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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.

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.

Proximal radius fractures are injuries that are very difficult to manage, given the complex anatomy and the rarity of the fracture. Typical fixation of the proximal radius involves open reduction and internal fixation. However, this fixation is challenging given the paucity of proximal radius-specific plating systems. In addition, proximal radius fixation constructs reported in the literature have been shown to have issues with fracture alignment. Our case report aims to highlight the utility of stabilizing proximal radius fractures with a contralateral posterolateral distal fibula plate. It involves a 29-year-old male who sustained a highly comminuted, ballistic left proximal radial shaft fracture that underwent successful fixation, fracture union, and return to function utilizing this plating system.

Adhesive capsulitis (frozen shoulder) is a chronic, painful shoulder condition characterized by progressive stiffness and restricted range of motion. Despite its prevalence, there is limited evidence, particularly in our regional population, regarding the optimal timing, dosage, and technique of corticosteroid injection to achieve maximal pain relief and functional recovery. The objective of this study was to evaluate the efficacy of intra-articular corticosteroid injections in patients with adhesive capsulitis, as measured by pain reduction and improvement in range of motion (ROM). Efficacy was defined as a reduction in pain exceeding the minimal clinically important difference (MCID) of 1.5 points on the visual analog scale (VAS) and an improvement in ROM of at least 20° in forward flexion or external rotation compared to baseline at the 12-week follow-up. This quasi-experimental study was conducted at the Orthopedic and Spine Department, Khyber Teaching Hospital, Peshawar, from January 5, 2024, to July 5, 2024. A total of 148 patients of both genders with adhesive capsulitis were included. After using aseptic technique, a solution containing 80 mg/mL Depo-Medrol and 2% lignocaine was injected into the affected shoulder joint via a posterior approach using a blind technique. Patients were followed weekly for 12 weeks. Efficacy was assessed at the end of the follow-up period, based on pain relief and improvement in range of motion. No adjuvant therapy, such as physiotherapy, was administered during the study period. The mean age of the patients was 48.99±10.03 years, with a mean BMI of 25.07±2.06 kg/m², a baseline VAS score of 6.12±1.21, and an average symptom duration of 13.17±5.06 weeks. At the end of the 12-week follow-up period, efficacy was defined as pain relief and improvement in range of motion, which were achieved in 53.4% of patients. Intra-articular corticosteroid injections are moderately effective in the treatment of adhesive capsulitis, with just over half of the patients experiencing positive outcomes.

Pseudopatella is a rare ossification within the quadriceps tendon, often associated with chronic mechanical stress or degenerative knee conditions, such as gonarthrosis. We report the case of a 59-year-old patient with bilateral gonarthrosis who underwent cruciate-retaining total knee arthroplasty (TKA). Intraoperatively, a pseudopatella was identified within the quadriceps tendon. To optimize the function of the extensor mechanism and prevent future complications, the ossified mass was carefully excised. The procedure proceeded with standard implant placement, ensuring proper alignment, stability, and soft tissue balance. Postoperative recovery was uneventful, and at follow-up, the patient achieved 100 degrees of flexion and full extension. This case underscores the importance of recognizing pseudopatella as a potential intraoperative finding during TKA, particularly in patients with advanced degenerative joint disease. Appropriate management can enhance joint biomechanics, reduce the risk of complications, and contribute to favorable functional outcomes.

 While research productivity surrounding the Step 1 scoring transition has been assessed, the specific impact on verified PubMed-indexed publications (PMIDs) has not been assessed. No study has quantified what proportion of self-reported research items reported in National Resident Match Program (NRMP) data is actually PubMed-indexed. Addressing these gaps is essential to understanding how research output is evolving and represented in residency applications. The objective of this study is to evaluate how the Step 1 pass/fail transition affected pre-residency research output among matched orthopedic surgery residents and whether medical school National Institutes of Health (NIH) funding independently predicts research productivity. This retrospective cohort study included 1,441 matched orthopedic surgery residents across two cycles: pre-transition (class of 2026) and post-transition (class of 2029). PubMed was used to identify total, first-author, in-specialty publications, and citation rates. Residents were categorized by medical school NIH funding and program tier. Mann-Whitney U tests compared groups, and negative binomial regression identified independent predictors. Research productivity increased significantly following the Step 1 transition. Post-transition residents published nearly twice as many PubMed-indexed articles as their pre-transition peers (IRR = 2.13, p < 0.001), with similar gains in first-author and in-specialty work. NIH funding and program tier were independent predictors across all metrics. Citation rates did not differ. Only 12-15% of reported abstracts, presentations, and publications (APPs) were PMIDs. This study provides the first validated analysis of PubMed-indexed research output before and after the Step 1 transition. These findings can inform future studies across specialties as research output becomes increasingly central to residency selection.

