Pub Date : 2017-12-01DOI: 10.1302/2048-0105.66.360578
B. Ollivere
The orthopaedic and general scientific world is entirely awash with publications and their associated data. I recently came across, and was surprised by, a relatively recent paper from the journal eLife , in which researchers established that synapses are more elaborate than previously thought.1 Their research puts the storage capacity of the human brain in the ‘petabyte’ range – more than the volume of information available on the entire internet. That, of course, is not to say that we can process, understand, or even learn this volume of information, but it does highlight the intricacy of biological systems. These days, acquiring data is cheap, and the internet is growing exponentially in size and complexity. This is reflected everywhere, and can clearly be seen in medical science. The volume of papers in indexed and unindexed journals is rising day on day. We are in the middle of an …
{"title":"Editorial discretion: Peer review or publish and perish?","authors":"B. Ollivere","doi":"10.1302/2048-0105.66.360578","DOIUrl":"https://doi.org/10.1302/2048-0105.66.360578","url":null,"abstract":"The orthopaedic and general scientific world is entirely awash with publications and their associated data. I recently came across, and was surprised by, a relatively recent paper from the journal eLife , in which researchers established that synapses are more elaborate than previously thought.1 Their research puts the storage capacity of the human brain in the ‘petabyte’ range – more than the volume of information available on the entire internet. That, of course, is not to say that we can process, understand, or even learn this volume of information, but it does highlight the intricacy of biological systems. These days, acquiring data is cheap, and the internet is growing exponentially in size and complexity. This is reflected everywhere, and can clearly be seen in medical science. The volume of papers in indexed and unindexed journals is rising day on day. We are in the middle of an …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"60 1","pages":"1-1"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87518356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-01DOI: 10.1302/2048-0105.66.360568
T. Luokkala, A. Watts
Although the first resection and interposition arthroplasties of the elbow were reported at the beginning of the 20th century, modern total elbow arthroplasty (TEA) started in the late 1960s with a cemented hinge design described by Dee and Sweetnam.1-3 Since then, other implants have been introduced with advances in design.4 Total elbow arthroplasty can be used to treat elbow joint pathology such as rheumatoid arthritis (RA), osteoarthritis (OA), trauma, and post-traumatic sequelae.5-7 In addition, TEA is used in rarer conditions, such as in haemophilic arthropathy, as well as in tumour reconstruction.8,9 From the early 1970s to the late 1990s, RA was the most common indication globally for TEA. In this millennium, the development of effective biologic drugs such as anti-TNFα – a medication for treatment of RA – has resulted in a marked decrease in the number of TEAs (Fig. 1).5-7,10,11 Simultaneously, TEA has been used more and more to treat primary osteoarthritis and post-traumatic sequelae such as instability, as well as acute elbow fractures in elderly patients who are both increasingly frail and have greater functional demands. Fig. 1 Annual numbers of TEAs over time. Figure reprinted from Jenkins PJ, Watts AC, Norwood T, et al. Total elbow replacement: outcome of 1,146 arthroplasties from the Scottish Arthroplasty Project. Acta Orthop 2013;84:119-123. Compared with lower limb arthroplasty, TEA can be considered an uncommon procedure, with an annual incidence of 1.4 per 100 000 people in Western countries.12,13 In Europe, TEA incidence has slightly but constantly decreased from the late 1990s (Fig. 1).12,14 Conversely, in the United States there has been an annual rise of 6.4% between 1993 and 2007, from 1000 to 2400 procedures per year. This …
