendations from the BOA, BSSH and NICE that they are associated with increased costs and prolonged waiting times. This prospective study aimed to assess if the Kamath and Stothard clinical questionnaire could accurately predict nerve conduction study (NCS) results when diagnosing carpal tunnel syndrome (CTS). Eighty-eight patients referred with signs and symptoms of CTS from September 2016 to February 2017 were included. All patients were assessed by specialist hand therapists using the Kamath and Stothard carpal tunnel questionnaire (CTQ) and all patients independently underwent NCS by neurophysiologists. We compared results of CTQ score versus NCS findings. Results showed that a CTQ score of less than 3 correlated 100% to negative NCS. When the CTQ score was more than or equal to 5, 90% of patients had a positive NCS result. For patients with a CTQ score of 3 or 4, the NCS could not be reliably predicted. These findings suggest that the Kamath and Stothard CTQ is a useful tool in determining which patients may require NCS. We suggest that only patients with a CTQ score of 3 or 4 and with equivocal signs and symptoms should undergo NCS. The questionnaire has the potential to be used as a primary tool for diagnosing CTS, with significant cost savings and reduction in waiting times for NCS.
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Affiliation(s)
- Belagodu S Sangram
- Trauma and Orthopaedic Surgery, NHS Tayside, Ninewells Hospital and Medical School, Dundee, United Kingdom.
| | - Alistair I W Mayne
- Trauma and Orthopaedic Surgery, NHS Tayside, Ninewells Hospital and Medical School, Dundee, United Kingdom.
| | - Arpit C Jariwala
- Trauma and Orthopaedic Surgery, NHS Tayside, Ninewells Hospital and Medical School, Dundee, United Kingdom.
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Jariwala AC, Phillips AR, Storey PA, Nuttall D, Watts AC. Internal fixation versus other surgical methods for treating distal radius fractures in adults. Hippokratia 2018. [DOI: 10.1002/14651858.cd011212.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Arpit C Jariwala
- Wrightington, Wigan and Leigh NHS Trust; Upper Limb Unit; Wrightington Hospital, Hall Lane Appley Bridge Wigan Lancashire UK WN6 9EP
| | - Alistair R Phillips
- Plymouth Hospitals NHS Trust; Department of Orthopaedics; Derriford Hospital Derriford Plymouth Devon UK PL6 8DH
| | - Philip A Storey
- Sheffield NHS Teaching Hospitals Trust; Department of Trauma and Orthopaedics, Northern General Hospital; Herries Road Sheffield South Yorkshire UK S7 5AU
| | - David Nuttall
- Wrightington, Wigan and Leigh NHS Trust; Upper Limb Unit; Wrightington Hospital, Hall Lane Appley Bridge Wigan Lancashire UK WN6 9EP
| | - Adam C Watts
- Wrightington, Wigan and Leigh NHS Trust; Upper Limb Unit; Wrightington Hospital, Hall Lane Appley Bridge Wigan Lancashire UK WN6 9EP
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Abstract
Background and purpose - About 86,000 total hip replacements (THR) have been registered in patients under 55 years in the National Joint Registry of England and Wales (NJR). The use of uncemented implants has increased, despite their outcomes not having been proven to be significantly better than cemented implants in this registry. We determined the implant survivorship and functional outcomes of cemented THR in patients under 55 years at a minimum follow-up of 22 years. Patients and methods - 104 hips in 100 patients were included in this prospective study. Functional outcome was assessed using the Harris Hip Score and radiographs were assessed for implant failure and "at risk" of failure. Kaplan-Meier survivorship analysis was performed. Results - 89% of hips showed good to excellent results at final follow-up with a mean Harris Hip Score of 88 at a mean follow-up of 25 years. Revision was performed in 3/104 hips. 14 acetabular components and 4 femoral components were "at risk" of failure. The survivorship at minimum 22 years with revision for any reason as the end-point was 97% (95% CI 95-98). Interpretation - Cemented hip replacements perform well in young patients with good long-term functional and radiographic outcomes.