Background Displaced femoral neck fractures in elderly patients pose significant challenges due to osteoporosis and comorbidities. Apart from Internal Fixation, which is reserved for non-osteoporotic young patients, bipolar hemiarthroplasty (BHA) and total hip arthroplasty (THA) are common surgical options, but optimal management remains debated. Objective To compare the functional outcomes, surgical parameters, and complications of cemented BHA versus uncemented THA in patients over 60 years with displaced femoral neck fractures. Methods In this prospective randomized study, 40 patients (mean age, 66.7 years) with displaced femoral neck fractures were allocated to either uncemented THA (group 1, n=20) or cemented BHA (group 2, n=20). Outcomes were assessed using the Harris Hip Score (HHS) at 14 days, one, three, six, and 12 months postoperatively. Secondary outcomes included surgical duration, blood loss, weight-bearing initiation, and complications. Results THA demonstrated significantly higher HHS at 14 days (21.40 vs 20.05, p=0.03) and three months (64.55 vs 59.60, p=0.001), but no significant differences were noted at six and 12 months. BHA was associated with shorter surgical duration (75.0 vs 96.25 minutes, p<0.001) and less blood loss (307.65 vs 357.50 mL, p<0.001). No significant differences were found in weight-bearing initiation or complication rates, including infection, dislocation, or reoperation. Conclusion Both THA and BHA yield comparable long-term functional outcomes in elderly patients with displaced femoral neck fractures. THA offers superior early functional recovery, while BHA is advantageous for shorter surgical time and reduced blood loss. Treatment should be individualized based on patient factors and surgical expertise.

To compare the clinical outcomes of bicompartmental knee arthroplasty (BKA) combined with patellofemoral arthroplasty and medial unicompartmental knee arthroplasty with bicruciate-retaining total knee arthroplasty (BCR-TKA) at a mean postoperative period of five years. A retrospective comparative study was conducted, including 16 knees in the BKA group and 39 knees in the BCR-TKA group. Demographic data and clinical outcomes, such as the 2011 Knee Society Score (2011 KSS), Forgotten Joint Score-12 (FJS-12), and knee range of motion (knee ROM), were collected and compared between the two groups. The mean follow-up period was six years for the BKA group and five years for the BCR-TKA group. Preoperative evaluations, including the 2011 KSS (except for patient expectations) and knee ROM, showed no significant differences between the groups. At the final follow-up, no statistically significant differences were observed in the 2011 KSS or FJS-12. However, knee ROM was significantly greater in the BKA group (141.9° ± 6.0° vs. 130.0° ± 10.7° for BCR-TKA, p < 0.05). No revisions were required in the BKA group, while one knee (2.6%) in the BCR-TKA group underwent revision surgery due to persistent pain. BKA demonstrated comparable patient-reported outcome measures to BCR-TKA and provided significantly greater knee ROM. BKA may be a viable treatment option for knees with degeneration and symptoms limited to the medial compartment and the patellofemoral joint.

Total hip replacement (THR) is a common orthopedic surgery performed to relieve pain and restore mobility in patients with severe hip arthritis. While most surgeries proceed without major issues, rare complications during the operation can make the procedure more challenging and potentially affect recovery. We present the case of a 77-year-old man who underwent a right THR through the anterior surgical approach to treat advanced osteoarthritis. During surgery, two unexpected problems occurred: the cut made to remove the damaged femoral head was placed too far down the bone, and a portion of the upper thigh bone called the greater trochanter, where important muscles attach, became detached. Before surgery, detailed planning was done using CT-based Mako robotic navigation, which helped choose the most suitable implant and determine the correct positioning. During the procedure, a high-offset cemented femoral stem was selected to restore the patient's natural hip mechanics. The detached greater trochanter was repaired using strong sutures passed through holes in the bone (transosseous fixation). After surgery, the patient was kept off the operated leg initially to protect the repair. He gradually progressed to partial weight-bearing by three months, and follow-up imaging showed excellent healing and implant position. Functionally, he returned to daily activities without pain. This case underscores the importance of adaptability during surgery, even with advanced planning. It also highlights how robotic planning, specialized implant selection, and careful repair of soft tissue attachments can be successfully combined to address unexpected challenges and achieve an excellent outcome.