Usman Ahmed

Worcestershire Acute Hospitals NHS Trust · Trauma & Orthopaedics

There is currently no biochemical test for detection of early-stage osteoarthritis (eOA). Tests for early-stage rheumatoid arthritis (eRA) such as rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) antibodies require refinement to improve clinical utility. We developed robust mass spectrometric methods to quantify citrullinated prot...

Increased damage to proteins by glycation, oxidation and nitration has been implicated in neuronal cell death leading to Alzheimer's disease (AD). Protein glycation, oxidation and nitration adducts are consequently formed. Quantitative screening of these adducts in CSF may provide a biochemical indicator for the diagnosis of AD. To assess this, we...

Dicarbonyl glycation of RGD and GFOGER sites in type IV collagen has been associated with decreased angiogenesis. In this study, we investigated whether overexpression of glyoxalase 1 to decrease dicarbonyl glycation would prevent the angiogenesis deficit induced by hyperglycemia in vitro. Transfection of human microvascular endothelial cells resul...

Background: The Headless Compression Screw(®) (HCS) is a cannulated screw that is used for scaphoid fracture fixation. The screw generates compression across the fracture site prior to being countersunk below the articular surface. Methods: We performed a retrospective review of 56 consecutive scaphoid fixations using this device in patients wit...

Aims: Periprosthetic fractures (PPFs) around the knee are challenging injuries. This study aims to describe the characteristics of knee PPFs and the impact of patient demographics, fracture types, and management modalities on in-hospital mortality. Methods: Using a multicentre study design, independent of registry data, we included adult patient...

Introduction Total knee arthroplasty (TKA) can be performed with either conventional off-the-shelf (OTS) or customized individually-made (CIM) implants. The evidence for CIM implants is limited and variable, and the aim of this review was to compare clinical and radiological outcomes between CIM and OTS implants. Methods A systematic review and me...

Aims: Periprosthetic fractures (PPFs) following hip arthroplasty are complex injuries. This study evaluates patient demographic characteristics, management, outcomes, and risk factors associated with PPF subtypes over a decade. Methods: Using a multicentre collaborative study design, independent of registry data, we identified adults from 29 cen...

Customised individually made implants(CIM) total knee arthroplasty(TKA) are custom-made to better fit patients native anatomy and aim to improve outcomes which can be variable with conventional off-the-shelf(OTS). A systematic review and meta-analysis was conducted searching the MEDLINE and Embase databases. Studies reporting on patient reported ou...

Industries such as agriculture, construction and military have stringent rules about hearing protection due to the risk of noise induced hearing loss (NIHL). Due to the use of power tools, orthopaedic staff may be at risk of the same condition. The UK Health and Safety Executive (HSE) have clear standards as to what is deemed acceptable occupationa...

Evaluation of the occupational sound exposure in orthopaedics

Aims: In the UK, the agricultural, military, and construction sectors have stringent rules about the use of hearing protection due to the risk of noise-induced hearing loss. Orthopaedic staff may also be at risk due to the use of power tools. The UK Health and Safety Executive (HSE) have clear standards as to what are deemed acceptable occupationa...

Background and objective: A significant increase has been observed globally in multi-centre trainee-led trauma & orthopaedic (T&O) research collaborative projects with more emphasis have been on tackling important research questions since the start of the COCID-19 pandemic. The objective of our analysis was to determine the number of trainee-led r...

Background Cauda equina syndrome (CES) results from nerve root compression in the lumbosacral spine, usually due to a prolapsed intervertebral disc. Evidence for management of CES is limited by its infrequent occurrence and lack of standardised clinical definitions and outcome measures. Methods This is a prospective multi-centre observational coho...

Introduction Virtual fracture clinics (VFC) have been shown to be a safe and cost-effective way of managing outpatient referrals to the orthopaedic department. During the coronavirus pandemic there has been a push to reduce unnecessary patient contact whilst maintaining patient safety. Method A protocol was developed by the clinical team on how to...

Introduction There has been a rise in trainee-led trauma & orthopaedic multi-centre research collaborative projects globally. These increase trainee involvement in research with an opportunity to deliver highly generalisable results on a particular topic. Objective: To evaluate the number of trauma & orthopaedic trainee-led research collaborative p...

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...

Background: Virtual fracture clinics (VFC) have been shown to be a safe and cost-effective way of managing outpatient referrals to the orthopaedic department. During the coronavirus pandemic there has been a push to reduce unnecessary patient contact whilst maintaining patient safety. Methods: A protocol was developed by the clinical team in col...

