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Summary Background Mental health problems are prevalent amongst medical students. However, many students delay seeking medical help or support from the medical school for a variety of reasons, including a fear of facing fitness to practice proceedings. Tackling this problem of awareness and delayed presentation will need a strong and dedicated focus at all stages, with prevention being of great importance. Methods A conference dedicated to mental health and well‐being was organised for students of all years. The first part of the conference centred on well‐being dilemmas and the second part focused on discussing important issues in small group sessions. Results Students were divided into eight groups and each group suggested improvements to the course that they felt would improve mental health and well‐being. The main suggestions raised were: reassurance that the disclosure of mental health problems would not automatically result in fitness to practice proceedings; separate academic and pastoral roles of tutors; open up the topic of mental health and well‐being more frequently during the programme; improve knowledge about the availability of support services; and have mentors who are at an earlier stage in postgraduate training (e.g. junior doctors). Discussion It is necessary to tackle the prevalent myths about this topic. Many students are unaware of the support services available. This conference has therefore sought to increase awareness of the topic. An approach is also now needed to identify those who need extra help. The authors strongly advocate opening up this topic throughout the course in the context of a dedicated conference, for example.

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A consensus on the framework of an advanced MIS training curriculum has been achieved defining the essential elements of entry criteria, selection of trainers and training units and curriculum content. Multimodal learning, clinical proctorship programme and competency based assessment are integral parts of the curriculum.

the reduction maintained by passing two smooth K-wires across the fracture site: one anterior in the tibia and one posterior (Fig 2). A transepiphyseal guidewire can then be placed between these two wires. After position is confirmed on x-ray, a 4mm cannulated, partially threaded cancellous screw can be placed (Fig 3). Once some compression is achieved, the smooth K-wires can be removed. DISCUSSION Although the exact technique is not original, it highlights important considerations around fixation of paediatric fractures. This method has advantages over other potential fixation options; as the K-wires are removed afterwards, there is less risk of growth arrest compared with tension band wiring and an anatomic reduction is more easily achieved (and maintained) than with a buttress plate.

BackgroundWith the increasingly accepted method of suprapatellar tibial nailing for tibial shaft fractures, we aimed to compare intraoperative and postoperative outcomes of infrapatellar (IP) vs suprapatellar (SP) tibial nails. MethodsThis is a retrospective cohort analysis of 34 SP tibial nails over three years vs 24 IP tibial nails over a similar time frame. We compared total radiation dose (TRD), patient positioning time (PPT), fracture healing and follow up time. Knee pain in the SP group was evaluated utilising the Hospital for Special Surgery (HSS) Knee Injury and Osteoarthritis Outcome Score (KOOS). ResultsFifty-eight patients with a mean age of 43 years were included. Mean intraoperative radiation dose for SP nails was 61.78 cGy (range: 11.60-156.01 cGy) vs 121.09 cGy (range: 58.01-18.03 cGy) for IP nails (p < 0.05). Mean PPT for SP nails was 10 minutes vs 18 minutes for IP nails (p < 0.05). All fractures united in the SP group vs one non-union in the IP group. Mean follow up was 5.5 months vs 11 months in the IP and SP groups, respectively. Mean KOOS was 7 (range: 0-22) at six months for the SP group. ConclusionThe semi-extended position (SP group) leads to reduced TRD because of ease of imaging. Patients showed improved outcomes with shorter follow up and fracture union in all patients (SP group). The KOOS revealed that SP nail patients had minimal pain and good knee function. This study establishes a management and patient-reported outcome measures (PROMs) baseline for ongoing evaluation of SP nails.

reduction and internal fixation is usually performed with a locking pre-contoured acromial plate (Fig 2). The addition of perioperative botulinum toxin injections into the three parts of deltoid (400 units in total) can temporarily defunction the deltoid muscle. DISCUSSION Botulinum toxin works by inhibiting the release of acetylcholine, which is an essential neurotransmitter at the neuromuscular junction, thereby causing muscle paralysis. 4 The use of botox for acromial fractures does temporary reduce the deltoid muscle tension. The effect of the botulinum toxin is known to last approximately 3-6 months and the injected muscle always recovers strength and function. 5 Patients should be warned of this prolonged recovery, but its use should result in a pain-free and functioning reverse arthroplasty.

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