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Article: The use of flexible nails in the treatment of paediatric long bone fractures: Experience at a level one paediatric trauma centre, a cohort study.

Hunt, Alexander / Judkins, Nicholas / Biggs, Alexandra / Sedgwick, Philip / Hing, Caroline B / Yeo, Andrea

Journal of clinical orthopaedics and trauma

2024 Volume 49, Page(s) 102355

Abstract: Introduction: Fractures occur in children at an incidence only surpassed by women >85 years and account for 25 % of paediatric injuries. Over the last three decades, there has been a trend towards operative management of children's fractures including ... ...

Abstract	Introduction: Fractures occur in children at an incidence only surpassed by women >85 years and account for 25 % of paediatric injuries. Over the last three decades, there has been a trend towards operative management of children's fractures including utilisation of flexible nails as popularised by the Nancy group in the 1980s. Between 5 and 11 % of paediatric forearm fractures are now fixed in this manner with complication rates of 12-42 %. This study shares the experience of a paediatric level one major trauma centre using this technique in managing long bone fractures in children. Methods and materials: This retrospective cohort study comprises a sequential series of 109 cases (71 children) of upper and lower limb fractures in children (aged 16 years and below) who underwent fracture fixation using flexible intramedullary nails between 1st April 2015 and 31st March 2019. Radiological and clinical outcomes and complications were assessed. Results: Ninety-three cases (10 in the lower limb, 83 in the upper limb) satisfied the inclusion criteria in 57 children with a mean age of 8.6 years. All cases were successfully reduced intra-operatively and 92 (98.9 %) achieved union. Taking into account all complications in the upper and lower limb, the overall complication rate is 30.1 % (28 cases) with the vast majority (13 cases, 46.4 %) occurring in the upper limb due to prominence of metalwork prompting early removal. Conclusions: This study has shown flexible intramedullary nailing to perform well with good stabilisation of a wide variety of paediatric long bone fractures with restoration of bone alignment, satisfactory outcomes with good union rates and a return to normal function. The technique is also safe and in the upper limb can be performed as day-case surgery by a generalist orthopaedic surgeon. Although the overall complication rate is not insignificant, major complications are rare.
Language	English
Publishing date	2024-02-01
Publishing country	India
Document type	Journal Article
ZDB-ID	2596956-0
ISSN	2213-3445 ; 0976-5662
ISSN (online)	2213-3445
ISSN	0976-5662
DOI	10.1016/j.jcot.2024.102355
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Article ; Online: Surgical versus non-surgical interventions for treating patellar dislocation.

Smith, Toby O / Gaukroger, Andrew / Metcalfe, Andrew / Hing, Caroline B

The Cochrane database of systematic reviews

2023 Volume 1, Page(s) CD008106

Abstract: Background: Patellar (knee cap) dislocation occurs when the patella disengages completely from the trochlear (femoral) groove. It affects up to 42/100,000 people, and is most prevalent in those aged 20 to 30 years old. It is uncertain whether surgical ... ...

