03 Jun 2024

JTO - June 2024

Volume 12 Issue 2

From the Executive Editor

The hard work continues as spring turns into summer and whilst often the thrust of the work is in dealing with numbers: numbers on the waiting list, the percentage theatre utilisation, numbers of overbookings, underutilisation etc., our energy should perhaps be directed to the field of human factors. The complex field of human factors as introduced by James Tomlinson can take up much ‘head space’ as depicted in the cover picture by Chryssa Neo, a ST3 in Edinburgh, but it is a recognition of these factors and their importance that does indeed make us human. An understanding of their relevance makes life safer for our patients (page 46) and for ourselves. An appreciation of diversity in design and the ergonomics of our workplace is also important (page 50) whilst Steven Yule introduces us to a whole new ball game (for me anyway) called surgical sabermetrics (page 53).

If human factors are important at home, they certainly must be so in the different and often challenging environments encountered during global surgery initiatives supported by our impressive trainees (page 38) and whilst running the Mercy Ships orthopaedic missions as described by Rachel Buckingham (page 34).

The kids I treat often ask for their pins and plates to take home with them for ‘show and tell’ at school, and I was interested to read about the current guidance on ownership and/or disposal of removed implants (page 42).

This edition of JTO also includes an introduction to the ‘new’ specialty of kids knee surgery (page 18) and reminds us that obesity must not be an exclusion to care that can transform lives (page 22). Perhaps for both paediatric knee conditions and obesity related problems, prevention is better than cure and certainly the remit of the fracture liaison services is to do just that – reduce the risk of secondary fractures. Andrew Gray comments how he himself is at risk of falls and what the services can do to help him and many of our patients! (page 16).

Teaching and training are always important aspects of our profession but we need to take care that we do not simply jump on each new bandwagon that passes by without evaluating whether or not it is going to be useful. The article by Kapil Sugand and Hiro Tanaka offers us some guidance on the role of simulation in formal orthopaedic training (page 26). Andrew Coppola and Vipin Asopa provide a similarly reasoned approach to the use of AI in Trauma and Orthopaedics and how it is affecting us now.

Remembering where we have come from should always be part of working out where we are headed. So it is fitting what whilst we embrace the excitement of the brave new world of technology that we are participating in, we remember the role of John Kirkup as the BOA archivist for many years as well as an orthopaedic colleague of note (page 56).

Whilst the world does remain in some turmoil, I hope that the summer brings the opportunity for a holiday with friends and family. 

 Deborah Eastwood, Immediate Past President 


Subspecialty Section


Guidance on the role of simulation in formal training by the British Orthopaedic Association

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  2. National Confidential Enquiry into Patient Outcome and Death. 2022. Available at: www.ncepod.org.uk/pdf/current/Recommendations_full%20list_with%20comments_December%202022.pdf.
  3. Sugand K, Aframian A, Park C COVERT Collaborative, et al. Impact of COVID-19 on acute trauma and orthopaedic referrals and surgery in the UK during the first wave of the pandemic: a multicentre observational study from the COVid Emergency-Related Trauma and orthopaedics (COVERT) Collaborative. BMJ Open. 2022;12(1):e054919.
  4. Weiser TG, Regenbogen SE, Thompson KD, et al. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet. 2008;372(9633):139-44.  
  5. World Health Organisation. Musculoskeletal health. 2022. Available at: www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions.
  6. Ferreira T, Collins AM, Feng O, The AIMS Collaborative, et al. Career intentions of medical students in the UK: a national, cross-sectional study (AIMS study). BMJ Open. 2023;13:e075598.
  7. Society for Simulation in Healthcare. 2020. Available at: www.ssih.org/Portals/48/v2_1-Final.pdf.
  8. General Medical Council. Promoting excellence: standards for medical education and training. 2015. Available at: www.gmc-uk.org/-/media/documents/promoting-excellence-standards-for-medical-education-and-training-2109_pdf-61939165.pdf.
  9. Dreyfus S, Dreyfus H. A five stage model of the mental activities involved in directed skill acquisition. 1980. Available at: https://apps.dtic.mil/sti/pdfs/ADA084551.pdf.