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Jariwala AC, Parthasarathy A, Kiran M, Johnston LR, Rowley DI. Numbness Around the Total Knee Arthroplasty Surgical Scar: Prevalence and Effect on Functional Outcome. J Arthroplasty 2017; 32:2256-2261. [PMID: 28336248 DOI: 10.1016/j.arth.2017.01.057] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/27/2017] [Accepted: 01/31/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Numbness around the surgical scar can be a source of discomfort or dissatisfaction in a proportion of patients undergoing total knee arthroplasty (TKA). Literature reports wide variation in its prevalence and the consequence of numbness on the outcome of TKA is not clear. We investigated the prevalence of numbness, along with contributing factors, and assessed its effect on the functional outcome of TKA. METHODS In total, 258 knees were included in this prospective patient-reported outcome measure case-control study. Demographic details, type and length of incision, pre-operative and 1-year post-operative Knee Society Scores were recorded and compared. RESULTS The prevalence of numbness at 1 year was 53%, with a female preponderance. Patients older than 70 years were less affected. Discomfort due to numbness was recorded in 8.7% of the patients, 75% of which were female. The length of the incision correlated positively with the presence of numbness. The Knee Society Scores did not correlate with the presence or area of numbness. CONCLUSION Our findings indicate a high prevalence of numbness after TKA. Nevertheless, numbness does not affect the functional outcome.
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Affiliation(s)
- Arpit C Jariwala
- Department of Trauma and Orthopaedics, University of Dundee, TORT Centre, Ninewells Hospital, Dundee, United Kingdom
| | - Avinash Parthasarathy
- Department of Trauma and Orthopaedics, University of Dundee, TORT Centre, Ninewells Hospital, Dundee, United Kingdom
| | - Manish Kiran
- Department of Trauma and Orthopaedics, University of Dundee, TORT Centre, Ninewells Hospital, Dundee, United Kingdom
| | - Linda R Johnston
- Department of Trauma and Orthopaedics, University of Dundee, TORT Centre, Ninewells Hospital, Dundee, United Kingdom
| | - David I Rowley
- Department of Trauma and Orthopaedics, University of Dundee, TORT Centre, Ninewells Hospital, Dundee, United Kingdom
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Lim JW, Ng GS, Jenkins RC, Ridley D, Jariwala AC, Sripada S. Total hip replacement for neck of femur fracture: Comparing outcomes with matched elective cohort. Injury 2016; 47:2144-2148. [PMID: 27461781 DOI: 10.1016/j.injury.2016.07.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 07/11/2016] [Accepted: 07/18/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Current literature suggests that total hip replacement (THR) is superior to hemiarthroplasty (HA) for neck of femur fracture in selected group of patients. The outcomes of THR undertaken for trauma setting remain unclear when comparing with elective THR. We compared the outcomes of THR trauma cohort with best-matched elective cohort. METHODS We retrospectively reviewed 102 patients that underwent THR due to trauma from 2011 to 2013. We had access to 90 cases with complete records. Another 90 matched elective cases were obtained from local arthroplasty database. The elective cases were matched for gender, surgical approaches, surgeon's grade, types of implant, patient's age at operation date of ±5 years and operation date of ±60days. Subsequently, the selection criteria were relaxed to patient's age at operation date of ±10 years and operation date of ±60days. Unmatched cases were excluded. Complications and death rate were compared. RESULTS The average age for both cohorts was 70 years. The trauma cohort had statistically significant lower BMI and longer hospital stay (p=0.001). The Functional Comorbidity Index (FCI) and Charlson Age Comorbidity Index (CACI) were the same for both cohorts, reflecting an active patient selection for THR in our centre. The trauma cohort had higher surgical complication rate (9% vs 4%), particularly higher dislocation rate (7% vs 1%); and higher medical complication rate (32% vs 6%). These were consistent with the literature. Contrary to literature, the trauma cohort had six dislocations that five of them were done via anterolateral approach. Among the eight trauma cases with surgical complications, six cases were performed by trainees. The cause of surgical complications remains unclear due to the nature of retrospective study. The trauma cohort had higher death rate than the elective cohort (14% vs 4%), with one post-operative cardiac arrest in the trauma cohort. The rest were non-orthopaedic related deaths, ranging between four months to four years. CONCLUSION A more robust way of selecting trauma patients for THR is warranted to reduce morbidity and mortality. Follow-up for the trauma cohort is warranted, as the patients are likely to outlive the implants.
