Shao-Ting Jerry Tsang

• BSc (Hons) | MBChB | MSc | MFSTEd | PhD | FRCSEd
• Senior Lecturer at Queen Mary University of London

Abstract Objectives To evaluate putative anti-staphylococcal biofilm antibiotic combinations used in the management of periprosthetic joint infections (PJIs). Methods Using the dissolvable bead biofilm assay, the minimum biofilm eradication concentration (MBEC) was determined for the most commonly used antimicrobial agents and combination regimen...

Background Gram-negative organisms are increasingly seen as causative pathogens in orthopaedic fracture surgery, which might necessitate a change in antibiotic prophylaxis protocols. Methods A single-centre retrospective review of antibiogram results from all patients treated for fracture- related infection (FRI) was conducted. Subgroup analysis wa...

Aims Global literature suggests that female surgical trainees have lower rates of independent operating (operative autonomy) than their male counterparts. The objective of this study was to identify any association between gender and lead/independent operating in speciality orthopaedic trainees within the UK national training programme. Methods Th...

Background Temporary ankle-spanning circular fixation aims to provide osseous stability while (1) allowing access to and recovery of the traumatized soft-tissue envelope and (2) facilitating safe, comfortable, and clinically relevant cross-sectional imaging for surgical planning. It is most commonly utilized in a “span-scan-plan” treatment strategy...

This poster describes the use of local antibiotics and their carriers in a large randimised trial in Europe.

Musculoskeletal infections have been shown to be associated with some of the worst pre-treatment quality of life reported in the literature, worse than the most common malignancies and cardiorespiratory conditions (Figure 1.) 1. Multiple surgeries are often required in the treatment of musculoskeletal infections, which can significantly affect heal...

This poster reports the effect of treatment on the quality of life in 995 patients with prosthetic joint infection, osteomyelitis and fracture-related infection.

Background Bone infections are dreaded complications and remain a challenge for orthopaedic surgeons. Unresolved bone infection is caused by a broad spectrum of microorganisms; however, a few microorganisms persist from the initial infection. There are no published series reporting the microbiology in unresolved bone infection in low- or middle-inc...

Background The reconstruction of segmental long bone defects remains one of ‘The holy grails of orthopaedics’. The optimal treatment of which remains a topic of great debate. This study aimed to evaluate the outcomes following the management of critical-sized bone defects using a classification-based treatment algorithm. Methods A retrospective re...

Background Calcaneal osteomyelitis remains a difficult condition to treat with high rates of recurrence and below knee amputation; particularly in cases of severe soft tissue destruction. Aim Assess the outcomes of combined ortho-plastics treatment of complex calcaneal osteomyelitis. Method A retrospective review was performed of all patients who...

Background: The management of fracture-related infection has undergone radical progress following the development of international guidelines. However, there is limited consideration to the realities of healthcare in low-resource environments due to a lack of available evidence in the literature from these settings. Initial antimicrobial suppressio...

Introduction The reconstruction of segmental long bone defects remains one of the holy grails of orthopaedic surgery. The optimal treatment of which remains a topic of great debate. This study aimed to evaluate the outcomes following the management of critical-sized bone defects using a classification-based treatment algorithm. Materials & Methods...

Introduction The management of fracture-related infection has undergone radical progress following the development of international guidelines. However, there is limited consideration to the realities of healthcare in low-resource environments due to a lack of available evidence in the literature from these settings. Initial antimicrobial suppressi...

Introduction The Cierny and Mader classification assists with decision-making by stratifying host status and the pathoanatomy of the disease. However, the anatomical type IV represents a heterogenous group with regards to treatment requirements and outcomes. We propose that modification of the Cierny and Mader anatomical classification with an addi...

Background The Cierny and Mader classification assists with decision-making by stratifying host status and the pathoanatomy of the disease. However, the anatomical type IV represents a heterogenous group with regard to treatment requirements and outcomes. We propose that modification of the Cierny and Mader anatomical classification with an additio...