A practical approach to artificial intelligence in trauma and orthopaedics

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  3. Al-Nasser S, Noroozi S, Harvey A, et al. Exploring the Performance of an Artificial Intelligence-Based Load Sensor for Total Knee Replacements. Sensors. 2024;24(2). https://doi.org/10.3390/s24020585.
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  7. Olczak J, Emilson F, Razavian A, et al. Ankle fracture classification using deep learning: automating detailed AO Foundation/Orthopedic Trauma Association (AO/OTA) 2018 malleolar fracture identification reaches a high degree of correct classification. Acta Orthop. 2020;92:102-8.
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  14. Sagi A, Asopa V, Mitchell M, et al. The digital divide between primary and secondary care: an analysis using SARS-CoV-2 hospital admissions. Health Informatics Journal. Article in press. 

Global surgery ‘the trainees’ perspective’: Ten things we have learnt so far...

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2.     Meara, J. G., Leather, A. J. M., Hagander, L., Alkire, B. C., Alonso, N., Ameh, E. A., et al. Global Surgery 2030: Evidence and Solutions for Achieving Health, Welfare, and Economic Development. Lancet. 2015; 386(9993): 569-624.

3.     World Health Organisation. Injuries and Violence. [Online] (19th March 2021)  2021. Available at: https://www.who.int/news-room/fact-sheets/detail/injuries-and-violence [Accessed 24th December 2021].

4.     Rossiter, N. D. “Trauma—the Forgotten Pandemic?”. International Orthopaedics. 2022; 46(1): 3-11. Available at: https://dx.doi.org/10.1007/s00264-021-05213-z.

5.     Executive Group of the British Orthopaedic Association. British Orthopaedic Association National Consultant Workforce Membership. 2024; Author's personal correspondence with executive group, [Received 4th April 2024].

6.     Banda, C. H., Baissa, L., Mutambanengwe, P., Nkoronko, M., Mwachiro, M., Osei-Kuffour, D., et al. Addressing the Gender Gap in the Cosecsa Surgical Workforce: Where Do We Stand? 23rd COSECSA Scientific Conference; 2023 5-7th December; Addis Abiba, Ethiopia.

7.     Ogbeiwi, O. Theoretical Frameworks for Project Goal-Setting: A Qualitative Case Study of an Organisational Practice in Nigeria. The International Journal of Health Planning and Management. 2022; 37(4): 2328-2344.

8.     World Orthopaedic Concern UK. World Orthopaedic Concern Uk - Home. [Online] (21st March 2024)  2019. Available at: https://wocuk.org/ [Accessed 1st April 2024].

9.     British Society for Surgery of the Hand. Lion Hand Unit | Lilongwe Institute for Orthopaedics and Neurosurgery - Malawi. [Online]  2024. Available at: https://www.bssh.ac.uk/about/lion_hand_unit.aspx [Accessed 1st April 2024].

10. World Orthopaedic Concern UK. Cambodia - the Kadoorie Senior Orthopaedic Fellowship, Children’s Surgical Centre (Csc), Phnom Penh, Cambodia. [Online] (28th October 2019)  2019. Available at: https://wocuk.org/locations/cambodia/ [Accessed 1st April 2024].

11. Cambridge Global Health Partnerships. Global Health Fellowships. [Online]  2024. Available at: https://cambridgeghp.org/get-involved/global-health-fellowships/ [Accessed 1st April 2024].

12. Poole Africa Link. Welcome to Poole Africa Link. [Online] (20th December 2023)  2016. Available at: https://pooleafricalink.org.uk/ [Accessed 1st April 2024].

13. Primary Trauma Care Foundation. Primary Trauma Care Foundation - Home. [Online] (4th October 2022)  2015. Available at: https://www.primarytraumacare.org/ [Accessed 1st April 2024].

14. Mercy Ships. Mercy Ships. [Online] (18th March 2024)  2018. Available at: https://www.mercyships.org.uk/ [Accessed 1st April 2024].

