Telemedicine in orthopaedics during COVID-19 and beyond: A systematic review.

INTRODUCTION: Telemedicine is the delivery of healthcare across a distance using some form of communication technology. The COVID-19 pandemic has led to increased adoption of telemedicine with national orthopaedic governing bodies advocating its use, as evidence suggests that social distancing maybe necessary until 2022. This systematic review aims to explore evidence for telemedicine in orthopaedics to determine its advantages, validity, effectiveness and utilisation. METHODS: Databases of PubMed, Web of Science, Scopus and CINAHL were systematically searched and articles were included if they involved any form of telephone or video consultation in an orthopaedic population. Findings were synthesised into four themes: patient/clinician satisfaction, accuracy and validity of examination, safety and patient outcomes and cost effectiveness. Quality assessment was undertaken using Cochrane and Joanna Briggs Institute appraisal tools. RESULTS: Twenty-one studies were included consisting of nine randomised controlled trials (RCTs). Studies revealed high patient satisfaction with telemedicine for convenience, less waiting and travelling time. Telemedicine was cost effective particularly if patients had to travel long distances, required hospital transport or time off work. No clinically significant differences were found in patient examination nor measurement of patient-reported outcome measures. Telemedicine was reported to be a safe method of consultation. DISCUSSION: Evidence suggests that telemedicine in orthopaedics can be safe, cost effective, valid in clinical assessment and with high patient/clinician satisfaction. However, more high-quality RCTs are required to elucidate long-term outcomes. This systematic review presents up-to-date evidence on the use of telemedicine and provides data for organisations considering its use during the COVID-19 pandemic and beyond.

Educational benefits of the online journal club: A systematic review.

INTRODUCTION: Online journal clubs (JCs) have increased during the COVID-19 pandemic with the resulting social distancing and popularity of online platforms. This systematic review aims to explore current evidence of their use/benefits for clinicians and compare their value to face-to-face (F2F) JCs. METHODS: PubMed, Web of Science, and Scopus were searched systematically, adhering to PRISMA guidelines. Articles were included if they involved clinicians in medical/surgical populations, using an online JC assessing utility, experience and educational value. Quality assessment was undertaken using MERSQI. RESULTS: Fifteen studies were included with findings synthesised into five themes: critical appraisal skills, satisfaction/value, accessibility/environment, evidence-based practice, and preference of online JC. Studies revealed high satisfaction and equivocal or increased preference of online JCs compared to F2F due to ease of access, diverse participation, and less time/cost spent travelling. Online JCs were found to be educationally valuable, aiding development of critical appraisal skills, and promoting change in practice. Disadvantages included lack of discussion intensity, technical issues, and limited interaction on some platforms. DISCUSSION: Online JCs are educationally valuable with high satisfaction rates and distinct advantages/disadvantages to F2F JCs. More high-quality studies are required to elucidate the ideal format to further improve their educational value, utility, and adoption.

Orthopedic Trainees' Perceptions of the Educational Value of Daily Trauma Meetings.

OBJECTIVE: The daily orthopedic trauma meeting is considered to serve a dual purpose; a way of discussing management of trauma patients and as a forum for teaching trainees. This study is first to explore orthopedic trainees' perspectives on the educational value of trauma meetings and identify factors that influence educational benefit across England. DESIGN: An online questionnaire was created including free text responses questions. After initial pilot testing, orthopedic registrar trainees with a national training number within England were emailed and the questionnaire completed online. Results were analyzed using thematic analysis and online survey software. SETTING: A national study conducted across England in trauma and orthopedic departments in a secondary care setting. RESULTS: One hundred and thirteen responses were recorded nationally with wide spread of seniority and geographical location. About 73.5 % of trainees found the trauma meeting to be educationally valuable. However, only 30.1% of trainees felt that they were "often" asked questions that aided their learning and 60.1% of trainees felt that decision making in patient management was only explained "sometimes" in the trauma meeting. Positive perceived educational themes included the volume of cases discussed, constructive questioning, and discussion as a form of learning. Negative themes involved time pressures, adverse consultant attitudes, and an aggressive trauma meeting atmosphere limiting learning. Suggested improvements include clearer explanation of decision making, detailed feedback, and a more supportive atmosphere with incorporation of postoperative radiographic review. CONCLUSIONS: This is the first nationwide study providing an insight into factors influencing the educational value of the trauma meeting as perceived by trainees with improvements being directly sourced from trainees. Recommendations from this study are applicable internationally and guide the implementation of changes to maximize the educational benefit for trainees during trauma meetings.

The Role of Early Post-Operative Radiographs Following Distal Radius Fracture Fixation with a Volar Locking Plate: Time for Change?