{"title":"Total elbow arthroplasty: A narrative review","authors":"T. Luokkala, A. Watts","doi":"10.1302/2048-0105.66.360568","DOIUrl":"https://doi.org/10.1302/2048-0105.66.360568","url":null,"abstract":"Although the first resection and interposition arthroplasties of the elbow were reported at the beginning of the 20th century, modern total elbow arthroplasty (TEA) started in the late 1960s with a cemented hinge design described by Dee and Sweetnam.1-3 Since then, other implants have been introduced with advances in design.4\u0000\u0000Total elbow arthroplasty can be used to treat elbow joint pathology such as rheumatoid arthritis (RA), osteoarthritis (OA), trauma, and post-traumatic sequelae.5-7 In addition, TEA is used in rarer conditions, such as in haemophilic arthropathy, as well as in tumour reconstruction.8,9 From the early 1970s to the late 1990s, RA was the most common indication globally for TEA. In this millennium, the development of effective biologic drugs such as anti-TNFα – a medication for treatment of RA – has resulted in a marked decrease in the number of TEAs (Fig. 1).5-7,10,11 Simultaneously, TEA has been used more and more to treat primary osteoarthritis and post-traumatic sequelae such as instability, as well as acute elbow fractures in elderly patients who are both increasingly frail and have greater functional demands.\u0000\u0000\u0000\u0000Fig. 1 \u0000Annual numbers of TEAs over time. Figure reprinted from Jenkins PJ, Watts AC, Norwood T, et al. Total elbow replacement: outcome of 1,146 arthroplasties from the Scottish Arthroplasty Project. Acta Orthop 2013;84:119-123.\u0000\u0000\u0000\u0000Compared with lower limb arthroplasty, TEA can be considered an uncommon procedure, with an annual incidence of 1.4 per 100 000 people in Western countries.12,13 In Europe, TEA incidence has slightly but constantly decreased from the late 1990s (Fig. 1).12,14 Conversely, in the United States there has been an annual rise of 6.4% between 1993 and 2007, from 1000 to 2400 procedures per year. This …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"1 1","pages":"2-10"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89756384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-01DOI: 10.1302/2048-0105.66.360567
M. Foy
The National Health Service Litigation Authority (NHSLA) was rebranded as National Health Service Resolution, or NHSR, on 03 April 2017. The stated aim of the rebranding process, according to the National Health Executive (NHE),1 is to combine the three operating arms of NHSLA, the National Clinical Assessment Service, and the Family Health Service Appeals Unit in order “to assist the NHS to resolve litigation concerns fairly, as well as share lessons learnt to improve clinical practice and preserve resources for patient care.” The NHE document points out that “Central to the change is the need for trusts across the country to learn from litigation cases and share experiences.” What then can we learn from the latest report on clinical negligence claims in the NHS, published this year by NHSR?2 During the last year, 17 338 claims were settled. In 67.8% (11 759) of those claims, resolution was achieved without issue of formal court proceedings. Damages were paid in 5226 cases (30.1%), and no damages were paid in 6533 cases (37.7%). In the former group, one assumes that the evidence for liability was clear, with compensation being paid for commercial or other reasons. Formal court proceedings were issued in 5498 claims (31.5%), with 4400 (25.4%) resulting in damages being paid and 1058 (6.1%) resulting in no damages. It is interesting that, of the 17 338 settled claims, only 121 (0.7%) ended up in court, with 49 (0.3%) resulting in payment of damages and 72 (0.4%) successfully defended. The projected expenditure for settlement of negligence claims in 2017/18 is £1.95 billion, representing a 17.5% increase compared with that of 2016/17. This latest increase does not take into account the effect of the change in the discount rate from 2.5% to -0.75% in March 2017.3 This affects the value placed on future losses …
{"title":"What is happening to clinical negligence claims in the NHS","authors":"M. Foy","doi":"10.1302/2048-0105.66.360567","DOIUrl":"https://doi.org/10.1302/2048-0105.66.360567","url":null,"abstract":"The National Health Service Litigation Authority (NHSLA) was rebranded as National Health Service Resolution, or NHSR, on 03 April 2017. The stated aim of the rebranding process, according to the National Health Executive (NHE),1 is to combine the three operating arms of NHSLA, the National Clinical Assessment Service, and the Family Health Service Appeals Unit in order “to assist the NHS to resolve litigation concerns fairly, as well as share lessons learnt to improve clinical practice and preserve resources for patient care.” The NHE document points out that “Central to the change is the need for trusts across the country to learn from litigation cases and share experiences.”