Archived project

Orthopaedic Surgery

Goal: Orthopaedic surgery is a specialty dealing with acute injuries, congenital and acquired disorders and chronic arthritic or overuse conditions of the bones, joints and their associated soft tissues, including ligaments, nerves and muscles.

Date: 1 January 1988

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Chris Oliver
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Purpose Positive ulnar variance following a distal radius malunion can lead to ulnar-sided wrist pain, loss of grip strength, and distal radioulnar joint impingement. The primary aim of this study is to describe upper limb-specific functional outcomes following ulnar shortening osteotomy (USO) for ulnar-sided wrist pain associated with malunion of the distal radius. Methods We retrospectively identified 40 adult patients from a single centre over a 9-year period that had undergone an USO for symptomatic malunion of the distal radius. The primary outcome was the patient-rated wrist evaluation (PRWE). Secondary outcomes were the QuickDASH, EQ-5D-5L, complications, and net promoter score (NPS). Results Outcomes were available for 37 patients (93%). The mean age was 56 years and 25 patients were female (68%). At a mean follow-up of 6 years (range 1–10 years) the median PRWE was 11 (IQR 0–29.5), the median QuickDASH 6.8 (IQR 0–29.5), and the median EQ-5D-5L index was 0.88 (IQR 0.71–1). The NPS was 73. Complications occurred in nine patients (24%) and included non-union (n = 4), early loss of fixation requiring revision surgery (n = 1), superficial wound infection (n = 2), neurological injury (n = 1), and further surgery for symptomatic hardware removal (n = 1). Conclusions For patients with a symptomatic distal radius malunion where the predominant deformity is ulnar positive variance, this study has demonstrated that despite 1 in 4 patients experiencing a complication, USO can result in excellent patient reported outcomes with high levels of satisfaction. Level of Evidence III (Cohort Study).
Chris Oliver
added a research item
Purpose: There is a paucity of literature regarding the long-term outcomes of scaphoid fractures managed with acute percutaneous fixation. The aim of this study was to report the long-term functional outcomes and complication rates following early percutaneous fixation of acute fractures of the scaphoid. Methods: A trauma database was searched to identify all skeletally-mature patients with a scaphoid fracture managed with early percutaneous fixation over a thirteen-year period from 1997-2010. Medical records were retrospectively reviewed, and complications documented. Long-term follow-up was by a questionnaire-based review. The Patient-Rated Wrist Evaluation (PRWE) was the primary outcome measure. Secondary outcomes included the Quick version of the Disability of the Arm, Shoulder and Hand score (QuickDASH), the EuroQol 5-dimensions score (EQ-5D-5L), and complications. Results: During the study period 114 patients underwent this procedure. The mean age was 28 years (SD 9; range 17-62 years) and 97 patients (85%) were male. The median time from injury to surgery was nine days (range 1-27; IQR 5-13 days). The mean time to radiographic union was 13 weeks (SD 7; range 5-40 weeks). Twelve patients (11%) reported a complication, all of whom required repeat surgical intervention (six revision ORIF for non-union, five elective removal of hardware, one acute revision fixation due to screw impingement). Long-term outcome data was available for 77 patients (68%) at mean follow-up of 11.4 years (range 6.4-19.8 years). The median PRWE was 0 (IQR 0-7.5), median QuickDASH 0 (IQR 0-4.5) and median EQ-5D-5L 1.0 (IQR 0.837-1.0). There were 97% (n=74) of patients satisfied with their outcome. Conclusion: This study has demonstrated that early percutaneous fixation of acute non-displaced or minimally displaced scaphoid fractures results in good long-term patient reported outcomes and health related quality of life. High patient satisfaction, along with return to work and physical activities were also observed, with minimal morbidity and low overall pain scores. Program https://simplebooklet.com/otaam21preliminaryprogram1#page=31
Chris Oliver
added a research item
Stress fractures of the metacarpals and phalanges are extremely rare injuries. They occur almost universally in adolescents. Metacarpal stress fractures are typically associated with racquet or grip sports, and phalangeal fractures typically occur in rock climbers. Symptoms can be subtle, but magnetic resonance imaging usually reveals the injury. Treatment is nonoperative, with high levels of return to sport, and minimal morbidity.
