Chris Oliver

Outcome after pelvic ring fractures: evaluation using the medical outcomes short form SF-36

Fifty-five multiply injured patients with operatively treated unstable pelvic fractures were evaluated for patient-oriented outcome measures. Forty-six adult patients were eligible to complete the SF-36 medical outcome score and completed the SF-36 eight scale medical outcome score by postal questionnaire at a mean follow up to 2 years. The average Injury Severity Score of the eligible patients was 17.5. The average age of the patients was 32 years and 8 months. Fractures were classified by the Tile classification and there were 13 type B and 33 type C pelvic fractures. Seventy-six per cent of patients responded to the surgery. There was a 14 per cent impairment in physical outcome score and a 5.5 per cent impairment in mental outcome score compared with the normal population. The physical and mental outcome of multiply injured patients with pelvic fractures can be measured objectively.

Fractures of the proximal interphalangeal joints of the fingers

Fractures of the proximal interphalangeal joint include a wide spectrum of injuries, from stable avulsion fractures to complex fracture-dislocations. Stability of the joint is paramount in determining the appropriate treatment, which should aim to facilitate early mobilisation and restoration of function.

Assessment of spinal musculature using surface electromyographic spectral color mapping

Study Design. A technique is described for analyzing electromyogram data from lumbar spinal muscles, with special reference to discrimination of people with back pain. The ability to discriminate was evaluated in 99 people (61 healthy and 38 with chronic or acute back pain), and the influence of load was assessed. Objectives. To evaluate methods of analysis of complex electromyogram data and to assess correlation of electromyogram information with clinical condition in people with and without back pain. Summary of Background Information. In previous analyses of electromyogram data, only a small part of the data have been used. Spinal muscular decompensation has been postulated in chronic low back pain, but there has been no direct demonstration of this phenomenon. Objective measures are still elusive. Methods. Lumbar spinal surface electromyograms were recorded during an isometric lifting task. The data were represented graphically as color‐coded plots of electromyogram frequency, time, and electromyogram amplitude. Spectral width at half‐peak amplitude (spectral half width) was calculated from the digitized, summed data. Ninety‐nine people were tested: 48 men (29 with no recent [in the past 2 years] history of back pain, 16 with chronic back pain, 3 with acute back pain) and 51 women (32 with no recent back pain and 19 with chronic back pain). Results. Spectral color maps in people with chronic back pain were markedly different from those in healthy people. Spectral half width was greater in people with chronic back pain than in healthy people (P < 0.01). Blinded analysis of spectral color maps allowed discrimination of people with back pain from healthy people with a sensitivity of 76% and a specificity of 81%. People with a history of back pain had markedly variable half widths. Conclusions. A new method of analysis of electromyogram data from lumbar spinal muscles has allowed discrimination between people with back pain and healthy people. This provides direct evidence of a correlation between muscular electrical function, measured by electromyogram, and low back pain. This technique may have potential as an objective measurement tool.

Hip disarticulation: the evolution of a surgical technique

Introduced in the 18th century, hip disarticulation was considered to be one of the most radical operations performed for trauma or disease of the lower limb. The high morbidity and mortality associated with it ensured that it was a rarely performed procedure. It is fortunate that it remains extremely uncommon to the present day. Since the first successful hip disarticulation was described, a number of important advances have occurred. General medical care has improved dramatically and the development of anaesthesia, analgesics, antibiotics and blood transfusions has resulted in greatly decreased morbidity associated with this dramatic operation. This review on the history of hip disarticulation outlines the surgical evolution of the operation, the indications for its use and the techniques used. It draws on the early experiences and preferred techniques of the surgeons of the 19th century, with some discussion on the methods employed to reduce intraoperative haemorrhage. Further development of techniques in the 20th century is also described together with discussion on the evolution of hindquarter amputation.

Why healthcare professionals should know a little about infographics

Infographics is an abbreviated term for an information graphic. Information is presented in a logical manner, similar to storytelling, using data visualisations, text and pictures.1 Statistically, the most successful infographics, in terms of number of ‘shares’ on social media, contain an average of 396 words2 and a combination of data visualisations (bar graphs, line graphs and pie charts) and illustrations. Although 396 words may seem like an inadequate amount of text for researchers to convey their findings comprehensively, when considering this in the infographics context, the saying, ‘a picture tells a thousand words’, comes to mind. Three days after learning new information, we are likely to remember up to 6.5 times more through learning from an infographic than by reading text alone.1 Many industries, such as the business, food, …

Fibular malreduction in AO/Weber type C ankle fractures

Determination of malreduction of the distal fibula in AO/Weber C fractures’ can be difficult. Plain X-rays may only give limited information regarding rotational deformities or persistent diastasis of the fibula. Transverse computer tomographic (CT) scans of the ankle at the level of the syndesmosis allow better assessment of any fibular rotational deformity. CT scans may be useful when planning revision fixation of a malreduced AOmeber C type ankle fracture.

