Pub Date : 2016-06-01DOI: 10.1302/2048-0105.53.360435
M. Raglan, B. Scammell
Diabetes is increasingly common, and is associated with significant patient morbidity, mortality and high socioeconomic costs (Table I). Due to the increasing prevalence of diabetes, almost all clinicians will treat patients who suffer from it, or will treat a direct complication of diabetes. One of the most serious complications affecting orthopaedic surgeons is the diabetic foot ulcer (DFU). The aim of this review is to update clinicians on the optimal management of the DFU. View this table: Table I. Diabetes-related statistics in the UK Diabetes is a metabolic disease characterised by hyperglycaemia as a result of defects in insulin secretion or action. In the long-term this leads to damage and dysfunction of organs, specifically the eyes, kidneys, heart, nerves and blood vessels.4 A break in the skin on the foot in the presence of diabetes is known as a diabetic foot ulcer (DFU), and is the leading cause of hospitalisation in patients with diabetes (Fig. 1).5,6 Fig. 1 Necrotic diabetic foot ulcer of calcaneum. There are multiple risk factors for the development of a DFU (Table II).5 The most common reasons are related to neuropathy, vasculopathy or a combination of both.7⇓-9 The vast majority of DFU seen in clinics or presenting as emergencies have combined pathology, and only 10% of DFU are due to isolated vasculopathy or peripheral vascular disease (PVD).10 View this table: Table II. Risk factors for the development of diabetic foot ulcers5 Diabetes is thought to cause damage to the vasa nervorum resulting in an ischaemic insult and a progressive irreversible sensory, motor and autonomic neuropathy. Most presentations of sensory neuropathy are insidious until the onset of complications. The sensory deficit usually occurs below the knee, is denser distally and is bilateral. Sensory deficit results in numbness of the feet with burning, pain or paraesthesia being …
{"title":"Diabetic foot ulcers: “Just chop it off”?","authors":"M. Raglan, B. Scammell","doi":"10.1302/2048-0105.53.360435","DOIUrl":"https://doi.org/10.1302/2048-0105.53.360435","url":null,"abstract":"Diabetes is increasingly common, and is associated with significant patient morbidity, mortality and high socioeconomic costs (Table I). Due to the increasing prevalence of diabetes, almost all clinicians will treat patients who suffer from it, or will treat a direct complication of diabetes. One of the most serious complications affecting orthopaedic surgeons is the diabetic foot ulcer (DFU). The aim of this review is to update clinicians on the optimal management of the DFU.\u0000\u0000View this table:\u0000\u0000Table I. \u0000Diabetes-related statistics in the UK\u0000\u0000\u0000\u0000Diabetes is a metabolic disease characterised by hyperglycaemia as a result of defects in insulin secretion or action. In the long-term this leads to damage and dysfunction of organs, specifically the eyes, kidneys, heart, nerves and blood vessels.4 A break in the skin on the foot in the presence of diabetes is known as a diabetic foot ulcer (DFU), and is the leading cause of hospitalisation in patients with diabetes (Fig. 1).5,6\u0000\u0000\u0000\u0000Fig. 1 \u0000Necrotic diabetic foot ulcer of calcaneum.\u0000\u0000\u0000\u0000There are multiple risk factors for the development of a DFU (Table II).5 The most common reasons are related to neuropathy, vasculopathy or a combination of both.7⇓-9 The vast majority of DFU seen in clinics or presenting as emergencies have combined pathology, and only 10% of DFU are due to isolated vasculopathy or peripheral vascular disease (PVD).10\u0000\u0000View this table:\u0000\u0000Table II. \u0000Risk factors for the development of diabetic foot ulcers5\u0000\u0000\u0000\u0000Diabetes is thought to cause damage to the vasa nervorum resulting in an ischaemic insult and a progressive irreversible sensory, motor and autonomic neuropathy. Most presentations of sensory neuropathy are insidious until the onset of complications. The sensory deficit usually occurs below the knee, is denser distally and is bilateral. Sensory deficit results in numbness of the feet with burning, pain or paraesthesia being …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"61 1","pages":"2-6"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81175856","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 : 2016-06-01DOI: 10.1302/2048-0105.53.360447
B. Ollivere
Right at the birth of orthopaedic surgery, innovations and new treatments were communicated through letters to societies and in treatises, and rather long textbooks describing experiences of treatments. In fact, the oldest known records of orthopaedic treatments described in the Edwin Smith papyrus from Ancient Egypt are true to this formula of simple series of descriptive cases, a method also used by the fathers of orthopaedic surgery in their own treatises in the 19th century. Academic medical writing, and specifically orthopaedic writing, became more formalised with the advent of scientific societies which soon started circulating newsletters that rapidly became journals with the addition of peer review, …
