The effect of handover location on trauma theatre start time: An estimated cost saving of £131 000 per year.

BACKGROUND: The National Health Service was estimated to be in £2.45 billion deficit in 2015 to 2016. Trauma theatre utilization and efficiency has never been so important as it is estimated to cost £15/minute. METHODS: Structured questionnaires were given to 23 members of staff at our Trust who are actively involved in the organization or delivery of orthopaedic trauma lists at least once per week. This was used to identify key factors that may improve theatre efficiency. Following focus group evaluation, the location of the preoperative theatre meeting was changed, with all staff involved being required to attend this. Our primary outcome measure was mean theatre start time (time of arrival in the anaesthetic room) during the 1 month immediately preceding the change and the month following the change. RESULTS: Theatre start time was improved on average 24 minutes (1 month premeeting and postmeeting change). This equates to a saving of £360 per day, or £131 040 per year. CONCLUSION: Changing the trauma meeting location to a venue adjacent to the trauma theatre can improve theatre start times, theatre efficiency, and therefore result in significant cost savings.

Challenges and solutions in the fixation of a hip fracture in the presence of a contralateral ankylosed hip: a case report.

BACKGROUND: An intracapsular femoral neck fracture is a common orthopaedic presentation and requires expedient fixation in a young adult. This case demonstrates how patient-specific factors, namely an ankylosed contralateral hip, can make a common operation challenging. CASE DESCRIPTION: A 22-year-old man with osteogenesis imperfecta and multiple bony deformities was brought to A&E after being involved in a motor vehicle collision. Plain radiographs and clinical examination demonstrated a right intracapsular femoral neck fracture, ipsilateral femora vara and a contralateral ankylosed hip secondary to protrusio acetabuli. The intraoperative patient and fluoroscopic positioning were technically challenging. CLINICAL RELEVANCE: Preoperative literature review revealed no operative strategy or case report describing how best to perform closed reduction and internal fixation of a femoral neck fracture with a co-existing contralateral ankylosed hip joint. We hope our experience will aid other surgeons who find themselves in a similar clinical scenario. We will present the difficulties faced and the adaptations made to our surgical technique which we utilised to achieve an anatomical fixation.

Lateral meniscal cyst presenting as Medial Compartment Knee Swelling: A case report and literature review.

INTRODUCTION: Meniscal cysts are relatively uncommon orthopaedic lesions usually arising from the meniscus. They present as clinically palpable masses and dull pain. PRESENTATION OF CASE: We report on a 33-year-old male patient who presented clinically with a medial knee swelling that arose from a lateral meniscal cyst. DISCUSSION: No similar cases were cited in the literature. The cyst was removed surgically with a good result obtained and no recurrence after 12 months. Typically, a clinically palpable mass corresponds to a meniscal cyst arising from the ipsilateral meniscus. CONCLUSION: Magnetic resonance imaging is vital to exclude such anomalies prior to surgical intervention.

Reduced bone tunnel enlargement post hamstring ACL reconstruction with poly-L-lactic acid/hydroxyapatite bioabsorbable screws.

Bone tunnel enlargement following anterior cruciate ligament (ACL) reconstruction can complicate revision surgery. This study compared postoperative tibial tunnel widening in patients who underwent arthroscopically assisted, single-incision, four-strand hamstring ACL reconstruction using a poly-L-lactic acid/hydroxyapatite blend (PLLA+HA) bioabsorbable interference screw for tibial fixation, with those in whom a plain poly-L-lactic acid (PLLA) screw was used. Thirty-four patients (13 with PLLA+HA tibial interference screw fixation and 21 with plain PLLA tibial interference screws) underwent a spiral CT scan to assess maximum tibial tunnel cross-sectional area at an average of 28.7 months follow-up. An assessment of tunnel wall sclerosis adjacent to the screw (cortication) was also made. The two groups were well matched for age, sex and graft diameters. Mean tibial tunnel enlargement in patients with PLLA+HA screws was 29.9% at average 30.9 months follow-up compared with 46% in patients with plain PLLA screw at an average 26.5 months follow-up (p=0.03). The tunnel wall adjacent to the screw appeared corticated in only 21% of patients with PLLA+HA screws (p=0.02) compared with 73% of patients with PLLA screws. The blending of HA with PLLA appears to reduce postoperative tunnel widening, and the reduced tunnel wall sclerosis seen postoperatively may indicate improved screw incorporation.

The effects of interscalene brachial plexus block on humeral arterial blood flow: a Doppler ultrasound study.

In this study we investigated and quantified the effects of interscalene block (ISB) on humeral arterial blood flow (HBF). Eleven patients scheduled for shoulder arthroscopic surgery under ISB were prospectively studied. A Doppler ultrasound of the humeral artery was performed before, and 30 min after, the ISB. The resistance index and the HBF were measured at the level of the midpoint of the upper arm. The median (interquartile range) of resistance index decreased from 0.98 (0.95-1.00) to 0.81 (0.77-0.91) (P < 0.01). The median HBF increased from 32 (18-46) to 88 (59-98) mL/min (P < 0.01). We conclude that ISB enhances arterial blood flow and decreases arterial resistance.