04 Dec 2019

Volume 7 Issue 4


From the Executive Editor

‘Winter drawers on’, one of the oldest of schoolboy jokes, with its novelty lost in years of repetition. The same is true of winter bed pressure. Instead of an unpredicted crisis, it seems a necessary ritual on the road to spring; so we must be ready and prepare. One way to avoid the grip of the bed managers is to push the boundaries of daycase surgery to include a greater proportion of our work. Hip and knee replacement surgery with discharge on the same calendar day is shown to be possible in an NHS setting (page 33). This practice is not yet widespread and so there continues to be a loss of training opportunities when ‘winter pressures’ lead to cancellations or movement of patients. Moving the trainee to follow the training opportunity is shown to be achievable (page 26), but naturally requires forethought.

“No man is an island entire in itself”; this sentiment of John Donne applies to surgeons too. We may realise that we should communicate, discuss, refer and transfer but we also need the structure and funding to achieve it. Networks, be they hub & spoke or more web-like, already exist for some areas of practice, but will become more common. The article relating knee revision surgery (page 24) outlines the proposals in this area.

Continuing to demonstrate the changing and more broad-minded image of the Orthopaedic Surgeon we have now officially gone holistic and will recognise the ‘whole of the femur’ in new changes to Best Practice Tariff previously restricted to hip fracture. It is my earnest hope that this will be seen as a broadening of an index of performance and not an end in itself, and that we should treat patients on merit and not on tariff.

The specialty section on pelvic trauma also includes a broadening of our vision. Whilst naturally referring to the time-critical, lifesaving aspects of pelvic injury that both scare and enthral us, it also explores the less glamorous side. There is hidden morbidity in patients with frailty or the higher energy fractures. The pelvic fragility fracture so often consigned to being swept under the carpet of a different hospital service is now being studied to establish whether there are indications to be when we should be more interventional to improve quality of life. The higher energy injury also has a hidden burden of urological and sexual dysfunction.

A newcomer to our regular features is now to ask the Robert Jones Lecturer from the BOA Congress to provide a precis of their presentation. It had seemed that we did not make the most of the time and effort put not only into the presentation itself but the professional life underpinning it. A worthy first is provided by John Skinner (page 20).

Increasingly in this world, we not only have to do the right thing but prove we that have done it; this is even the case with the reading of the JTO. So I would ask that in addition to cherishing and studying your paper copy of JTO please do some of your reading on line via the App (see bottom page 1) or the BOA website; this helps our relationship with advertisers!

Bob Handley, Vice President Elect



Subspecialty Section



Robert Jones Lecture

  1. Hart AJ, Sabah S, Henckel J, Lewis A, Cobb J, Sampson B, Skinner JA. The painful metal-on-metal hip resurfacing. J Bone Joint Surg Br. 2009;91-B(6):738-44.
  2. Sampson B, Hart AJ. Clinical usefulness of blood metal measurements to assess the failure of metal-on-metal orthopaedic implants. Ann Clin Biochem. 2012;49(Pt 2):118-31. 
  3. Bills PJ, Racasan R, Underwood RJ, Cann P, Skinner J, Hart AJ, et al. Volumetric wear assessment of retrieved metal-on-metal hip prostheses and the impact of measurement uncertainty. Wear. 2012;274-275:212-9.
  4. Hart AJ, Muirhead-Allwood S, Porter M, Matthies A, Ilo K, Maggiore P, et al. Which Factors Determine the Wear Rate of Large-Diameter Metal-on-Metal Hip Replacements? Multivariate Analysis of Two Hundred and Seventy-six Components. J Bone Joint Surg Am. 2013;95(8):678-85.
  5. Hart AJ, Dandachli W, Schlueter-Brust K, Henckel J, Cobb J. Large ball metal on metal hips obscure cup angle measurement on plain radiographs. Hip Int. 2009;19(4):323-9.
  6. Hart AJ, Buddhev P, Winship P, Faria N, Powell J, Skinner JA. Cup Inclination Angle of Greater Than 50 Degrees Increases Whole Blood Concentrations Of Cobalt And Chromium Ions After Metal-On-Metal Hip Resurfacing. Hip Int. 2008;18(3):212-9.
  7. Underwood R, Matthies A, Cann P, Skinner JA, Hart AJ. A comparison of explanted Articular Surface Replacement and Birmingham Hip Resurfacing components. J Bone Joint Surg Br. 2011;93(9):1169-77.
  8. Hart AJ, Quinn PD, Lali F, Sampson B, Skinner JA, Powell JJ, et al. Cobalt from metal-on-metal hip replacements maybe the clinically relevant active agent responsible for periprosthetic tissue reactions. Acta Biomat. 2012;8(10):3865-73.
  9. Powell J, Papadaki A, Hand J, Hart A, McRobbie D. Numerical simulation of SAR induced around Co-Cr-Mo hip prostheses in situ exposed to RF fields associated with 1.5- and 3-T MRI body coils. Magn Res Med. 2012;68(3):960-8.
  10. Hart AJ, Quinn PD, Sampson B, Sandison A, Atkinson KD, Skinner JA, et al. The chemical form of metallic debris in tissues surrounding metal-on-metal hips with unexplained failure. Acta Biomat. 2010;6(11):4439-46.
  11. Goode AE, Perkins JM, Sandison A, Karunakaran C, Cheng H, Wall D, et al. Chemical speciation of nanoparticles surrounding metal-on-metal hips. Chem Commun (Camb). 2012;48(67):8335-7.