BACKGROUND: Bone infections are dreaded complications and remain a challenge for orthopaedic surgeons. Unresolved bone infection is caused by a broad spectrum of microorganisms; however, a few microorganisms persist from the initial infection. There are no published series reporting the microbiology in unresolved bone infection in low- or middle-in...

Antimicrobial strategies for musculoskeletal infections are typically first developed with in vitro models. The In Vitro Section of the 2023 Orthopaedic Research Society Musculoskeletal Infection (ORS MSKI) international consensus meeting (ICM) probed our state of knowledge of in vitro systems with respect to bacteria and biofilm phenotype, standar...

Aim Calcaneal osteomyelitis remains a difficult condition to treat with high rates of recurrence and below knee amputation; particularly in cases of severe soft tissue destruction. This study assesses the outcomes of combined ortho-plastics treatment of complex calcaneal osteomyelitis. Method A retrospective review was performed of all patients wh...

Aim Patient quality of life (QoL) in untreated bone infection was compared to other chronic conditions and stratified by disease severity. Method Patients referred for treatment of osteomyelitis (including fracture related infection) were identified prospectively between 2019 and 2023. Patients with confirmed infection completed the EuroQol EQ-5D-...

Gram-negative organisms are increasingly seen as causative pathogens in orthopaedic fracture surgery, which might necessitate a change in antibiotic prophylaxis protocols. A single-centre retrospective review of antibiogram results from all patients treated for fracture-related infection (FRI) was conducted. Subgroup analysis was undertaken to iden...

The Cierny and Mader classification assists with decision-making in the management of osteomyelitis by strafying the host status and the pathoanatomy of disease. However the anatomical type IV represents a heterogenous group with regards to treatment requirements and outcomes. We propose that modification of the Cierny and Mader anatomical classifi...

Fracture-related infection (FRI) management has advanced considerably in recent years, offering new possibilities for predictable rates of infection eradication. Debridement, antibiotics, and implant retention (DAIR) procedures have shown promise in the treatment of early FRI. This article provides an overview of the principles and indications of D...

Abstract Fracture-related infection (FRI) is a serious complication that can result in poor outcomes, delayed bone-healing, soft tissue compromise, and prolonged hospitalization. FRI can present in various ways, largely depending on the timepoint after fracture. Management of this condition can be challenging. In this article we consider how to app...

Pressure-ulcer related pelvic osteomyelitis is managed with little high-quality evidence. We undertook an international survey of orthopaedic surgical management, covering diagnostic parameters, multi-disciplinary input, and surgical approaches (indications, timing, wound closure, and adjunctive therapies). This identified areas of consensus and di...

Aims The purpose of this study was to determine the weightbearing practice of operatively managed fragility fractures in the setting of publically funded health services in the UK and Ireland. Methods The Fragility Fracture Postoperative Mobilisation (FFPOM) multicentre audit included all patients aged 60 years and older undergoing surgery for a f...

Debridement is a central tenet in the management of prosthetic joint infections (PJIs). Modern debridement has three distinct stages: 1) surgical; 2) mechanical/physical; and 3) chemical. Given more recent understanding in the pathogenesis of PJI, the microscopic targeting of the bacterial biofilm and intracellular pathogens should also be included...

Introduction: Pressure ulcer-related pelvic osteomyelitis is a relatively under-studied entity in the field of bone infection. We sought to add to the limited evidence base for managing this challenging syndrome. Methods: Cases were identified retrospectively from a surgical database and hospital discharge codes at a U.K. tertiary centre (2009-201...

Biomaterial infections associated with indwelling surgical devices are responsible for ~50% of all nosocomial infections. The development of orthopedic biomaterial-associated infections comes at great physical and emotional cost to patients, resulting in substantial economic costs to healthcare providers. Understanding of its pathogenesis has progr...

Introduction Staphylococci are responsible for ~60% prosthetic joint infections, costing the NHS £70-120 million per annum. Its ability to develop tolerance to a diverse range of antimicrobial compounds threatens to halt routine elective implant surgery. One strategy to overcome this problem is to look beyond traditional antimicrobial drug therapie...