{"title":"The demise of reading: a problem reflected in open access journals?","authors":"B. Ollivere","doi":"10.1302/2048-0105.53.360447","DOIUrl":"https://doi.org/10.1302/2048-0105.53.360447","url":null,"abstract":"Right at the birth of orthopaedic surgery, innovations and new treatments were communicated through letters to societies and in treatises, and rather long textbooks describing experiences of treatments. In fact, the oldest known records of orthopaedic treatments described in the Edwin Smith papyrus from Ancient Egypt are true to this formula of simple series of descriptive cases, a method also used by the fathers of orthopaedic surgery in their own treatises in the 19th century. Academic medical writing, and specifically orthopaedic writing, became more formalised with the advent of scientific societies which soon started circulating newsletters that rapidly became journals with the addition of peer review, …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"1 1","pages":"1-1"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76337233","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 : 2016-06-01DOI: 10.1302/2048-0105.53.360434
P. Worlock
In 2015, the Supreme Court gave their decision on a case involving the issue of informed consent for an obstetric procedure.1 That judgement (referred to hereafter as ‘Montgomery’) has implications for all doctors practising within the United Kingdom. The claimant was a small, diabetic woman with a large foetus. The risk of shoulder dystocia was estimated to be between 9% and 10%, but the mother was not informed of this because her consultant considered the risk of a ‘grave problem’ for the baby to be “very small” (in the event of shoulder dystocia occurring, there was a 0.2% chance of brachial plexus injury and a 0.1% chance of prolonged hypoxia). The option of planned caesarean section (CS) was not discussed with the claimant, and induction was planned for 39 weeks. During delivery, there was occlusion of the umbilical cord resulting in a hypoxic brain injury. Subsequently, the mother claimed that she should have been warned of the risk of shoulder dystocia and the potentially catastrophic consequences, and of the alternative of planned CS, in which case she would have opted for CS. At both the initial trial and on appeal, the defendant’s experts stated that the “risk of grave problems was very small”, but also that “if such women were warned, most would opt for CS”. Both courts concluded that to not warn the patient was accepted as proper by a responsible body of medical opinion. The Supreme Court accepted that the consultant’s decision accorded with a reasonable body of opinion, but that patients have rights and are not passive recipients of the care of the medical profession. A person is entitled to decide which, if any, of the available forms of treatment to undergo. The Supreme Court accepted that, if appropriately warned, the claimant would not have agreed …
{"title":"Consent: Where are we in 2016?","authors":"P. Worlock","doi":"10.1302/2048-0105.53.360434","DOIUrl":"https://doi.org/10.1302/2048-0105.53.360434","url":null,"abstract":"In 2015, the Supreme Court gave their decision on a case involving the issue of informed consent for an obstetric procedure.1 That judgement (referred to hereafter as ‘Montgomery’) has implications for all doctors practising within the United Kingdom.\u0000\u0000The claimant was a small, diabetic woman with a large foetus. The risk of shoulder dystocia was estimated to be between 9% and 10%, but the mother was not informed of this because her consultant considered the risk of a ‘grave problem’ for the baby to be “very small” (in the event of shoulder dystocia occurring, there was a 0.2% chance of brachial plexus injury and a 0.1% chance of prolonged hypoxia). The option of planned caesarean section (CS) was not discussed with the claimant, and induction was planned for 39 weeks. During delivery, there was occlusion of the umbilical cord resulting in a hypoxic brain injury.\u0000\u0000Subsequently, the mother claimed that she should have been warned of the risk of shoulder dystocia and the potentially catastrophic consequences, and of the alternative of planned CS, in which case she would have opted for CS. At both the initial trial and on appeal, the defendant’s experts stated that the “risk of grave problems was very small”, but also that “if such women were warned, most would opt for CS”. Both courts concluded that to not warn the patient was accepted as proper by a responsible body of medical opinion.\u0000\u0000The Supreme Court accepted that the consultant’s decision accorded with a reasonable body of opinion, but that patients have rights and are not passive recipients of the care of the medical profession. A person is entitled to decide which, if any, of the available forms of treatment to undergo. The Supreme Court accepted that, if appropriately warned, the claimant would not have agreed …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"13 1","pages":"38-40"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77913364","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 : 2016-04-01DOI: 10.1302/2048-0105.52.360431