BASK Revision Knee Working Group Update

  1. Phillips JRA, Al-Mouazzen L, Morgan-Jones R, Murray JR, Porteous AJ, Toms AD. Revision knee complexity classification-RKCC: a common-sense guide for surgeons to support regional clinical networking in revision knee surgery. Knee Surg Sports Traumatol Arthrosc 2019;27(4):1011-7.
  2. Kallala RF, Vanhegan IS, Ibrahim MS, Sarmah S, Haddad FS. Financial analysis of revision knee surgery based on NHS tariffs and hospital costs: does it pay to provide a revision service? Bone Joint J. 2015;97-B(2):197–201.
  3. NJR Annual Reports. Avaialble at: http://www.njrreports.org.uk/. Accessed 15th September 2019.
  4. Malik AT, Jain N, Scharschmidt TJ, Li M, Glassman AH, Khan SN. Does Surgeon Volume Affect Outcomes Following Primary Total Hip Arthroplasty? A Systematic Review. J Arthroplasty. 2018;33(10):3329-42.

Winter Pressures and effects on training

  1. Supporting winter pressures safely through managed education and training programmes (2018). Available from: https://www.hee.nhs.uk/sites/default/files/documents/HEE%20winter%20pressures%20guidance%20FINAL.pdf. Accessed 5th July 2019.
  2. Coping with winter pressures: A practical guide (2018). Available from: http://www.aomrc.org.uk/reports-guidance/coping-winter-pressures-practical-guide/. Accessed 5th June 2019.
  3. Junior doctors covering different roles during winter (2018). Available from: https://www.bma.org.uk/collective-voice/policy-and-research/nhs-structure-and-delivery/monitoring-quality-in-the-nhs/pressure-points-in-the-nhs/junior-doctors-covering-different-roles-during-winter. Accessed 5th June 2019.
  4. Guidance to help manage winter pressures (2018). Available from: https://www.rcseng.ac.uk/news-and-events/news/archive/guidance-to-help-manage-winter-pressures/. Accessed 5th July 2019.
  5. British Orthopaedic Trainees Association (2018). Position statement. Available from: http://www.bota.org.uk/bota-asit-position-statement-winter-pressures-affecting-surgeons-in-training/. Accessed November 2019.
  6. Royal College of Surgeons of England (2018). Press release. Available from: https://www.rcseng.ac.uk/news-and-events/media-centre/press-releases/more-patients-wait-longer-for-elective-surgery. Accessed 12th December 2018.
  7. Koç T, Bowditch M, Bucknall V. The Effects of 'Winter Pressures' on Trauma and Orthopaedic Training. Journal of Trauma & Orthopaedics. 2018;6(4):24-25.
  8. 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.
  9. The NHS Long Term Plan (2019). Available from: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/01/nhs-long-term-plan-june-2019.pdf. Accessed 4th July 2019.
  10. https://www.theguardian.com/society/2019/jun/19/hospital-bed-cutbacks-have-gone-too-far-nhs-england-boss-simon-stevens-says. Accessed 5th July 2019.