\u0000\u0000What then can we learn from the latest report on clinical negligence claims in the NHS, published this year by NHSR?2 During the last year, 17 338 claims were settled. In 67.8% (11 759) of those claims, resolution was achieved without issue of formal court proceedings. Damages were paid in 5226 cases (30.1%), and no damages were paid in 6533 cases (37.7%). In the former group, one assumes that the evidence for liability was clear, with compensation being paid for commercial or other reasons. Formal court proceedings were issued in 5498 claims (31.5%), with 4400 (25.4%) resulting in damages being paid and 1058 (6.1%) resulting in no damages. It is interesting that, of the 17 338 settled claims, only 121 (0.7%) ended up in court, with 49 (0.3%) resulting in payment of damages and 72 (0.4%) successfully defended.\u0000\u0000The projected expenditure for settlement of negligence claims in 2017/18 is £1.95 billion, representing a 17.5% increase compared with that of 2016/17. This latest increase does not take into account the effect of the change in the discount rate from 2.5% to -0.75% in March 2017.3 This affects the value placed on future losses …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"89 1","pages":"41-43"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84460733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-01DOI: 10.1302/2048-0105.65.360555
F. Monsell
The British Orthopaedic Trainees’ Association (BOTA) recently commissioned a members’ survey to identify and quantify the presence and extent of bullying in the contemporary workplace. This highlighted a number of complex issues that are relevant to trauma and orthopaedic surgeons in particular but may also have implications for the medical profession in general. The survey was simple, asked binary questions and identified that 73% of respondents had witnessed bullying, harassment or undermining at some point. Harassment had been witnessed by 37%; sexist, racist or homophobic language had been witnessed by 23%; and 17.4% had witnessed a colleague being undermined. This paints a bleak picture of the professional health of trauma and orthopaedic surgery in this country, and many professional bodies have rapidly aligned to demand change. A statement from the Joint Surgical Colleges and Joint Committee on Surgical Training “welcomed” this survey and this has led to a greater focus on eliminating this behaviour from clinical practice. The British Orthopaedic Trainees’ Association have responded with the “Hammer It Out” initiative and a mission statement that aspires to create a positive workplace culture and a balanced and representative workforce, in which individuals are empowered to speak up when unacceptable behaviour is witnessed. It is perhaps more straightforward to deal with overt nastiness, including acts of public humiliation and discrimination based on gender, ethnicity or sexual orientation. This is something that tends to be visible and is simply not tolerated in contemporary society. We are, however, a complex group of individuals and there will be a proportion in whom bigotry is an unmodifiable character trait. This initiative will not make these people good but, in order to succeed, it just needs to stop them being bad in public. Even the most naive among us, irrespective of their actual opinion and structure of …
英国骨科实习生协会(BOTA)最近委托进行了一项会员调查，以确定和量化当代工作场所欺凌的存在和程度。这突出了一些复杂的问题，特别是与创伤和矫形外科医生有关，但也可能对一般的医学专业产生影响。这项调查很简单，提出了二元问题，并确定73%的受访者在某种程度上目睹了欺凌、骚扰或破坏。37%的人目睹过骚扰;23%的人目睹了性别歧视、种族主义或恐同语言;17.4%的人目睹过同事被诋毁。这描绘了一个暗淡的画面，在这个国家的创伤和矫形外科的专业健康，许多专业机构已迅速联合起来，要求改变。联合外科学院和外科培训联合委员会的一份声明“欢迎”这项调查，这使得人们更加关注在临床实践中消除这种行为。英国整形外科培训生协会(British Orthopaedic Trainees’Association)发起了一项名为“Hammer It Out”的倡议，并发布了一份使命声明，希望创造一种积极的职场文化，以及一支平衡和具有代表性的员工队伍，在这种队伍中，当目睹不可接受的行为时，个人有权大声疾呼。处理公开的肮脏行为，包括公开羞辱和基于性别、种族或性取向的歧视，可能更为直接。这往往是显而易见的，在当代社会根本不能容忍。然而，我们是一个复杂的个体群体，在其中会有一部分人的偏执是不可改变的性格特征。这项倡议不会让这些人变好，但为了成功，它只需要阻止他们在公众面前变坏。即使是我们当中最天真的人，不管他们的实际意见和结构如何……
{"title":"Bullying in the orthopaedic workplace","authors":"F. Monsell","doi":"10.1302/2048-0105.65.360555","DOIUrl":"https://doi.org/10.1302/2048-0105.65.360555","url":null,"abstract":"The British Orthopaedic Trainees’ Association (BOTA) recently commissioned a members’ survey to identify and quantify the presence and extent of bullying in the contemporary workplace. This highlighted a number of complex issues that are relevant to trauma and orthopaedic surgeons in particular but may also have implications for the medical profession in general.\u0000\u0000The survey was simple, asked binary questions and identified that 73% of respondents had witnessed bullying, harassment or undermining at some point. Harassment had been witnessed by 37%; sexist, racist or homophobic language had been witnessed by 23%; and 17.4% had witnessed a colleague being undermined.