SAFE USE OF INTRA-OPERATIVE TOURNIQUETS IN A DISTRICT HOSPITAL IN THE UK-AN AUDIT STUDY IN ORTHOPAEDIC THEATRES AND REVIEW OF CURRENT LITERATURE.

The use of tourniquet is common in orthopaedic surgeries as it reduces blood loss, enhances visualization of the operating field, and leads to quicker procedures. However, the use of tourniquet has certain risks which can be avoided by following guidelines like British Orthopaedic Association Standards for Trauma (BOAST) guidelines for safe use of tourniquet. This audit study was done in a District general hospital to check the compliance of two trauma theatres with BOAST guidelines. The audit found that there was poor documentation of tourniquet details in the operation notes (10%). Regarding tourniquet time and pressure, the compliance in the two theatres was 95 % & 97.5 %. The recommendations of this audit were to use a template to improve documentation of tourniquet details in the operation notes and training of theatre staff on BOAST guidelines for safe use of tourniquet.

IMPORTANCE OF JOINT LINE RESTORATION IN TOTAL KNEE ARTHROPLASTY.

The restoration of the joint line is important for a good functional outcome after a Total Knee Arthroplasty(TKA). Knee joint biomechanics need to be restored as near normal as possible. Joint line elevation leads to anterior knee pain, decrease in range of motion, patella baja ,mid-flexion instability and impingement of patellar tendon. Joint line depression on the other hand leads to patella alta, risk of patellar subluxation and mid-flexion instability of the knee. Various studies have demonstrated various range of acceptable joint line variation but there is no clear acceptable range of joint line variation. More studies are required for establishing the acceptable range of joint line variation and standard practices should be established for arthroplasty surgeons for preventing variation of joint line.

CURRENT CONCEPTS IN THE MANAGEMENT OF BOXER'S FRACTURE.

Fractures of the metacarpal particularly the 5th metacarpal is quite common among all hand fractures and has a high incidence in male adult population. Proper management of these fractures plays a key role in rehabilitation and early return to work thus reducing the economic burden. Treatment of these injuries depends on the type of injury: whether it is a closed/open fracture, degree of angulation at the fracture site and also mal-rotation and shortening of the finger. Non-operative management is suitable for fractures which are closed, non-displaced and without angulation or rotation. Open fractures, fractures with angulation and/or mal-rotation and fractures with neuro-vascular injury are more suitable for operative management. The acceptable angulation for conservative management for most studies is 70 degrees. Buddy strapping with a Futura splint provides good functional results. In fractures requiring operative intervention, K-wire fixation is a minimally invasive method of fixation, which in most cases has good functional results. Plate and screw fixation, however, is preferred for cases with significant comminution or multiple metacarpal fractures.

THE ROLE OF DISTAL LOCKING IN INTRAMEDULLARY NAILS FOR HIP FRACTURE FIXATION: A REVIEW OF CURRENT LITERATURE.

Traditionally, it was believed that both proximal and distal locking are essential for achieving stability during intra-medullary fixation for extra-capsular hip fractures. However, recent literature has presented varying perspectives on the necessity of distal locking. Distal locking plays a significant role in managing hip fractures with uncertainties regarding longitudinal and rotational stability. This includes cases of comminuted intertrochanteric fractures with subtrochanteric extension, reverse oblique and high oblique fractures, broad medullary canals, comminution of the lateral wall, diaphyseal fractures, and large posteromedial fragments extending below the level of the lesser trochanter. In stable pertrochanteric fractures, with the lag screw passing through the lateral cortex of the distal fragment, may not require a distal locking screw. Distal locking has been associated with potential complications, including irritation of the fascia lata, prolonged operation time, increased radiation exposure, greater blood loss, implant loosening, secondary femoral stress fractures, and damage to the femoral artery. Thus, although distal locking is of doubtful significance in stable pertrochanteric fractures it is essential in unstable fracture patterns.

SAFE USE OF FLUOROSCOPY AND PERSONAL PROTECTION EQUIPMENT IN TRAUMA & ORTHOPAEDICS.

Fluoroscopy is an indispensable tool that forms a significant part of the standard practice in many trauma and orthopaedic (T&O) procedures, as it facilitates dynamic assessment and aids intraoperative visualization and decision-making. It exposes patients and theatre staff to the potential hazards of ionizing radiation. Thus, the awareness of these hazards and proper use of personal protective equipment (PPE) will help mitigate increased exposure. This audit aimed to assess awareness regarding the safe use of fluoroscopy in T&O theatres, evaluate the level of PPE use and the knowledge of relevant guidelines, such as the British Orthopaedic Association (BOA) recommendations and local trust policy.A prospective audit was performed between June and July 2023 using an online survey sent to healthcare professionals working in T&O theatres across two hospital sites. Data were collected using an online questionnaire and responses kept anonymous and thus implied consent was applied. Standards followed the local trust policy at the University Hospitals Sussex NHS Trust and the BOA guidelines.Of the 49 respondents, 59% were fully aware of radiation hazards, and only the theatre radiographers were all fully aware. Surgeons (56%) and anaesthetists (46%) considered themselves to have adequate knowledge of these hazards. Just over half of the respondents (69%) could identify the major source of radiation, while only 37% understood the effect of distance on dose exposure. Of those surveyed, 49% knew the local trust policy, while 39.6% knew the BOA guidelines; less than half had formal training (40.8%). The results showed that less than half of the participants used the full PPE highlighted in the guidelines. Statistical analysis showed that only 46% of participants used a protective lead apron/lead skirt with a coat and thyroid shield. Of the survey participants, 84% never used eye protection during fluoroscopy procedures, and 58% had never received any formal training on radiation safety.The findings from this audit highlight the lack of awareness of the guidelines, resulting in suboptimal use of PPE in procedures with fluoroscopy. Recommendations for improvement include mandatory training for all theatre personnel. Methods of increasing awareness include using posters, performing regular audits to monitor the usage of PPE, and discussing the results in clinical governance meetings.

OCCUPATIONAL HAZARDS IN ORTHOPAEDIC PROCEDURES-A NARRATIVE REVIEW OF CURRENT LITERATURE.

Orthopaedic surgeries pose various risks to the health of orthopaedic surgeons: radiation, noise, infection, chemical exposure, and musculoskeletal injury. These are associated with short and long-term health problems including malignancy and teratogenicity. Orthopaedic surgeons' health is critical to ensure optimal patient care. Most of these hazards can be obviated or minimized by adopting rigorous prevention protocols and raising awareness. Further related research is warranted and guidelines regarding prevention need to be framed by regulatory bodies.

Vitamin D receptor gene polymorphisms association with the risk of sepsis and mortality.

Association of vitamin D receptor (VDR) gene polymorphisms with sepsis risk and mortality was studied. VDR FokI CC genotype was associated with increased sepsis risk (OR = 13.396, p = .000009) compared to the TT genotype. Results suggest possible role of VDR FokI (rs2228570) as a molecular biomarker of increased sepsis risk.