No abstract

The results show that the length of stay and cost is significantly reduced by operating on ankle fractures early. There is no significant difference in the length of stay or cost if the operation is performed earlier than 24 or 48 h from admission.

Introduction It is widely accepted that physical activity is beneficial to both physical and mental health. This study looked at current activity levels of UK doctors outside the workplace and how this compared with the general population. Methods An online anonymous cross-sectional survey was circulated to UK-based doctors. Four questions regarding self-reported physical activity levels were used to generate a score, which placed respondents into ‘active’ and ‘inactive’ categories, with those in the former group not meeting the current UK guidelines for minimum levels of activity. Results A total of 245 doctors responded to the survey. Just under half (42%) of doctors did not meet the UK guidelines for physical activity; this did not differ significantly from the activity levels of the general population (p>0.05). Those working in anaesthetics and intensive care had the highest levels of active respondents (69%). When the respondents’ activity levels were compared with those of the general population within the same age group, doctors aged 25–34 years were significantly less active (p<0.001). Conclusions A national unified approach to increasing the activity levels of UK doctors should be implemented to improve their physical and mental wellbeing. Making this possible will include addressing barriers such as shift work patterns, education and the resources available.

Background: A number of radiographic signs have been previously demonstrated to be associated with degenerative rotator cuff tears. An ability to predict the presence of a tear by radiography would permit the early commencement of appropriate treatment and the avoidance of unnecessary invasive investigations. The aim of the present study was to determine the accuracy of using radiographic signs to predict the presence of a cuff tear on arthroscopy. Methods: Fifty consecutive patients who had undergone shoulder arthroscopy and had pre-operative plain radiographs were included. Pre-operative radiographs were reviewed by a consultant shoulder surgeon, a consultant radiologist and a senior clinical fellow for the following signs: acromial spur; subjective reduction of subacromial space; sourcil sign; acromial acetabularization; os acromiale; greater tuberosity cortical irregularity; greater tuberosity sclerosis; humeral head rounding; cyst; and reduction in acromiohumeral head distance. Results: The presence of tuberosity sclerosis (p < 0.0001), tuberosity irregularities (p < 0.0001), tuberosity cyst (p ¼ 0.004) and sourcil sign (p ¼ 0.019) was associated with the presence of a rotator cuff tear. The combined sensitivity of prediction of tear by the observers following radiographic review was 91.7%, with a combined negative predictive value of 80%. Conclusions: The assessment of radiographs by senior clinicians is a useful tool for confirming the absence of a rotator cuff tear.

Background: The surgical treatment of irreparable massive rotator cuff tears is challenging. The purpose of the present study was to report the initial outcomes after a modified latissimus dorsi transfer (LDT) augmented by acellular dermal allograft (ADA). Methods: This retrospective study includes 24 patients managed with LDT using ADA augmentation as a bursal-sided onlay between March 2009 and December 2015. Results: All patients were men with a mean age of 57 years (range 48 years to 70 years). Seven patients had a previously failed rotator cuff repair and ten patients presented with a deficient subscapularis tendon. At last follow-up (mean 27 months), there was a significant improvement in active forward flexion (mean increase 31 ; p ¼ 0.016), and abduction by 25 (p ¼ 0.059). The acromiohumeral distance remained stable and the failure rate was low (4%). Neither a history of previous rotator cuff surgery, nor the presence of a subscapularis tear had a negative impact on functional outcome. Conclusions: In our cohort of patients, LDT augmented with ADA was a reasonable option for patients with previously failed rotator cuff repair, as well as in the subgroup of patients with a deficient subscapularis tendon.