Objectives The aim of this study was to review the current evidence and future application for the role of diagnostic and therapeutic ultrasound in fracture management. Methods A review of relevant literature was undertaken, including articles indexed in PubMed with keywords “ultrasound” or “sonography” combined with “diagnosis”, “fracture healing...

Introduction Staphylococci are responsible for ~60% prosthetic joint infections, costing the NHS £70-120 million per annum. Its ability to develop tolerance to a diverse range of antimicrobial compounds threatens to halt routine elective implant surgery. One strategy to overcome this problem is to look beyond traditional antimicrobial drug therapie...

External fixation is currently used as the definitive mode of fracture stabilisation in the management of ˜50% of long-bone non-unions. Distinction between non-union and delayed union is a diagnostic dilemma especially in fractures healing by primary bone repair. This distinction is important, as non-unions are not necessarily part of the same spec...

INTRODUCTION: Staphylococcus aureus is responsible for 60-70% infections of surgical implants and prostheses in Orthopaedic surgery, with cumulative treatment costs for all prosthetic joint infections estimated to be ~ $1 billion per annum. Its ability to develop resistance or tolerance to a diverse range of antimicrobial compounds, threatens to ha...

Introduction Staphylococci are responsible for ~50% fracture-related infections, with cumulative treatment costs of all implant-related infections estimated to be ~ $1 billion per annum in the USA alone. Its ability to develop antimicrobial tolerance presents a clinical conundrum. Biophysical modalities, such as ultrasound, are poorly explored, but...

Staphylococcus aureus is responsible for 60-70% infections of surgical implants and prostheses in Orthopaedic surgery, costing the NHS £120-200 million per annum. Its ability to develop resistance or tolerance to a diverse range of antimicrobial compounds, threatens to halt routine elective implant surgery. One strategy to overcome this problem is...

Background: Biofilm-associated infections are one of the most feared complications in orthopaedics. The key to successful revision surgery, regardless of treatment strategy, is a thorough deep debridement. There has been increasing interest in the use of acetic acid as an adjunct to debridement strategies in the management of biofilm-associated inf...

Objectives Nasal carriers of Staphylococcus aureus (MRSA and MSSA) have an increased risk for health-care associated infections. There are currently limited national screening policies for the detection of S. aureus despite WHO recommendations. This study aimed to; evaluate the diagnostic performance of molecular and culture techniques in S. aureus...

Staphylococcus aureus is responsible for 60-70% infections of surgical implants and prostheses in Orthopaedic surgery, costing the NHS £120-200 million per annum. Its ability to develop resistance or tolerance to a diverse range of antimicrobial compounds, threatens to halt routine elective implant surgery. One strategy to overcome this problem is...

Staphylococcus aureus is responsible for 60-70% infections of surgical implants and prostheses in Orthopaedic surgery, costing the NHS £120-200 million per annum. Its ability to develop resistance or tolerance to a diverse range of antimicrobial compounds, threatens to halt routine elective implant surgery. One strategy to overcome this problem is...

Objectives Periprosthetic joint infection following joint arthroplasty surgery is one of the most feared complications. The key to successful revision surgery for periprosthetic joint infections, regardless of treatment strategy, is a thorough deep debridement. In an attempt to limit antimicrobial and disinfectant use, there has been increasing int...

Approximately a third of patients presenting with long-bone non-union have undergone plate fixation as their primary procedure. In the assessment of a potential fracture non-union it is critical to understand the plating technique that the surgeon was intending to achieve at the primary procedure, i.e. whether it was direct or indirect fracture rep...

Aim The aim of this study was to determine whether the absence of periosteal reaction on plain radiographs was predictive of exchange nail failure in lower limb diaphyseal fracture non-unions. Methods A consecutive cohort of 20 femora and 35 tibiae undergoing exchange nailing for diaphyseal aseptic (n=39) and septic (n=16) fracture non-union at a...