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Affiliation(s)
- J W Lim
- Department of Orthopaedics and Trauma, Ninewells Hospital, Dundee, DD1 9SY, UK.
| | - G S Ng
- University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - R C Jenkins
- University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - D Ridley
- Department of Orthopaedics and Trauma, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - A C Jariwala
- Department of Orthopaedics and Trauma, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - S Sripada
- Department of Orthopaedics and Trauma, Ninewells Hospital, Dundee, DD1 9SY, UK
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Abstract
Aim: To assess the value of directing the attention of patients to sources of medical information on the internet. Design: Prospective qualitative study in an orthopaedic outpatient clinic. Participants: 253 patients agreed to complete electronic questionnaires before and after reviewing information relevant to their conditions on the internet. Patients were allocated randomly into two groups; one group was given indications of general sites and the other recommended specific non-commercial sites. Completed questionnaires were received from 44 patients. Results: 95% of the patients found the internet information easy to understand and 84% said that it was helpful for coping. 86% of the patients were satisfied that their current treatment was appropriate in the light of what they had learned from the internet. Ten patients out of the 36 who expressed a view thought that the internet information contradicted that provided by the doctor. Despite these results most patients still said that the doctor represented the best source of patient education. Conclusions: Increasing numbers of patients are familiar with the internet. Most of our patients felt that the internet was, on balance, helpful in providing information. The main difficulties with the internet are the sheer volume of information, the potential for misleading and the danger of misunderstanding. We feel that there is a real place for the specific prescription of an internet site by a clinician who has personally reviewed it to a patient thought to be able to benefit from it.
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Affiliation(s)
- A C Jariwala
- Department of Orthopaedic and Trauma Surgery, University of Dundee
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Malhas AM, Skarparis YG, Sripada S, Soames RW, Jariwala AC. How well do contoured superior midshaft clavicle plates fit the clavicle? A cadaveric study. J Shoulder Elbow Surg 2016; 25:954-9. [PMID: 26776945 DOI: 10.1016/j.jse.2015.10.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 10/11/2015] [Accepted: 10/18/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Given the degree of variation in clavicular morphology, 4 clavicle plating systems were examined for their congruity as superior, midshaft, anatomic clavicle (SMAC) plates in a cadaveric study. METHODS SMAC plates from 4 manufacturers were applied to 79 dry right human clavicles. Two systems offered multiple (4) variations of plates (MP), 1 offered two variations (TP), and 1 had a single plate (SP). Two examiners applied and clamped the best-fitting plate from each system onto each of the 79 clavicles and then graded them: 1, poor fit; 2, good fit; and 3, anatomic fit. Each examiner repeated the process to assess intraobserver and interobserver reliability. The scores were averaged to produce a final score for each system for each clavicle. RESULTS The MP systems scored the highest (32%-37% anatomic, 54%-63% good, 5%-8% poor), followed by the TP system (30% anatomic, 53% good, 17% poor), and finally the SP system (9% anatomic, 59% good, 32% poor). Of note, clavicular length significantly correlated with a higher degree of conformity in all plating systems (Spearman rank correlation P < .05 for each system). In clavicles longer than 150 mm, the MP and TP systems performed identically, with the SP system close behind. Contouring of the plate is needed in 73% of cases overall. CONCLUSION Plating systems with multiple plate shape variations are more advantageous when dealing with smaller-sized clavicles, typically in females. However, when dealing with larger clavicles, there was no real difference.
