In contrast to aSBP1, the association between bSBP and aSBP2 is significantly less dominant and therefore aSBP2 may have potential prognostic superiority over bSBP.

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BACKGROUND: Never Events (NE) are serious clinical incidents that are wholly preventable if appropriate institutional safeguards are in place and followed. They are often used as a surrogate of the quality of healthcare delivered by an institution. Most NEs are surgical and orthopaedic surgery is one of the most involved specialties. OBJECTIVE: The aim of this study was to identify common NE themes associated with orthopaedics within the National Health Service (NHS) of England. METHOD: We conducted an observational study analysing the annual NE data published by the NHS England from 2012 to 2020 to collate all orthopaedic surgery-related NE and construct relevant recurring themes. RESULTS: We identified 460 orthopaedic NE out of a total of 3247 (14.16%) reported NE to NHS England. There were 206 Wrong implants/prostheses under 8 different themes. Wrong hip and knee prosthesis were the commonest “wrong implants” (n = 94; 45.63% and n = 91; 44.17% respectively). There were 197 “Wrong-site surgery” incidents in 22 different themes. The commonest of these was the laterality problems accounting for 64 (32.48%) incidents followed by 63 (31.97%) incidents of wrong spinal level interventions. There were 18 (9.13%) incidents of intervention on the wrong patients and 17 (8.62%) wrong incisions. Retained pieces of instruments were the commonest retained foreign body with 15 (26.13%) incidents. The next categories were retained drill parts and retained instruments with 13 (22.80%) incidents each. CONCLUSION: We identified 47 different themes of NE specific to orthopaedic surgery. Awareness of these themes would help in their prevention. Site marking can be challenging in the presence of cast and on operating on the digits and spine. Addition of a Real-time intra-operative implant scan to the National Joint Registry can avoid wrong implant selection while Fiducial markers, intraoperative imaging, O-arm navigation, and second time-out could help prevent wrong level spinal surgery.

BACKGROUND: Hand surgical procedures are common interventions in elective and emergency settings. The complex nature of the injuries and management by multiple specialities could be a potential source of medical errors and never events (NEs). Awareness of the common NEs could potentially help prevent their occurrence in the future. OBJECTIVE: To analyse the NHS England database to identify the common NEs in hand surgery and present a simple, practical safety checklist for hand surgery. METHODS: The NHS NEs database from 2012 to 2021 has been analysed to identify the common hand surgery-related never events. We identified the common categories and themes within. Our theme development process is based on anatomical considerations and the nature of the incidents. Additionally, we designed a simple Safety Checklist for hand surgery. RESULTS: We identified a total of 3742 never events with 50 incidents related to hand surgery, representing (1.3%). Wrong-site surgery was the commonest category (n = 30), representing 60% of the hand surgery-related NEs. We identified seven different themes under wrong-site surgery. Wrong finger or digit surgery was the commonest theme, with 17 reported incidents representing 57% of wrong-site surgeries. This is followed by five wrong digits injections and three wrong k wire placements representing 16.6% and 10%, respectively. The second most common category was wrong incisions (n = 15), representing 30%; 13 patients had wrong finger incisions. Two patients had carpal tunnel incisions before surgeons realised that the procedures were for trigger finger release. The third category included four wrong procedures, with two incidents of carpal tunnel release instead of trigger finger operation or Dequervain tendon release. Finally, one patient had an injection for carpal tunnel intended for another patient. CONCLUSION: Hand surgery-related NEs represent a small fraction (1.3%) of all NEs within the NHS database. We identified 50 hand surgery-related NEs arranged into 14 different themes. Additionally, we proposed a hand surgery-specific safety checklist to reduce the incidence of these incidents in the future.

Abstract Herniation pits are small benign oval lesions that were reported to be always lying within the super-lateral femoral neck, and were first described in 1982 by Michael J. Pitt. They are usually a unilateral incidental finding along with asymptomatic course. It was widely believed that herniation pits are a result of invagination of the overlying synovium into small cortical defects in the femoral neck. In our case; the mentioned lesions were found atypically bilaterally at the inferomedial aspect of the neck of femur of a 7-year old child. Radiological scans were efficient to obtain an adequate diagnosis whereas conservative management proved to be sufficient dealing with the lesions. Synovial pits may have atypical clinical and radiological course, and this can raise concerns especially with symptomatic hip that may encourage surgical interventions. However, due to benign course of these lesions, we do not recommend any surgical intervention for such lesions.

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Background Avoidable medical errors and never events represent a significant problem with negative consequences on the patient, the healthcare professionals, and the healthcare facilities. Hand surgery is a unique multidisciplinary speciality in which orthopaedics, plastic and general surgery are usually involved in the care of their patients, which makes this speciality prone to medical errors. The study highlights these preventable errors in hand surgery in NHS England. Methods We analysed hand surgery-related preventable medical errors published by the NHS England during the last ten years from 2012 till July 2021. Results Out of 3742 never events during the review period, only 50 never events related to hand surgery were found, representing (1.3%). The majority were under wrong-site surgery category 30 (60%), which included 17 (57%) wrong finger or digit surgery followed by five wrong digit or thumb injections, three wrong K wire placement, and three scaphoid bones were mistakenly removed during trapeziectomy. The second most common category was wrong incision 15 (30%), with 13 wrong finger incisions, two wrong carpal tunnel incisions for trigger finger release. Four patients had wrong procedures, including CTR rather than trigger finger or Dequervain release or an unnecessary carpal tunnel release in addition to one wrong hand tendon transfer. Lastly, only one patient had a wrong injection for carpal tunnel that was intended for another patient. Conclusions Hand surgery-related medical errors represent 1.3% of the whole Never Events reported. Awareness of these incidents will help prevent their occurrence in the future.