01 Dec 2015

Volume 3 Issue 4


From the Editor

Welcome to the December issue of JTO. There is an air of apprehension as we move into the winter months as to where will we be in the spring. Winter pressures are going to affect many units, the juniors are understandably eyeing up a fight and there is an increasing feeling that the consultant negotiations are panning out like a bad version of Groundhog Day.

Looking at our front page you could speculate that this is some form of tribute to our spinal colleagues, but could it be some allusion to the “bare to the bone” health service?

We move forward and having had one excellent deputy in Ananda Nanu, we have managed to target a man of experience and resolution in Fred Robinson to take over. Welcome aboard Fred!

JTO continues to target content which looks at our wider professional needs and skills; the guest editorship of Mez Acharya allows expression from one of our active trauma educationalists.

Looking at our data is an important issue both generic and individual. Objectivity in diagnosis and coding issues are also covered.

Of course, the annual quiz has been carefully engineered to give you an excuse to sit aside from the festivities and do something really vital.

It remains important that we increasingly take control of our orthopaedic world; we look forward to building upon last year’s successes together in 2016.

Season’s Greetings


Ian Winson – BOA Vice President

Reference Lists


Lessons of War

1. Robertson OH. Transfusion with preserved red cells. Brit Med J 1:691–695, 1918.

2. Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study.  Morrison JJ et al. Arch Surg. 2012 Feb; 147(2) 113-119

3. Association of cryoprecipitate and tranexamic acid with improved survival following wartime injury: findings from the MATTERs II Study. Morrison JJ et al JAMA Surg. 2013 Mar; 148(3): 218-225

4. Battle casualties. Melsom MA et al. Ann R Coll Surg Engl. 1975 Jun;56(6):289-303.

5. Diagnosis and management of coagulopathy after major trauma. Brohi K (BJS 2009; 96: 963-964)

6. A proactive approach to the coagulopathy of trauma: the rationale and guidelines for treatment. Kirkman E et al. JRAMC 154(4); 302-306

7. Management of Massive Haemorrhage on Operations. Surgeon General’s Operational Policy Letter. 08/09; 10 Jun 2009

8. Feasibility of using rotational thromboelastometry to assess coagulation status of combat casualties in a deployed setting. Doran CM et al. J Trauma 2010 Jul; 69 Suppl 1 S40-48

9. Utility of interim ROTEM(®) values of clot strength, A5 and A10, in predicting final assessment of coagulation status in severely injured battle patients. Woolley T et al. Injury 2013 May; 44(5) 593-599

10. High rate of candidemia in patients sustaining injuries in a bomb blast at a marketplace: a possible environmental source. Wolf D G et al. Clin Infect Dis. 2000; 31: 712-716 

Clinical Coding Explained

1. Monitor and NHS England took on responsibility for the NHS payment system from the Department of Health following the introduction of the Health and Social Care Act 2012 www.gov.uk/government/collections/the-nhspayment-system-regulating-prices-for-nhs-funded-healthcare

2. The National Clinical Coding Standards ICD-10 and OPCS-4 reference books are available as a free PDF download, subject to registration, on the Technology Reference Data update Distribution website at: https://isd.hscic.gov.uk/trud3/user/guest/group/0/home

3. The Coding Clinic is a technical supplement published on the HSCIC website at: http://systems.hscic.gov.uk/data/clinicalcoding/codingstandards/publications/codingclinic

4. www.who.int/classifications/icd/revision/en/ 5. www.hscic.gov.uk/isce 

Over-Diagnosis, Over-Screening and Over-Treatment: an Orthopaedic Problem?