\u0000\u0000This paints a bleak picture of the professional health of trauma and orthopaedic surgery in this country, and many professional bodies have rapidly aligned to demand change. A statement from the Joint Surgical Colleges and Joint Committee on Surgical Training “welcomed” this survey and this has led to a greater focus on eliminating this behaviour from clinical practice.\u0000\u0000The British Orthopaedic Trainees’ Association have responded with the “Hammer It Out” initiative and a mission statement that aspires to create a positive workplace culture and a balanced and representative workforce, in which individuals are empowered to speak up when unacceptable behaviour is witnessed.\u0000\u0000It is perhaps more straightforward to deal with overt nastiness, including acts of public humiliation and discrimination based on gender, ethnicity or sexual orientation. This is something that tends to be visible and is simply not tolerated in contemporary society.\u0000\u0000We are, however, a complex group of individuals and there will be a proportion in whom bigotry is an unmodifiable character trait. This initiative will not make these people good but, in order to succeed, it just needs to stop them being bad in public.\u0000\u0000Even the most naive among us, irrespective of their actual opinion and structure of …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"52 1","pages":"2-4"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83677456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-01DOI: 10.1302/2048-0105.65.360554
A. Ross
Iatrogenic nerve injuries are always a matter for concern. This article will address the common causes, diagnosis and management of iatrogenic peripheral nerve injuries. The most widely used classification of peripheral nerve injury is that described by Seddon in 1943.1 He divided nerve injuries into three types: neurapraxia, axonotmesis and neurotmesis. Neurapraxia (inactivity of the nerve) is a non-degenerative lesion of a nerve characterised by a complete or partial failure to propagate an action, potentially resulting in motor and/or sensory loss. It is usually caused by compression or ischaemia, resulting in ischaemia of the myelin sheath. The nerve remains intact and Wallerian degeneration does not occur. It is reversible if the injurious agent is removed. If the distal segment of the nerve is stimulated, there is a motor response. The lesion recovers by remyelination of the distal segment and takes between two and 12 weeks, depending on the age of the patient and the site of the injury. In practice, it is unwise to assume that a lesion is a neurapraxia rather than a more severe injury because this will lead to delay in diagnosis and a poorer outcome. The presence of persistent pain suggests that the injurious agent is continuing to act. The diagnosis should not be made in the presence of a strong Tinel test which indicates that axons have been ruptured. An axonotmesis (cutting of the axon) is the result of disruption of the axon and its myelin sheath. The supporting structures, Schwann cells, endoneurium, perineurium and epineurium remain intact. It is usually the result of severe compression or a crush injury. Wallerian degeneration occurs distally, and proximally to the closest node of Ranvier. Repair is by a combination of collateral sprouting in lesser injuries and axonal regeneration in more severe injuries. The latter occurs at …
{"title":"Medico-legal aspects of peripheral nerve injury","authors":"A. Ross","doi":"10.1302/2048-0105.65.360554","DOIUrl":"https://doi.org/10.1302/2048-0105.65.360554","url":null,"abstract":"Iatrogenic nerve injuries are always a matter for concern. This article will address the common causes, diagnosis and management of iatrogenic peripheral nerve injuries.\u0000\u0000The most widely used classification of peripheral nerve injury is that described by Seddon in 1943.1 He divided nerve injuries into three types: neurapraxia, axonotmesis and neurotmesis.\u0000\u0000Neurapraxia (inactivity of the nerve) is a non-degenerative lesion of a nerve characterised by a complete or partial failure to propagate an action, potentially resulting in motor and/or sensory loss. It is usually caused by compression or ischaemia, resulting in ischaemia of the myelin sheath. The nerve remains intact and Wallerian degeneration does not occur. It is reversible if the injurious agent is removed. If the distal segment of the nerve is stimulated, there is a motor response. The lesion recovers by remyelination of the distal segment and takes between two and 12 weeks, depending on the age of the patient and the site of the injury.