Enis Guryel

Brighton and Sussex University Hospitals NHS Trust | BSUH · Major Trauma Centre

Introduction The British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) guide the optimal management of open lower limb fractures. Adherence of the newly established Orthoplastic service at the Major Trauma Centre covering the Southeast of England was audited in relation to these standards. Materials and methods Audit standa...

Introduction The regionalisation of major trauma in the UK has significantly improved outcomes for patients with severe, lower limb injuries. Chronic pain after complex lower limb injuries is well documented, but seems to remain a problem despite better clinical and radiological outcomes. We hypothesised that pain was mediated through the saphenous...

Aims Ankle fractures are common injuries and the third most common fragility fracture. In all, 40% of ankle fractures in the frail are open and represent a complex clinical scenario, with morbidity and mortality rates similar to hip fracture patients. They have a higher risk of complications, such as wound infections, malunion, hospital-acquired in...

Background Type C3 distal tibial plafond fractures consistently show poor outcomes with high complication rates and significant risk of posttraumatic arthritis. We describe a minimally invasive technique of performing a primary ankle fusion using an anterograde tibial nail and compare our early results to traditional methods of fixation. Methods D...

Headless compression screws (HCS) have a variable thread pitch and headless design enabling them to embed below the articular surface and generate compression force for fracture healing without restricting movement. Locking screws have greater variety of dimensions and a threaded pitch mirroring the design of the HCS. The objective of this study is...

Novel uses of lengthening nails

Introduction: ORTHOPOD: Day Case Trauma is a multicentre prospective service evaluation of day-case trauma surgery across four countries. It is an epidemiological assessment of injury burden, patient pathways , theatre capacity, time to surgery and cancellation. It is the first evaluation of day-case trauma processes and system performance at natio...

Background: Nonunions following fracture fixation result in significant patient morbidity and financial burden. Traditional operative management around the elbow consists of removal of metalwork, debridement of the nonunion and re-fixation with compression, often with bone grafting. Recently, some authors in the lower limb literature have describe...

Category Ankle; Trauma Introduction/Purpose Multi-centre assessment of utilisation and outcomes of hindfoot intramedullary fixation (HFN) or fibula pro-tibial screw fixation (PTS) in complex ankle fractures. Methods From January 2020 - June 2021, demographic data, co-morbidities, was collected on all patients undergoing HFN or PTS for an AO44 ank...

Category Trauma; Ankle Introduction/Purpose Lower limb fractures account for a third of all orthopaedic injuries of which 22% are ankle fractures. With a gradual move toward minimally invasive surgery for ankle fractures, intramedullary implants have evolved over the years to dedicated fixation devices for fibula fractures. The aim of this study w...

Background To determine the clinical outcomes following fibula nail fixation and to identify the indication for the use of fibula nails in lower limb fractures. Methods Retrospective study of adult patients from 2 major trauma centers (MTCs) and 9 trauma units (TUs) who underwent fibula nail fixation for AO/OTA 44 fractures between January 1, 2018...

Aim The primary aim of this quality improvement project was to assess compliance with BOAST 4 guidelines for the delivery of antibiotic prophylaxis in patients presenting to a major trauma centre with open limb fracture and evaluate the impact of implemented changes on attainment of these guidelines. Secondary aims were to assess adherence to local...

PurposeTalar neck and body fractures are uncommon injuries that are challenging to manage with high reported complication rates, including post-traumatic arthritis, avascular necrosis, and poor functional outcomes. The aim of this study was to assess the complication rates for patients with talus fractures across three major trauma centres (MTCs) i...

Background Coronal shear fractures of the capitellum and trochlea are relatively uncommon and can be challenging to treat because of variable articular comminution and poor bone stock. Classification is valuable to help guide surgical decision making and prognosis. The aim of this study was to present a large series of coronal shear fractures treat...

