This review aimed to synthesise the findings of literature that have assessed the changes in lower limb biomechanics following anterior cruciate ligament (ACL) reconstructive surgery. Systematic searches of CINHAL, MEDLINE, SCOPUS, and SPORTDiscus databases were run. All included studies had presented biomechanical variables pre-and post-surgery for the same participants. Articles were categorised by the analysed movement, and effect sizes were calculated.Fifty-four studies met the inclusion criteria, providing data on gait (n=31), balance (n=12), joint position sense (n=5), stair ambulation (n=4), pivoting (n=6), and landing (n=5). Measures of balance performance and joint position sense showed improvements from pre-to post-surgery. Changes in joint kinematics were inconsistent between studies, however increased knee flexion excursion, and reduced tibial anterior translation and internal rotation post reconstruction were identified. Joint kinetics reduced in magnitude in the early stages after surgery (≤5 weeks), then increased later in recovery (≥24 weeks). Risk of bias assessment identified most articles had a moderate or high risk (low=5; moderate=21; high=11) resulting from participant retention and surgical intervention differences. The results of the review identified that although lower limb biomechanics did alter following reconstruction, few variables provided consistent results across studies and tasks.The low methodological quality of some articles may have contributed to these inconsistent findings. Alternatively, differences across studies may have resulted from individual coping strategies of participants that have previously been suggested to be present before reconstructive surgery, and future research should look to explore individual coping strategies to ACL reconstruction.

Purpose.To evaluate outcome of 6-strand triple Kessler repair for flexor tendon injuries, followed by early active motion rehabilitation. Methods. 25 men and one woman (36 fingers) underwent 6-strand triple Kessler repair for flexor tendon injuries in zones 2 to 5, followed by early active motion rehabilitation. Rehabilitation was started at days 3 to 5. Patients were instructed to passively flex all the fingers with the uninjured hand and to actively retain this position for 10 seconds. Active extension within the confines of the splint was allowed. At the end of week 8, strength training was commenced until a satisfactory range of motion was regained. Outcome measures included total active motion, grip strength, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Complications such as infection and wound dehiscence were recorded. Results. The mean follow-up was 1.2 (range, 1-2) years. Outcome was excellent in 24 digits, good in 4, and poor in 8. The mean grip strength was 80%Early active motion protocol following triple Kessler repair for flexor tendon injury S Rajappa, PG Menon, M Mohan Kumar, D Gokul RajDepartment of Orthopedics and Hand surgery, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India Address correspondence and reprint requests to: Dr S Rajappa, B2 Clinic, Sri Ramachandra Medical Centre, Porur, Chennai, Tamil Nadu, 600 116, India. Email: chickko2002@yahoo.com Surgery 2014;22(1):96-9 (range, 60-100%) of normal in dominant hands and 60% (range, 50-65%) of normal in non-dominant hands. The mean DASH score was 15 (range, 0-52). One patient had wound dehiscence and superficial infection. Conclusion. Six-strand triple Kessler repair for flexor tendon injuries, followed by early active motion rehabilitation yields satisfactory results. Journal of Orthopaedic

Junior Doctors working on the Orthopaedic wards at a district general hospital identified the lack of a formal weekend handover. The Royal Colleges,GMC and Foundation Programme curriculum all emphasise the importance of a safe and effective handover. Doctors found that the current system of using a written, paper-based handover was unreliable, un-legible, and inefficient. Baseline measurements were sought in the form of a questionnaire which allowed us to obtain the limitations to the current handover. After this and a focus group, a new electronic, 'Microsoft Word' based handover was created and a repeat surgery issued in 2 weeks. Further PDSA cycles over the course of 8 weeks helped to improve and implement the new handover. The overall rating, out of 10, of the new handover increased from 3.4 to 8. Doctors felt the new handover was safer for patients and could be used as a tool for reviewing or referring patients. This project describes the use of a simple, cost-effective intervention that helped to improve patient safety and staff satisfaction. PROBLEMThe junior doctor weekend handover within the orthopaedic department at Pilgrim Hospital, Boston (United Lincolnshire Hospitals NHS Trust) was felt to be sub-optimal.The department is made up of two 29-bed Trauma and Orthopaedic wards: one trauma and one elective ward. The doctors working on these wards were only responsible for the patients under the care of the orthopaedic team. Surgical and medical outlier patients were excluded. In the past, each junior doctor working in either of the two wards were responsible for generating a list of jobs for the weekend on-call junior doctor team to complete. These included and were not limited to: chasing bloods, reviewing patients and ordering investigations. It was then the responsibility of the Foundation Year 1 Doctor, providing cover for the wards, to obtain this list from the ward desk or in person, from a junior doctor on the wards during the week, and carry out the jobs stated. When solely taking care of approximately sixty orthopaedic patients and having a poorly communicated handover provided to you on loose sheets of paper, within a blank book of notes or even verbally, the task of taking care of these patients seems momentous.Informal opinions of Junior Doctors found that this handover was unreliable, un-legible, and inefficient and there was no standardised format, timing or emphasis put on its importance. As a result, a number of jobs, such as chasing blood results, were not being completed by the weekend team and subsequently putting patient safety at risk.The SMART aim of the project was asses the opinion of the current handover with a staff questionnaire and subsequently phase out the current written handover by creating and implementing an affordable, safe and effective electronic handover based on the opinions of junior doctors within an 8-week time-frame. The team involved in this project included myself, as author and my named supervisor. The participation of all junior doctors in focus grou...