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Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA PrizesBackground and Aims Fasting guidelines have been established to reduce the risk of a pulmonary aspiration event in patients undergoing anaesthesia. Excessive fasting can contribute to anxiety, nausea, dehydration and physiological derangement. In practice, patients are likely to be fasted for longer than the conventional times. The aim of our project was to identify the average length of fluid fast in our elective patients.MethodsThis was a retrospective case-note review of 50 patients undergoing elective upper limb surgery in our tertiary orthopaedic institution. Their reported fasting times for solids and liquids were recorded. Their sent for operation times were interrogated from Operating Room Management Information System (ORMIS) computer system. This information was subsequently compiled into a datasheet.ResultsThe average fasting time for solids was 14h 30mins. The average conventional fluid fasting time was 3h 29 mins. When this adjusted to a sent for operating time, the average time was 6 h 11min (range 0min to 18h 10 min). 16% of patients included in the study were fluid fasted for greater than 12 hours.ConclusionsOur study revealed excessive fasting times in the majority of our patients. Evidently a two-hour fluid fasting target becomes a longer fast in the real world. We have adapted out current fasting guidelines to align with progressive institutions which use a sip-till-send approach to allow 170ml of water each hour until sent for operating (Checketts 2023). We will re-audit these times after implementation of the guideline.

This retrospective study investigated the relationship between preoperative comorbidities and hospitalization duration in patients undergoing total hip arthroplasty. Conducted at a single tertiary center, the analysis included 85 patients, who were stratified based on length of hospital stay into two groups: short stay (≤10 days) and prolonged stay (>10 days). Comorbidities were recorded as binary variables, and statistical tests, including Chi-square analysis, were applied to identify associations with hospitalization length. The most prevalent condition was arterial hypertension, followed by congestive heart failure, hepatic steatosis, and atrial fibrillation. Significant associations were found between prolonged hospitalization and specific comorbidities, notably congestive heart failure, liver cirrhosis, mitral regurgitation, pleural effusion, and arterial hypertension. In contrast, other conditions such as diabetes mellitus and depression did not significantly affect length of stay. These findings emphasize the role of cardiovascular and hepatic comorbidities as key predictors of delayed recovery and support the integration of individualized risk assessment into perioperative planning to improve clinical outcomes and optimize resource utilization.

Calcium pyrophosphate dihydrate deposition (CPPD) disease, also known as pseudogout, is the most common cause of calcification of ligamentum flavum (CLF) compared to other degenerative conditions. Symptomatic CLF is a rare cervical spine disorder that leads to spinal cord compression, resulting in myelopathic symptoms. We report two rare cases of pseudogout-induced cervical myelopathy, along with a review of the literature. Both patients were seen at Al-Azhar University Hospital in Cairo, Egypt, presenting with severe neck pain, gait disturbances, and hand clumsiness. The first patient had these symptoms for two months, while the second patient experienced them for three months. The second patient also had restricted motion in extension and rotation, as well as shooting pain in both upper extremities. Cervical spine MRI revealed posterior cord compression and myelomalacia at the C3-C6 levels in the first patient and at the C4-C5 levels in the second patient. Pseudogout (CPPD) disease was suspected as the cause of spinal cord compression, and histopathological analysis of the deposits found at the site of compression during the decompression procedure confirmed the diagnosis. The deposits were characterized by rhomboid blue calcium crystals that were mildly birefringent, distinguishing them from the needle-shaped crystals seen in gout. At the four-week postoperative follow-up, both patients showed significant improvement in clinical and functional outcomes, as measured by the Japanese Orthopaedic Association score. In summary, CLF due to pseudogout (CPPD deposition) is a rare but clinically significant cause of cervical myelopathy. Histopathological examination is crucial for a definitive diagnosis. Early posterior cervical decompression with instrumentation appears to be an effective treatment, though larger studies and long-term follow-up are necessary to confirm these findings and optimize management strategies.

This study aims to investigate the clinical outcomes and magnetic resonance imaging evaluation (MRI) of intra-articular injection of autologous protein solution (APS) in patients with knee osteoarthritis of varying severities. A retrospective analysis was conducted on the clinical data of consecutive subjects with knee osteoarthritis (KOA) of varying Kellgren-Lawrence (KL) grades who underwent a single APS injection. The Knee injury and Osteoarthritis Outcome Score (KOOS), covering symptoms (S), pain (P), activity (A), sports (SP), and quality of life (Q), was used to evaluate the patients at pre-treatment and 12 months post-treatment. Minimal Clinically Important Difference (MCID) and Osteoarthritis Research Society International Set Responder Criteria Osteoarthritis Clinical Trials Revisited (OMERACT-OARSI) tools were used to observe improvement in different KL grades. Additionally, an MRI was performed pre-treatment and 12 months post-treatment. Semi-quantitative analysis (Magnetic Resonance Imaging Osteoarthritis Knee Score (MOAKS)) was applied to assess bone marrow lesions (BMLs), articular cartilage, osteophytes, synovitis and effusion, and meniscal lesions in various subregions of the knee joint. A total of 53 patients (66 knees) were included in the final analysis. At 12 months post-treatment, overall KOOS scores showed improvement. The responder rates were 78.6% (11 knees) in KL2, 68.4% (13 knees) in KL3, and 51.5% (17 knees) in KL4. Significant improvements were observed in KOOS-S, KOOS-P, and KOOS-Q across all patients. KOOS-A and KOOS-SP demonstrated statistically significant differences only in the KL2 and KL4 groups (P < 0.05). Comparisons of KOOS score differences between groups revealed that patients in the KL2 group experienced greater improvements in activity levels and quality of life compared to those in the KL3 and KL4 groups (P < 0.05). MOAKS evaluation revealed no significant improvement in cartilage damage, BMLs, synovitis-effusion, and meniscal status. In the KL4 group, the post-treatment scores for patellar superior and inferior osteophytes were higher than the pre-treatment scores (P = 0.039). This study provides evidence supporting the clinical efficacy of a single intra-articular injection of APS in KOA. However, the therapeutic effect of APS for structural changes in imaging remains limited.