Abstract	Background: Patellar (knee cap) dislocation occurs when the patella disengages completely from the trochlear (femoral) groove. It affects up to 42/100,000 people, and is most prevalent in those aged 20 to 30 years old. It is uncertain whether surgical or non-surgical treatment is the best approach. This is important as recurrent dislocation occurs in up to 40% of people who experience a first time (primary) dislocation. This can reduce quality of life and as a result people have to modify their lifestyle. This review is needed to determine whether surgical or non-surgical treatment should be offered to people after patellar dislocation. Objectives: To assess the effects (benefits and harms) of surgical versus non-surgical interventions for treating people with primary or recurrent patellar dislocation. Search methods: We searched the Cochrane Bone, Joint and Muscle Trauma Group's Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, AMED, CINAHL, Physiotherapy Evidence Database and trial registries in December 2021. We contacted corresponding authors to identify additional studies. Selection criteria: We included randomised and quasi-randomised controlled clinical trials evaluating surgical versus non-surgical interventions for treating primary or recurrent lateral patellar dislocation in adults or children. Data collection and analysis: We used standard Cochrane methods. Our primary outcomes were recurrent patellar dislocation, and patient-rated knee and physical function scores. Our secondary outcomes were health-related quality of life, return to former activities, knee pain during activity or at rest, adverse events, patient-reported satisfaction, patient-reported knee instability symptoms and subsequent requirement for knee surgery. We used GRADE to assess the certainty of evidence for each outcome. Main results: We included 10 studies (eight randomised controlled trials (RCTs) and two quasi-RCTs) of 519 participants with patellar dislocation. The mean ages in the individual studies ranged from 13.0 to 27.2 years. Four studies included children, mainly adolescents, as well as adults; two only recruited children. Study follow-up ranged from one to 14 years. We are unsure of the evidence for all outcomes in this review because we judged the certainty of the evidence to be very low. We downgraded each outcome by three levels. Reasons included imprecision (when fewer than 100 events were reported or the confidence interval (CI) indicated appreciable benefits as well as harms), risk of bias (when studies were at high risk of performance, detection and attrition bias), and inconsistency (in the event that pooled analysis included high levels of statistical heterogeneity). We are uncertain whether surgery lowers the risk of recurrent dislocation following primary patellar dislocation compared with non-surgical management at two to nine year follow-up. Based on an illustrative risk of recurrent dislocation in 348 people per 1000 in the non-surgical group, we found that 157 fewer people per 1000 (95% CI 209 fewer to 87 fewer) had recurrent dislocation between two and nine years after surgery (8 studies, 438 participants). We are uncertain whether surgery improves patient-rated knee and function scores. Studies measured this outcome using different scales (the Tegner activity scale, Knee Injury and Osteoarthritis Outcome Score, Lysholm, Kujala Patellofemoral Disorders score and Hughston visual analogue scale). The most frequently reported score was the Kujala Patellofemoral Disorders score. This indicated people in the surgical group had a mean score of 5.73 points higher at two to nine year follow-up (95% CI 2.91 lower to 14.37 higher; 7 studies, 401 participants). On this 100-point scale, higher scores indicate better function, and a change score of 10 points is considered to be clinically meaningful; therefore, this CI includes a possible meaningful improvement. We are uncertain whether surgery increases the risk of adverse events. Based on an assumed risk of overall incidence of complications during the first two years in 277 people out of 1000 in the non-surgical group, 335 more people per 1000 (95% CI 75 fewer to 723 more) had an adverse event in the surgery group (2 studies, 144 participants). Three studies (176 participants) assessed participant satisfaction at two to nine year follow-up, reporting little difference between groups. Based on an assumed risk of 763 per 1000 non-surgical participants reporting excellent or good outcomes, seven more participants per 1000 (95% CI 199 fewer to 237 more) reported excellent or good satisfaction. Four studies (256 participants) assessed recurrent patellar subluxation at two to nine year follow-up. Based on an assumed risk of patellar subluxation in 292 out of 1000 in the non-surgical group, 73 fewer people per 1000 (95% CI 146 fewer to 35 more) had patellar subluxation as a result of surgery. Slightly more people had subsequent surgery in the non-surgical group. Pooled two to nine year follow-up data from three trials (195 participants) indicated that, based on an assumed risk of subsequent surgery in 215 people per 1000 in the non-surgical group, 118 fewer people per 1000 (95% CI 200 fewer to 372 more) had subsequent surgery after primary surgery. Authors' conclusions: We are uncertain whether surgery improves outcome compared to non-surgical management as the certainty of the evidence was very low. No sufficiently powered trial has examined people with recurrent patellar dislocation. Adequately powered, multicentre, randomised trials are needed. To inform the design and conduct of these trials, expert consensus should be achieved on the minimal description of both surgical and non-surgical interventions, and the pathological variations that may be relevant to both choice of these interventions.
MeSH term(s)	Adult ; Child ; Adolescent ; Humans ; Young Adult ; Patellar Dislocation/surgery ; Fractures, Bone ; Knee Joint ; Patella ; Quality of Life
Language	English
Publishing date	2023-01-24
Publishing country	England
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't ; Systematic Review
ISSN	1469-493X
ISSN (online)	1469-493X
DOI	10.1002/14651858.CD008106.pub4
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Article: Subjective scar assessment scales in orthopaedic surgery and determinants of patient satisfaction: A systematic review of the literature.

Abelleyra Lastoria, Diego A / Benny, Clerin K / Hing, Caroline B

Chinese journal of traumatology = Zhonghua chuang shang za zhi

2023 Volume 26, Issue 5, Page(s) 276–283

Abstract: Purpose: Scar assessment tools can be utilized during the post-operative period to monitor scar progress. The primary aim of this systematic review was to evaluate current subjective scar assessment scales utilized in orthopaedic surgery. The secondary ... ...

