Comparison of Digital Versus Conventional Documentation of Ward Round in Terms of Staff Satisfaction, Effect on Education, and Adherence to British Orthopaedic Association Guidelines.

Objective To compare the role of paper-based versus digital record keeping in the orthopaedic ward in terms of staff satisfaction, education of staff, and adherence to British Orthopaedic Association (BOA) guidelines. Materials and methods Forty-four participants including nurses, senior house officers, foundation year trainees, and consultants completed a questionnaire. The first survey was done to introduce electronic records keeping to the participants and the second survey was conducted to review the collected record. Three parameters were assessed, which were adherence to BOA guidelines, staff satisfaction, and effect of education for both paper-based and electronic records. Comparison between two methods of record keeping was done by independent t-test for continuous data and chi-square test for categorical.  Results For all four questions about staff satisfaction, the score of the electronic method was higher than paperwork statistically. The score for 'opportunity to learn images in ward round' was higher in electronic (3.9±0.8) than paperwork (2.6±1.3) statistically (p<0.001). Comparable results were found for 'educational usefulness of ward round' and 'typing time affecting learning time'. For adherence to guidelines, the electronic record keeping was more effective in storing the patient's ID and name (p=0.05), details of documenting clinician (p<0.001), time of ward round ((p=0.005), whom to contact in case of concern (p=0.050), and grade of ward round clinician (<0.001). Conclusion Electronic records in the orthopaedic ward were deemed better than paperwork in terms of staff satisfaction, positive effect on the education of doctors, and adherence to BOA guidelines.

Hip and distal femur fracture outcomes over three successive UK lockdown periods during the COVID-19 pandemic: what have we learnt? : a single-centre retrospective cohort study.

AIMS: This study assessed the impact of COVID-19 on hip and distal femur fracture patient outcomes across three successive UK lockdown periods over one year. METHODS: A single-centre retrospective cohort study was performed at an acute NHS Trust. Hip and distal femur fracture patients admitted within the first month from each of the three starting dates of each national lockdown were included and compared to a control group in March 2019. Data were collected as per the best practice tariff outcomes including additional outcomes as required. Data collection included COVID-19 status, time to theatre, 30-day mortality, presence of acute kidney injury (AKI) and pneumonia, and do not attempt cardiopulmonary resuscitation (DNACPR) status. Data were analyzed using an independent-samples t-test or chi-squared test with Fisher's exact test where applicable. A p-value of < 0.05 was considered statistically significant. RESULTS: A total of 95 patients during the pandemic were included and 20 were COVID-positive. Patients experienced a statistically significant increase in time to theatre in Lockdown 1 compared to 2019 (p = 0.039) with a decrease with successive lockdown periods by Lockdown 3. The 30-day mortality increased from 8.8% in 2019 to 10.0% to 14.8% in all lockdown periods. COVID-positive patient mortality was 30.0% (p = 0.063, odds ratio (OR) = 4.43 vs 2019). The rates of AKI and pneumonia experienced were higher for patients during the pandemic. The highest rates were experienced in COVID-positive patients, with 45.0% of patients with AKI versus 27.0% in 2019 (p = 0.38, OR = 1.80), and 50.0% of patients diagnosed with pneumonia versus 16.2% in 2019 (p = 0.0012, OR = 5.17). The percentage of patients with a DNACPR increased from 30.0% in 2019 to 60.7% by Lockdown 3 (p = 0.034, OR = 3.61). CONCLUSION: COVID-positive hip and distal femur fracture patients are at a higher risk of mortality due to AKI and pneumonia. Patient outcomes have improved with successive lockdowns to pre-pandemic levels. Cite this article: Bone Jt Open 2021;2(12):1017-1026.

Orthopaedic Trauma Theatre Efficiency in the COVID-19 Pandemic: Are We Returning to Normality?

Background Recent studies have shown a decline in theatre efficiency and productivity coinciding with the coronavirus disease 2019 (COVID-19) pandemic. In this study, we evaluate trauma theatre task efficiency in three different time periods (April 2019, April 2020, and November 2020), and analyse if productivity has altered since the start of the pandemic. Methods The records of a total of 320 patients who underwent orthopaedic trauma surgery at a large district general hospital in April 2019, April 2020 (during the first wave of the pandemic) and November 2020 (during the second wave of the pandemic) were analysed. Primary outcomes measured include time to get to the theatre, anaesthetic preparation time, the sum of time of anaesthesia and surgical preparation time, duration of surgery and time to transfer to recovery. Patient demographics as well as the type of surgery were also analysed. Results The time to get to the theatre and anaesthetic preparation time significantly increased in April 2020 (p<0.05) but fell in November 2020 with no significant difference in comparison to before the pandemic in April 2019 (p>0.05). The duration of surgery and time to transfer to recovery significantly increased in April 2020 (p<0.05) and though reduced in November 2020, was still significantly greater in comparison to April 2019 (p<0.05). In April 2020, the proportion of patients aged 18-65 was just 26% as compared to 35% in April 2019. This figure rose again to 45% in November 2020. The number of hip fracture procedures remained similar during the three time periods, with 32, 32 and 36 hip fracture operations in April 2019, April 2020 and November 2020, respectively. Conclusion While operating theatres' efficiency decreased during the first wave of the COVID-19 pandemic, it increased again in the second wave, coming close to the 'normal' levels before the pandemic struck.

A new system of computer-assisted navigation leading to reduction in operating time in uncemented total hip replacement in a matched population.

Computer-assisted navigation techniques are used to optimise component placement and alignment in total hip replacement. It has developed in the last 10 years but despite its advantages only 0.3% of all total hip replacements in England and Wales are done using computer navigation. One of the reasons for this is that computer-assisted technology increases operative time. A new method of pelvic registration has been developed without the need to register the anterior pelvic plane (BrainLab hip 6.0) which has shown to improve the accuracy of THR. The purpose of this study was to find out if the new method reduces the operating time. This was a retrospective analysis of comparing operating time in computer navigated primary uncemented total hip replacement using two methods of registration. Group 1 included 128 cases that were performed using BrainLab versions 2.1-5.1. This version relied on the acquisition of the anterior pelvic plane for registration. Group 2 included 128 cases that were performed using the newest navigation software, BrainLab hip 6.0 (registration possible with the patient in the lateral decubitus position). The operating time was 65.79 (40-98) minutes using the old method of registration and was 50.87 (33-74) minutes using the new method of registration. This difference was statistically significant. The body mass index (BMI) was comparable in both groups. The study supports the use of new method of registration in improving the operating time in computer navigated primary uncemented total hip replacements.

Posterior dislocation of the sternoclavicular joint in a young rugby player.

Posterior dislocation of the sternoclavicular joint is a well-reported condition, but can be overlooked as it is difficult to diagnose. We present the case of a 17-year-old male rugby player in which the diagnosis was not recognised at his initial presentation.

Resurfacing and uncemented arthroplasty for young hip arthritis: functional outcomes at 5 years.

The management of osteoarthritis of the hip in young active patients is challenging. We compared the functional outcomes and activity levels following hip resurfacing and uncemented THA in young active patients matched for age, gender and activity levels. Mean follow-up period was five years (4-7 years). Within each group there was a statistically significant improvement in the mean University of California at Los Angeles (UCLA) and Oxford Hip Score (OHS) scores following surgery. This study found no statistically significant difference in the levels of function (p= 0.82) or activity pursued (p= 0.60) after surgery between uncemented THA and hip resurfacing. The potential complications unique to hip resurfacing may be avoided by the use of uncemented THA which in itself has longer follow-up compared to resurfacing.