Background Women and minorities remain underrepresented in orthopaedic surgery. In an attempt to increase the diversity of those entering the physician workforce, Nth Dimensions implemented a targeted pipeline curriculum that includes the Orthopaedic Summer Internship Program. The program exposes medical students to the specialty of orthopaedic surgery and equips students to be competitive applicants to orthopaedic surgery residency programs. The effect of this program on women and underrepresented minority applicants to orthopaedic residencies is highlighted in this article. Questions/purposes (1) For women we asked: is completing the Orthopaedic Summer Internship Program associated with higher odds of applying to orthopaedic surgery residency? (2) For underrepresented minorities, is completing the Orthopaedic Summer Internship Program associated with higher odds of applying to orthopaedic residency? Methods Between 2005 and 2012, 118 students completed the Nth Dimensions/American Academy of Orthopaedic Surgeons Orthopaedic Summer Internship Program. The summer internship consisted of an 8-week clinical and research program between the first and second years of medical school and included a series of musculoskeletal lectures, hands-on, practical workshops, presentation of a completed research project, ongoing mentoring, professional development, and counselling through each participant’s subsequent years of medical school. In correlation with available national application data, residency application data were obtained for those Orthopaedic Summer Internship Program participants who applied to the match between 2011 through 2014. For these 4 cohort years, we evaluated whether this program was associated with increased odds of applying to orthopaedic surgery residency compared with national controls. For the same four cohorts, we evaluated whether underrepresented minority students who completed the program had increased odds of applying to an orthopaedic surgery residency compared with national controls. Results Fifty Orthopaedic Summer Internship scholars applied for an orthopaedic residency position. For women, completion of the Orthopaedic Summer Internship was associated with increased odds of applying to orthopaedic surgery residency (after summer internship: nine of 17 [35%]; national controls: 800 of 78,316 [1%]; odds ratio [OR], 51.3; 95% confidence interval [CI], 21.1–122.0; p < 0.001). Similarly, for underrepresented minorities, Orthopaedic Summer Internship completion was also associated with increased odds of orthopaedic applications from 2011 to 2014 (after Orthopaedic Summer Internship: 15 of 48 [31%]; non-Orthopaedic Summer Internship applicants nationally: 782 of 25,676 [3%]; OR, 14.5 [7.3–27.5]; p < 0.001). Conclusions Completion of the Nth Dimensions Orthopaedic Summer Internship Program has a positive impact on increasing the odds of each student participant applying to an orthopaedic surgery residency program. This program may be a key factor in contributing to the pipeline of women and underrepresented minorities into orthopaedic surgery. Level of Evidence Level III, therapeutic study.

Background Severe osteoarthritis (OA) of the first metatarsophalangeal joint (MTPJ) is usually treated by arthrodesis, which results in a loss of mobility in the joint. Cartiva (Stryker Corporation, Kalamazoo, USA) is a synthetic cartilage implant (SCI) designed to repair osteochondral defects in the treatment of the first MTP OA. Treatment using the Cartiva SCI should relieve symptoms of OA whilst sparing motion in the first MTPJ and may provide a superior alternative to arthrodesis. Objectives The objective of this article is to assess the clinical outcomes of a novel SCI, Cartiva, for arthroplasty in the management of the first MTPJ arthritis. Study design and methods We retrospectively reviewed 64 patients who had received a total of 67 Cartiva implants between May 2016 and June 2020. The average age of these patients at the time of surgery was 54.3 years with a range from 19 to 77 years. Forty-five of the 67 implants were used in females and 22 were used in males. Radiological Grade 2 OA was present in 46 cases with Grade 3 in 21 (Hattrup and Johnson classification). Validated patient-reported outcomes measures (PROMs) were used to assess the functional efficacy of the implants. All cases were performed by a single surgeon. The PROMs data was collected via follow-up phone calls with the patients who were asked questions from the American Academy of Orthopaedic Surgeons' Foot and Ankle Measure (AAOS-FAM), the EQ-5D-3L survey and the Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ). All data collected was anonymised to preserve confidentiality and local hospital ethics committee approval was sought. All statistical analysis was done using Microsoft Excel (Microsoft® Corp., Redmond, WA) and Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 23.0, Armonk, NY). Results There was a significant improvement in all PROMs at three years, and one patient developed an implant-related infection. The average scores for the EQ-5D-3L survey significantly improved from 0.69 to 0.85 post-operative (post-op) (p<0.05). The mean MOXFQ scores improved from 42.5 to 15.4 post-op (p<0.05). The radiologic evaluation demonstrated satisfactory implant positioning in all cases at the last follow-up. Conclusions The data shows significant improvements between pre-op and post-op scores. The implication of this is that synthetic cartilage arthroplasty provides a viable alternative to arthrodesis in the treatment of OA affecting the first MTPJ. However, more studies may need to be done focusing on larger sample sizes and patients should be observed over a longer term, including a formal multi-centred clinical trial.