Is day case hip and knee replacement surgery achievable in the NHS?

  1. Lazic S, Boughton O, Kellett CF, Kader DF, Villet L, Rivière C. Day-case surgery for total hip and knee replacement: How safe and effective is it? EFORT Open Rev. 2018;3(4):130-5.
  2. Kolisek FR, McGrath MS, Jessup NM, Monesmith EA, Mont MA. Comparison of outpatient versus inpatient total knee arthroplasty. Clin Orthop Relat Res. 2009;467(6):1438-42.
  3. Kelly MP, Calkins TE, Culvern C, Kogan M, Della Valle CJ. Inpatient Versus Outpatient Hip and Knee Arthroplasty: Which Has Higher Patient Satisfaction? J Arthroplasty. 2018;33(11):3402-6.
  4. 2016 Orthopaedics Landscape. Sg2 Analysis 2016. Available at: https://orthoserviceline.com/wp-content/uploads/2016/11/Wellbe-Orthopedics-Forecast-Webinar-Final.pdf. Accessed November 2019.
  5. Meermans G, Konan S, Das R, Volpin A, Haddad FS. The direct anterior approach in total hip arthroplasty: a systematic review of the literature. Bone Joint J. 2017;99-B(6):732-40.
  6. Huang A, Ryu JJ, Dervin G. Cost savings of outpatient versus standard inpatient total knee arthroplasty. Can J Surg. 2017;60(1):57-62.
  7. Aynardi M, Post Z, Ong A, Orozco F, Sukin D C. Outpatient surgery as a means of cost reduction in total hip arthroplasty: a case-control study. HSS J. 2014;10(3):252-5.
  8. Malviya A, Martin K, Harper I, Muller SD, Emmerson KP, Partington PF, Reed MR. Enhanced recovery program for hip and knee replacement reduces death rate. Acta Orthop. 2011;82(5):577-81.
  9. Husted H, Lunn TH, Troelsen A, Gaarn-Larsen L, Kristensen BB, Kehlet H. Why still in hospital after fast-track hip and knee arthroplasty? Acta Orthop. 2011;82(6):679-84.
  10. Courtney PM, Boniello AJ, Berger RA. Complications Following Outpatient Total Joint Arthroplasty: An Analysis of a National Database. J Arthroplasty. 2017;32(5):1426-30.
  11. Shah RR, Cipparrone NE, Gordon AC, Raab DJ, Bresch JR, Shah NA. Is it safe? Outpatient total joint arthroplasty with discharge to home at a freestanding ambulatory surgical center. Arthroplast Today. 2018;4(4):484-7.