Chris Oliver
added 2 research items
The aim of this study was to report the long-term functional outcomes and complication rates following early percutaneous fixation of acute fractures of the scaphoid. A trauma database was searched to identify all skeletally-mature patients with an undisplaced or minimally-displaced scaphoid waist fracture managed with early percutaneous retrograde screw fixation over a thirteen-year period from 1997-2010. Medical records were retrospectively reviewed, and complications documented. Long-term follow-up was by a questionnaire-based review. The Patient-Rated Wrist Evaluation (PRWE) was the primary outcome measure. Secondary outcomes included the Quick version of the Disability of the Arm, Shoulder and Hand score (QuickDASH), the EuroQol 5-dimensions score (EQ-5D-5 L), and complications. During the study period 114 patients underwent this procedure. The mean age was 28 years (range, 17–62) and 97 patients (85%) were male. The median time from injury to surgery was nine days (range, 1–27). Twelve patients (11%) reported a complication, all of whom required repeat surgical intervention (six revision ORIF for non-union, five elective removal of hardware, one early revision fixation due to screw impingement). Long-term outcome data was available for 77 patients (68%) at mean follow-up of 11.4 years (range, 6.4–19.8). The median PRWE was 0 (IQR 0–7.5), median QuickDASH 0 (IQR 0–4.5) and median EQ-5D-5 L 1.0 (IQR 0.837–1.0). There were 97% (n = 74) patients satisfied with their outcome. Early percutaneous fixation of acute non-displaced or minimally displaced scaphoid fractures results in good long-term patient reported outcomes and health-related quality of life. Although comparable with previous studies, the overall surgical reintervention rate is notable and can result in inferior outcomes. Level of evidence Therapeutic level III (Retrospective Cohort Study).
Chris Oliver
added a research item
Invited Gold Medal lecture. "How not to be a surgeon!" Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK. Closed virtual event. 2021. The pdf file is only pictures. The original presentation has sound and video, the file is too big for ResearchGate, contact me for a DropBox Link.
Chris Oliver
added a research item
Aims: Patient-reported outcomes after corrective osteotomy for a symptomatic malunion of the distal radius aims the primary aim of this study was to describe patient satisfaction and health-related quality of life (HrQoL) following corrective osteotomy for a symptomatic malunion of the distal radius. Methods: We retrospectively identified 122 adult patients from a single centre over an eight-year period who had undergone corrective osteotomy for a symptomatic malunion of the distal radius. the primary long-term outcome was the Patient-rated Wrist Evaluation (PrWE) score. secondary outcomes included the Quick disabilities of the arm, shoulder and Hand (QuickdasH) score, the EQ-5d-5L score, complications, and the net Promoter score (nPs). Multivariate regression analysis was used to determine factors associated with the PrWE score. Results: Long-term outcomes were available for 89 patients (72%). The mean age was 57 years (SD 15) and 68 were female (76%). The median time from injury to corrective osteotomy was nine months (interquartile range (IQR) 6 to 13). At a mean follow-up of six years (1 to 11) the median PRWE score was 22 (IQR 7 to 40), the median QuickDASH score was 11.4 (IQR 2.3 to 31.8), and the median EQ-5D-5L score was 0.84 (IQR 0.69 to 1). The NPS was 69. Multivariate regression analysis showed that the presence of an associated ulnar styloid fracture was the only significant independent factor associated with a worse PRWE score when adjusting for confounding variables (p = 0.004). Conclusion: We found that corrective osteotomy for malunion of the distal radius can result in good functional outcomes and high levels of patient satisfaction. However, the presence of an ulnar styloid fracture may adversely affect function. Level of Evidence: iii (cohort study). Cite this article: Bone Joint J 2020;102-B(11):1542-1548.
Chris Oliver
added 2 research items
Invited Opinion Platform piece. Edinburgh Evening News. 30th Sept 2019 https://www.edinburghnews.scotsman.com/news/opinion/lower-road-speeds-can-help-to-save-more-cyclists-lives-prof-chris-oliver-1-5013190/amp
AO Surgery Reference is an internet-based resource for the management of fractures, based on current clinical principles, practices and available evidence. It describes the complete surgical management process from diagnosis to aftercare for fractures in a given anatomical region, and also assembles relevant published AO material. Chris Oliver, Florian Gebhard and Phil Kregor prepared the first edition of distal femur and patella. Web https://www2.aofoundation.org/wps/portal/surgery App https://apps.apple.com/us/app/ao-surgery-reference/id403961165?ls=1
Chris Oliver
added a research item
Plenary lecture by Prof Chris Oliver on "Medical issues surrounding vibration exposure & chronic pain". The UK Conference on Human Responses to Vibration #54UKHRV2019 is an opportunity for specialists from the UK and further afield to exchange information, disseminate research findings and get updated on current issues related to human exposure to vibration. Presented papers cover all aspects of hand-transmitted vibration, whole-body vibration and motion sickness. organisations since the first conference in 1968.