Cubital tunnel syndrome (CuTS) is the second most common nerve entrapment syndrome of the upper extremity after carpal tunnel syndrome. In situ decompression (ISD) and ulnar nerve transposition (UNT) are the major surgery methods in practice for the treatment of CuTS. However, controversies exist over the efficacy and safety of these methods. The objective of the study was to compare the short- and long-term clinical outcomes in patients treated with ISD and UNT surgery. This was a retrospective study comprising 56 patients who underwent either ISD or UNT at Naresuan University Hospital between January 2013 and December 2022. Data on age, sex, hand involved, duration of the surgery, duration of the symptoms including the clinical outcomes such as elbow range of motion (ROM), quick disabilities of the arm, shoulder, and hand (QuickDASH), McGowan grade (MGG), Visual Analog Scale (VAS) for pain scores, motor and sensory conduction velocity (MCV1, MCV2, and SCV), and Tinel's sign were collected during the two-week, one-month, three-month, and six-month follow-ups post-surgery.  Of the 56 patients in the study, 62.5% were female. The number of patients aged <60 years was higher in both groups. The mean age of patients in the ISD group was 49.07±6.13 years, while in the UNT group, it was 51.5±7.04 years. After one month, 53.57% and 32.14% of the patients recovered to MGG 1 in the ISD and UNT groups, respectively. The majority of the patients had MGG 1 six months after the surgery. The QuickDASH score and pain scores of the patients improved during all follow-ups, but no statistical significance was revealed when the two techniques were compared. The study found that both the ISD and UNT were efficient and safe in treating CuTS. Further study with the inclusion of parameters such as revision surgery and complications would be vital.

This study aims to present a new endoscopic lumbar interbody fusion technique, multiple endoscopic access lumbar interbody fusion (MALIF), which applies the assisted full-endoscopic spine surgery (AFESS) technique to unilateral biportal endoscopic lumbar interbody fusion (UBE-LIF). AFESS represents an advancement over UBE by utilizing a monoportal scope in the camera portal during biportal endoscopic spine surgery, which enables greater stability, controlled irrigation for muscle preservation, and improved protection of neural structures. We performed MALIF on 15 consecutive patients with symptomatic lumbar spondylolisthesis resistant to conservative treatment and showing radiographic evidence of instability. The technique was performed through a unilateral percutaneous pedicle screw (PPS) incision, minimally exposing the lateral facet joint, followed by superior articular process (SAP) resection and interbody cage placement for indirect decompression and fusion. The mean operative time was 97.4 ± 17.5 minutes (range: 70-129 minutes), with minimal blood loss (mean: 24.3 ± 13.8 ml) and short hospital stay (mean: 15.0 ± 3.5 days). All patients showed symptomatic improvement without major complications, except for one case of transient dysesthesia that resolved within two weeks. MALIF offers three key advantages: (1) multi-angle endoscopic access to the surgical site, (2) precise endoscopic discectomy, and (3) enhanced safety through monoportal sleeve protection of the exiting nerve root. These initial results suggest that MALIF is a promising minimally invasive surgical option for lumbar interbody fusion.

Osteoarthritis (OA) of the foot and ankle is prevalent and often debilitating, necessitating effective treatment options. This study evaluates the analgesic efficacy of corticosteroid injections in individual foot and ankle joints. Stepping Hill Hospital conducted a retrospective audit of 166 patients who received guided corticosteroid injections. We assessed pain relief using a questionnaire to obtain numerical pain scores before and after the injections. Of the 166 patients evaluated, 51% (85) reported complete pain relief and 32% (53) reported partial relief following the injections, with a significant mean pain score reduction from 8.45 (pre-injection) to 3.42 (post-injection) (p<0.05). A total of 83 patients (47.6%) sought re-injection, which also provided significant pain relief, although slightly less effective than the first injection (pain scores: 3.42 (pre-injection) vs. 4.90 (post-injection), p<0.05). Patient satisfaction was 83% overall, with the highest satisfaction at tarsometatarsal joint injections (95%). Corticosteroid injections for foot and ankle OA demonstrate significant analgesic benefits with high patient satisfaction. While first injections were most effective, re-injections remain a viable option, particularly for patients postponing surgery. These results support corticosteroid injections as an essential component of OA management in foot and ankle conditions.