Litigation, regulation and the cost of indemnity

  1. Lance B (1977). OMB Director Bert Lance seeks business help. Nation’s Business, 1977:65(5);27.
  2. NHS Resolution (2018). Annual Report and Accounts 2017/18. Available at: https://resolution.nhs.uk/wp-content/uploads/2018/08/NHS-Resolution-Annual-Report-2017-2018.pdf. Accessed November 2019.
  3. Law Reform (Personal Injuries) Act 1948. Available at: https://www.legislation.gov.uk/ukpga/Geo6/11-12/41/contents. Accessed November 2019.
  4. England and Wales Court of Appeal (Civil Division) Decisions (2009). Available at: https://www.bailii.org/ew/cases/EWCA/Civ/2009/145.html. Accessed November 2019.
  5. National Audit Office (2017). Managing the costs of clinical negligence in trusts. Available at: https://www.nao.org.uk/wp-content/uploads/2017/09/Managing-the-costs-of-clinical-negligence-in-trusts.pdf. Accessed November 2019.
  6. NHS Resolution (2018) Annual Report and Accounts 2017/18. Available at: https://resolution.nhs.uk/wp-content/uploads/2018/08/NHS-Resolution-Annual-Report-2017-2018.pdf. Accessed November 2019.
  7. Legal Aid, Sentencing and Punishment of Offenders Act 2012. Available at: http://www.legislation.gov.uk/ukpga/2012/10/contents. Accessed November 2019.
  8. GMC (2018). The state of medical education and practice in the UK. Available at: https://www.gmc-uk.org/about/what-we-do-and-why/data-and-research/the-state-of-medical-education-and-practice-in-the-uk. Accessed November 2019.
  9. National Audit Office (2017). Managing the costs of clinical negligence in trusts. Available at: https://www.nao.org.uk/wp-content/uploads/2017/09/Managing-the-costs-of-clinical-negligence-in-trusts.pdf. Accessed November 2019.
  10. Ministry of Justice: Press Release (27 February 2017). New discount rate for personal injury claims announced. Available at: https://www.gov.uk/government/news/new-discount-rate-for-personal-injury-claims-announced. Accessed November 2019.
  11. House of Commons: Committee of Public Accounts (2017). Managing the costs of clinical negligence in hospital trusts, HC 397. Available at: https://publications.parliament.uk/pa/cm201719/cmselect/cmpubacc/397/397.pdf. Accessed November 2019.
  12. HM Treasury (2017). Government response to the Committee of Public Accounts on the Fourth to the Eleventh reports from Session 2017-19, Cm 9575. Available at: https://www.parliament.uk/documents/commons-committees/public-accounts/Cm-9575-Treasury-Minutes-march-2018.pdf#page=5. Accessed November 2019.
  13. Medical Defence Union (2019). Billions of pounds are haemorrhaging out of the NHS in clinical negligence damages awards. Available at: https://www.themdu.com/about-mdu/fair-compensation. Accessed November 2019.
  14. Department of Health and Social Care (2018). Appropriate clinical negligence cover. Available at: https://www.gov.uk/government/consultations/appropriate-clinical-negligence-cover. Accessed November 2019.
  15. Medical Defence Union (2019). MDU response to the Department of Health and Social Care consultation: Appropriate clinical negligence cover. Available at: https://www.themdu.com/about-mdu/our-impact/our-impact-archive/-/media/223d4ad6362e45d6b82946c239b08c94.ashx. Accessed November 2019.
  16. St Paul Companies (2001). 2001 Annual Report. Available at: http://media.corporate-ir.net/media_files/NYS/SPC/2001arb/stpar01/6mda/spc01ar_fin.pdf. Accessed November 2019.
  17. Financial Services Compensation Scheme (2019). Failed companies. Available at: https://www.fscs.org.uk/failed-firms/. Accessed November 2019.

Cognitive Simulation: A novel method to improve operative skills

  1. Shiralkar U. It’s not all in the mind - the evidence in Cognitive Simulation - techniques to enhance surgical skills. Stourbridge: Surgical Psychology Publishing; 2013. p. 109-22.
  2. Suinn R. Body Thinking: Psychology for Olympic Champions. In: Suinn R, Psychology in Sports: Methods and Applications. Minneapolis: Burgess; 1980. p 306-15
  3. Decety J. The neurological basis of motor imagery. Behav Brain Res. 1996;77(1-2):45-52.
  4. Richardson A. Mental Practice: a review and discussion, part one. Res Quart. 1967;38(1):95-107.
  5. Weinberg R. The relationship between mental preparation strategies and motor performance: a review and critique. Quest. 1982;33(2):195-213.
  6. Durand M, Hall C, Haslam IR. The effects of combining mental and physical practice on motor skill acquisition. The Hong Kong Journal of Sports Medicine and Sports Science. 1997;4:36-41.
  7. Park SH, Suh IH, Chien JH, Paik J, Ritter FE, Oleynikov D, Siu KC. Modelling surgical skill learning with cognitive simulation. Stud Health Technol Inform. 2011;163:428-32.
  8. Immenroth M, Buerger T, Brenner J, Nagelschmidt M, Eberspaecher H, Troidl H. Mental training in surgical education - randomized control trial. Ann Surg. 2007;245(3):385-91.
  9. Arora S, Aggarwal R, Sirimanna P, Moran A, Grantcharov T, Kneebone R, Sevdalis N, Darzi A. Mental practice enhances surgical technical skills, a randomized controlled study. Ann Surg. 2011;253(2):265-70.