Chris Oliver
added a research item
King James IV Professorial Lecture. Prof Chris Oliver shares insights into improving data visualisation and knowledge transfer. Publication in Surgeons News. Royal College of Surgeons of Edinburgh. https://www.rcsed.ac.uk/news-public-affairs/surgeons-news/september-2019 pages 28-32
Chris Oliver
added a project goal
Orthopaedic surgery is a specialty dealing with acute injuries, congenital and acquired disorders and chronic arthritic or overuse conditions of the bones, joints and their associated soft tissues, including ligaments, nerves and muscles.
 
Chris Oliver
added a research item
Early percutaneous screw fixation is increasingly used to manage acute scaphoid fractures as it provides a quicker return to work and sports, but little is known about the long-term subjective outcomes following surgery. The aim of this study was to report the long-term outcomes and complication rates following early percutaneous fixation of acute fractures of the scaphoid. A prospective trauma database was searched to identify all skeletally-mature patients with scaphoid fractures managed with early percutaneous fixation over a thirteen-year period from 1997-2010. Medical records were retrospectively reviewed, and complications documented. Long-term follow-up was by a questionnaire-based telephone review: The Patient-Reported Wrist Evaluation (PRWE) was the primary outcome measure. Secondary outcomes included subjective ratings of pain, stiffness and satisfaction, the Quick Disability of the Arm, Shoulder and Hand (QuickDASH) score, and the EQ-5D-5L questionnaire as a standardized measure of general health status. Patients managed with early percutaneous fixation of acute scaphoid fractures report excellent long-term subjective outcomes with minimal persistent pain, low complication rates and high satisfaction. The long-term outcomes are comparable to other management approaches but offer a quicker return to work and sport. Patients who developed complications reported poorer long-term outcomes, therefore future research should aim to determine predictors of complication in patients selected for early percutaneous fixation. Recent meta-analyses have highlighted the need for sufficiently-powered, multicenter RCTs directly comparing early percutaneous fixation and conservative management. The results of the UK SWIFFT trial are awaited.
Chris Oliver
added a research item
Hypothesis: Early percutaneous screw fixation is increasingly used to manage acute scaphoid fractures as it provides a quicker return to work and sports, but little is known about the long-term subjective outcomes following surgery. The aim of this study was to report the long-term outcomes and complication rates following early percutaneous fixation of acute fractures of the scaphoid. Methods: A prospective trauma database was searched to identify all skeletally-mature patients with scaphoid fractures managed with early percutaneous fixation over a thirteen-year period from 1997-2010. Medical records were retrospectively reviewed and complications documented. Long-term follow-up was by a questionnaire based telephone review. The Patient-Reported Wrist Evaluation (PRWE) was the primary outcome measure. Secondary outcomes included subjective ratings of pain, stiffness and satisfaction, the Quick Disability of the Arm, Shoulder and Hand (QuickDASH) instrument, and the EuroQol EQ-5D-5L questionnaire as a standardised measure of general health status. Results: 116 patients (88% male) with a mean age of 28.5 years (range, 15-62) at time of injury were identified. Thirteen patients (11%) had an identified complication during their recovery, with twelve patients requiring further surgical intervention. Six patients developed a non-union, with 3 patients having persistent non-union despite further with ORIF and bone grafting. Six patients had a prominent symptomatic screw that was either subsequently removed or one that underwent early revision. There was an association between mechanism of injury and development of a complication (p=0.007), with higher than expected rates of falls from height in the complication group. At a mean follow-up of 9.9 years (range, 6.4-19.0; n=50 currently), six patients (12%) reported persistent pain in their wrist with a mean VAS score of 0.6/10. Stiffness was more prevalent at 24%. Ninety-six percent of patients were satisfied with their wrist, with a median satisfaction rating of 10/10 (completely satisfied). The mean PRWE score was 7.4 ±14.6 (range, 0.0-84.5) and mean QuickDASH score was 3.6 ±7.8 (range, 0.0-45.0). The median EQ-5D-5L impairment index value was 1.000 (no impairment), and the mean self-perceived global health rating (EQ-VAS) was 82/100. Summary Points:  Patients managed with early percutaneous fixation of acute scaphoid fractures report excellent long-term subjective outcomes with minimal persistent pain, low complication rates and high satisfaction  The long-term outcomes are comparable to other management approaches but offer a quicker return to work and sport. Was selected as top 5 poster at the ASSH meeting
Chris Oliver
added a research item
Introduction: Understanding of tram-system related cycling injuries (TSRCI) is poor. The aim of this study was to report the spectrum of injuries, demographics and social deprivation status of patients. Secondary aims included assessment of accident circumstances, effects of TSRCI on patients' confidence cycling, together with time off work and cycling. Methods: A retrospective review of patients presenting to emergency services across all hospitals in Edinburgh and West Lothian with tram related injuries between May 2009 and April 2016 was undertaken. Medical records and imagining were analysed and patients were contacted by telephone. Results: 191 cyclists (119 males, 72 females) were identified. 63 patients sustained one or more fractures or dislocations. Upper limb fractures/dislocations occurred in 55, lower limb fractures in 8 and facial fractures in 2. Most patients demonstrated low levels of socioeconomic deprivation. In 142 cases, the wheel was caught in tram-tracks, while in 32 it slid on tracks. The latter occurred more commonly in wet conditions (p = 0.028). 151 patients answered detailed questionnaires. Ninety-eight were commuting. 112 patients intended to cross tramlines and 65 accidents occurred at a junction. Eighty patients reported traffic pressures contributed to their accident. 120 stated that their confidence was affected and 24 did not resume cycling. Female gender (p < 0.001) and presence of a fracture/dislocation (p = 0.012) were independent predictors of negative effects on confidence. Patients sustaining a fracture/dislocation spent more time off work (median 5 days vs 1, p < 0.001) and cycling (median 57 days vs 21, p < 0.001). Conclusions: TSRCI occur predominantly in young to middle-aged adults with low levels of socioeconomic deprivation, most commonly when bicycle wheels get caught in tram-tracks. They result in various injuries, frequently affecting the upper limb. Traffic pressures are commonly implicated. Most patients report negative effects on confidence and a sizeable minority do not resume cycling. TSRCI can result in significant loss of working and cycling days.