\u0000\u0000In practice, it is unwise to assume that a lesion is a neurapraxia rather than a more severe injury because this will lead to delay in diagnosis and a poorer outcome. The presence of persistent pain suggests that the injurious agent is continuing to act. The diagnosis should not be made in the presence of a strong Tinel test which indicates that axons have been ruptured.\u0000\u0000An axonotmesis (cutting of the axon) is the result of disruption of the axon and its myelin sheath. The supporting structures, Schwann cells, endoneurium, perineurium and epineurium remain intact. It is usually the result of severe compression or a crush injury. Wallerian degeneration occurs distally, and proximally to the closest node of Ranvier. Repair is by a combination of collateral sprouting in lesser injuries and axonal regeneration in more severe injuries. The latter occurs at …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"29 1","pages":"42-44"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88737493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-01DOI: 10.1302/2048-0105.65.360566
B. Ollivere
As I type out this editorial and revise this issue of 360 (left-handed, attempting to get my speech recognition software to produce something resembling what I’ve just said), I have had plenty of time to reflect on what it is like to ‘walk a mile in my patient’s shoes’, being, as I am, in the process of recovery from orthopaedic surgery myself. This gives me a reasonable moment to pause and reflect on the advice I have given patients in the past about expectations following shoulder surgery. Sure, I’ve remembered to tell them it’s very painful (not my experience), to sit up in bed to sleep for comfort (I’ve found it easier lying down), and that putting a loose jumper over the sling with a chest strap is the best thing to do (not if you want to …
{"title":"Walking A Mile in My Patient’s Shoes","authors":"B. Ollivere","doi":"10.1302/2048-0105.65.360566","DOIUrl":"https://doi.org/10.1302/2048-0105.65.360566","url":null,"abstract":"As I type out this editorial and revise this issue of 360 (left-handed, attempting to get my speech recognition software to produce something resembling what I’ve just said), I have had plenty of time to reflect on what it is like to ‘walk a mile in my patient’s shoes’, being, as I am, in the process of recovery from orthopaedic surgery myself.\u0000\u0000This gives me a reasonable moment to pause and reflect on the advice I have given patients in the past about expectations following shoulder surgery. Sure, I’ve remembered to tell them it’s very painful (not my experience), to sit up in bed to sleep for comfort (I’ve found it easier lying down), and that putting a loose jumper over the sling with a chest strap is the best thing to do (not if you want to …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"82 1","pages":"1-1"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83411864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-01DOI: 10.1302/2048-0105.64.360547
T. Khan
Despite rising numbers of randomised controlled trials (RCTs) being undertaken, for many research questions in trauma and orthopaedics, randomisation is often either unfeasible or inappropriate. There has been a historical natural reliance on observational studies expanding the evidence base, and these are commonly referenced both in published work and during the process of day-to-day clinical decision making. Prior to the advent of large-scale databases, institutional case series of diagnoses and interventions accounted for the vast majority of observational studies within our specialty. The advantage of these case series is the potential breadth of data collected on a clearly defined population – these can be used to pose study questions for higher quality research or in many cases may answer questions definitively in their own right. However, there is wide variation in the quality of reporting, they are often single-surgeon retrospective studies, and generalising findings can be problematic. Epidemiological studies using registries are surely then the solution, or are they? Arthroplasty registries, designed initially to identify poorly performing implants, have led the way in terms of collecting national-level longitudinal data on individuals undergoing an orthopaedic intervention. The Swedish Arthroplasty Register is the oldest joint registry in the world and, since its creation, the number of worldwide registries has increased. The National Joint Registry of England and Wales (NJR) is the largest arthroplasty registry with over a million recorded procedures. In the UK, there are now several other orthopaedic registries including the Non-Arthroplasty Hip Register, the UK …