Abstract	Purpose: Scar assessment tools can be utilized during the post-operative period to monitor scar progress. The primary aim of this systematic review was to evaluate current subjective scar assessment scales utilized in orthopaedic surgery. The secondary aim was to identify determinants of patients' satisfaction with their scars and evaluate current measurement scales. Methods: The preferred reporting items for systematic reviews and meta-analyses checklist was followed. Electronic databases, currently registered studies, conference proceedings and the reference lists of included studies were searched. There were no constraints based on language or publication status. A narrative synthesis provided a description and evaluation of scales utilized in orthopaedic surgery. Determinants of patient satisfaction were identified along with the scales used to measure satisfaction. Results: A total of 6059 records were screened in the initial search. Twenty-six articles satisfied the inclusion criteria, assessing 7130 patients. In the literature, six validated subjective scar scales were identified, including the Vancouver scar scale, patient and observer scar assessment scale, Manchester scar scale, Stony Brook scar evaluation scale, visual analogue scale, and Hollander wound evaluation scale. Studies utilizing these scales to evaluate scars following orthopaedic procedures did so successfully. These were total hip arthroplasty, total knee arthroplasty, and limb reconstruction. The scales demonstrated satisfactory validity. Functional outcomes such as restoration of movement ranked among patients' highest concerns. Scar cosmesis was found to be amongst patients' lowest priorities. Conclusions: Subjective scar assessment scales identified in the literature were not designed specifically for orthopaedic surgery. However, these were able to appropriately assess scars in the studies identified in this review. Current evidence suggests the effect of scar cosmesis on patient satisfaction with orthopaedic procedures is limited.
MeSH term(s)	Humans ; Cicatrix ; Orthopedic Procedures/adverse effects ; Patient Satisfaction ; Pain Measurement
Language	English
Publishing date	2023-02-09
Publishing country	China
Document type	Systematic Review ; Journal Article
ZDB-ID	2276839-7
ISSN	1008-1275
ISSN	1008-1275
DOI	10.1016/j.cjtee.2023.02.001
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Article ; Online: Returning to sports.

Hing, Caroline B / Al-Dadah, Oday

The Knee

2022 Volume 36, Page(s) A1

MeSH term(s)	Humans ; Return to Sport ; Sports
Language	English
Publishing date	2022-05-20
Publishing country	Netherlands
Document type	Editorial ; Comment
ZDB-ID	1200476-5
ISSN	1873-5800 ; 0968-0160
ISSN (online)	1873-5800
ISSN	0968-0160
DOI	10.1016/j.knee.2022.05.010
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Article ; Online: Is obesity the new pandemic?

Hing, Caroline B / Al-Dadah, Oday

The Knee

2022 Volume 38, Page(s) A1

MeSH term(s)	Humans ; Obesity/complications ; Obesity/epidemiology ; Pandemics/prevention & control ; SARS-CoV-2
Language	English
Publishing date	2022-10-11
Publishing country	Netherlands
Document type	Editorial
ZDB-ID	1200476-5
ISSN	1873-5800 ; 0968-0160
ISSN (online)	1873-5800
ISSN	0968-0160
DOI	10.1016/j.knee.2022.09.015
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Article ; Online: Consensus guidelines for management of patellofemoral instability.

Bailey, Morgan E A / Metcalfe, Andrew / Hing, Caroline B / Eldridge, Jonathan

The Knee

2021 Volume 29, Page(s) 305–312

Abstract: Background: The aim of this consensus process was to provide robust national guidelines to assist with decision making with regards to surgical management of patellofemoral instability.: Methods: A national group of surgeons, physiotherapists, basic ... ...

Abstract	Background: The aim of this consensus process was to provide robust national guidelines to assist with decision making with regards to surgical management of patellofemoral instability. Methods: A national group of surgeons, physiotherapists, basic scientists and a radiologist with expert experience in patellofemoral instability was convened. A formal consensus process was undertaken using validated methodology. They reviewed the existing literature, performed a group consensus meeting to develop recommendations and followed this with a wider consultation meeting with an open invitation for final ratification. The guidelines were reviewed and authorised by the BASK executive committee, followed by the British Orthopaedic Association prior to final publication. Results: The review of the literature confirmed a significant absence of an evidence base to guide clinicians in the surgical management of patellofemoral instability. The consensus process outlined guidance relating to diagnosis and clinical assessment, appropriate imaging modalities, recommendations for surgical options and appropriate post operative physiotherapy. Following wide invitation to contribute to the final document, 102 people responded. Twenty six of those provided additional comments which were blinded, discussed and included or excluded following further discussion amongst the working group. Conclusion: Patellofemoral instability is a complex pathology with multiple surgical options available to those who decide surgery is indicated. In the absence of a strong evidence base, these guidelines aim to assist with that decision making process and will pave the way for more robust clinical trials in the future.
MeSH term(s)	Humans ; Joint Instability/diagnosis ; Joint Instability/surgery ; Orthopedic Procedures ; Patellofemoral Joint/diagnostic imaging ; Patellofemoral Joint/surgery ; Physical Therapy Modalities ; Postoperative Care
Language	English
Publishing date	2021-03-05
Publishing country	Netherlands
Document type	Consensus Development Conference ; Journal Article ; Practice Guideline
ZDB-ID	1200476-5
ISSN	1873-5800 ; 0968-0160
ISSN (online)	1873-5800
ISSN	0968-0160
DOI	10.1016/j.knee.2021.02.018
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Article ; Online: Regional variation in the provision of major trauma services for the older injured patient.

