A representative assessment of the management of open fractures of the lower limb within UK orthoplastic centres: A two-centre audit of compliance with national standards.

BACKGROUND: Open fractures of the lower limb represent a complex and varied array of injuries. The BOAST 4 document produced by BAPRAS and the BOA provides standards on how to manage these patients, and NICE have recently produced additional guidance. We aimed to assess concordance with these standards in a large cohort representative of UK orthoplastic centres. METHODS: Patients admitted to the orthoplastic units at Norfolk and Norwich University Hospital and Royal Stoke University Hospital with open lower limb fractures between 2009 and 2014 were included. Data was gathered from notes and endpoints based on the BOAST 4 document. RESULTS: In total, 84 patients were included across the two sites, with 83 having their initial debridement within 24h (98.8%). Forty-two patients had a documented out-of-hours initial surgery. Of these, 10 (23.8%) had an indication for urgent surgery. This pattern was consistent across both hospitals. A plastic surgeon was present at 33.3% of initial operations. Of 78 patients receiving definitive soft tissue cover, 56.4% had cover within 72h and 78.2% within 7days. Main reasons for missing these targets were transfer from other hospitals, plastic surgeons not present at initial operation and intervening critical illness. CONCLUSIONS: This study has identified key areas for improving compliance with the national BOAST 4 and NICE standards. Out-of-hours operating is occurring unnecessarily and time targets are being missed. The development of dedicated referral pathways and a true orthoplastic approach are required to improve the management of this complex set of injuries.

A global bibliometric analysis of otolaryngology: Head and neck surgery literature.

OBJECTIVE: Bibliometrics uses analysis of content and citations of journal articles to quantify trends in published data. We aim to use bibliometric analysis to identify the global contribution by country to the ENT surgical literature over a 5-year period. DATA SOURCE: The top 20 countries for number of articles published in surgery and the 11 English-language otolaryngology surgical journals with the highest impact factors (IF) were included. Numbers of scientific articles per year (2009-2013) per country for each journal were identified through PubMed. As a marker of quality, a mean IF for each country was calculated, using number of articles and journal IF. These data were compared against population, GDP and dollars spent on research. RESULTS: In total, 10 574 articles were included. The USA was the largest contributor, with 4462 articles published over 5 years. The second largest was the UK (1215 articles). Spain's mean IF was 2.136, followed by Taiwan (2.110). The Netherlands (19.7) and the UK (18.9) had the highest number of publications per million population. When considering overall research spending per country, Greece had the most cost-effective publication output. The least cost-effective country was Japan. India, Greece and Japan had the greatest increase in publication quality. CONCLUSIONS: Bibliometric analysis can be used to identify not only major centres of English-language ENT surgical research, such as the USA and UK but centres that are producing high-quality data, such as Spain, and cost-effective research, such as the UK. It can also highlight areas of increasing success in ENT research.

The Camitz transfer and its modifications: a review.

UNLABELLED: The Camitz procedure involves transfer of the insertion of the palmaris longus tendon with a strip of the palmar aponeurosis to the insertion of abductor pollicis brevis in order to improve thumb opposition, and is usually done when severe carpal tunnel syndrome results in complete wasting of the thenar muscles. We carried out a systematic review of the published reports of this procedure. Analysis of available outcome data showed improvement in overall hand function in 86-100% of patients undergoing the original Camitz procedure. Several modifications of the original Camitz transfer have been described, with most focusing on the incorporation and placement of pulleys. All studies are limited by their small sample sizes. Overall, there is a lack of studies comparing the Camitz transfer with other opponensplasty techniques and comparing the various modifications of the original procedure. LEVEL OF EVIDENCE: IV.

A worldwide bibliometric analysis of published literature in plastic and reconstructive surgery.

BACKGROUND: Bibliometrics is the analysis of the content and citations of journal articles to quantify trends in published data. In this study, we aimed to use bibliometric analysis to identify the contribution of various countries to the plastic surgical literature over a 5-year period. METHODS: In this study, the top 20 countries publishing articles on surgery and 10 plastic surgical journals with the highest impact factors (IFs) were included. The number of scientific articles published in each journal per year (2009-2013) in each country was found using PubMed. As a marker of quality, the mean IF for each country was calculated using the number of articles and journal IF. These data were compared with population, gross domestic product (GDP) and dollars spent on research. RESULTS: A total of 10,051 articles were included. The USA was the largest contributor, with 4008 articles published over 5 years, followed by the UK (1163 articles). The USA's mean IF was 2.084, closely followed by Canada (2.037). The UK had the highest number of publications per million population (PMP; 18.14 publications PMP). When considering the overall research spending per country, Turkey had the most cost-effective publication output. The least cost-effective country was South Korea. Sweden, the Netherlands and Canada had the greatest increase in publication quality. CONCLUSIONS: Bibliometric analysis can be used to identify not only major centres of plastic surgical research, such as the USA and UK, but also centres that produce high-quality data, such as Canada, and cost-effective research, such as Turkey. It can also highlight the areas of increasing success in plastic surgical research.