{"title":"Epidemiological Studies in Orthopaedics: A Brief Overview","authors":"T. Khan","doi":"10.1302/2048-0105.64.360547","DOIUrl":"https://doi.org/10.1302/2048-0105.64.360547","url":null,"abstract":"Despite rising numbers of randomised controlled trials (RCTs) being undertaken, for many research questions in trauma and orthopaedics, randomisation is often either unfeasible or inappropriate. There has been a historical natural reliance on observational studies expanding the evidence base, and these are commonly referenced both in published work and during the process of day-to-day clinical decision making. Prior to the advent of large-scale databases, institutional case series of diagnoses and interventions accounted for the vast majority of observational studies within our specialty. The advantage of these case series is the potential breadth of data collected on a clearly defined population – these can be used to pose study questions for higher quality research or in many cases may answer questions definitively in their own right. However, there is wide variation in the quality of reporting, they are often single-surgeon retrospective studies, and generalising findings can be problematic. Epidemiological studies using registries are surely then the solution, or are they?\u0000\u0000Arthroplasty registries, designed initially to identify poorly performing implants, have led the way in terms of collecting national-level longitudinal data on individuals undergoing an orthopaedic intervention. The Swedish Arthroplasty Register is the oldest joint registry in the world and, since its creation, the number of worldwide registries has increased. The National Joint Registry of England and Wales (NJR) is the largest arthroplasty registry with over a million recorded procedures. In the UK, there are now several other orthopaedic registries including the Non-Arthroplasty Hip Register, the UK …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"20 1","pages":"38-39"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87318692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-01DOI: 10.1302/2048-0105.64.360540
J. Bono
All orthopaedic surgeons consenting patients for elective surgery should be aware of the recent High Court decision in Thefaut v. Johnston. Lisa Thefaut won her claim for damages against very experienced spinal surgeon Francis Johnston on the basis that the consenting process for an elective discectomy had been substandard. This decision sets the bar for clinicians higher than ever before. Mr Justice Green made clear that surgeons are required to engage in a consenting process tailored to the individual patient with detailed, accurate and realistic explanations of the pros and cons of surgery. This was a spinal case but a patient’s rights would be the same with any other operation. The Judge’s starting point was the landmark decision of the Supreme Court in Montgomery v. Lanarkshire Health Board in March 2015. Nadine Montgomery was pregnant and diabetic. The risk of shoulder dystocia during a vaginal delivery was about 10% and the risk of serious harm to her baby as a result was about 1%. A consultant obstetrician did not tell Ms Montgomery of the risk or offer her a caesarean section. This was because the consultant believed that, given the choice, Ms Montgomery would opt for a caesarean section, something which the consultant thought better avoided if possible. The Supreme Court decided that the time had come to assess consent on the basis of what the reasonable patient wanted to know rather than what a reasonable doctor chose to say. Where different treatment options were available, it should be the patient rather than the doctor who decides which option to take. Two limited exceptions were preserved where it would be ‘seriously detrimental to the patient’s health’ to provide information to a patient and cases of necessity, for example where an unconscious patient requires urgent treatment. The decision in Montgomery is …
所有同意病人进行选择性手术的整形外科医生都应该知道最近高等法院在Thefaut v. Johnston一案中的判决。丽莎·特福赢得了对经验丰富的脊柱外科医生弗朗西斯·约翰斯顿的赔偿要求，理由是选择性椎间盘切除术的同意程序不符合标准。这一决定为临床医生设定了比以往更高的标准。格林法官明确表示，外科医生必须根据病人的具体情况，详细、准确和现实地解释手术的利弊。这是一个脊柱病例，但是病人的权利和其他手术是一样的。法官的出发点是2015年3月最高法院在Montgomery诉拉纳克郡卫生委员会案中作出的具有里程碑意义的裁决。纳丁·蒙哥马利怀孕并患有糖尿病。阴道分娩时发生肩难产的风险约为10%，对婴儿造成严重伤害的风险约为1%。一位产科顾问医生没有告诉蒙哥马利女士剖腹产的风险，也没有建议她进行剖腹产。这是因为咨询师认为，如果可以选择，蒙哥马利女士会选择剖腹产，而咨询师认为如果可能的话，最好避免剖腹产。最高法院决定，现在是时候根据理性的病人想知道什么而不是理性的医生选择说什么来评估是否同意了。如果有不同的治疗方案可供选择，应该由病人而不是医生来决定采取哪种治疗方案。保留了两种有限的例外情况，即向病人提供信息会"严重损害病人的健康"，以及必要的情况，例如昏迷的病人需要紧急治疗。蒙哥马利的决定是…