Pelvic Ring Injuries – An overview

  1. Jansen JO, Thomas R, Loudon MA, Brooks A. Damage control resuscitation for patients with major trauma. BMJ. 2009;338:b1778.
  2. Mossadegh S, Tai N, Midwinter M, Parker P. Improvised explosive device related pelvi-perineal trauma: anatomic injuries and surgical management. J Trauma Acute Care Surg. 2012;73(2 Suppl 1):S24-31.
  3. Morris R, Loftus A, Friedmann Y, Parker P, Pallister I. Intra-pelvic pressure changes after pelvic fracture: A cadaveric study quantifying the effect of a pelvic binder and limb bandaging over a bolster. Injury. 2017;48(4):833-40.
  4. CRASH-2 collaborators, Roberts I, Shakur H, Afolabi A, Brohi K, Coats T, et al. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet. 2011;377(9771):1096-101. Morrison JJ, Dubose JJ, Rasmussen TE, Midwinter MJ. Military application of tranexamic acid in trauma emergency resuscitation (MATTERs) study. Arch Surg. 2012;147(2):113-9.
  5. Suzuki T, Smith WR, Moore EE. Pelvic packing or angiography: competitive or complementary? Injury. 2009;40(4):343-53.
  6. Burlew CC, Moore EE, Stahel PF, Geddes AE, Wagenaar AE, Pieracci FM. Preperitoneal pelvic packing reduces mortality in patients with life-threatening hemorrhage due to unstable pelvic fractures. J Trauma Acute Care Surg. 2017;82(2):233-42.
  7. Costantini TW, Coimbra R, Holcomb JB, Podbielski JM, Catalano R, Blackburn A. Current management of hemorrhage from severe pelvic fractures: Results of an American Association for the Surgery of Trauma multi-institutional trial. J Trauma Acute Care Surg. 2016;80(5):717-23; discussion 723-5.
  8. Mason LWBD, Pallister I. Catastrophic myonecrosis following circumferential pelvic binding after massive crush injury: A case report. Injury Extra. 2009;(40):84-6.
  9. Steele N, Dodenhoff RM, Ward AJ, Morse MH. Thromboprophylaxis in pelvic and acetabular trauma surgery: the role of early treatment with low-molecular-weight heparin. J Bone Joint Surg Br. 2005;87(2):209-12.
  10. Fang R, Rodriguez CJ. Venous thromboembolism among military combat casualties. Curr Trauma Rep. 2016;2:48.
  11. Steer R, Balendra G, Matthews J, Wullschleger M, Reidy J. The use of anterior subcutaneous internal fixation (INFIX) for treatment of pelvic ring injuries in major trauma patients, complications and outcomes. SICOT J. 2019;5:22.
  12. Smith A, Malek IA, Lewis J, Mohanty K. Vascular occlusion following application of subcutaneous anterior pelvic fixation (INFIX) technique. J Orthop Surg (Hong Kong). 2017;25(1):2309499016684994.
  13. Booth, Alison, et al. (2019), 'Effectiveness of surgical fixation for lateral compression type one (LC-1) fragility fractures of the pelvis: a systematic review. BMJ Open. 2019;9(5):e024737.
  14. Borg T, Hernefalk B, Carlsson M, Larsson S. Development of a pelvic discomfort index to evaluate outcome following fixation for pelvic ring injury. J Orthop Surg (Hong Kong). 2015;23(2):146-9.

