Dermoscopy use in UK primary care: a survey of GPs with a special interest in dermatology.

BACKGROUND: Melanoma accounts for 90% of skin cancer mortality and typically presents in primary care, where it can be challenging to distinguish from benign lesions. Dermoscopy is a tool for skin visualization that is routinely used for melanoma diagnosis in secondary care. However, the role of dermoscopy in primary care remains unclear. OBJECTIVES: To determine views on, and use of, dermoscopy by dermatology-interested general practitioners (GPs). METHODS: An online questionnaire was emailed to the UK Primary Care Dermatology Society members in February 2018, and responses collected over the following 4 weeks. RESULTS: A total of 205 responses were analysed. Most respondents were GPs (94%), aged over 50 (53%), had a postgraduate dermatological qualification (67%) and used dermoscopy regularly when reviewing pigmented skin lesions (97%). Dermoscopy use was commoner amongst GPs who had worked longer in primary care and had experience of secondary care dermatology. Most had undertaken training in dermoscopy (91%), although one-fifth (20%) had not updated their training in over 5 years. Most of those who had received only 1 day of face-to-face training reported feeling confident using a dermatoscope. Few respondents (11%) reported access to teledermatology or teledermoscopy for urgent or routine referrals. CONCLUSIONS: UK GPs with a special interest in dermatology are routinely using dermoscopy in the primary care setting. More research is needed to establish optimal approaches to training and updating GP dermoscopy skills. When dermoscopy has been shown to be safe, effective, acceptable and cost-effective in this setting, more GPs may also be able to gain and maintain the skills to implement dermoscopy into routine primary care. Technological advances, including incorporation of artificial intelligence (AI) and algorithms to guide GPs, could also contribute to widening use of dermoscopy among GPs.

Patient-based outcomes in patellofemoral arthroplasty.

This retrospective study evaluated the short-term functional outcome of patellofemoral arthroplasty using patient-based outcome measures. The study cohort included 17 patients who underwent patellofemoral arthroplasty (14 unilateral and 3 bilateral) between 1996 and 2005. Mean patient age was 56 years (range, 43-65 years), and mean follow-up was 52.5 months (range, 24-84 months). Clinical and radiographic assessment was performed using the Hospital for Special Surgery (HSS) knee score. Functional assessment was performed using the Short Form-36 (SF-36) and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Mean HSS knee score was 64 (range, 51-79) preoperatively and 90 (range, 71-100) postoperatively. Mean postoperative SF-36 scores were compared with normative data compiled by the British Omnibus Survey in 1992. Scores for physical and social functioning, role limitation due to physical and emotional problems, and pain were poorer compared with mental health and energy/vitality. Mean postoperative scores for the 5 KOOS subscales ranged from 51% to 72%. These findings indicate patient-based outcome measures should be used routinely for functional assessment of patients undergoing patellofemoral arthroplasty.

Combined reconstruction of chronic posterior cruciate ligament and posterolateral corner deficiency. A two- to nine-year follow-up study.

We report a retrospective analysis of the results of combined arthroscopically-assisted posterior cruciate ligament reconstruction and open reconstruction of the posterolateral corner in 19 patients with chronic (three or more months) symptomatic instability and pain in the knee. All the operations were performed between 1996 and 2003 and all the patients were assessed pre- and post-operatively by physical examination and by applying three different ligament rating scores. All also had weight-bearing radiographs, MR scans and an examination under anaesthesia and arthroscopy pre-operatively. The posterior cruciate ligament reconstruction was performed using an arthroscopically-assisted single anterolateral bundle technique and the posterolateral corner structures were reconstructed using an open Larson type of tenodesis. The mean follow up was 66.8 months (24 to 110). Pre-operatively, all the patients had a grade III posterior sag according to Clancy and demonstrated more than 20 degrees of external rotation compared with the opposite normal knee on the Dial test. Post-operatively, seven patients (37%) had no residual posterior sag, 11 (58%) had a grade I posterior sag and one (5%) had a grade II posterior sag. In five patients (26%) there was persistent minimal posterolateral laxity. The Lysholm score improved from a mean of 41.2 (28 to 53) to 76.5 (57 to 100) (p = 0.0001) and the Tegner score from a mean of 2.6 (1 to 4) to 6.4 (4 to 9) (p = 0.0001). We conclude that while a combined reconstruction of chronic posterior cruciate ligament and posterolateral corner instability improves the function of the knee, it does not restore complete stability.

Update on paediatric ACL injuries.

In the last two decades there has been an increase in the incidence of anterior cruciate ligament (ACL) injuries in children. This may be due to increased awareness, more participation in high demand contact and non-contact sports at an earlier age and better diagnosis as a result of better imaging. A review of the literature suggests that the long-term results of non-operative treatment are poor. While the short to medium-term results of ACL reconstruction in children are encouraging, the long-term results are unknown. In this review, the current trends in the management of paediatric ACL injuries are discussed with particular emphasis on the natural history, surgical techniques, the effect of surgery on the growth plate and complications.

Haemophilic arthropathy of the elbow.

Patients affected by haemophilia commonly have recurrent intra-articular bleeding which leads to progressive destruction and instability of joints. Severe arthropathy of the elbow is complicated by pain, stiffness and loss of function which can be debilitating. Conservative measures such as analgesics, physiotherapy and orthotics are commonly used in the management of these patients. Surgery is considered when conservative measures fail to control the symptoms. Total elbow replacement is now increasingly performed with the advances made in factor replacement therapy and evolution of better implants and techniques of total elbow arthroplasty. The pathogenesis, clinical features and radiological changes of haemophilic arthropathy of the elbow are described in this review article.

Successful excision of neurogenic heterotopic ossification around the hip in cerebral palsy.

We present the case of an 11-year-old girl with cerebral palsy, who developed bilateral spontaneous ankylosis of the hips as a result of heterotopic ossification following hip surgery. This was treated successfully by a combination of surgical excision, single dose radiotherapy and bisphosphonate treatment at five months from the time of the original surgery. A review of the literature shows that a combination treatment can be recommended in severe cases of heterotopic ossification to prevent recurrence. A review of neurogenic heterotopic ossification is presented. (Hip International 2005; 15: 123-7) KEY WORDS: Neurogenic heterotopic ossification, Hip reconstruction, Ankylosis, Cerebral palsy.

The value of the axial view in assessing calcaneal fractures.

We studied the value of the axial view of the calcaneum in diagnosing fractures. Fifty sets calcaneal radiographs were studied by four senior trauma staff and four orthopeadic trainees on two occasions 2-3 weeks apart. On the first occasion only the lateral view was studied; on the second, both lateral and axial views were studied. The axial view did not improve the sensitivity or specificity of the lateral view alone. Senior staff were more accurate in assessing the radiographs. We suggest that the axial view should not be used routinely in assessing a patient with a possible calcaneal fracture.