1. Welch G, Schwarz L, Woloshin S, Over-diagnosed: making people sick in the pursuit of health: Beacon Press, 2011

2. Heath I, Role of fear in over-diagnosis and over-treatment, BMJ, 349: g6123 2014

3. Moynihan R, Doust J, Henry D, Preventing over-diagnosis: how to stop harming the healthy BMJ 344: e3502, 2012

4. Black W., Advances in radiology and the real versus the apparent effects of early diagnosis Eur J Radiol 27:11622, 1998

5. Wilson J Jungner G, Principles and practice of screening for disease. World Health Organisation, Geneva, 1968

6. Barkatali BM, Heywood N ,White R, Paton RW, MRSA screening in orthopaedic surgery: clinically valuable and  cost effective?  A prospective study of 8,867 patients Acta Orthop Belg 79 (4): 463-9, 2013

7. Jones D, Dezateux CA, Danielsson LG, Paton RW, Clegg J, At the crossroads- neonatal detection of Developmental Dysplasia of the Hip Journal Bone Joint Surg (Br) 82(2): 160-4, 2000

8. Paton RW, Does selective ultrasound imaging of at risk hips & clinically unstable hips in DDH produce an effective screening programme, PhD Thesis, University of Lancaster, 2011

9. Cochrane Review (2013): Shorter D, Hong T, Osborn DA Screening programmes for developmental dysplasia of the hip in newborn infants Evid. based Child Health 8(1): 11-54, 2013

10. Von Kries R, Ihme N, Oberle D et al, Effect of ultrasound screening on the rate of the first operative procedures for developmental hip dysplasia I Germany.  Lancet 362(9399): 1883-7, 2003

11. Cochrane review (2003): Loeb MB, Main C, Eady A, Walkers-Dilk C., Antimicrobial drugs for treating methicillin resistant Staphylococcus aureus colonisation. Cochrane database of Systematic Reviews, 2003, Issue 4, Art.no. CD003340, DOI: 10.1002/146518.

12. National screening Committee, Screening for adolescent idiopathic scoliosis Version3, November 2011, www.screening.nhs.uk/policies

13. Greenhalgh T, Howick J, Maskrey N; Based Medicine Renaissance Group. BMJ.  Jun 13; 348:g3725. 2014

14. Dreyfus SE, The five-stage model of adult skill acquisition  Bulletin of science, technology & society 24(3): 177181, 2004

15. Choosing Wisely®, the American Academy of Orthopaedic Surgeons (AAOS). 2014

16. Less is more medicine, www.lessismoremedicine.com

17. Too much medicine: from evidence to action, BMJ 347:f7141, 2013

18. Carpal tunnel syndrome, BMJ 349:g6437, 2014

19. Buchbinder R, Osbourne RH, Kallmes D, Vertebroplasty appears no better than placebo for painful osteoporotic spinal fractures and has the potential to cause harm Med J Aust 191(9): 476-7, 2009

20. Moseley JB. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med.347:81– 88.2007

21. NICE, arthroscopic knee washout, with or without debridement in the treatment of osteoarthritis, Interventional procedures guidance (IPG230), 2007

22. Staheli L, Practice of pediatric orthopaedics, Lippincott, Williams & Wilkins, 2001

23. Boden RA, Nuttall GH, Paton RW,  A 14 year longitudinal comparison study of two treatment methods in clubfoot: Ponseti versus traditional, Acta Orthop Belg 77(4): 522-8, 2011

24. Toros T, Sugun TS, Ozaksar K, Complications of distal radius locking plates, Injury 44: 336-9, 2013

25. Choi KY, Chan WS, Lam TP, Cheng JCY, Percutaneous Kirschner wire pinning for severely displaced distal radial fractures in children J Bone Joint Surg 77-B: 797-801, 1995 

26. Costa ML, Achten J, Parsons NR et al, DRAFFT Study Group. Percutaneous fixation with Kirschner wires versus volar locking plate fixation in adults with dorsally displaced fracture of distal radius: randomised controlled trial. BMJ. 5; 349: g4807. 2014

27. Handoll H, Brealey S, Rangan A et al, Protocol for the ProFHER (PROximal Fracture of the Humerus: Evaluation by Randomisation) trial: a pragmatic multi-centre randomised controlled trial of surgical versus non-surgical treatment for proximal fracture of the humerus in adults. BMC Musculoskelet Disord. 2009 Nov 16;10:140.

28. Commission on human medicines mhra.gov.uk 29. www.beyondcompliance.org.uk