Blast injuries to the pelvis: essential lessons learned

  1. Ramasamy A, Harrisson S, Lasrado I, Stewart MP. A review of casualties during the Iraqi insurgency 2006--a British field hospital experience. Injury. 2009;40(5):493-7. 
  2. Edwards DS, McMenemy L, Stapley SA, Patel HD, Clasper JC. 40 years of terrorist bombings - A meta-analysis of the casualty and injury profile. Injury. 2016;47(3):646-52. 
  3. Bailey JR, Stinner DJ, Blackbourne LH, Hsu JR, Mazurek MT. Combat-related pelvis fractures in nonsurvivors. J Trauma. 2011;71(Suppl. 1):S58-61.
  4. Oh JS, Tubb CC, Poepping TP, Ryan P, Clasper JC, Katschke AR, et al. Dismounted Blast Injuries in Patients Treated at a Role 3 Military Hospital in Afghanistan: Patterns of Injury and Mortality. Mil Med. 2016;181(9):1069-74. 
  5. Ramasamy A, Evans S, Kendrew JM, Cooper J. The open blast pelvis: The significant burden of management. J Bone Joint Surg Br. 2012;94(6):829-35.
  6. Ficke JR, Eastridge BJ, Butler FK, Alvarez J, Brown T, Pasquina P, et al. Dismounted complex blast injury report of the army dismounted complex blast injury task force. J. Trauma Acute Care Surg. 2012;73(6 Suppl 5):S520-34. 
  7. Webster CE, Clasper J, Stinner DJ, Eliahoo J, Masouros SD. Characterization of Lower Extremity Blast Injury. Mil Med. 2018;183(9-10):e448-53.
  8. Mossadegh S, Tai N, Midwinter M, Parker P. Improvised explosive device related pelvi-perineal trauma: Anatomic injuries and surgical management. J Trauma Acute Care Surg. 2012;73(2 Suppl 1):S24-31.
  9. Webster CE, Clasper J, Gibb I, Masouros SD. Environment at the time of injury determines injury patterns in pelvic blast. J R Army Med Corps. 2019;165(1):15-17.
  10. Singleton JA, Gibb IE, Hunt NC, Bull AM, Clasper JC. Identifying future 'unexpected' survivors: a retrospective cohort study of fatal injury patterns in victims of improvised explosive devices. BMJ Open. 2013;3(8):e003130. 
  11. Burgess AR, Eastridge BJ, Young JW, Ellison TS, Ellison PS Jr, Poka A, et al. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma. 1990;30(7):848-56.
  12. Bull AM, Clasper JC, Mahoney PF. (2016). Comprar Blast Injury Science And Engineering. A Guide For Clinicians And Researchers. Anthony M.J. Bull. 9783319218663, Springer.
  13. Rankin IA, Nguyen TT, Carpanen D, Clasper JC, Masouros SD. Restricting Lower Limb Flail is Key to Preventing Fatal Pelvic Blast Injury. Ann Biomed Eng. 2019;47(11):2232-40.
  14. Osler T, Baker SP, Long W. A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma. 1997;43(6):922-5; discussion 925-6. 
  15. Gennarelli TA, Wodzin E. AIS 2005: a contemporary injury scale. Injury. 2006;37(12):1083-91. 
  16. Lakstein D, Blumenfeld A, Sokolov T, Lin G, Bssorai R, Lynn M, et al. Tourniquets for hemorrhage control on the battlefield: a 4-year accumulated experience. J Trauma. 2003;54(5 Suppl):S221-5. 
  17. Wedmore I, McManus JG, Pusateri AE, Holcomb JB. A Special Report on the Chitosan-based Hemostatic Dressing: Experience in Current Combat Operations. J Trauma. 2006;60(3):655-8. 
  18. Manzano Nunez R, Naranjo MP, Foianini E, Ferrada P, Rincon E, García-Perdomo HA, et al. A meta-analysis of resuscitative endovascular balloon occlusion of the aorta (REBOA) or open aortic cross-clamping by resuscitative thoracotomy in non-compressible torso hemorrhage patients. World J Emerg Surg. 2017;12:30. 
  19. Lendrum R, Perkins Z, Chana M, Marsden M, Davenport R, Grier G, et al. Pre-hospital Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for exsanguinating pelvic haemorrhage. Resuscitation. 2019;135:6-13. 
  20. Bonner TJ, Eardley WGP, Newell N, Masouros S, Matthews JJ, Gibb I, et al. Accurate placement of a pelvic binder improves reduction of unstable fractures of the pelvic ring. J Bone Joint Surg Br. 2011;93-B(11):1524-8. 
  21. Dubose J, Inaba K, Barmparas G, et al. Bilateral internal iliac artery ligation as a damage control approach in massive retroperitoneal bleeding after pelvic fracture. J Trauma 2010;69(6):1507-14.
  22. Gordon WT, O'Brien FP, Strauss JE, Andersen RC, Potter BK. Outcomes associated with the internal fixation of long-bone fractures proximal to traumatic amputations. J Bone Joint Surg Am. 2010;92(13):2312-8. 
  23. Penn-Barwell JG, Bennett PM, Kay A, Sargeant ID, Severe Lower Extremity Combat Trauma (SeLECT) Study Group. Acute bilateral leg amputation following combat injury in UK servicemen. Injury. 2014;45(7):1105-10. 
  24. Glasgow SC, Heafner TA, Watson JD, Aden JK, Perry WB. Initial management and outcome of modern battlefield anal trauma. Dis Colon Rectum. 2014;8:1012-8. 
  25. Fleming M, Waterman S, Dunne J, D’Alleyrand JC, Andersen RC. Dismounted complex blast injuries: patterns of injuries and resource utilization associated with the multiple extremity amputee. J Surg Orthop Adv. 2012;21(1):32-7. 
  26. Williams M, Jezior J. Management of combat-related urological trauma in the modern era. Nat Rev Urol. 2013;10(9):504-12. 
  27. Bumbasirevia M, Lesic A, Mitkovic M, Bumbasirević V. Treatment of blast injuries of the extremity. J Am Acad Orthop Surg. 2006;14(10 Spec No.):S77-81.
  28. Valerio IL, Sabino J, Mundinger GS, Kumar A. From battleside to stateside: the reconstructive journey of our wounded warriors. Ann Plast Surg. 2014;72(Suppl 1):S38-45. 
  29. Brown KV, Murray CK, Clasper JC. Infectious complications of combat-related mangled extremity injuries in the British military. J Trauma. 2010;69(Suppl 1):S109-15.
  30. Hospenthal DR, Murray CK, Andersen RC, Bell RB, Calhoun JH, Cancio LC, et al. Guidelines for the prevention of infections associated with combat-related injuries: 2011 update: endorsed by the Infectious Diseases Society of America and the Surgical Infection Society. J Trauma. 2011;71(2 Suppl 2):S210-34.
  31. Rodriguez CJ, Weintrob AC, Shah J, Malone D, Dunne JR, Weisbrod AB, et al. Risk factors associated with invasive fungal infections in combat trauma. Surg Infect (Larchmt). 2014;15(5):521-6. 
  32. Rodriguez C, Weintrob AC, Dunne JR, Weisbrod AB, Lloyd B, Warkentien T, et al. Clinical relevance of mold culture positivity with and without recurrent wound necrosis following combat-related injuries. J Trauma Acute Care Surg. 2014;77(5):769-73. 
  33. Gordon W, Talbot M, Fleming M, Shero J, Potter B, Stockinger ZT. High bilateral amputations and dismounted complex blast injury (DCBI). Mil Med. 2018;183(Suppl 2):118-22. 