15. Joint Committee on Surgical Training. Out of Programme Experience. [Online]  2024. Available at: https://www.jcst.org/uk-trainees/str-trainees/out-of-programme/out-of-programme-experience/ [Accessed 1st April 2024].

16. Academy of Medical Royal Colleges. Academy Statement on Volunteering: Health Professional Volunteers and Global Health Development. [Online] London: Academy of Medical Royal Colleges; 2013. Available at: http://www.wessexghnetwork.org.uk/media/11724/ACADEMY-STATEMENT-ON-VOLUNTEERING.pdf [Accessed 1st April 2024].

17. While, R. Health Education England Guidance for Trainees Planning to Volunteer or Work Overseas. [Online] London: Health Education England; 2017. Available at: https://www.hee.nhs.uk/sites/default/files/documents/HEE%20Guidance%20for%20Trainees%20planning%20to%20volunteer%20or%20work%20overseas%20v2%20(Low%20resolution).pdf?fbclid=IwAR0rLuvpbUoQN4ZlzrgBotu552SHNg_HISTmGqlnAsVEMKgkiTaAN51ES4c [Accessed 1st April 2024].

18. Berwin J.T., Brown M., Bucknall V., Bose D., On behalf of the BOTA Committee. Attitudes Towards Orthopaedic Volunteering in Low-Resource Settings. The Bulletin of the Royal College of Surgeons of England. 2020; 102(4): 144-149.

19. Bauer, I. More Harm Than Good? The Questionable Ethics of Medical Volunteering and International Student Placements. Tropical Diseases, Travel Medicine and Vaccines. 2017; 3(1). Available at: https://dx.doi.org/10.1186/s40794-017-0048-y [Accessed 1st April 2024].

20. Singer, P. A., Pellegrino, E. D., Siegler, M. Clinical Ethics Revisited. BMC Medical Ethics. 2001; 2: 1. Available at: https://dx.doi.org/10.1186/1472-6939-2-1 [Accessed 1st April 2024].

21. Zitzman, E., Berkley, H., Jindal, R. M. Accountability in Global Surgery Missions. BMJ Global Health. 2018; 3(6): e001025. Available at: https://dx.doi.org/10.1136/bmjgh-2018-001025 [Accessed 1st April 2024].

22. All-Party Parliamentary Group on Global Health. The Uk as a Global Centre for Health and Health Science: A Go-to Place for All Aspects of Health Globally. [Online] London: All-Party Parliamentary Group on Global Health; 2020. Available at: https://globalhealth.inparliament.uk/files/globalhealth/2020-12/The%20UK%27s%20contribution%20to%20health%20globally%20%E2%80%93%202020%20update%20FINAL.pdf [Accessed 1st April 2024].

23. All-Party Parliamentary Group on Global Health. Improving Health at Home and Abroad: How Overseas Volunteering from the Nhs Benefits the Uk and the World. [Online] London: All-Party Parliamentary Group on Global Health; 2013. Available at: https://www.thet.org/wp-content/uploads/2017/08/APPG-Report.pdf [Accessed 1st April 2024].

24. Van Hoving, D. J., Wallis, L. A., Docrat, F., Vries, S. D. Haiti Disaster Tourism—a Medical Shame. Prehospital and Disaster Medicine. 2010; 25(3): 201-202.

25. Arnaouti, M. Core Trainee Prize 2021/2022: Global Orthopaedics: The Norm, Not the Exception. Bone & Joint 360. 2023; 12(5): 6-10. Available at: https://doi.org/10.1302/2048-0105.125.360084 [Accessed 1st April 2024].26. Global Anaesthesia Surgery and Obstetric Collaboration. About. [Online]  2024. Available at: https://www.gasocuk.co.uk/about [Accessed 1st April 2024].

27. International Student Surgical Network. Incision - Home. [Online]  2024. Available at: https://incisionetwork.org/ [Accessed 1st April 2024].

28. InciSioN UK Collaborative. Global Health Education in Medical Schools (Ghems): A National, Collaborative Study of Medical Curricula. BMC Medical Education. 2020; 20(1). Available at: https://dx.doi.org/10.1186/s12909-020-02315-x.