Introduction Virtual fracture clinics (VFC) have been shown to be a safe and cost-effective way of managing outpatient referrals to the orthopaedic department. During the coronavirus pandemic there has been a push to reduce unnecessary patient contact whilst maintaining patient safety. Method A protocol was developed by the clinical team on how to...

Introduction There has been a significant rise in trainee-led trauma & orthopaedic (T&O) multi-centre research collaborative projects globally. Since the start of the COVID-19 pandemic, more emphasis has been on global collaborative research efforts to tackle important research questions. The aim was to evaluate the number of T&O trainee-led resear...

Background: The COVID-19 pandemic has resulted in significantly reduced educational opportunities for vascular trainees in the UK. Senior trainees preparing for their FRCS exam and future consultant interviews could not attend the usual preparation courses due to the pandemic. Learning Management Systems (LMS) have been used to good effect in under...

Background: There has been a rising tendency towards surgical intervention for diaphyseal forearm fractures in children in recent years; however, the literature lacks robust evidence for this. The aim of this systematic review was to identify and critically analyse studies examining the functional outcomes and complications of operative versus non-...

Aim The Postgraduate Virtual Learning Environment (PGVLE) is a digital platform developed by HEEWM in response to the COVID-19 pandemic to deliver a virtual teaching programme to surgical trainees. The programme is delivered through the BigBlueButton; an integrated virtual classroom. All teaching sessions are recorded and archived to allow trainees...

Introduction Surgical conferences are invaluable events for healthcare professionals; they provide opportunities to engage with upcoming scientific discoveries, network professionally with peers as well as expand learning through lectures and workshops. For medical students, conferences provide an opportunity to expand understanding beyond the unde...

Ruptures of the extensor mechanism of the knee are serious injuries requiring prompt diagnosis and treatment. They can be divided into soft tissue and bony causes. Soft tissue tendon injuries can be either partial or complete. Rupture of the quadriceps tendon is an uncommon injury and is more frequent in patients over the age of 40 years. Patella t...

Introduction Postgraduate medical education in the wake of a pandemic has sparked creativity, evolving novel platforms concordant with socially distanced learning. Inevitably, evaluation is critical in navigating improvements in content delivery. However, as culture continues to shift away from didactic teaching, students are at risk of ‘feedback o...

The COVID-19 pandemic has required educators to adapt quickly to the needs of the surgical trainee, in particular during the “lockdown” period of March to July 2020. Redeployments for service provision yielded the knock-on effects of trainees losing theatre opportunities and face-to- face teaching sessions.

Background Many worldwide regulatory authorities recommend regular surveillance of metal-on-metal hip arthroplasty patients given high failure rates. However, concerns have been raised about whether such regular surveillance, which includes asymptomatic patients, is evidence-based and cost-effective. We determined: (1) the cost of implementing the...

Introduction There is a huge variation in the depth and breadth of content taught regarding orthopaedic examinations. Undergraduate students are often confused by the variability in examination teaching, therefore increasing concerns for upcoming objectively structured clinical examinations (OSCEs). Doctors, despite being expected to teach, rarely...

Postgraduate medical education in the wake of a pandemic has sparked creativity, evolving novel platforms concordant with socially distanced learning. Inevitably, evaluation is critical in navigating improvements in content delivery. However, as culture continues to shift away from didactic teaching, students are at risk of 'feedback overload'. We...

Aims The increased use of social media creates opportunity for new, effective methods of delivering medical and clinical education. Twitter is a popular social media platform where users can post frequent updates and create threads containing related content using hashtags. This study aims to investigate and analyse the type of content relating to...

Aims: we aimed to find out: the typical workload for metastatic bone disease, the conventional treatment for femoral metastases and whether there is a trend for arthroplasty and endoprosthetic reconstruction. Materials and methods: All sequential patients undergoing surgery for femoral metastatic lesions (both pathological fracture and impending p...

Objective The aim of this study was to review our experience of managing Ewing's sarcoma of scapula and to identify features predictive of a good outcome. Hypothesis Surgery and neo-adjuvant chemotherapy would have a better survival than surgery alone. Patients & Methods Between 1988 and 2018, 29 patients (14 females and 15 males) were treated at...