Dixon, Jan / Bouamra, Omar / Lecky, Fiona / Hing, Caroline B / Baxter, Mark / Eardley, William

Injury

2022 Volume 53, Issue 7, Page(s) 2470–2477

Abstract: Introduction: The establishment of national trauma networks have resulted in significant benefits to injured patients. Older people are the majority of major trauma patients and there is need to study variations in care and performance against clinical ... ...

Abstract	Introduction: The establishment of national trauma networks have resulted in significant benefits to injured patients. Older people are the majority of major trauma patients and there is need to study variations in care and performance against clinical metrics for them. We aim to describe this patient group in terms of injury, demographics, episode of care assessment and variation between component regions of the Major Trauma Network of England and Wales. Method: The Trauma Audit and Research Network (TARN) database was analysed from April 2017 to March 2019. Patients aged 65 years and above with injury severity score (ISS) greater than eight were selected for analysis. Patients were compared by care pathway in terms of first and second treating hospitals and by demographics, injury mechanism, severity, physiology at arrival to hospital (including Glasgow Coma Score (GCS)) and mortality, where known, at discharge. Results: Fifty-three thousand three hundred and forty-seven older injured patients (median age 82.5 years and 58.2% female), were treated in 165 hospitals within the 17 regional trauma networks over the two-year study period. Aside from GCS and gender, all other patient characteristics were significantly different between networks and specifically, a large variation between the network with the highest proportion of older patients (60.4%) and that with a preponderance of younger patients (40.2%) is seen. 84% of cases were due to a fall <2 m and 36.7% of cases had a brain injury. 73.5% of cases had one or more comorbidities. Discussion: We have increased the understanding of how older patients contribute to and are managed by a national trauma service. We have demonstrated variation in numbers and patient characteristics throughout regional trauma networks. We have detailed the whole patient episode, allowing us to comment on disparities in management such as senior review and access to specialist clinical care settings. Older patients dominate United Kingdom major trauma and considerable variations and shortfalls have been identified. Work is needed to focus on the whole clinical episode for these patients both to improve outcome and patient experience but to also to ensure sustainable clinical care in a resource deplete era.
MeSH term(s)	Accidental Falls ; Aged ; Aged, 80 and over ; Brain Injuries ; Female ; Humans ; Injury Severity Score ; Male ; Patient Discharge ; Retrospective Studies ; United Kingdom ; Wounds and Injuries/epidemiology ; Wounds and Injuries/therapy
Language	English
Publishing date	2022-05-13
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	218778-4
ISSN	1879-0267 ; 0020-1383
ISSN (online)	1879-0267
ISSN	0020-1383
DOI	10.1016/j.injury.2022.04.008
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Article: Does medial patellofemoral ligament reconstruction result in femoral tunnel enlargement? A systematic review.

Abelleyra Lastoria, Diego Agustín / Gopinath, Vathana / Divekar, Omkaar / Smith, Toby / Roberts, Tobias R W / Hing, Caroline B

Knee surgery & related research

2023 Volume 35, Issue 1, Page(s) 13

Abstract: Background: Medial patellofemoral ligament (MPFL) reconstruction is a common surgical procedure for treating patellar instability. The primary aim of this systematic review was to determine whether MPFL reconstruction (MPFLR) leads to femoral tunnel ... ...