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Affiliation(s)
- Amar M Malhas
- Department of Trauma and Orthopaedics, NHS Tayside, Ninewells Hospital, Dundee, UK.
| | - Yiannis G Skarparis
- Department of Trauma and Orthopaedics, NHS Tayside, Ninewells Hospital, Dundee, UK
| | - Sankar Sripada
- Department of Trauma and Orthopaedics, NHS Tayside, Ninewells Hospital, Dundee, UK
| | - Roger W Soames
- Centre for Anatomy and Human Identification, University of Dundee, Dundee, UK
| | - Arpit C Jariwala
- Department of Trauma and Orthopaedics, NHS Tayside, Ninewells Hospital, Dundee, UK
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15
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Jariwala AC, Phillips AR, Storey PA, Nuttall D, Watts AC. Internal fixation versus other surgical methods for treating distal radius fractures in adults. Cochrane Database of Systematic Reviews 2014. [DOI: 10.1002/14651858.cd011212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Arpit C Jariwala
- Wrightington, Wigan and Leigh NHS Trust; Upper Limb Unit; Wrightington Hospital, Hall Lane Appley Bridge Wigan Lancashire UK WN6 9EP
| | - Alistair R Phillips
- Plymouth Hospitals NHS Trust; Department of Orthopaedics; Derriford Hospital Derriford Plymouth Devon UK PL6 8DH
| | - Philip A Storey
- Sheffield NHS Teaching Hospitals Trust; Department of Trauma and Orthopaedics, Northern General Hospital; Herries Road Sheffield South Yorkshire UK S7 5AU
| | - David Nuttall
- Wrightington, Wigan and Leigh NHS Trust; Upper Limb Unit; Wrightington Hospital, Hall Lane Appley Bridge Wigan Lancashire UK WN6 9EP
| | - Adam C Watts
- Wrightington, Wigan and Leigh NHS Trust; Upper Limb Unit; Wrightington Hospital, Hall Lane Appley Bridge Wigan Lancashire UK WN6 9EP
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Jariwala AC, Scott I, Arnold GP, Abboud RJ, Wigderowitz CA. Objective assessment of the alterations in wrist mobility with the fastrak(®) system following dorsal capsulodesis. Hand Surg 2010; 15:237-41. [PMID: 21089203 DOI: 10.1142/s0218810410004904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 06/09/2010] [Accepted: 06/14/2010] [Indexed: 11/18/2022]
Abstract
The treatment for scapholunate dissociation is challenging and its management is varied depending on type, severity and duration of injury, and surgeon's preferred technique. This study aimed to objectively assess the variations in the range and patterns of wrist movements using the Fastrak(®) system in patients having undergone Blatt's dorsal capsulodesis (BDC). The wrist movements were successively measured between the operated and unoperated wrists, while the patients performed set tasks. Seventeen patients agreed to participate in the study. Following BDC the mean flexion loss was 23° (range 10°-38°). However, functional tasks revealed that the BDC did not adversely affect the function of the operated wrist. This novel study demonstrates objectively the functional restrictions that patients are likely to experience postoperatively following BDC. It would be interesting to note the pattern of wrist motion using the Fastrak(®) system in various other clinical settings.
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Affiliation(s)
- A C Jariwala
- Department of Orthopaedics and Trauma Surgery, TORT Centre, Ninewells Hospital and Medical School, University of Dundee, Scotland, DD1 9SY, UK.
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Abstract
The Internet is a rich source of medical information but relatively few studies have evaluated its use by patients who seek medical information. The purpose of this study is to assess the demographics of Internet access and attitudes towards the Internet in a cohort of orthopaedic out-patients. Four hundred and three patients attending the orthopaedic outpatient fracture clinic completed a questionnaire consisting of six divisions including personal information, facility to access the Internet and their attitudes towards the information retrieved. Fifty per cent of the patients accessed the Internet, either from home or office and the maximum usage being in the younger age group. Twenty-nine per cent of the patients were aware of the medical information available through the Internet. 19% patients would like to have a consultation through the Internet, the maximum being in the middle-aged group. 70% of those patients who accessed the medical information reported that the Internet information was different than that obtained at consultation with the doctor at the out-patient clinic. This study reveals that the Internet use by patients is still limited. If an increased percentage of medical conditions is to be addressed through the Internet, involving patient information, on-line consultations, prescriptions and referrals, then a substantial amount of patient education and training is required
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Affiliation(s)
- A C Jariwala
- Department of Trauma and Orthopaedic Surgery, University of Dundee, Ninewells Hospital, Dundee DD1 9SY
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