Volume 6 Issue 2
From the Executive Editor
The second edition of our centenary year marks the close links between our association and the armed forces.
Sir Robert Jones is illustrated on the front cover wearing his military uniform. This could give the impression that these links are purely historical, but the three articles in our themed section show that orthopaedic trauma and reconstructive surgery remains at the core of the Defence Medical Services. Nick Ward describes his career trajectory and his experiences during two tours in Afghanistan. Sarah Stapley and her co-authors cover the advances made in the areas of blast injury, severe pelvic and extremity trauma, the complications of infection and heterotopic ossification and the importance of outcome measures for those suffering severe trauma. Jon Kendrew and his co-authors describe the ground-breaking field of direct skeletal fixation of prostheses for those where limb salvage is impossible.
Sadly, these advances are increasingly relevant to civilian practise in the UK and across the world. Many of us have been involved in treating the victims of terrorist incidents and the article by Juan de Dios Robinson vividly describes the breadth and complexity of injury patterns that we have to be prepared to assess and treat when the need arises.
Chris Ackroyd returns us to the most direct involvement of surgeons in war. His eloquent story of profound bravery recognised by the award of the Victoria Cross gives a totally different perspective. Before reading it, guess how many VCs have been awarded to medical personnel.
I hope you will enjoy reading the full content of the Journal. The editorial team would be pleased to receive proposed submissions from our members or any comments on this edition.
Phil Turner – BOA Vice President Elect
Quality Improvement in Surgical Teams (QSIT) - Anaemia and Infection
1. Conlon NP, Bale EP, Herbison GP MM. Postoperative anemia and quality of life after primary hip arthroplasty in patients over 65 years old. Anesth Analg. 106(4):1056–61.
2. Shander A, Knight K, Thurer R, Adamson J, Spence R. Prevalence and outcomes of anemia in surgery: A systematic review of the literature. Am J Med. 2004;116(7 SUPPL. 1):58–69.
3. Husted H, Holm G, Jacobsen S. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: Fast-track experience in 712 patients. Acta Orthop. 2008;79(2):168–73.
4. Innovate I, Encourage D. COULD quality be cheaper? how difficult it is to accurately. 2011.
5. Pujol-Nicolas A, Morrison R, Casson C, Khan S, Marriott A, Tiplady C, et al. Preoperative screening and intervention for mild anemia with low iron stores in elective hip and knee arthroplasty. Transfusion. 2017;57(12):3049–57.
6. Hickson CJ, Metcalfe D, Elgohari S, Oswald T., Masters J. P., Rymaszewska M., Reed M. R. SAP. Prophylactic antibiotics in elective hip and knee arthroplasty: an analysis of organisms reported to cause infections and National survey of clinical practice. Bone Jt Res. 2015;4(11):181–9.
7. Bode LGM, Kluytmans JAJW, Wertheim HFL, Bogaers D, Vandenbroucke-Grauls CM, Roosendaal R, Troelstra A, Box AT, Voss A, van der Tweel I, van Belkum A, Verbrugh HA VM. Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. New Engl J Med. 2010;362(1):9–17.
8. Jeans E, Holleyman R, Malviya A, Tate D RM. Methicillin sensitive staphylococcus aureus screening and decolonisation in elective hip and knee arthroplasty. Under Rev - available Req.
Operations I No Longer Do - Shoulder and Elbow - Ten Years On
1. Chen D1, Goldberg J2, Herald J3, Critchley I4, Barmare A4. Effects of surgical management on multidirectional instability of the shoulder: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2016 Feb;24(2):630-9.
Re-branding T&O - The Undergraduate Experience
1. Subramanian P, Kantharuban S, Subramanian V et al. Orthopaedic surgeons: as strong as an ox and almost twice as clever? Multicentre prospective comparative study. BMJ 2011; 343:D75006.
2. Evans S and Sarani B. The modern medical school graduate and general surgical training: are they compatible? Arch Surg 2002; 137(3):274-7.
3. Vint H, Chapman AP and Daly K. Women in Orthopaedics. JTO 2016; 4(1):26-28.
4. Eardley I, Scott H and Wilkinson D. Why a career in surgery is no longer the golden ticket. BMJCareers. 2015. (Accessed March 2018)(Available from: http://careers.bmj.com/careers/advice/Why_a_career_in_surgery_is_no_longer_the_golden_ticket).
5. Twigg V, Aldridge K, McNally SA and Eardley I. Does choice of medical school affect a student’s likelihood of becoming a surgeon? The Bulletin (RCS) 2018; 100(2):90-95.
6. Young AF, Mason W, and Curwen CH. Motivating and Deterring Factors behind Orthopaedic Surgery as a Career Choice in UK Medical Students. JUTO 2014; 1:14-17.
The Cost of Training in Trauma and Orthopaedics - Where Do All The Pennies Go
1. Memorandum of Evidence to the Review Body on Doctors’ and Dentists’ Remuneration. The BMA. 30 Sep 2016. Available at: www.bma.org.uk//media/files/pdfs/working%20for%20change/policy%20and%20lobbying/bma%20ddrb%20evidence%20final%2 0300915.pdf?la=en (Accessed 19 Aug 2017).
The Continuing Saga of Informed Consent
1. De Bono J (2017) Thefault v Johnston: a game changer for consent in elective surgery Bone & Joint 360 6(4) 4143.
2. GMC (2008) Consent: patients and doctors making decisions together https://www.gmcuk.org/guidance/ethical_guidance/consent_guidance_index.asp.
3. Hassell v Hillingdon Hospitals NHS Foundation Trust (2018) EWHC 164 (QB) Case No: HQ14C03779.
4. Montgomery v Lanarkshire Health Board (2015) UKSC 11 https://www.supremecourt.uk/decidedcases/docs/UKSC_2013_0136_Judgment.pdf.
5. Powell JM, Rai A, Foy MA, Casey A, Dabke H, Gibson A, Hutton M (2017) The “three legged stool” A system for spinal informed consent Bone Joint Journal 98-B (11) 1427-30.
6. Sokol D (2016) Who will operate on you? A late change of surgeon may invalidate patient’s consent BMJ