Rajan Madhok

Ten-Year Follow-Up Study of Missed, Simultaneous, Bilateral Femoral-Neck Fractures Treated by Bipolar Arthroplasties in a Patient With Chronic Renal Failure

Fracture of the femoral neck associated with seizure disorders is uncommon. Bilateral fractures of the femoral neck are exceedingly rare. Early recognition of the fracture is essential. A patient with unrecognized bilateral femoral-neck fractures with nonunion was successfully treated by bilateral, bipolar hip arthroplasty.

Mortality as an indicator of patient safety in orthopaedics: lessons from qualitative analysis of a database of medical errors

BackgroundOrthopaedic surgery is a high-risk specialty in which errors will undoubtedly occur. Patient safety incidents can yield valuable information to generate solutions and prevent future cases of avoidable harm. The aim of this study was to understand the causative factors leading to all unnecessary deaths in orthopaedics and trauma surgery reported to the National Patient Safety Agency (NPSA) over a four-year period (2005–2009), using a qualitative approach.MethodsReports made to the NPSA are categorised and stored in the database as free-text data. A search was undertaken to identify the cases of all-cause mortality in orthopaedic and trauma surgery, and the free-text elements were used for thematic analysis. Descriptive statistics were calculated based on the incidents reported. This included presenting the number of times categories of incidents had the same or similar response. Superordinate and subordinate categories were created.ResultsA total of 257 incident reports were analysed. Four main thematic categories emerged. These were: (1) stages of the surgical journey – 118/191 (62%) of deaths occurred in the post-operative phase; (2) causes of patient deaths – 32% were related to severe infections; (3) reported quality of medical interventions – 65% of patients experienced minimal or delayed treatment; (4) skills of healthcare professionals – 44% of deaths had a failure in non-technical skills.ConclusionsMost complications in orthopaedic surgery can be dealt with adequately, provided they are anticipated and that risk-reduction strategies are instituted. Surgeons take pride in the precision of operative techniques; perhaps it is time to enshrine the multimodal tools available to ensure safer patient care.

A Systematic Review of Rehabilitation for Distal Radial Fractures in Adults

We undertook a systematic review of the evidence from randomised controlled trials for effectiveness of rehabilitation intervention(s) for adults with fractures of the distal radius. A comprehensive search yielded 12 eligible trials, which were assessed for methodological quality. This paper presents the findings of these trials, which covered nine treatment comparisons, and explains why we concluded that there was insufficient evidence to inform practice.

Systematic Reviews, Meta-Analyses, and Methodology

To The Editor: We have been encouraged by the explicit emphasis on evidence-based orthopaedics in The Journal, and we read with great interest “Meta-Analyses in Orthopaedic Surgery. A Systematic Review of Their Methodologies” (83-A: 15-24, Jan. 2001), by Bhandari et al. This article raised some important points, one being that adherence to strict scientific methodology can limit bias and improve the validity of meta-analyses. However, we would like to comment on the methodology and consequent findings of their study. The first issue is their omission of relevant studies published in the Cochrane Database of Systematic Reviews. As Bhandari et al. stated, they consulted this database in their search for meta-analyses, yet some thirty to fifty systematic reviews available in this database in 1999 were not included, which we find puzzling. Omission of these reviews, which, if included, would have more than doubled the number of reviews of fracture treatment, results in a distorted picture of the information that is available to the orthopaedic specialist. Moreover, as acknowledged by Bhandari et al., there is evidence that these reviews have higher scientific quality than …

Systematic Reviews, the Cochrane Collaboration and Hand Therapy:

This paper describes the work of the Cochrane Collaboration in producing systematic reviews of health care interventions. It examines the present and potential relevance of Cochrane reviews to clinicians providing hand therapy and gives some pointers for those who wish to take a more active role in evaluating the evidence for their clinical practice.