Purpose. Despite WHO recommendations, there is currently no national screening and eradication policy for the detection of methicillin-sensitive Staphylococcus aureus (MSSA) in the UK prior to elective orthopaedic surgery. This study aimed to evaluate the effectiveness of current standard methicillin-resistant S. aureus (MRSA) eradication therapies...

Purpose: Despite WHO recommendations, there is currently no national screening and eradication policy for the detection of methicillin-sensitive Staphylococcus aureus (MSSA) in the UK prior to elective orthopaedic surgery. This study aimed to evaluate the effectiveness of current standard methicillin-resistant S. aureus (MRSA) eradication therapie...

Abstract Aim: The aim of this study was to determine whether the absence of periosteal reaction on plain radiographs was predictive of exchange nail failure in lower limb diaphyseal fracture non-unions. Methods: A consecutive cohort of 20 femora and 35 tibiae undergoing exchange nailing for diaphyseal aseptic (n=39) and septic (n=16) fracture no...

Objectives Periprosthetic joint infection following joint replacement surgery is one of the most feared complications. The key to successful revision surgery for periprosthetic joint infections, regardless of treatment strategy is a thorough deep debridement. In an attempt to limit antimicrobial and disinfectant use, there has been increasing inter...

Objectives Periprosthetic joint infection following joint replacement surgery is one of the most feared complications. The key to successful revision surgery for periprosthetic joint infections, regardless of treatment strategy is a thorough deep debridement. In an attempt to limit antimicrobial and disinfectant use, there has been increasing inter...

Abstract Objectives Nasal carriers of Staphylococcus aureus (MRSA and MSSA) have an increased risk for health-care associated infections. There are currently limited national screening policies for the detection of S. aureus despite WHO recommendations. This study aimed to; evaluate the diagnostic performance of molecular and culture techniques in...

Abstract Purpose. Despite WHO recommendations there is currently no national screening and eradication policy for the detection of methicillin-sensitive Staphylococcus aureus (MSSA) in the UK prior to elective orthopaedic surgery. This study aimed to evaluate the effectiveness of current standard methicillin-resistant S. aureus (MRSA) eradication t...

Objectives: Nasal carriers of Staphylococcus (S.) aureus (MRSA and MSSA) have an increased risk for healthcare-associated infections. There are currently limited national screening policies for the detection of S. aureus despite the World Health Organization's recommendations. This study aimed to evaluate the diagnostic performance of molecular an...

Nasal carriers of methicillin sensitive Staphylococcus aureus (MSSA) have an increased risk for health-care associated infections. There is currently no national screening policy for the detection of MSSA in the UK. This study aimed to: evaluate the diagnostic performance of molecular and culture techniques in MSSA screening, determine the cause of...

Aims: The aims of the study were to review and analyse the reported series of debridement, antibiotics and implant retention (DAIR) in the management of infected total hip arthroplasties (THAs) to establish the overall success and the influencing factors. Patients and methods: Using a standardised recognised study protocol, meta-analysis of obse...

INTRODUCTION: Carriers of Staphylococcus aureus, both methicillin sensitive (MSSA) and methicillin resistant (MRSA), have an increased risk for health-care associated infections. Despite WHO recommendations there is currently no national screening and eradication policy for the detection of MSSA in the UK or USA. This study aimed to evaluate the ef...

Nasal carriers of methicillin sensitive Staphylococcus aureus (MSSA) have an increased risk for health-care associated infections. There is currently no national screening policy for the detection of MSSA in the UK. This study aimed to: evaluate the diagnostic performance of molecular and culture techniques in MSSA screening, determine the cause of...

Nasal carriers of methicillin sensitive Staphylococcus aureus (MSSA) have an increased risk for health-care associated infections. There is currently no national screening policy for the detection of MSSA in the UK. This study aimed to: evaluate the diagnostic performance of molecular and culture techniques in MSSA screening, determine the cause of...