Introduction Open fractures are associated with increased infection rates and the evidence shows timely administration of prophylactic antibiotics within one hour of injury improves the outcomes. Method A multi-cycle audit was carried out retrospectively for patients presenting to Brighton and Sussex University Hospitals NHS Trust (BSUH) with an o...

PurposeCircular frames have been the gold standard of treatment for complex deformity corrections and bone loss. However, despite the success of frames, patient satisfaction has been low, and complications are frequent. Most recently, lengthening nails have been used to correct leg length discrepancies. In this article, we review the current trends...

Tibiotalar fusion for C3 Pilon fractures

Amazing outcomes in C3 Pilon fractures by performing primary fusion and antegrade tibial nailing. Fully weight bearing from day 1 and no complications reported after 2 years

Introduction: Open fractures are associated with increased rates of infection due to impairment of normal barriers to infection. The evidence shows that administration of antibiotic prophylaxis reduces infection rates. Timely administration of antibiotics within one hour of injury has been suggested to further improve outcomes, and is incorporated...

We performed the UK first case of a new device, The Bone Transport Nail as part of the alpha launch.

Osteomyelitis is a complex and potentially devastating condition. Appropriate therapy requires a multimodal orthoplastic approach and the cornerstone of treatment is surgical management. The aim is eradication of infection by thorough debridement, leaving only viable tissue and restoring function. Despite the unquestionable need for surgical debrid...

Background: Traditional fracture clinics are some of the busiest clinics in a hospital, often with significant patient waiting times and delays. The use of virtual fracture clinic (VFC) for the management of certain injuries to reduce the workload on the traditional fracture clinic, in addition to reducing costs is growing in popularity. The tendo...

Aims Fractures of the distal femur can be challenging to manage and are on the increase in the elderly osteoporotic population. Management with casting or bracing can unacceptably limit a patient’s ability to bear weight, but historically, operative fixation has been associated with a high rate of re-operation. In this study, we describe the outcom...

The incidence of deep vein thrombosis, non-fatal pulmonary embolism and fatal pulmonary embolism may be as high as 61%, 10% and 2%, respectively, in patients with pelvic and acetabular injuries. A survey of the pelvic and acetabular units across the United Kingdom was performed to ascertain the thrombo-prophylaxis policy for these patients. In part...

A patient who presented with a displaced subcapital fracture of the proximal femur in her third trimester of pregnancy is reported. Following delivery of the baby with an emergency caesarean section, the fracture was immediately reduced and fixed using cannulated screws. The outcome of her fracture management for this rare condition is discussed. O...

Clinical audit plays an important role in the drive to improve the quality of patient care and thus forms a cornerstone of clinical governance. Assurance that the quality of patient care has improved requires completion of the audit cycle. A considerable sum of money and time has been spent establishing audit activity in the UK. Failure to close th...

We describe a case of symptomatic focal femoral osteolysis around a screw hole distal to the hydroxyapatite-coated portion of a cannulated femoral component in a revision hip replacement. No locking screw had been inserted into this, the most proximal of the three distal holes for locking screws. The presence of polyethylene wear debris in the tiss...

Up to 63% of the chapters in major orthopaedic textbooks use the results from abstracts that have been presented at international orthopaedic meetings. Orthopaedic abstracts were reviewed that were presented at the 1997 and 1998 meetings of the British Orthopaedic Association and other specialist orthopaedic meetings. The number of abstracts that h...

About 60,000 patients are treated for hip fractures each year in the UK and the incidence is increasing. The majority of these patients are elderly and sick, and delay to operation may be fatal. The National Confidential Enquiry into Peri-Operative Deaths (NCEPOD) guidelines aim to improve quality of care for such patients. However, we present an a...

Giant cell tumor of the tendon sheath has frequently been described in the hand, but it is much less common in the foot. The case report presents an apparent cystic bony lesion of the proximal phalanx of the second toe of the foot. The operative findings and histological examination revealed a giant cell tumor of the tendon sheath that had eroded t...