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Haddaway M.J.,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust | Davie M.W.J.,Charles Salt Center for Human Metabolism | Davies H.L.,Charles Salt Center for Human Metabolism | Sharp C.A.,Charles Salt Center for Human Metabolism | Sharp C.A.,Linkoping University
Physiological Measurement | Year: 2013

Bone mineral density at spine and hip is widely used to diagnose osteoporosis. Certain conditions cause changes in bone density at other sites, particularly in the lower limb, with fractures occurring in non-classical locations. Bone density changes at these sites would be of interest for diagnosis and treatment. We describe an application, based on an existing software option for Hologic scanners, which allows reproducible measurement of bone density at six lower limb sites (upper femur, mid-femur, lower femur; upper leg, mid-leg, lower leg). In 30 unselected subjects, referred for bone density, precision (CV%) measured on 2 occasions, separated by repositioning, ranged from 1.7% (mid-femur) to 4.5% at the lowest leg site. Intra-operator precision, measured by three operators on ten subjects on three occasions, was between 1.0% and 2.9%, whilst inter-operator precision was between 1.0% and 3.6%, according to region. These values compare well with those at the spine and upper femur, and in the literature. There was no evidence that this operator agreement improved between occasions 1 and 3. This technique promises to be useful for assessing bone changes at vulnerable sites in the lower limb, in diverse pathological states and in assessing response to treatment. © 2013 Institute of Physics and Engineering in Medicine. Source

Thomason K.,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust | Burkhart K.J.,University of Cologne | Wegmann K.,University of Cologne | Muller L.P.,University of Cologne
Strategies in Trauma and Limb Reconstruction | Year: 2013

Radial head fractures are the most common type of elbow fracture in adults. Unrecognised disruption of the intraosseous membrane at the time of injury can lead to severe wrist pain from proximal radial migration especially if the radial head is excised. In this case, despite anatomical reduction and internal fixation of the radial head fracture, longitudinal forearm instability developed after delayed radial head resection was performed 7 months post-injury. A Suave-Kapandji procedure was performed due to ongoing wrist pain. Because of the previous radial head resection, this led to a floating forearm that could only be solved by creating a one-bone forearm, sacrificing all forearm rotation to achieve a stable lever arm between the elbow and wrist joint. © 2013 The Author(s). Source

Karmali S.,University College London | Jenkins N.,University College London | Sciusco A.,University College London | John J.,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust | And 2 more authors.
British Journal of Anaesthesia | Year: 2015

Background Enhanced recovery, in part, aims to reduce postoperative gastrointestinal dysfunction (PGID). Acquired - or established- vagal dysfunction may contribute to PGID, even for surgery not involving the gastrointestinal tract. However, direct evidence for this is lacking. We hypothesized that chewing gum reduces morbidity (including PGID) by preserving efferent vagal neural activity postoperatively after elective orthopaedic surgery. Methods In a two-centre randomized controlled trial (n=106), we explored whether patients randomized to prescribed chewing gum for five days postoperatively sustained less morbidity (primary outcome, defined by the Postoperative Morbidity Survey), PGID and faster time to become morbidity free (secondary outcomes). In a subset of patients (n=38), cardiac parasympathetic activity was measured by serial Holter monitoring and assessed using time and frequency domain analyses. Results Between September 2011 and April 2014, 106 patients were randomized to chewing gum or control. The primary clinical outcome did not differ between groups, with similar morbidity occurring between patients randomized to control (26/30) and chewing gum (21/28; absolute risk reduction (ARR):13% (95%C I:- 6-32); P=0.26). However, chewing gum reduced PGID (ARR:20% (95% CI: 1-38); P=0.049). Chewing gum reduced time to become morbidity-free (relative risk (RR): 1.62 (95% CI: 1.02-2.58); P=0.04) and was associated with a higher proportion of parasympathetic activity contributing to heart rate variability (11% (95% CI: 1-20); P=0.03). Conclusions Chewing gum did not alter overall morbidity, but reduced PGID. These data show for the first time that prescription of sham feeding preserves vagal activity in surgery not directly involving the gastrointestinal tract. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. Source

Winn N.,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust | Spratt J.,Sunderland General Hospital | Wright E.,Durham University | Cox J.,Northumbria Healthcare Trust
Multidisciplinary Respiratory Medicine | Year: 2014

Background: CT guided lung biopsy is a commonly performed procedure to obtain tissue for a histological diagnosis in cases of suspected lung cancer. Methods: This is a prospective cohort study to obtain information directly from patients about their experiences of the biopsy procedure, thus obtaining a more accurate picture of complications compared with previously performed retrospective reviews. Patients participated in a post-procedure telephone interview and information was gathered about any procedural complications and personal experiences. We also compared the patient reported complications with those obtained from a retrospective review of hospital databases, analogous to previously performed retrospective studies. Results: In our patient group, reported procedural complication rates were 10% pneumothorax rate (4% requiring a chest drain) and 10% haemoptysis. Post-procedural pain and shortness of breath showed positive correlation, with one patient experiencing prolonged pain. No statistical difference was found between the patient reported complication rates and those obtained from retrospective review of the hospital database. Conclusions: Our study demonstrates CT guided lung biopsy is a safe procedure and is generally well tolerated. Some patients may experience significant and lasting pain and therefore should be counselled about this pre-procedure. © 2014 Winn et al. Source

Roberts A.,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust | Wales J.,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust | Smith H.,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust | Sampson C.J.,University of Nottingham | And 2 more authors.
Prosthetics and Orthotics International | Year: 2016

Background: Three-dimensional laser scanning has been used for patient measurement for cranial helmets and spinal braces. Ankle-foot orthoses are commonly prescribed for children with orthopaedic conditions. This trial sought to compare ankle-foot orthoses produced by laser scanning or traditional plaster casting. Objectives: Assessment of the effectiveness and efficiency of using laser scanning to produce ankle-foot orthoses. Study design: Randomised controlled trial with blinding of orthotists and patients to the construction technique used. Methods: A randomised double-blind trial comparing fabrication of ankle-foot orthoses from casts or laser scans. Results: The time spent in the rectification and moulding of scanned ankle-foot orthoses was around 50% less than for cast ankle-foot orthoses. A non-significant increase of 9 days was seen in the time to delivery to the patient for laser scanning with computer-aided design and computer-aided manufacturing. There was a higher incidence of problems with the scan-based ankle-foot orthoses at delivery of the device, but no difference in how long the ankle-foot orthoses lasted. Costs associated with laser scanning were not significantly different from traditional methods of ankle-foot orthosis manufacture. Conclusion: Compared with conventional casting techniques, laser scan-based ankle-foot orthosis manufacture did not significantly improve either the quality of the final product or the time to delivery. Clinical relevance Ankle-foot orthoses (AFOs) are a common requirement for chronic neurological conditions during childhood. Improved efficiency of provision of AFOs would benefit children and families by reducing the delay in provision of devices and would benefit the health service by making best use of valuable orthotist time. Source

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