The hidden side of pelvic fractures: Urological and sexual dysfunction following injury

  1. Ayers DC, Franklin PD, Ring DC. The Role of Emotional Health in Functional Outcomes After Orthopaedic Surgery: Extending the Biopsychosocial Model to Orthopaedics: AOA Critical Issues. J Bone Joint Surg Am. 2013;95(21):e165.
  2. British Orthopaedic Association. The Management of Patients With Pelvic Fractures. Available from: https://www.boa.ac.uk/uploads/assets/e0ff512b-6364-42ef-af23617e1894d8bd/04fe5a18-47a2-46d7-9aa6cc158825014d/the%20management%20of%20patients%20with%20pelvic%20fractures.pdf. Accessed November 2019.
  3. Odutola AA, Sabri O, Halliday R, Chesser TJ, Ward AJ. High rates of sexual and urinary dysfunction after surgically treated displaced pelvic ring injuries. Clin Orthop Relat Res. 2012;470(8):2173–84.
  4. Harvey-Kelly KF, Kanakaris NK, Eardley I, Giannoudis PV. Sexual function impairment after high energy pelvic fractures: evidence today. J Urol. 2011;185(6):2027-34.
  5. Chung PH, Gehring C, Firoozabadi R, Voelzke BB. Reconstructive Urology Risk Stratification for Erectile Dysfunction After Pelvic Fracture Urethral Injuries. Urology. 2018;115:174–8.
  6. Ter-Grigorian AA, Kasyan GR, Pushkar DY. Urogenital disorders after pelvic ring injuries. Cent European J Urol. 2013;66(3):352-6.
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