29. Patel, R., Khundkar, R., Peter, N., Turner, J., Edgcombe, H., Makins, A., et al. Improving Global Surgery Education for Trainees. International Journal of Surgery: Global Health. 2019; 2(3): e07. Available at: http://dx.doi.org/10.1097/GH9.0000000000000007 [Accessed 1st April 2024].

30. Welling, D. R., Ryan, J. M., Burris, D. G., Rich, N. M. Seven Sins of Humanitarian Medicine. World Journal of Surgery. 2010; 34(3): 466-470.

31. Jaffry, Z., Sabawo, M., Harrison, W. J., Schade, A. T. Using a Consensus Meeting to Enhance Fracture Care Education in Low Income Countries. BMC Medical Education. 2023; 23(1): 111. Available at: https://dx.doi.org/10.1186/s12909-023-04077-8 [Accessed 1st April 2024].

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33. Abimbola, S. The Foreign Gaze: Authorship in Academic Global Health. BMJ Global Health. 2019; 4(5): e002068. Available at: https://dx.doi.org/10.1136/bmjgh-2019-002068 [Accessed 1st April 2024].

34. Khan, M., Abimbola, S., Aloudat, T., Capobianco, E., Hawkes, S., Rahman-Shepherd, A. Decolonising Global Health in 2021: A Roadmap to Move from Rhetoric to Reform. BMJ Global Health. 2021; 6(3): e005604. Available at: https://dx.doi.org/10.1136/bmjgh-2021-005604 [Accessed 1st April 2024].

35. Graham, S. M., Render, L., Maqungo, S., Ferreira, N., Marais, L. C., Held, M., et al. Establishing a Consensus on Research Priorities in Orthopaedic Trauma within South Africa. European Journal of Orthopaedic Surgery & Traumatology. 2023; 33(3): 533-540. Available at: https://dx.doi.org/10.1007/s00590-022-03413-w [Accessed 1st April 2024].

36. Sigamoney, K. V., Jones, H. W., Tony Clayson. The Northwest Orthopaedic Trauma Alliance for Africa (Notta): Approaching Sustainable Development through International Collaboration and the Ethiopian and Uk residents day. Journal of Trauma and Orthopaedics. 2019; 7(2): 58-63. Available at: https://issuu.com/britorthopaedic/docs/boa_jto_v07_i02_final_draft [Accessed 1st April 2024].

37. Global Scalpels. Global Scalpels | a Global Surgery Podcast. [Online]  2020. Available at: https://www.globalscalpels.com/ [Accessed 1st April 2024].

38. Jenner, E. Setting up Virtual Teaching Sessions for Guyana. World Orthopaedic Concern UK: 7th Annual Conference; 2021. Available at: https://orthohub.xyz/course/world-orthopaedic-concern-conference-2021

39. Yeomans, D., Le, G., Pandit, H., Lavy, C. Is Overseas Volunteering Beneficial to the Nhs? The Analysis of Volunteers’ Responses to a Feedback Questionnaire Following Experiences in Low-Income and Middle-Income Countries. BMJ Open. 2017; 7(10): e017517. Available at: https://dx.doi.org/10.1136/bmjopen-2017-017517 [Accessed 1st April 2024].

40. Tyler, N., Chatwin, J., Byrne, G., Hart, J., Byrne-Davis, L. The Benefits of International Volunteering in a Low-Resource Setting: Development of a Core Outcome Set. Human Resources for Health. 2018; 16(1): 69. Available at: https://dx.doi.org/10.1186/s12960-018-0333-5 [Accessed 1st April 2024].

41. NHS Employers. Supporting Nhs Staff Who Are Volunteers. [Online] London: NHS Confederation; 2016.

42. Ng-Kamstra, J. S., Greenberg, S. L. M., Abdullah, F., Amado, V., Anderson, G. A., Cossa, M., et al. Global Surgery 2030: A Roadmap for High Income Country Actors. BMJ Global Health. 2016; 1(1): e000011. Available at: https://dx.doi.org/10.1136/bmjgh-2015-000011 [Accessed 1st April 2024].