Objective: The aim of this study was to review our experience of managing Ewing's sarcoma of scapula and to identify features predictive of a good outcome. Hypothesis: Surgery and neo-adjuvant chemotherapy would have a better survival than surgery alone. Patients and methods: Between 1988 and 2018, 29patients, (14females and 15males) were trea...

Introduction: The purpose of this national study was to audit the weight-bearing practice of orthopaedic services in the National Health Service (NHS) in the treatment of operatively and non-operatively treated ankle fractures. Methods: A multicentre prospective two-week audit of all adult ankle fractures was conducted between July 3rd 2017 and...

Superficial surgical site infection is recognised as a risk factor for deep joint infection in arthroplasty. Deep joint infections cause significant morbidity, adversely affecting a patient’s quality of life and are expensive to manage. Since the advent of arthroplasty there has been a drive towards reducing infection rates and managing risk. Our i...

Background: Delirium is a common complication after surgery in the elderly that leads to increased length of stay and other adverse outcomes. The aim of this study was to better understand the exact causes of post-operative delirium in patients undergoing surgery for neck of femur (NOF) fractures. Methods: We performed a prospective cohort study of...

Abstract Background Changes of serum concentrations of glycated, oxidized, and nitrated amino acids and hydroxyproline and anticyclic citrullinated peptide antibody status combined by machine learning techniques in algorithms have recently been found to provide improved diagnosis and typing of early-stage arthritis of the knee, including osteoarthr...

Background Glycation, oxidation and nitration of proteins are reactions involved in accelerated ageing of tissues. The products of these reactions are used as biomarkers of chronic pathologies such as diabetes or chronic inflammatory states. Objectives In this work, we studied by mass spectrometry the levels of amino acids and glycated, oxidised o...

Tibial dorsiflexion osteotomy for recalcitrant equinus in clubfeet is reported to have a high recurrence rate with growth. We present the results of closing wedge tibial dorsiflexion osteotomy and tendon transfers in 15 feet and 11 patients. The mean age at presentation was 7 (range: 3.98-12.38) years. At a mean follow-up of 4.16 (range: 2.09-6.87)...

Background The orientation of the acetabulum is a critical factor in the success of total hip arthroplasty (THA). Surprisingly, there is no consensus on the correct angle of acetabular inclination, with surgeons reliant on small studies or product literature to inform their practice. Recent literature has demonstrated there is a significant differ...

Background Currently, magnetic resonance imaging techniques have been developed for evaluation of cartilage damage in early-stage osteoarthritis (eOA). These imaging techniques have approximately 70% sensitivity and 90% specificity compared to reference diagnosis by arthroscopy. They require expensive instrumentation, time and facilities. In search...

Introduction: Scapula is a relatively rare site for bone tumours with approximately 3% of bone tumours affecting this location. Tumours of the scapula can become very large before presentation and functional deficit is often limited initially. There is a variety of resection and reconstruction techniques available. Aim To investigate the type of b...

The patella is an uncommon location for neoplastic lesions to develop. The patient may present with anterior knee pain or, occasionally, a pathological fracture of patella. The diagnosis is not always clear on plain radiological images. Detailed cross sectional imaging is required along with a biopsy to obtain a definitive tissue diagnosis. Reports...

Aim: To assess how accurately orthopaedic surgeons and anaesthesiologists estimate intraoperative blood loss during hip fracture surgery as part of the Surgical Safety Checklist (SCC). Methods: A prospective study of 55 operations over 9 months. Pre- and post-operative estimations of blood loss were documented. Actual blood loss was determined b...

Background There is currently no blood-based test for detection of early-stage osteoarthritis (OA) and the anti-cyclic citrullinated peptide (CCP) antibody test for rheumatoid arthritis (RA) has relatively low sensitivity for early-stage disease. Morbidity in arthritis could be markedly decreased if early-stage arthritis could be routinely detected...

OA (osteoarthritis) and RA (rheumatoid arthritis) lead to deterioration of the joints. Early OA is associated with loss of bone due to increased bone remodelling. A role for inflammation is thought to be integral to the pathology. RA is a chronic inflammatory disease of the synovium, a membrane lining the non-weight-bearing surfaces of the joint. T...

Hallux valgus is one of the commonest conditions of the foot and has been reported to affect nearly half of the adult population. It is most effectively treated by a corrective osteotomy of which there a numerous subtypes. The Mau osteotomy confers the greatest structural stability but is not thought to provide adequate correction of moderate-sever...

Usman Ahmed and colleagues consider the costs of postgraduate medical training and how to minimise their impact