{"title":"Thefaut v. Johnston (2017): A game changer for consent in elective surgery","authors":"J. Bono","doi":"10.1302/2048-0105.64.360540","DOIUrl":"https://doi.org/10.1302/2048-0105.64.360540","url":null,"abstract":"All orthopaedic surgeons consenting patients for elective surgery should be aware of the recent High Court decision in Thefaut v. Johnston. Lisa Thefaut won her claim for damages against very experienced spinal surgeon Francis Johnston on the basis that the consenting process for an elective discectomy had been substandard. This decision sets the bar for clinicians higher than ever before. Mr Justice Green made clear that surgeons are required to engage in a consenting process tailored to the individual patient with detailed, accurate and realistic explanations of the pros and cons of surgery. This was a spinal case but a patient’s rights would be the same with any other operation.\u0000\u0000The Judge’s starting point was the landmark decision of the Supreme Court in Montgomery v. Lanarkshire Health Board in March 2015. Nadine Montgomery was pregnant and diabetic. The risk of shoulder dystocia during a vaginal delivery was about 10% and the risk of serious harm to her baby as a result was about 1%. A consultant obstetrician did not tell Ms Montgomery of the risk or offer her a caesarean section. This was because the consultant believed that, given the choice, Ms Montgomery would opt for a caesarean section, something which the consultant thought better avoided if possible.\u0000\u0000The Supreme Court decided that the time had come to assess consent on the basis of what the reasonable patient wanted to know rather than what a reasonable doctor chose to say. Where different treatment options were available, it should be the patient rather than the doctor who decides which option to take. Two limited exceptions were preserved where it would be ‘seriously detrimental to the patient’s health’ to provide information to a patient and cases of necessity, for example where an unconscious patient requires urgent treatment.\u0000\u0000The decision in Montgomery is …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"5 1","pages":"41-43"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74238087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-01DOI: 10.1302/2048-0105.64.360551
B. Ollivere
We are now 17 years into the 21st century and how far have we really moved on in orthopaedic surgery? The Time magazine ‘operation of the century’ in the year 2000 was the hip arthroplasty. Developed over a relatively short period of time, the efforts of Charnley, Harris, Muller and countless others have left a legacy of literally millions of patients whose lives have been transformed by orthopaedic surgeons. One of my old mentors used to refer to hip arthroplasty as a ‘Christmas Card operation’, by which he meant that, long after one had forgotten the patient, it was not uncommon to receive an unsolicited Christmas card with a short but personal note letting the surgeon know how the patient was doing often a decade or more after they had undergone their surgery. The problem is that hip arthroplasty remains one of …
{"title":"Orthopaedics in the next millennium","authors":"B. Ollivere","doi":"10.1302/2048-0105.64.360551","DOIUrl":"https://doi.org/10.1302/2048-0105.64.360551","url":null,"abstract":"We are now 17 years into the 21st century and how far have we really moved on in orthopaedic surgery? The Time magazine ‘operation of the century’ in the year 2000 was the hip arthroplasty. Developed over a relatively short period of time, the efforts of Charnley, Harris, Muller and countless others have left a legacy of literally millions of patients whose lives have been transformed by orthopaedic surgeons. One of my old mentors used to refer to hip arthroplasty as a ‘Christmas Card operation’, by which he meant that, long after one had forgotten the patient, it was not uncommon to receive an unsolicited Christmas card with a short but personal note letting the surgeon know how the patient was doing often a decade or more after they had undergone their surgery.\u0000\u0000The problem is that hip arthroplasty remains one of …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"1 1","pages":"1-1"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91086922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-01DOI: 10.1302/2048-0105.64.360539
A. Titchener, A. Tambe, D. Clark