B. Ollivere
I find myself stood on the start line for the Beyond the Ultimate Ice Ultra marathon in Northern Lapland, well into the Sami territories of the European Arctic, contemplating just over four days of running over 240 km of mountains and frozen lakes using ancient migration trails. With home, work and worries far away I always find time for my annual pilgrimage to run an ultramarathon in a far flung area of the planet. Racing with a good friend for five days across frozen lakes, over mountains, braving snow shoes and temperatures as low as -25 might not be everyone’s cup of tea but it certainly serves to put life into perspective. This was one of the best ultra races I have had the opportunity to race …
{"title":"Work life balance and unusual activities in the Arctic","authors":"B. Ollivere","doi":"10.1302/2048-0105.52.360431","DOIUrl":"https://doi.org/10.1302/2048-0105.52.360431","url":null,"abstract":"I find myself stood on the start line for the Beyond the Ultimate Ice Ultra marathon in Northern Lapland, well into the Sami territories of the European Arctic, contemplating just over four days of running over 240 km of mountains and frozen lakes using ancient migration trails. With home, work and worries far away I always find time for my annual pilgrimage to run an ultramarathon in a far flung area of the planet. Racing with a good friend for five days across frozen lakes, over mountains, braving snow shoes and temperatures as low as -25 might not be everyone’s cup of tea but it certainly serves to put life into perspective. This was one of the best ultra races I have had the opportunity to race …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"14 1","pages":"1-1"},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89682713","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 : 2016-04-01DOI: 10.1302/2048-0105.52.360419
M. Foy
In 2013 we ran a session entitled, ‘Pain, Percentages, Advancement/Acceleration and other nebulous concepts in medico-legal practice’ at the BOA Annual Congress in Birmingham. The session was vastly oversubscribed with people sitting/standing in the aisles and over 50 attendees locked out by the fire safety officer. Speakers included a barrister, psychiatrist, pain specialist and an orthopaedic surgeon. The level of interest in this session emphasised the topicality of the issues under review. As I continue to read medical reports in personal injury claims where it is argued that such and such an injury has caused the onset of certain symptoms and disability to be advanced/accelerated by a certain period, I thought that it might be worth re-visiting the subject to consider its validity in these cases. What do we mean by advancement or acceleration of symptoms? Effectively we are arguing that given the nature of the underlying condition (most commonly back pain), and our understanding of the epidemiology and pathophysiology of that condition, the injury or incident in question has brought forward what would invariably have happened in any event by a certain period of time. Clearly if a pedestrian is walking along the pavement and is struck by a car, it would be ridiculous to argue that this insult had brought forward the tibial fracture by a certain period. However, in a condition as common as back pain where most of the patients we see in clinical practice develop symptoms during the activities of daily living, rather than after a specific injury, it is frequently argued that such an injury or incident has triggered the onset of symptoms which would probably have come on at a later date in any event. Why do we introduce the concept? The simple answer is that we are trying to help the legal …
{"title":"Advancement and acceleration in medico-legal practice: what’s it all about?","authors":"M. Foy","doi":"10.1302/2048-0105.52.360419","DOIUrl":"https://doi.org/10.1302/2048-0105.52.360419","url":null,"abstract":"In 2013 we ran a session entitled, ‘Pain, Percentages, Advancement/Acceleration and other nebulous concepts in medico-legal practice’ at the BOA Annual Congress in Birmingham. The session was vastly oversubscribed with people sitting/standing in the aisles and over 50 attendees locked out by the fire safety officer. Speakers included a barrister, psychiatrist, pain specialist and an orthopaedic surgeon. The level of interest in this session emphasised the topicality of the issues under review. As I continue to read medical reports in personal injury claims where it is argued that such and such an injury has caused the onset of certain symptoms and disability to be advanced/accelerated by a certain period, I thought that it might be worth re-visiting the subject to consider its validity in these cases.