TRAUMA AND ORTHOPAEDIC SURGERY ON THE INTERNET

The Internet is rapidly expanding as a means of acquiring health information for medical professionals. It is now impossible to identify the total number of websites providing specialist information in trauma and orthopaedic surgery. Webpages may be from a leading expert with excellent documentation and a complete bibliography or merely in the form of encouragement from a friendly online support group. This makes it difficult to determine which information is usable and credible. Strategies for identifying quality academic information for trauma and orthopaedic surgery on the Internet are beginning to evolve. Information overload can be very difficult to cope with and surgeons will need to identify methods to deal with large volumes of material from the Internet. The rate of progress in information technology has been phenomenal and will change the way in which trauma and orthopaedic surgery is practised in the next millennium. The Cold War was the initial stimulus for the development of the Internet which began in 1969 as an initiative of the United States Defence Department to link four American academic institutions. It was designed to put in place a computer system which was accessible across the USA and could survive a nuclear strike, but it was not until 1985 that the National Science Foundation developed the NSFNET 1 (the Internet). It has now become a household appliance because of advances in personal home computing and is, in essence, a vast network of interlinked computers scattered across the world. Many see the future as more of the same with faster computers, better cars, more television channels and better shopping, but developments in information technology (IT) will change life beyond current imagination. 2

Artificial intelligence analysis of paraspinal power spectra

OBJECTIVE: As an aid to discrimination of sufferers with back pain an artificial intelligence neural network was constructed to differentiate paraspinal power spectra. DESIGN: Clinical investigation using surface electromyography. METHOD: The surface electromyogram power spectra from 60 subjects, 33 non-back-pain sufferers and 27 chronic back pain sufferers were used to construct a back propagation neural network that was then tested. Subjects were placed on a test frame in 30 degrees of lumbar forward flexion. An isometric load of two-thirds maximum voluntary contraction was held constant for 30 s whilst surface electromyograms were recorded at the level of the L(4-5). Paraspinal power spectra were calculated and loaded into the input layer of a three-layer back propagation network. The neural network classified the spectra into normal or back pain type. RESULTS: The back propagation neural was shown to have satisfactory convergence with a specificity of 79% and a sensitivity of 80%. CONCLUSIONS: Artificial intelligence neural networks appear to be a useful method of differentiating paraspinal power spectra in back-pain sufferers.

LONG-TERM PATIENT-REPORTED OUTCOMES FOLLOWING BENNETT'S FRACTURES

We define the long-term outcomes and rates of further operative intervention following displaced Bennetts fractures treated with Kirschner (K-) wire fixation between 1996 and 2009. We retrospectively identified 143 patients (127 men and 16 women) with a mean age at the time of injury of 33.2 years (18 to 75). Electronic records were examined and patients were invited to complete the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire in addition to a satisfaction questionnaire. The time since injury was a mean of 11.5 years (3.4 to 18.5). In total 11 patients had died, one had developed dementia and 12 patients were lost to follow-up. This left 119 patients available for recruitment. Of these, 57 did not respond, leaving a study group of 62 patients. Patients reported excellent functional outcomes and high levels of satisfaction at follow-up. Median satisfaction was 94% (interquartile range 91.5 to 97.5) and the mean DASH score was 3.0 (0 to 38). None of the patients had undergone salvage procedures and none of the responders had changed occupation or sporting activities. Long-term patient reported outcomes following displaced Bennetts fractures treated by closed reduction and K-wire fixation show excellent functional results and a high level of patient satisfaction. The rate of infection is low and similar to other surgical procedures with percutaneous K-wires.

Surgical training 2.0: How contemporary developments in information technology can augment surgical training

BACKGROUND The current surgical trainee is faced with reduced training time compared to predecessors as a result of changes in working practices. The past decade has seen marked developments in the information technology sector. This editorial will review how modern technological innovations could augment current surgical training. METHODS We review the literature and summarize important developments in information technology that could assist the modern surgical trainee. We also look at some of the challenges faced by use of this technology. FINDINGS Developments in mobile internet connectivity will improve access to online resources for the surgical trainee. Web 2.0 will revolutionise the way trainees interact with textbooks, journals, webpages and each other. Simulators could help to fill gaps created by reduced operating hours. To maximize the effectiveness of these resources they need to be accessible and incorporated into training in a structured way, ensuring patient safety and accuracy of information. CONCLUSION Contemporary developments in technology offer benefits to the surgical trainee and could fill gaps left by reduced operating times. In order to ensure efficient use of technology and patient safety, bodies such as the Royal Colleges and Training Programmes must embrace these developments.