JTO
02 Dec 2020

Volume 8 Issue 4

From the Executive Editor

Well, fancy that... I find myself the Editor of a prestigious journal – one of the many surprises that 2020 has dealt me and us! I admit I am looking forward to carrying on where Bob left off under the expert guidance of Nick, Annette and my colleagues Hiro Tanaka and Rhidian Morgan Jones. We will continue to try and play nicely with the new kid on the block – the Transient Journal where Fergal Monsell helps us curate the content!

For all this tumultuous year has taught us, I for one will be glad to welcome in the new year – I am not naïve enough to think that ‘all will be well’ in 2021 with COVID-19 merely a distant memory but I do believe I will approach it with renewed optimism and determination. This year has taught us to pull together in a way that has been unique to me in my career-time and perhaps in yours too. Our front cover echoes all our thoughts when we say thank you to our colleagues, our patients, our families and friends who have helped us through…

One high spot of 2020 was the BOA medical student essay prize which attracted a record number of entries and a worthy winner in Silvia Allikmets (page 17). The BOA Council is now much more knowledgeable about the benefits of social media and as a result, several of us are now active twitterers! Never let it be said that we don’t move with the times. If these students are the future of orthopaedics, I am very impressed. Whilst on the subject of ‘youngsters’, I was glad to hear that a past president of BOTA enjoyed his BOA supported fellowship to France (page 10).

2021 sees four new recruits joining Council, bringing some welcome diversity, as well as huge knowledge and experience, to the leadership of our Association. You can read about them on page 18. It is clear too from the articles on NICE Guidelines including the call for involvement from our members, our response to Cumberledge and the future of UK plc, and on the role of the first contact practitioners (FCPs) in the delivery of MSK services that the future is looking bright. We must ensure that it lives up to its promise.

The subspecialty section on amputation shows how far this quintessential original surgical procedure has moved with the times and rightly highlights the value of prehabilitation when possible. Innovation has always been a key aspect of our profession as illustrated in the short biography of Lipmann-Kessel. The fields of war may have taught us much but he felt that ‘exciting and wonderous enterprise is more profitably to be found in peacetime’. This year during our war against the virus, significant and rapid scientific progress has been made in the field of vaccine development with perhaps wider implications for the management of other infectious diseases too, another reason for hope for 2021.

Despite my hopes for 2021, the past year has been difficult and Ben Caesar’s article (page 31) about the Double Pandemic we have been facing reminds us to be kind to ourselves and to others.

On behalf of the BOA and all of us at the JTO, I thank you all for your support and I wish you all some fun and relaxation over the festive season...

Deborah Eastwood, Vice President Elect

 

Subspecialty Section

 

References

Double pandemic, Dr Forte and the fork in our road

  1. Caesar B, Barakat A, Bernard C, Butler D. Evaluation of physician burnout at a major trauma centre using the Copenhagen burnout inventory: cross-sectional observational study. Ir J Med Sci. 2020;189(4):1451-6.
  2. Gerada C. Doctors, suicide and mental illness. BJPsych Bulletin. 2018;42(4):165-68.
  3. Greenberg N, Docherty M, Gnanapragasam S, Wessely S. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ. 2020;368:m1211.
  4. Han S, Shanafelf TD, Sinsky CA, Awad KM, Dyrbye LN, Fiscus LC. Estimating the Attributable Cost of Physician Burnout in the United States. Ann Intern Med. 2019;170(11):784-90.
  5. Hawton K, Clements A, Sakarovitch C, Simkin S, Deeks J. Suicide in doctors: a study of risk according to gender, seniority and specialty in medical practitioners in England and Wales, 1979-1995. J Epidemiol Community Health. 2001;55(5):296-300.
  6. Lindeman S, Laara E, Hakko H, Lonnqvist J. A systematic review on gender-specific suicide mortality inmedical doctors. Br J Psychiatry. 1996;168(3):274-9.
  7. Schernhammer ES, Colditz GA. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). Am J Psychiatry. 2004;161(12):2295-302.
  8. Shanafelt TD, Balch CM, Bechamps GJ, Russell T, Dyrbye L, Satele D. Burnout and Career Satisfaction Among American Surgeons. Ann Surg. 2009;250(3):463-71.
  9. Tawfik DS, Profit J, Morgenthaler TI, Satele DV, Sinsky CA, Dyrbye LN. Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported Medical Errors. Mayo Clin Proc. 2018;93(11):1571-80.
  10. Guardian (2020). NHS sickness rate hit record high during coronavirus peak, data reveals. Available at: https://www.theguardian.com/society/2020/aug/20/nhs-sickness-rate-record-high-coronavirus-peak-england.