\u0000\u0000What do we mean by advancement or acceleration of symptoms? Effectively we are arguing that given the nature of the underlying condition (most commonly back pain), and our understanding of the epidemiology and pathophysiology of that condition, the injury or incident in question has brought forward what would invariably have happened in any event by a certain period of time. Clearly if a pedestrian is walking along the pavement and is struck by a car, it would be ridiculous to argue that this insult had brought forward the tibial fracture by a certain period. However, in a condition as common as back pain where most of the patients we see in clinical practice develop symptoms during the activities of daily living, rather than after a specific injury, it is frequently argued that such an injury or incident has triggered the onset of symptoms which would probably have come on at a later date in any event.\u0000\u0000Why do we introduce the concept? The simple answer is that we are trying to help the legal …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"4 1","pages":"37-38"},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84279792","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 : 2016-04-01DOI: 10.1302/2048-0105.52.360427
M. Patel, N. Eastley, R. Ashford
This paper aims to provide evidence-based guidance for the general orthopaedic surgeon faced with the presentation of a potential soft tissue sarcoma in an extremity.
本文旨在为普通骨科医生面对潜在的肢体软组织肉瘤的表现提供循证指导。
{"title":"Extremity soft tissue sarcomas: what’s hot and what’s not","authors":"M. Patel, N. Eastley, R. Ashford","doi":"10.1302/2048-0105.52.360427","DOIUrl":"https://doi.org/10.1302/2048-0105.52.360427","url":null,"abstract":"This paper aims to provide evidence-based guidance for the general orthopaedic surgeon faced with the presentation of a potential soft tissue sarcoma in an extremity.","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"17 1","pages":"3-6"},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82293901","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 : 2016-02-01DOI: 10.1302/2048-0105.51.360403
D. Bryson, F. Shivji, K. Price, D. Lawniczak, J. Chell, J. Hunter
The orthopaedic surgeon practising general trauma will invariably encounter fractures in children. Mercer Rang points out in the opening chapter of his textbook, “children are not just small adults”.1 The paediatric skeleton is more forgiving, demonstrates greater rapidity of healing and has an unrivalled capacity to remodel. Greater angulation, translation, and shortening can be accepted and reliably expected to remodel without clinical, functional or radiological shortcomings. Despite the fact that the outcomes following paediatric fractures are predictable and the healing potential offers considerable latitude for restoration of normality, there has been a global paradoxical shift from conservative treatment to early fracture fixation. This has perhaps been driven by the desire for immediate correction of clinical deformities or by financial incentives to minimise hospital costs accrued with prolonged admissions during periods of immobilisation. This review examines the evidence and indications for conservative treatment, and describes our preferences for the management of some commonly encountered paediatric fractures. The ability of the paediatric skeleton to remodel lies at the heart of non-operative management. Semantically, this process is called modeling; remodeling being the constant homeostatic cycling of calcium and phosphate from bone stores. Everyone understands remodeling so we use it now even though it’s wrong! It is the process by which angulation and translation are corrected to restore acceptable alignment. The potential for remodeling is influenced by a number of factors:
{"title":"The lost art of conservative management of paediatric fractures","authors":"D. Bryson, F. Shivji, K. Price, D. Lawniczak, J. Chell, J. Hunter","doi":"10.1302/2048-0105.51.360403","DOIUrl":"https://doi.org/10.1302/2048-0105.51.360403","url":null,"abstract":"The orthopaedic surgeon practising general trauma will invariably encounter fractures in children. Mercer Rang points out in the opening chapter of his textbook, “children are not just small adults”.1 The paediatric skeleton is more forgiving, demonstrates greater rapidity of healing and has an unrivalled capacity to remodel. Greater angulation, translation, and shortening can be accepted and reliably expected to remodel without clinical, functional or radiological shortcomings. Despite the fact that the outcomes following paediatric fractures are predictable and the healing potential offers considerable latitude for restoration of normality, there has been a global paradoxical shift from conservative treatment to early fracture fixation. This has perhaps been driven by the desire for immediate correction of clinical deformities or by financial incentives to minimise hospital costs accrued with prolonged admissions during periods of immobilisation. This review examines the evidence and indications for conservative treatment, and describes our preferences for the management of some commonly encountered paediatric fractures.