COVID-19 infection is related to differences in the use of personal protective equipment by orthopaedic specialist trainees caring for hip fracture patients during the second surge of COVID-19 in the North West of England.

INTRODUCTION: Personal protective equipment (PPE) may protect health-care workers from COVID-19 infection and limit nosocomial spread to vulnerable hip fracture patients. METHODS: We performed a cross-sectional survey amongst orthopaedic trainees to explore PPE practice in 19 hospitals caring for hip fracture patients in the North West of England. RESULTS: During the second wave of the pandemic, 14/19 (74%) hospitals experienced an outbreak of COVID-19 amongst staff or patients on the orthopaedic wards. An FFP3 respirator mask was used by doctors in only 6/19 (32%) hospitals when seeing patients with COVID-19 and a cough and in 5/19 (26%) hospitals when seeing asymptomatic patients with COVID-19. A COVID-19 outbreak was reported in 11/13 (85%) orthopaedic units where staff wore fluid resistant surgical masks compared to 3/6 (50%) units using an FFP3 respirator mask (RR 1.69, 95% CI 0.74-3.89) when caring for symptomatic patients with COVID-19. Similarly, a COVID-19 outbreak was reported in more orthopaedic units caring for asymptomatic patients with COVID-19 where staff wore fluid resistant surgical masks (12/14 (86%)) as compared to an FFP3 respirator mask (2/5 (40%)) (RR 2.14, 95% CI 0.72-6.4). CONCLUSION: Urgent re-evaluation of PPE use is required to reduce nosocomial spread of COVID-19, amongst highly vulnerable patients with hip fracture.

Functional outcomes & metal ion levels following ceramic on metal total hip arthroplasty: 9 Year follow-up.

In this study, we evaluate the mid-term functional and radiological outcomes of Ceramic on Metal Total Hip Arthroplasty (CoM THA) THA. 66 CoM THAs were performed between 2008 and 2010. These were evaluated and followed up in 2017-18, at a mean follow-up of 9 years to record the Oxford Hip Score [OHS] and whole blood Cobalt and Chrome levels. Our all cause revision rate was 4.5% (3 out of 66). At mid-term follow up, patients with CoM THAs are mostly asymptomatic with reasonable functional outcomes, we have reported similar revision rates in conjunction with raised blood metal ion levels and frequency of radiolucent lines.

The use of esketamine sedation in the emergency department for manipulation of paediatric forearm fractures: A 5 year study.

The purpose of this study is to assess the use of esketamine as procedural sedation for the reduction of paediatric forearm fractures in the emergency department (ED). A retrospective analysis was undertaken of forearm fractures between 1st January 2012 to 31st December 2016 which were treated with manipulation in ED using esketamine sedation. Patient demographics and fracture configuration were collected. Patient radiographs were evaluated and cast index calculated. 151 patients (103 male, 48 female) were included (average age of 8.5 [1 to 15]). Four (2.6%) patients were lost to final follow up. 11 (7%) fractures were not accepted after initial manipulation and required formal surgical management under general anaesthetic. At one week follow up, a further 5 (3%) fractures displaced requiring operative management. 100% of patients who slipped at one week had a cast index greater than 0.8 [average 0.86, 95% CI 0.80-0.92]. At final follow up successful reduction was achieved in 89.1% (131/144) of patients. No adverse events occurred following administration of esketamine. This study provides evidence that manipulation of paediatric forearm fractures using esketamine as procedural sedation in the ED is comparable to other methods in achieving acceptable outcomes. This is in addition to the potential for cost savings. However, future studies formally assessing cost effectiveness and patient outcomes are needed.

Increased Mortality Amongst Patients Sustaining Neck of Femur Fractures as In-Patients in a Trauma Centre.

PURPOSE: Neck of Femur (NOF) fracture is a common injury with high mortality that all orthopaedic departments must contend with [1]. The aim of this study was to report incidence and mortality of NOF fractures occurring while patients were being admitted to hospital for other conditions. METHODS: A retrospective review was performed of all NOF fracture admissions between 1(st) of Jan 2010 to 31(st) of Dec 2012 at a University Hospital trauma centre. Fractures were divided according to the location where the fracture occurred, either in the community (acute NOF) or in-hospital (in-hospital NOF). RESULTS: In-hospital mortality, 30-day, 90-day and 1 year mortality were recorded. There were 1086 patients in the acute NOF fracture group (93.9%) and 70 patients in the in-hospital group (6.1%) over three years. The odds of inpatient death was 2.25 times higher for inpatient NOFs (p=0.012). 86% of all in-hospital NOF fractures occurred on medical and rehabilitation wards. NOF fractures result in increased mortality and morbidity. CONCLUSION: All patients in hospital should be assessed to identify those at high risk of falls and implemented measures should be taken to reduce this.

BOLD fMRI of the visual cortex: quantitative responses measured with a graded stimulus at 1.5 Tesla.

PURPOSE: To measure and quantitatively characterize an activity generated by the neurons of the visual cortex (VC) in response to graded luminous intensity contrast stimuli using a 1.5 Tesla scanner. MATERIALS AND METHODS: Functional magnetic resonance imaging (fMRI) of the vc with the intrinsic blood oxygenation level dependent (BOLD) mechanism was performed by using a paradigm with a 5 x 5 flashing checkerboard pattern flickering eight times per second at eight luminance contrasts presented in a randomized order. The changes of the luminance contrast were obtained by varying the luminance intensity of the white checkerboard squares. Each of eight trials, corresponding to eight luminance contrasts, consisted of six "rest" and six "activation" epochs, repeated five times, amounting to 60 measurement periods per trial. During each epoch, 10 contiguous oblique axial-to-coronal slices covering the calcarine fissure region and parallel to a line through the anterior-posterior commissure (AC-PC) markers were acquired using a gradient-recalled echo planar imaging (GRE-EPI) sequence. RESULTS: The measurements showed changes in the activation extent in the VC following the stimulus' rising luminance intensity contrast. In addition, the fMRI signal in those activated areas present throughout all eight trials, referred to as "common" voxels in this report, showed an increasing trend as a function of the rising luminance intensity contrast. CONCLUSION: These results suggest that the processes of the neuronal recruitment that affects the extent and number of activated neurons, and the neuronal enhancement that defines the magnitude of the neuronal activation are dependent on the luminance intensity contrast. These changes can be visualized and quantified using BOLD fMRI at 1.5 Tesla.