Stephen Gwilym

One in 13 ‘original’ articles in the Journal of Bone and Joint Surgery are duplicate or fragmented publications

Duplicate publication in orthopaedic journals may further an authors academic career but this is at the cost of both scientific integrity and knowledge. Multiple publications of the same work increase the workload of editorial boards, misguide the reader and affect the process of meta-analysis. We found that of 343 original articles published in the Journal of Bone and Joint Surgery in 1999, 26 (7.6%) had some degree of redundancy. The prevalence of duplicate publications in the orthopaedic literature appears to be less than that in other surgical specialties but it is still a matter of concern. It is the authors responsibility to notify the editor of any duality when submitting a paper for publication.

Interprofessional Relationships between Orthopaedic and Podiatric Surgeons in the UK

INTRODUCTIONnThe first comprehensive report on the interprofessional relationships between foot and ankle surgeons in the UK is presented.nnnMATERIALS AND METHODSnA questionnaire was sent to orthopaedic surgeons with membership of the British Foot and Ankle Surgery Society (BOFAS), orthopaedic surgeons not affiliated to the specialist BOFAS and podiatrists specialising in foot surgery. The questionnaire was returned by 77 (49%) of the BOFAS orthopaedic consultant surgeons, 66 (26%) of non-foot and ankle orthopaedic consultant surgeons and 99 (73%) of the podiatric surgeons.nnnRESULTSnWhile most respondents have experience of surgeons working in the other specialty in close geographical proximity, the majority do not believe that this has adversely affected their referral base. The experience of podiatrists of the outcomes of orthopaedic surgery has been more positive than orthopaedic surgeons of podiatric interventions. Podiatrists are more welcoming of future orthopaedic involvement in future foot and ankle services than in reverse. However, there are a sizeable number of surgeons in both professions who would like to see closer professional liaisons. The study has identified clear divisions between the professions but has highlighted areas where there is a desire from many clinicians to work more harmoniously together, such as in education, training and research.nnnCONCLUSIONSnWhile major concerns exist over issues such as surgery by non-registered medical practitioners and the suitable spectrum of surgery for each profession, many surgeons, in both professions, are willing to provide training for juniors in both specialties and there is a wish to have closer working relationships and common educational and research opportunities than exists at present.

Sciatic nerve injury caused by pre-operative intraneural injection of local anaesthetic during total hip replacement

We report a case of iatrogenic sciatic nerve injury caused by pre-operative intraneural injection of local anaesthetic at total hip replacement. To our knowledge, this is unreported in the orthopaedic literature. We consider sacral nerve blockade in patients undergoing total hip replacement to be undesirable and present guidelines for the management of peri-operative sciatic nerve injury.

Sesamoid arthrodesis of the thumb: a technique using a Mitek anchor and wire suture.

Hyperextension of the thumb metacarpophalangeal joint affects a diverse population of patients. This includes those with cerebral palsy, degenerative or inflammatory arthritides, or following hand trauma. The abnormal movement may result in decreased pinch-grip strength, sesamoid-metacarpal or metacarpophalangeal joint arthritis, or an adduction deformity of the thumb. Sesamoid arthrodesis is indicated to improve function and relieve pain, and is considered superior to metacarpophalangeal joint arthrodesis. Capsuloplasty and capsulodesis have also been described as surgical techniques capable of correcting metacarpophalangeal joint hyperextension.1,2 Sesamoid fusion by interosseous wire suture, as first described by Zancolli, has gained widespread favour and was previously the technique of choice for the senior author (HPG).3 However, this technique can be both cumbersome and time consuming, and there is the inherent risk of potential damage to the extensor mechanism. We describe a new technique involving a modified Mitek® anchor. The device is re-threaded with an interosseous wire, which allows controlled compression between the sesamoid bone and metacarpal.

An alternative use of the surgical mask for the protection of healthcare workers managing epistaxis

Epistaxis has a reported prevalence of 10-12 per cent in the general population and is thus one of the commonest emergencies in Otolaryngology. We suggest that the patient uses a surgical mask to prevent blood spray during epistaxis management. Utilizing the described technique we have found that protective clothing worn by the healthcare professional is consistently blood-free at the end of the procedure. This is in contrast to findings when no facemask is applied.