Major Alexander William Lipmann-Kessel MBE MC: Surgeon, paratrooper, prisoner of war, and orthopaedic innovator

  1. Cherry N. Red Berets and Red Crosses: Story of the Medical Services in the 1st Airborne Division in World War Two. 2nd Revised edition ed: R. Sigmond; 1999. 168p.
  2. Hickman M. Captain Alexander Lipmann-Kessel. Available at: www.pegasusarchive.org/arnhem/alexander_lipmann_kessel.htm.
  3. Cherry N. Roll Call MAJOR LIPMANN KESSEL, MBE MC  [Available at: https://www.paradata.org.uk/people/lipmann-kessel.
  4. St Mary’s Hospital, London. Available at: https://www.imperial.nhs.uk/our-locations/st-marys-hospital.
  5. Longland CJ, Kessel. THE PARACHUTE SURGICAL TEAM. The Lancet. 1944;243(6290):381.
  6. Bayley I, Kessel L, University of London. Institute of Orthopaedics. Shoulder Surgery. Berlin; New York: Springer-Verlag; 1982. xvi, 221pp.
  7. Wretenberg PF, Wallensten R. The Kessel total shoulder arthroplasty. A 13- to 16-year retrospective followup. Clin Orthop Relat Res. 1999;(365):100-3.
  8. Kessel L. A colour atlas of rupture of the rotator cuff (the coronal transacromical approach). London Chicago, Ill.: Wolfe Medical Publications; Year Bk. Medical Publishers distributor; 1986. 64pp.
  9. Kessel L. Clinical disorders of the shoulder. Edinburgh; New York: Churchill Livingstone; 1982. 182pp.
  10. Kessel L, Bayley I. Clinical disorders of the shoulder. 2nd ed. Edinburgh ; New York: Churchill Livingstone; 1986. x, 244pp.
  11. Kessel L, Boundy U. Color atlas of clinical orthopaedics. Chicago: Year Book Medical Publishers; 1980, 176pp.
  12. Kessel L, Boundy U. Diagnostic picture tests in orthopedics. Chicago: Year Book Medical Publishers; 1988, 128pp.
  13. Truesdale D, Smith A. Theirs is the Glory: Arnhem, Hurst and Conflict on Film. Solihull, West Midlands, England: Helion & Company; 2016. xiv, 355pp.