\u0000\u0000The ability of the paediatric skeleton to remodel lies at the heart of non-operative management. Semantically, this process is called modeling; remodeling being the constant homeostatic cycling of calcium and phosphate from bone stores. Everyone understands remodeling so we use it now even though it’s wrong! It is the process by which angulation and translation are corrected to restore acceptable alignment. The potential for remodeling is influenced by a number of factors:","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"1 1","pages":"2-8"},"PeriodicalIF":0.0,"publicationDate":"2016-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74049095","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 : 2016-02-01DOI: 10.1302/2048-0105.44.360418
B. Ollivere
As Douglas Adams famously said, the answer to life, the universe and everything is “42”. (Question of course as yet unknown). I was taught as a trainee and a young academic that the perennial problem in conducting research is asking the right question – a point Adams makes very eloquently. If you don’t ask the correct question you clearly will not get a reasonable answer – “garbage in – garbage out”. Over the last few years the quality of orthopaedic research in terms of methodology has skyrocketed. Randomised controlled trials abound and there doesn’t seem to be an edition of 360 that goes by without a number of excellent randomised controlled trials to comment upon. Controversially I have become however increasingly concerned about the RCT. Whilst methodologically better at addressing biases there is a risk in the orthopaedic community that …
{"title":"Health economic quality of life the bane of genuine outcomes","authors":"B. Ollivere","doi":"10.1302/2048-0105.44.360418","DOIUrl":"https://doi.org/10.1302/2048-0105.44.360418","url":null,"abstract":"As Douglas Adams famously said, the answer to life, the universe and everything is “42”. (Question of course as yet unknown). I was taught as a trainee and a young academic that the perennial problem in conducting research is asking the right question – a point Adams makes very eloquently. If you don’t ask the correct question you clearly will not get a reasonable answer – “garbage in – garbage out”. Over the last few years the quality of orthopaedic research in terms of methodology has skyrocketed. Randomised controlled trials abound and there doesn’t seem to be an edition of 360 that goes by without a number of excellent randomised controlled trials to comment upon.\u0000\u0000Controversially I have become however increasingly concerned about the RCT. Whilst methodologically better at addressing biases there is a risk in the orthopaedic community that …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"1 1","pages":"1-1"},"PeriodicalIF":0.0,"publicationDate":"2016-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87966027","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 : 2016-02-01DOI: 10.1302/2048-0105.45.360404
W. Ribbans
Like all subspecialty areas within orthopaedic surgery, foot and ankle work carries risks, complications and the potential for litigation. Certain areas of this work have been highlighted for this article to aid the surgeon in appropriately counselling the patient, and improving understanding of major risk areas and knowledge of the outcomes of injury and surgery. Historically, information on litigation claims has been difficult to acquire because it involves obtaining information from a number of different bodies. There is no mechanism for compulsory reporting of complications, coding accuracy is usually found wanting, and most claims are either dismissed or settled without going to court. However, in 2014, Ring1 provided an analysis of 1214 National Health Service Litigation Authority (NHSLA) claims in England, involving foot and ankle surgery, over 17 years. These represented 12.6% of orthopaedic claims. Thirty-four per cent of claims involved the ankle, with 73% resulting from trauma. Twenty-one per cent involved the first ray, of which 98% involved elective surgery. Nineteen per cent of claims involved diagnostic errors, 19% were for alleged incompetent surgery, and a further 13% for mismanagement. The authors recognised that reducing incorrect, delayed and missed diagnoses was a key area for improvement. #### Medico-legal implications: Nerve injury is a common foot and ankle surgical complication, with the most frequent causes being inadvertent laceration, entrapment under metalwork, contusion/soft-tissue swelling and accidental injury from suture needle placement. This may result in diminished sensation, painful neuroma formation, adverse effects on mobility and problems with footwear. The sural, superficial peroneal, deep peroneal, saphenous and tibial nerves can all be injured. Bai2 reported a …