INTRODUCTION: Nasal carriers of Staphylococcus aureus (MRSA and MSSA) have an increased risk for health-care associated infections. There are currently limited screening policies for the detection of S. aureus in the US and UK despite WHO recommendations. This study aimed to; evaluate the diagnostic performance of molecular and culture techniques i...

In vitro biofilm assays are a vital first step in the assessment of therapeutic effectiveness. Current biofilm models have been found to be limited by throughput, reproducibility, and cost. We present a novel in vitro biofilm model, utilising a sodium alginate substratum for surface biofilm colony formation, which can be readily dissolved for accur...

The aims of the study were primarily to establish the overall success of debridement, antibiotics and implant retention (DAIR) in the management of infected total hip replacements (THRs) and secondarily to identify risk factors for failure. Using a standardised and recognised study protocol (“Meta-analysis of observational studies in epidemiology...

Non-union is a devastating consequence of a fracture. Non-unions cause substantial patient morbidity with patients suffering from loss of function of the affected extremity, increased pain, and a substantial decrease in the quality of life. The management is often associated with repeated, unsuccessful operations resulting in prolonged hospital sta...

Abstract Aims The aims of the study were primarily to establish the overall success of debridement, antibiotics and implant retention (DAIR) in the management of infected total hip replacements (THRs) and secondarily to identify risk factors for failure. Patients and methods Using a standardised and recognised study protocol (“Meta-analysis of ob...

Objectives: A successful outcome following treatment of nonunion requires the correct identification of all of the underlying cause(s) and addressing them appropriately. The aim of this study was to assess the distribution and frequency of causative factors in a consecutive cohort of nonunion patients in order to optimise the management strategy f...

To evaluate the outcome of combined tibialis anterior tendon shortening (TATS) and calf muscle-tendon lengthening (CMTL) in spastic equinus. Prospectively collected data was analysed in 26 patients with hemiplegic (n=13) and diplegic (n=13) cerebral palsy (CP) (GMFCS level I or II, 14 males, 12 females, age range 10–35 years; mean 16.8 years). Non...

Aims: The aim of this study was to identify risk factors for the failure of exchange nailing in nonunion of tibial diaphyseal fractures. Patients and methods: A cohort of 102 tibial diaphyseal nonunions in 101 patients with a mean age of 36.9 years (15 to 74) were treated between January 1992 and December 2012 by exchange nailing. Of which 33 (3...

The aim of this study was to identify risk factors for failure of exchange nailing for femoral diaphyseal fracture non-unions. The study cohort comprised 40 patients with femoral diaphyseal non-unions treated by exchange nailing. The main outcome measures were union, number of secondary fixation procedures required to achieve union and time to unio...

Exchange nailing for tibial diaphyseal fracture non-unions. Risk factors for failure.

Introduction Hip fractures remain the most common orthopaedic injury requiring hospital admission. Failed surgery for any cause carries a higher morbidity, mortality, and healthcare-related cost. The aims of this study were to determine risk factors for surgical complications of hip fracture surgery, when they occurred and their effect on mortality...

Total hip replacement (THR) has been shown to be a cost-effective procedure. However, it is not risk-free. Certain conditions, such as diabetes mellitus, are thought to increase the risk of complications. In this study we have evaluated the prevalence of diabetes mellitus in patients undergoing THR and the associated risk of adverse operative outco...

Proximal femoral fractures remain the most common reason for admission to hospital following orthopaedic injury, with an annual cost of £1.7 billion to the National Health Service and social care services. Fragility fractures of the hip in the elderly are a substantial cause of mortality and morbidity. Revision surgery for any cause carries a highe...

Introduction Fracture non-union is a devastating cause of patient morbidity. The cost of NU treatment ranges from £7,000 to £79,000. With an estimated 11,700 cases in the UK pa the financial implications are huge, potentially costing several hundreds of million of pounds annually. Successful outcome in the management of non-union is based upon cor...

Patient-reported outcomes following hip arthroscopy