Chris Oliver
added 3 research items
The centenarian population is increasing yet there is little about their morbidity and mortality rates following hip fracture. The aim was to review centenarians treated for proximal femoral fractures in Edinburgh describing treatment outcomes in relation to mortality, walking ability and residential status comparing centenarians with a the more typical hip fracture population. In this retrospective review, 18 centenarians sustaining hip fractures in Edinburgh between 1998 and 2002 were compared to 18 randomly selected "normal" hip fracture patients aged 75-83 years. Centenarian in-hospital, 1 and 4 month mortality was 11.1, 33.3 and 50%, respectively, versus 0, 0 and 5.6% in the normal group. Centenarian 4 month mortality was significantly greater than that of the normal group (Fisher's Exact Test, P = 0.00723). A total of 22.2% of centenarians regained pre-fracture walking ability compared to 58.8% of the normal patients. A total 28.6% of centenarians could continue living independently post-fracture compared to 69.2% of the normal group.
What's in a name. What email names do doctors and medics call themselves.
Chris Oliver
added a research item
Chris Oliver
added 8 research items
Initial Impact of a Back Care Screening Program for Hospital Employees on Back Sickness; Cost Benefit Analysis
The use of an end cap to avoid osseous ingrowth and to facilitate later removal of intramedullary nails is a widely practised technique. The authors have experi- enced problems during the insertion of the end cap, especially with regard to the femoral nail. It is possible to dislodge the cap from the end of the screwdriver prior to insertion in the thread of the nail, resulting in either losing the cap in the Figure 1. Marlingspike hitch knot.
Chris Oliver
added 3 research items
Inefficiency in surgical training has been identified as a result of low rates of supervision, with direct teaching of operating by consultants occurring in less than 20% of cases in papers dealing with general surgery and cardiac surgery training. The introduction of an audit system in an orthopaedic training programme was associated with an improvement of teaching from an already high 30% to 40% of cases. A logbook programme was introduced which allows easy analysis of the distribution of experience on an anatomical basis.
A case of cellulitis of the hand resulting from embedding of a dental crown following a punch injury is described. This report emphasises the need for X-ray imaging in all cases of penetrating hand trauma, particularly when the history is vague, and also the difficulty in using metronidazole in alcoholic patients.
Chris Oliver
added 7 research items
Objective. To establish the reproducibility of surface recordings of electromyograms from lumbar erector spinae muscles.Design. Repeated measurements in 10 male volunteers under controlled conditions.Methods. While isometric load was held constant at of maximum voluntary contraction, surface electromyograms were recorded from the 4th/5th lumbar interspace on three occasions separated by at least a day. Fresh surface electrodes were applied on each test occasion. The raw electromyographic signal was filtered and digitized and the signal processed by fast Fourier transformation to give median frequency and total amplitude spectra. Linear regression lines of median frequency and amplitude against time were calculated. The ‘spectral halfwidth’ was defined as the full width at half maximum of the composite amplitude spectrum. Reproducibility was assessed by calculation of the intraclass correlation coefficient.Results. Reproducibility of initial median frequency and spectral halfwidth were found to be excellent at both (ICCC 0.91 and 0.88) and (ICCC 0.84 and 0.83) maximum voluntary contraction. Initial power and regression slopes of power and median frequency were not reproducible.Conclusions. The reproducibility of two electromyographic variables, the initial median frequency and the spectral halfwidth, were found to be satisfactory.