{"title":"Medico-legal issues in the foot and ankle specialty","authors":"W. Ribbans","doi":"10.1302/2048-0105.45.360404","DOIUrl":"https://doi.org/10.1302/2048-0105.45.360404","url":null,"abstract":"Like all subspecialty areas within orthopaedic surgery, foot and ankle work carries risks, complications and the potential for litigation. Certain areas of this work have been highlighted for this article to aid the surgeon in appropriately counselling the patient, and improving understanding of major risk areas and knowledge of the outcomes of injury and surgery.\u0000\u0000Historically, information on litigation claims has been difficult to acquire because it involves obtaining information from a number of different bodies. There is no mechanism for compulsory reporting of complications, coding accuracy is usually found wanting, and most claims are either dismissed or settled without going to court. However, in 2014, Ring1 provided an analysis of 1214 National Health Service Litigation Authority (NHSLA) claims in England, involving foot and ankle surgery, over 17 years. These represented 12.6% of orthopaedic claims. Thirty-four per cent of claims involved the ankle, with 73% resulting from trauma. Twenty-one per cent involved the first ray, of which 98% involved elective surgery. Nineteen per cent of claims involved diagnostic errors, 19% were for alleged incompetent surgery, and a further 13% for mismanagement. The authors recognised that reducing incorrect, delayed and missed diagnoses was a key area for improvement.\u0000\u0000#### Medico-legal implications:\u0000\u0000Nerve injury is a common foot and ankle surgical complication, with the most frequent causes being inadvertent laceration, entrapment under metalwork, contusion/soft-tissue swelling and accidental injury from suture needle placement. This may result in diminished sensation, painful neuroma formation, adverse effects on mobility and problems with footwear. The sural, superficial peroneal, deep peroneal, saphenous and tibial nerves can all be injured.\u0000\u0000Bai2 reported a …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"16 1","pages":"37-40"},"PeriodicalIF":0.0,"publicationDate":"2016-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84424965","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 : 2015-12-01DOI: 10.1302/2048-0105.44.360401
B. Ollivere
I was recently privileged to sit through a short lecture by Bill Bryson, someone for whom I have had affection for many years. I had been struck by his earnest humour and thoughtful charm the first time I heard him speak at the BOA a few years ago and was excited to be able to hear him again at a much smaller Orthopaedic forum. Mr Bryson gave a thought-provoking talk set off by his usual amusing anecdote about ‘bears and bells’. However, taking the opportunity to converse with the trainees in the auditorium, he went on to give one of the most profound and beautifully-delivered commentaries on what is wrong and right with modern healthcare I have heard in a number of years. Bryson told of the fate of Katz, the other protagonist of A Walk in the Woods which I am sure will be familiar to many. He traced the difficulties experienced by his childhood friend as a result of the development of simple complications from diabetes, which led eventually …
{"title":"Bears, bells, healthcare and how do we actually get it right first time?","authors":"B. Ollivere","doi":"10.1302/2048-0105.44.360401","DOIUrl":"https://doi.org/10.1302/2048-0105.44.360401","url":null,"abstract":"I was recently privileged to sit through a short lecture by Bill Bryson, someone for whom I have had affection for many years. I had been struck by his earnest humour and thoughtful charm the first time I heard him speak at the BOA a few years ago and was excited to be able to hear him again at a much smaller Orthopaedic forum. \u0000\u0000Mr Bryson gave a thought-provoking talk set off by his usual amusing anecdote about ‘bears and bells’. However, taking the opportunity to converse with the trainees in the auditorium, he went on to give one of the most profound and beautifully-delivered commentaries on what is wrong and right with modern healthcare I have heard in a number of years. Bryson told of the fate of Katz, the other protagonist of A Walk in the Woods which I am sure will be familiar to many. He traced the difficulties experienced by his childhood friend as a result of the development of simple complications from diabetes, which led eventually …","PeriodicalId":50250,"journal":{"name":"Journal of Bone and Joint Surgery","volume":"12 1","pages":"1-1"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88283027","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}
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