Amputation after trauma

  1. Moxey PW, Hofman D, Hinchliffe RJ, Jones K, Thompson MM, Holt PJ. Epidemiological study of lower limb amputation in England between 2003 and 2008. Br J Surg. 2010;97(9):1348-53.
  2. Dillingham TR, Pezzin LE, MacKenzie EJ. Limb amputation and limb deficiency: epidemiology and recent trends in the United States. South Med J. 2002;95(8):875-83.
  3. Gregory RT, Gould RJ, Peclet M, Wagner JS, Gilbert DA, Wheeler JR, et al. The mangled extremity syndrome (M.E.S.): a severity grading system for multisystem injury of the extremity. J Trauma. 1985;25(12):1147-50.
  4. Howe HR Jr, Poole GV Jr, Hansen KJ, Clark T, Plonk GW, Koman LA, Pennell TC. Salvage of lower extremities following combined orthopedic and vascular trauma. A predictive salvage index. Am Surg. 1987;53(4):205-8.
  5. Johansen K, Daines M, Howey T, Helfet D, Hansen ST Jr. Objective criteria accurately predict amputation following lower extremity trauma. J Trauma. 1990;30(5):568-72; discussion 572-3.
  6. Russell WL, Sailors DM, Whittle TB, Fisher DF Jr, Burns RP. Limb salvage versus traumatic amputation. A decision based on a seven-part predictive index. Ann Surg. 1991;213(5):473-80; discussion 480-1.
  7. Tscherne H, Oestern HJ. [A new classification of soft-tissue damage in open and closed fractures (author's transl)]. Unfallheilkunde. 1982;85(3):111-5.
  8. Rajasekaran S, Sabapathy SR. A philosophy of care of open injuries based on the Ganga hospital score. Injury. 2007;38(2):137-46.
  9. Bosse MJ, MacKenzie EJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, et al. A prospective evaluation of the clinical utility of the lower-extremity injury-severity scores. J Bone Joint Surg Am. 2001;83-A(1):3-14.
  10. Brown KV, Ramasamy A, McLeod J, Stapley S, Clasper JC. Predicting the need for early amputation in ballistic mangled extremity injuries. J Trauma. 2009;66(4 Suppl):S93-97; discussion S97-98.
  11. NICE (2016) Fractures (complex): assessment and management. NICE guideline [NG37]. Available at: www.nice.org.uk/guidance/ng37.
  12. Eccles S, Handley B, Khan U, Nanchahal J, Nayagam S, McFadyen. Standards for the management of open fractures. Oxford University Press: Oxford, 2020.
  13. Doukas WC, Hayda RA, Frisch HM, Andersen RC, Mazurek MT, Ficke JR, et al. The Military Extremity Trauma Amputation/Limb Salvage (METALS) study: outcomes of amputation versus limb salvage following major lower-extremity trauma. J Bone Joint Surg Am. 2013;95(2):138-45.
  14. Bosse MJ, Teague D, Reider L, Gary JL, Morshed S, Seymour RB, et al. Outcomes After Severe Distal Tibia, Ankle, and/or Foot Trauma: Comparison of Limb Salvage Versus Transtibial Amputation (OUTLET). In: Orthopaedic Trauma Association Annual Meeting. Vancouver, Canada; 2017.
  15. Bosse MJ, Teague D, Reider L, Gary JL, Morshed S, Seymour RB, et al. Outcomes After Severe Distal Tibia, Ankle, and/or Foot Trauma: Comparison of Limb Salvage Versus Transtibial Amputation (OUTLET). J Orthop Trauma. 2017;31 Suppl 1:S48-S55.
  16. Bennett PM, Stevenson T, Sargeant ID, Mountain A, Penn-Barwell JG. Outcomes following limb salvage after combat hindfoot injury are inferior to delayed amputation at five years. Bone Joint Res. 2018;7(2):131-8.
  17. Burgess EM. The below-knee amputation. Bulletin of Prosthetics Research. 1968;10(9):19-25.
  18. Park HW, Jahng JS, Hahn SB, Shin DE. Lengthening of an amputation stump by the Ilizarov technique. A case report. Int Orthop. 1997;21(4):274-6.
  19. Eldridge JC, Armstrong PF, Krajbich JI. Amputation stump lengthening with the Ilizarov technique. A case report. Clin Orthop Relat Res. 1990(256):76-9.
  20. Penn-Barwell JG. Outcomes in lower limb amputation following trauma: a systematic review and meta-analysis. Injury. 2011;42(12):1474-9.

