2023 Eastern publications

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    The British Orthopaedic Oncology Management (BOOM) audit
    (British Editorial Society of Bone and Joint Journal, 2023-10-01) Archer, J. E.; Chauhan, G. S.; Dewan, V.; Osman, K.; Thomson, C.; Nandra, R. S.; Ashford, R. U.; Cool, P.; Stevenson, J.
    AIMS: Most patients with advanced malignancy suffer bone metastases, which pose a significant challenge to orthopaedic services and burden to the health economy. This study aimed to assess adherence to the British Orthopaedic Oncology Society (BOOS)/British Orthopaedic Association (BOA) guidelines on patients with metastatic bone disease (MBD) in the UK. METHODS: A prospective, multicentre, national collaborative audit was designed and delivered by a trainee-led collaborative group. Data were collected over three months (1 April 2021 to 30 June 2021) for all patients presenting with MBD. A data collection tool allowed investigators at each hospital to compare practice against guidelines. Data were collated and analyzed centrally to quantify compliance from 84 hospitals in the UK for a total of 1,137 patients who were eligible for inclusion. RESULTS: A total of 846 patients with pelvic and appendicular MBD were analyzed, after excluding those with only spinal metastatic disease. A designated MBD lead was not present in 39% of centres (33/84). Adequate radiographs were not performed in 19% of patients (160/846), and 29% (247/846) did not have an up-to-date CT of thorax, abdomen, and pelvis to stage their disease. Compliance was low obtaining an oncological opinion (69%; 584/846) and prognosis estimations (38%; 223/846). Surgery was performed in 38% of patients (319/846), with the rates of up-to-date radiological investigations and oncology input with prognosis below the expected standard. Of the 25% (215/846) presenting with a solitary metastasis, a tertiary opinion from a MBD centre and biopsy was sought in 60% (130/215). CONCLUSION: Current practice in the UK does not comply with national guidelines, especially regarding investigations prior to surgery and for patients with solitary metastases. This study highlights the need for investment and improvement in care. The recent publication of British Orthopaedic Association Standards for Trauma (BOAST) defines auditable standards to drive these improvements for this vulnerable patient group.
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    Management of bleeding varicose veins
    (Atypon, 2023-12-01) Tan, M.; Campbell, B.; Parsi, K.; Davies, A. H.
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    Outcomes in Ankle Replacement Study (OARS)
    (British Editorial Society of Bone and Joint Journal, 2023-08-01) Smith, T. O.; Dainty, J.; Loveday, D. T.; Toms, A.; Goldberg, A. J.; Watts, L.; Pennington, M. W.; Dawson, J.; van der Meulen, J.; MacGregor, A. J.
    AIMS: The aim of this study was to capture 12-month outcomes from a representative multicentre cohort of patients undergoing total ankle arthroplasty (TAA), describe the pattern of patient-reported outcome measures (PROMs) at 12 months, and identify predictors of these outcome measures. METHODS: Patients listed for a primary TAA at 19 NHS hospitals between February 2016 and October 2017 were eligible. PROMs data were collected preoperatively and at six and 12 months including: Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ (foot and ankle)) and the EuroQol five-dimension five-level questionnaire (EQ-5D-5L). Radiological pre- and postoperative data included Kellgren-Lawrence score and implant position measurement. This was supplemented by data from the National Joint Registry through record linkage to determine: American Society of Anesthesiologists (ASA) grade at index procedure; indication for surgery, index ankle previous fracture; tibial hind foot alignment; additional surgery at the time of TAA; and implant type. Multivariate regression models assessed outcomes, and the relationship between MOXFQ and EQ-5D-5L outcomes, with patient characteristics. RESULTS: Data from 238 patients were analyzed. There were significant improvements in MOXFQ and EQ-5D-5L among people who underwent TAA at six- and 12-month assessments compared with preoperative scores (p < 0.001). Most improvement occurred between preoperative and six months, with little further improvement at 12 months. A greater improvement in MOXFQ outcome postoperatively was associated with older age and more advanced radiological signs of ankle osteoarthritis at baseline. CONCLUSION: TAA significantly benefits patients with end-stage ankle disease. The lack of substantial further overall change between six and 12 months suggests that capturing PROMs at six months is sufficient to assess the success of the procedure. Older patients and those with advanced radiological disease had the greater gains. These outcome predictors can be used to counsel younger patients and those with earlier ankle disease on the expectations of TAA.
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    Making fracture fixation teaching Child's play
    (Elsevier, 2023-12-01) Spolton-Dean, C.; Hunter, C.; Donaldson, O.
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    Two to Five-Year Outcomes of Total Ankle Arthroplasty with the Infinity Fixed-Bearing Implant: A Concise Follow-up of a Previous Report
    (Journal of Bone & Joint Surgery, 2023-12-01) Townshend, D.; Bing, A.; Blundell, C.; Clough, T.; Davenport, J.; Davies, H.; Davis, J.; Dhar, S.; Hepple, S.; Kakwani, R.; Karski, M.; Makwana, N.; McKinley, J.; Murty, A.; Raglan, M.; Shalaby, H.; Sharpe, I.; Smith, R.; Taylor, H.; Goldberg, A.
    Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.