Reverse polarity total shoulder arthroplasty is an innovation primarily designed to treat the rotator cuff-deficient shoulder by increasing constraint and thereby addressing the challenges of pseudoparalysis. Forward elevation can be regained, pain and quality of life can be improved. Recently, there has been an expansion in both the breadth of indications and the volume of surgeries performed. We aim to review current practice and direction of travel. The impact of rotator cuff tear arthropathy (CTA) is often significant and disabling. This condition is associated with painful arthrosis of the shoulder in conjunction with instability, which allows the humeral head to escape antero-superiorly. The resulting loss of function in the shoulder is aptly described as ‘pseudoparalysis’. Figure 1 shows the normal deltoid function around a shoulder with an intact soft-tissue envelope, and the superior migration that results when the superiorly directed force vector is not neutralised. Conventional anatomical arthroplasty of the shoulder fails to restore function in these patients due to the inadequate stability of the joint around a central point of pivot, combined with an inability of the surrounding muscles to compensate for a weak or torn rotator cuff. Fig. 1 Proximal migration in cuff tear arthropathy with resulting deltoid dysfunction- schematic This combination results in a complex and disabling condition that has vexed shoulder surgeons since the early days of development in shoulder arthroplasty systems. A better understanding of shoulder biomechanics and the mechanisms of failure in total shoulder arthroplasty led to the development of reverse shoulder arthroplasty (RSA) designs. While the original indication was CTA, there has been a rapid expansion of indications to include a spectrum of pathologies: proximal humeral fractures and trauma sequelae; massive cuff tears; tumours; primary glenohumeral osteoarthritis (OA); and the revision of failed shoulder arthroplasties. Themistocles Gluck most likely developed a shoulder arthroplasty in the …
{"title":"Reverse shoulder arthroplasty: Is reverse the way forward?","authors":"A. Titchener, A. Tambe, D. Clark","doi":"10.1302/2048-0105.64.360539","DOIUrl":"https://doi.org/10.1302/2048-0105.64.360539","url":null,"abstract":"Reverse polarity total shoulder arthroplasty is an innovation primarily designed to treat the rotator cuff-deficient shoulder by increasing constraint and thereby addressing the challenges of pseudoparalysis. Forward elevation can be regained, pain and quality of life can be improved. Recently, there has been an expansion in both the breadth of indications and the volume of surgeries performed. We aim to review current practice and direction of travel.\u0000\u0000The impact of rotator cuff tear arthropathy (CTA) is often significant and disabling. This condition is associated with painful arthrosis of the shoulder in conjunction with instability, which allows the humeral head to escape antero-superiorly. The resulting loss of function in the shoulder is aptly described as ‘pseudoparalysis’. Figure 1 shows the normal deltoid function around a shoulder with an intact soft-tissue envelope, and the superior migration that results when the superiorly directed force vector is not neutralised. Conventional anatomical arthroplasty of the shoulder fails to restore function in these patients due to the inadequate stability of the joint around a central point of pivot, combined with an inability of the surrounding muscles to compensate for a weak or torn rotator cuff.\u0000\u0000\u0000\u0000Fig. 1 \u0000Proximal migration in cuff tear arthropathy with resulting deltoid dysfunction- schematic\u0000\u0000\u0000\u0000This combination results in a complex and disabling condition that has vexed shoulder surgeons since the early days of development in shoulder arthroplasty systems. A better understanding of shoulder biomechanics and the mechanisms of failure in total shoulder arthroplasty led to the development of reverse shoulder arthroplasty (RSA) designs. While the original indication was CTA, there has been a rapid expansion of indications to include a spectrum of pathologies: proximal humeral fractures and trauma sequelae; massive cuff tears; tumours; primary glenohumeral osteoarthritis (OA); and the revision of failed shoulder arthroplasties.\u0000\u0000Themistocles Gluck most likely developed a shoulder arthroplasty in the …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"10 1","pages":"2-7"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88804654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：