Abstract	Background: Medial patellofemoral ligament (MPFL) reconstruction is a common surgical procedure for treating patellar instability. The primary aim of this systematic review was to determine whether MPFL reconstruction (MPFLR) leads to femoral tunnel enlargement (FTE). The secondary aims were to explore the clinical effects and risk factors of FTE. Electronic databases (MEDLINE, Global Health, Embase), currently registered studies, conference proceedings and the reference lists of included studies were searched independently by three reviewers. There were no constraints based on language or publication status. Study quality assessment was conducted. 3824 records were screened in the initial search. Seven studies satisfied the inclusion criteria, evaluating 380 knees in 365 patients. Rates of FTE following MPFLR ranged from 38.7 to 77.1%. Five low quality studies reported FTE did not lead to detrimental clinical outcomes as assessed with the Tegner, Kujala, IKDC, and Lysholm scores. There is conflicting evidence regarding change in femoral tunnel width over time. Three studies (of which two had a high risk of bias) reported age, BMI, presence of trochlear dysplasia and tibial tubercle-tibial groove distance did not differ between patients with and without FTE, suggesting these are not risk factors for FTE. Conclusion: FTE is a common postoperative event following MPFLR. It does not predispose poor clinical outcomes. Current evidence lacks the ability to identify its risk factors. The reliability of any conclusions drawn is hindered by the low level of evidence of the studies included in this review. Larger prospective studies with long-term follow up are required to reliably ascertain the clinical effects of FTE.
Language	English
Publishing date	2023-05-02
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2673841-7
ISSN	2234-2451 ; 2234-0726
ISSN (online)	2234-2451
ISSN	2234-0726
DOI	10.1186/s43019-023-00187-1
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Article ; Online: Editorial.

Hing, Caroline B / Al Dadah, Oday

The Knee

2019 Volume 26, Issue 1, Page(s) 1

Language	English
Publishing date	2019-02-12
Publishing country	Netherlands
Document type	Editorial ; Introductory Journal Article
ZDB-ID	1200476-5
ISSN	1873-5800 ; 0968-0160
ISSN (online)	1873-5800
ISSN	0968-0160
DOI	10.1016/j.knee.2019.01.021
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Article: Increased proportion of alcohol-related trauma in a South London major trauma centre during lockdown: A cohort study.

Brown, Oliver S / Smith, Toby O / Gaukroger, Andrew J / Tsinaslanidis, Prodromos / Hing, Caroline B

Chinese journal of traumatology = Zhonghua chuang shang za zhi

2021 Volume 25, Issue 5, Page(s) 277–282

Abstract: Purpose: Alcohol has been associated with 10%-35% trauma admissions and 40% trauma-related deaths globally. In response to the COVID-19 pandemic, the United Kingdom entered a state of "lockdown" on March 23, 2020. Restrictions were most significantly ... ...

Abstract	Purpose: Alcohol has been associated with 10%-35% trauma admissions and 40% trauma-related deaths globally. In response to the COVID-19 pandemic, the United Kingdom entered a state of "lockdown" on March 23, 2020. Restrictions were most significantly eased on June 1, 2020, when shops and schools re-opened. The purpose of this study was to quantify the effect of lockdown on alcohol-related trauma admissions. Methods: All adult patients admitted as "trauma calls" to a London major trauma centre during April 2018 and April 2019 (pre-lockdown, n = 316), and 1st April-31st May 2020 (lockdown, n = 191) had electronic patient records analysed retrospectively. Patients' blood alcohol level and records of intoxication were used to identify alcohol-related trauma. Trauma admissions from pre-lockdown and lockdown cohorts were compared using multiple regression analyses. Results: Alcohol-related trauma was present in a significantly higher proportion of adult trauma calls during lockdown (lockdown 60/191 (31.4%), vs. pre-lockdown 62/316 (19.6%); (odds ratio (OR): 0.83, 95% CI: 0.38-1.28, p < 0.001). Lockdown was also associated with increased weekend admissions of trauma (lockdown 125/191 weekend (65.5%) vs. pre-lockdown 179/316 (56.7%); OR: 0.40, 95% CI: 0.79 to -0.02, p = 0.041). No significant difference existed in the age, gender, or mechanism between pre-lockdown and lockdown cohorts (p > 0.05). Conclusions: The United Kingdom lockdown was independently associated with an increased proportion of alcohol-related trauma. Trauma admissions were increased during the weekend when staffing levels are reduced. With the possibility of further global "waves" of COVID-19, the long-term repercussions of dangerous alcohol-related behaviour to public health must be addressed.
MeSH term(s)	Adult ; COVID-19/epidemiology ; Cohort Studies ; Communicable Disease Control ; Humans ; London/epidemiology ; Pandemics ; Retrospective Studies ; Trauma Centers
Language	English
Publishing date	2021-12-14
Publishing country	China
Document type	Journal Article
ZDB-ID	2276839-7
ISSN	1008-1275
ISSN	1008-1275
DOI	10.1016/j.cjtee.2021.11.006
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