Amputation in the context of tumour or infection

  1. Markatos K, Karamanou M, Saranteas T et al. Hallmarks of amputation surgery. Int Ortho. 2019; 43(2): 493-499.
  2. Kapadia BH, Berg RA, Daley JA et al. Periprosthetic joint infection. Lancet 2016; 387(10016): 386-394.
  3. Kurtz SM, Lau E, Watson H et al. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty 2012; 27: 61-65.
  4. Kurtz S, Ong K, Lau E el al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. JBJS (AM) 2007; 89-A: 780-785.
  5. McPherson EJ, Woodson C, Holtom P et al. Periprosthetic total hip infection: outcomes using a staging system. Clin Orthop Relat Res 2002; 403: 8-15.
  6. Sierra RJ, Trousdale RT, Pagnnano MW. Above-the-knee amputation after total knee replacement; prevalence, etiology and functional outcome. JBJS (AM) 2003; 85-A: 1000-1004.
  7. Lieber AM, Kircher GJ, Kerbel YE at al. Socioeconomic status is associated with risk of above-knee amputation after periprosthetic joint infection of the knee. Clin Orthop Relat Res. 2019; 477(7): 1531-1536.
  8. Pring DJ, Marks L, Angel JC. Mobility after amputation for failed knee replacement. JBJS (Br) 1988; 70-B: 770-771.
  9. Gerrand C, Athanasou N, Brennan B et al. UK guidelines for the management of bone sarcomas. Clin Sarcoma Res. 2016; 6:7.
  10. Grimer RJ, Briggs TW. Earlier diagnosis of bone and soft-tissue tumours.. JBJS Br 2010; 92(11): 1489-92.
  11. Stiller CA, Craft AW, Corazziari I, EUROCARE working Group. Survival of children with bone sarcoma in Europe since 1978: results from the EUROCARE study. Eur J Cancer. 2001; 37(6): 760-6.
  12. Albritton K, Bleyer WA. The management of cancer in the older adolescent. Eur J Cancer. 2003; 39(18): 2584-2599.
  13. Geraci M, Birch JM, Alston RD et al. Cancer mortality in 13 to 29 year olds in England and Wales, 1981-2005. Br J Cancer. 2007; 97(11): 1588-1594.
  14. Coindre JM, Terrier P, Guillou L et al. Predictive value of grade for metastasis development in the main histologic types of adult soft tissue sarcomas: a study of 1240 patients from the French Federation of Cancer Centers sarcoma group. Cancer 2001; 91(10): 1914-1926.
  15. Kotilingam D, Lev DC, Lazar AJF Pollock RE. Staging soft tissue sarcoma; evolution and change. CA Cancer J Clin. 2006; 56(5):282-291.
  16. Cancer Research UK (2020). Lifetime risk of cancer.  Available at: www.cancerresearchuk.org/health-professional/cancer-statistics/risk/lifetime-risk#heading-Zero. [Accessed 10th November 2020.]
  17. Li C, Renz N, Trampuz A, Ojeda-Thies C. Twenty common errors in the diagnosis and treatment of periprosthetic joint infection. Int Orthop 2020; 44(1): 3-14.
  18. Ibrahim MS, Raja S, Khan MA, Haddad FS. A multidisciplinary team approach to two-stage revision for the infected hip replacement: a minimum five-year follow-up study. BJJ 2014; 96-B: 1312-1318.
  19. Laurent E, Lemaignen A, Gras G et al. Multidisciplinary team meeting for complex bone and joint infectious diagnosis: the PHICTOS study. Rev Epidemiol Sante Publique 2019; 67:149-154.
  20. Ntalos D, Berger-Groch J, Rohde H et al. Implementation of a multidisciplinary infections conference affects the treatment plan in prosthetic joint infections of the hip: a retrospective study. Arch Orthop Trauma Surg. 2019; 139:467-473.
  21. Tsai CH, Tzeng HE, Juang WK et al. Curative use of forequarter amputation for recurrent breast cancer over an axillary area: a case report and literature review. World J Surg Oncol. 2014; 12: 346.

 

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