Background: The role of early radiographic imaging in the management of distal radius fractures (DRFs) is unclear. The aim of this study was to assess whether early post-operative radiographs for DRFs influences the ongoing management of this patient group. We hypothesize that routine early radiographs do not influence the management of DRFs. Methods: This was a retrospective review of patients undergoing open reduction and internal fixation using a volar locking plate between 2012 and 2017 at our institution. Patients were identified using hospital electronic databases. Clinical information was gathered from the electronic health records and PACS systems and analysed on a spreadsheet. An early post-operative radiograph was defined by the authors as imaging on a patient's first postoperative visit. Results: 237 patients were identified. The median number of days patients were reviewed post-operatively was 13 (interquartile range 9-16). 172 (73.1%) patients had early post-operative radiographs, with 100 (58.1%) intra-articular and 72 (41.9%) extra-articular fractures. Of patients who underwent imaging, 7 (4.0%) had their post-operative fracture management altered (7 intra-articular, 0 extra-articular) with 1 (0.58%) requiring immediate surgical revision as indicated by imaging. Conclusions: Our study questions the value of routine early post-operative radiographs in the management of distal radius fracture fixations, in particular if the fracture is extra-articular. This is of importance in the setting of constrained resources and represents a poor use of limited healthcare facilities, as well as unnecessary radiation exposure.

Treatment modalities for hip and knee osteoarthritis: A systematic review of safety.

Current guidelines on the management of hip and knee osteoarthritis (OA) do not compare safety of treatment modalities. We therefore systematically reviewed 20 studies investigating mortality and serious complications of both medical and surgical treatments for hip and knee OA using PubMed, Scopus, Web of Knowledge and Google Scholar. Mortality was the highest for naproxen (hazard ratio (HR) = 3 (1.9, 4.6)) and lowest for total hip replacement (relative risk (RR) = 0.7 (0.7, 0.7)). Highest gastrointestinal complications were reported for diclofenac (odds ratio (OR) = 4.77 (3.94, 5.76)) and lowest for total knee replacement (HR = 0.6 (0.49, 0.75)). Ibuprofen had the highest renal complications (OR = 2.32 (1.45, 3.71)), whereas celecoxib had the highest cardiovascular risk (OR = 2.26 (1, 5.1)) and lowest was for tramadol (RR = 1.1 (0.87, 1.4)). Results show that medical management of hip and knee OA, particularly with non-steroidal anti-inflammatory drugs, may carry higher mortality compared to surgery. Careful consideration should be given to medical management taking into account known co-morbidities.

Atraumatic sequential bilateral locking of the knee joints secondary to dislocation of non-discoid lateral menisci without radiological abnormality.

Lateral meniscus dislocation, as a cause of atraumatic knee locking, is often attributed to a discoid meniscus which can be readily diagnosed on MRI. In the absence of radiological abnormality, a dislocated lateral meniscus is a rare occurrence. We present a case of a 14 year old male who presented with atraumatic sequential locking of bilateral knees 6 months apart. Although on both occasions, MRI was normal, arthroscopy demonstrated dislocating lateral menisci that were subsequently surgically stabilised. To date, there have been no reports describing this phenomenon bilaterally in the same patient. A high index of suspicion is needed to evaluate a locked knee in an adolescent in the absence of trauma or a radiological abnormality. Furthermore there is a probability of a similar occurrence in the opposite knee.

Early results of patellofemoral inlay resurfacing arthroplasty using the HemiCap Wave prosthesis.

BACKGROUND: Common surgical treatment options for isolated patellofemoral osteoarthritis include arthroscopic procedures, total knee replacement and patellofemoral replacement. The HemiCap Wave patellofemoral resurfacing prosthesis is a novel inlay design introduced in 2009 with scarce published data on its functional outcomes. We aim to prospectively evaluate early functional outcomes and complications, for patients undergoing a novel inlay resurfacing arthroplasty for isolated patellofemoral arthrosis in an independent centre. METHODS: From 2010 to 2013, 16 consecutive patients underwent patellofemoral resurfacing procedures using HemiCap Wave (Arthrosurface Inc., Franklin, Massachusetts, USA) for anterior knee pain with confirmed radiologically and/or arthroscopically isolated severe patellofemoral arthrosis. Standardized surgical technique, as recommended by the implant manufacturer, was followed. Outcome measures included range of movement, functional knee scores (Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Short Form-36 (SF-36)), radiographic disease progression, revision rates and complications. RESULTS: Eight men and eight women underwent patellofemoral HemiCap Wave resurfacing, with an average age of 63 years (range: 46-83). Average follow-up was 24.1 months (6-34). Overall, post-operative scores were excellent. There was a statistically significant improvement in the post-operative OKS, KOOS and SF-36 scores ( p < 0.01). One patient had radiological disease progression. One patient underwent revision for deep infection. Two other minor complications were observed and treated conservatively. CONCLUSIONS: The HemiCap Wave patellofemoral resurfacing prosthesis has excellent early results in terms of functional outcomes, radiological outcomes and low complication rates. At the very least, early results show that the HemiCap Wave is comparable to more established onlay prostheses. The HemiCap Wave thus provides a safe and effective surgical option in the treatment of isolated patellofemoral osteoarthritis in selected patients.