01 Dec 2018

Volume 6 Issue 4


From the Executive Editor

Having been honoured with task of Executive Editor, I sought a guiding principle. The positive route of aiming for a commendable objective “Caring for patients, supporting surgeons” was already in use. An alternative was to choose something to avoid; the surgeon’s stereotype of “Often wrong but never in doubt” seemed appropriate.

Our Medico-Legal Feature article – ‘Evolution of the objective-subjective test for material risk in consent’ by Simon Britten explores an area of importance to us all, both in our clinical duties and medico-legal work. Our duties and responsibilities have evolved as consequence of legal judgements relating to consent, which have presented some answers but also some problems. I would also like to thank Mike Foy, for whom this is the last appearance as Medic-Legal Editor of the JTO.

Having stated the objective of dispelling a negative stereotype it may seem strange to include ‘Life Outside of the Ring’ by Tom Carter describing his parallel interests Trauma and Orthopaedic surgery and Boxing. However, the article does just that, exploring the positive side of a medically maligned sport. The article is a theme we aim to pursue, and we would welcome further submissions on interests away from the operating theatre.

Custom, opinion and preference are clearly factors important in guiding our practice, particularly as we approach an individual patient. These may be challenged by research, standardisation and cost. The Subspecialty section provocatively pursues these points in looking at how we respond to data, research and health economics, particularly when our prejudices are challenged.

There are some external pressures we cannot avoid, and as this issue comes out Winter will no doubt be manifesting itself not just as a picture postcard backdrop but as coverall term for lack of resource in health provision. The “pressures” do not only affect patient care but training too; the BOTA collaborative describe both the nature of this problem and goes further to suggest ways of mitigating the adverse effects.

As the 100th year of the BOA draws to a close, we can reflect on past glories by gazing at the sepia-toned faces on the front cover of a lineage to be proud of. The alternative is write submissions and suggestions for future editions. As the new Executive Editor I would encourage you to do both.


Bob Handley, Vice President Elect




Reference Lists


The Effects of 'Winter Pressures' on Trauma & Orthopaedic Training


1. Halkias C, Chatzikonstantinou M, Kaptanis S, Argiriou O, Demetriou G, Andrews B & Preziosi G. Response to “Winter pressure leaves surgeons short of training opportunities”. BMJ 2017; 356:j281.

2. Norrish A, Bowditch M & Large D. The effect of winter pressures on operative experience in orthopaedics: does the length of training need to be extended? BOA Congress 2018, submitted for publication.

3. Kilbane L, Coltman T, Stapley S & Hodkinson S. The impact of NHS winter pressures on the training of orthopaedic surgical trainees. BOA Congress 2018 Best of the Best.

The Fate of Abstracts Presented at the Welsh Orthopaedic Registrars Day Orthopaedic Meetings


1. Sahu A, Nazary N, Harshavardana NS, et al The publication rates of presentations made at BASK annual meeting: an in-depth observational study.  J Bone Joint Surg 2010;92(Supp III):409.

2. Whitehouse MR, Atwal NS, Blom AW Publication rates for hip surgery-related abstracts presented at national and international meetings.  Orthopedics 2009;32:407–10.

3. Collier T et al Analysis of conference abstract-to-publication rate in UK orthopaedic research    BMJ EvidenceBased Medicine 2018;23:7-11

Use of Interpreters in Orthopaedics


1. Principle for high quality interpreting and translation services; NHS guidance.   https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/03/it_principles.pdf.

2. Karliner LS, Jacobs EA, Chen AH, Muthu S.  Do Professional Interpreters Improve Clinical Care for Patients with Limited English Proficiency? A Systematic Review of the Literature.  Health Serv Res 2007 42: 727–754.

3. Kuckett G and Unger Appropriate use of medical interpreters.  Am Fam Physician 2104 1;90 : 476-480. 

Evolution of the Objective-Subjective Test for Material Risk in Consent


1. Montgomery v Lanarkshire Health Board [2015] UKSC 11.

2. MA Foy, The Continuing Saga of Informed Consent (2018) 6(2) Journal of Trauma and Orthopaedics, at 54-57.

3. Roe v Minister of Health [1954] 2 QB 66; [1954] 2 All ER 131.

4. TL Beauchamp and JF Childress, Principles of Biomedical Ethics Oxford University Press 2009.

5. Bolam [1957] 1 WLR 582, at 589.

6. Canterbury v Spence (DC, 1972) 464 F 2d 772.

7. Sidaway [1985] AC 871, at 889.

8. Montgomery [2015] UKSC 11, at 87.

9. Rogers v Whitaker [1993] 4 Med LR 79; (1992) 175 CLR 479.

10. Wyatt v Curtis [2003] EWCA Civ 1779, at 16.

11. Chester [2004] UKHL 41, at 16.

12. General Medical Council, Good medical practice 2013 http://www.gmcuk.org/Good_medical_practice___English_1215.pdf_51527435.pdf accessed 4 December 2017.

13. Montgomery [2015] UKSC 11, at 87.

14. James Badenoch,  A doctor's duty of disclosure and the decline of 'The Bolam Test': A dramatic change in the law on patient consent (2016) 84(1) Medico-Legal Journal 5-17, at 13.

15. S Seewoonarain, AA Johnson and M Barrett, Informed consent in orthopaedics: Do patients in the United Kingdom understand the written information we provide? (2018) 100-B (9) Bone and Joint Journal 1253-1259.

16. FM v Ipswich Hospital NHS Trust [2015] EWHC 775 (QB).

17. RA Wheeler, Consent in surgery: Is there a Montgomery effect? (2016) 22(1-2) Clinical Risk 21-24, at 22.

18. Alex Matthews-King, NHS could be bankrupted by 'unsustainable' £65bn clinical negligence bill warn experts, Independent 2 February 2018 http://www.independent.co.uk/news/nhs-clinical-negligence-fine-bankrupt-crisisheathcare-experts-a8191241.html accessed 2 February 2018. 

It's Showtime! #ActItOut Lights, Camera, Action!


1. Rimmer, A.  Anti-Bullying Programme is Launched by Orthopaedic Trainees.  BMJ 2017; 356: 241.

2. Elsey L, Bucknall V, Lay S, O’Bierne J.  Bullying and Undermining Behaviors in Surgery.  Presented at: the ASiT Annual Congress, April 2018; Edinburgh, UK.