01 Mar 2015

Volume 3 Issue 1


From the Editor

So we enter 2015 in the knowledge that this is the year of an election a time of uncertainty which breeds an air of despondency. How will the political scene change? Will we be confronted with more change? Should we be pushing our political voice through the BMA? Should we embrace new ways of getting an even handed discussion about Orthopaedics into the public arena? As we all know change for changes sake does not always achieve predictable consequences, so maybe the right thing is to use the structures and tools available to us and push our agenda hard for the sake of our patients. One of our tools is now the established JTO, so sit back, read, shout at the bits you don’t like and write us a letter or two!

This issue is jam-packed full of great features including a Trauma update from Prof Christopher Moran, the National Clinical Director for Trauma (page 16). His article focuses on his commitment to two key areas: fragility fractures and major trauma.

We see how reconfiguring orthopaedic services in a difficult changing environment has affected two merged hospitals in the Bristol and Maidstone areas (page 20).

BOTA President, Peter Smitham, commissioned an article about a trainee led mentor programme for help passing the FRCS exams which you will find on page 36.

The Medico-legal section in this issue is part one of the Code of Practice for orthopaedic surgeons preparing reports in personal injury and other cases, approved by the Professional Practice Committee (page 38). You will find part two in our next issue.

You may be wondering about the front cover image. This piece of artwork is called “Ballet” by the artist Mojgan Safa. Mojgan was born with Cerebral Palsy but found that she had incredible dexterity with her toes. She painted this piece with her foot. This leads us onto the focus of our Peer-Review Section which is Foot & Ankle thanks to our Guest Editor, Fred “the foot” Robinson. You will find a general interest piece about the BOFAS Course and scientific piece on osteochondral lesions and a controversial piece being the pros and cons of minimally invasive forefoot surgery on pages 46-58. Our regular “How I Do…” piece submitted by a member of the Orthopaedic Trauma Society (OTS) follows these and appropriately is about ankles (page 59).

On a sad note we also pay tribute to an incredibly brave man – Stuart Calder – who will be deeply missed (page 62).


Ian Winson – BOA Vice President Elect


Reference Lists


When Two Become One

1. NCEPOD, 2007. Trauma. Who Cares? London: NCEPOD. 
2. National Audit Office, 2010. Major trauma care in England. London: Stationery Office. 
3. Royal College of Surgeons of England 1997. The Provision of Emergency Surgical Services. An Organisational Framework. London: RCSEng. 
4. British Medical Association 1997. Leaner and fitter: What future model of delivery for acute hospital services? London: BMA. 
5. Department of Health 1997. Future Patterns of Medical Care: Standing Medical Committee Advice. London: DOH. 
6. British Medical Association; Royal College of Physicians of London; Royal College of Surgeons of England 1998. Provision of acute general hospital services—consultation document. London: RCSEng.  

Wilful Neglect and Ill-Treatment - New Criminal Offence

1. www.publications.parliament.uk/pa/bills/lbill/2014-2015/0043/15043.pdf  
2. www.gov.uk/government/consultations/ill-treatment-or-wilful-neglect-in-health-and-social-care 
3. www.publications.parliament.uk/pa/ld201415/ldhansrd/text/140714-0003.htm#1407154000295  
4. www.gmc-uk.org/guidance/good_medical_practice/respect_patients.asp  
5. www.themdu.com/guidance-and-advice/latest-updates-and-advice/duty-of-candour-survey  
6. www.gov.uk/cma-cases/private-healthcare-market-investigation  
7. https://assets.digital.cabinet-office.gov.uk/media/5329dc4eed915d0e5d00010d/130614_boa.pdf  
8. https://assets.digital.cabinet-office.gov.uk/media/542c1543e5274a1314000c56/NonDivestment_Order_amended.pdf  
9. www.gov.uk/government/news/cat-ruling-on-private-healthcare-remittal 

Improvements in Musculoskeletal Triage and Assessment

1. Department of Heath. Budgeting estimated England level gross expenditure for all programmes and subcategories for all years collected. http://www.dh.gov.uk/health/2012/08/programmebudgeting-data/, 2012. 
2. NICE, The Management of Hip Fracture  in Adults. National Clinical Guideline Centre (NICE) London: National Clinical Guideline Centre, 2011. CG124. 
3. The musculoskeletal services framework: a joint responsibility: doing it differently. Department of health. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance /DH_4138413, 2006. 
4. European Bone and Joint Heath Stratergies Project . European action towards better musculoskeletal health: A public health strategy to reduce the burden of musculoskeletal conditions. The Bone and Joint Decade,Lund, Sweden. 2005. 
5. Maddison, P., et al., Improved access and targeting of musculoskeletal services in northwest Wales: targeted early access to musculoskeletal services (TEAMS) programme. BMJ, 2004. 329(7478): p. 1325-7. 
6. Dr Foster Health guide weblink http://www.drfosterhealth.co.uk/features/outpatientappointment-no-shows.aspx. 
7. O'Farrell, S., et al., Orthopaedic triage at a physiotherapist-led 'Musculoskeletal Assessment Clinic': a seven-month service evaluation of outcomes. Ir J Med Sci, 2014. 183(4): p. 565-71. 
8. Hussenbux, A., et al., Intermediate Care pathways for musculoskeletal conditions - Are they working? A systematic review. Physiotherapy, 2014.