Background. Turf toe is used to describe an injury occurring at the plantar aspect of the metatarsophalangeal- sesamoid complex of the hallux. Typically seen in athletes, it occurs due to hyperdorsiflexion and axial loading of the hallux metatarsophalangeal joint with the foot fixed in equinus. The injury causes pain and joint instability, missed athletic activity and potentially end careers. Turf toe can be managed conservatively or operatively, with controversy regarding the indications for operative intervention. This study aims to conduct a systematic review to determine whether and in what circumstances operative intervention is superior to conservative management of turf toe in adults. Methods. A systematic review of the literature was performed using PubMed, Embase, Cochrane and Scopus databases. The search terms used were “turf toe”, “first metatarsophalangeal joint injury”, “conservative”, “nonoperative”, and “operative”. All articles published in English reporting on the management of turf toe were reviewed. The primary outcome measure was the time to return to pre-injury activity with the secondary outcome of the time to symptom resolution. Results. Seven studies met the inclusion criteria. Three patients were successfully managed conservatively returning to athletic activity, on average at 12 weeks. Seventeen patients underwent surgical intervention with an average return to athletic activity at 18 weeks. Conclusion. Operative intervention was shown to give a successful outcome in patients with grade three turf toe injuries or those who have failed conservative management. However, there is insufficient evidence to determine whether operative intervention is superior to conservative management.
Introduction Virtual reality (VR) fully immersive interactive video teaching (VR FIIT) allows learners to develop through observing and interacting with complex realistic environments, developing technical and nontechnical skills. One such complex clinical environment is managing a trauma patient. Despite the significant developments in managing these patients, foundation doctors are frequently highly anxious due to their limited knowledge and experience. The aim of this project was twofold; to improve foundation doctor performance of managing trauma patients and to reduce their associated anxiety, through the use of VR teaching. Methods A total of 14 foundation doctors were divided into two groups. One group underwent departmental teaching. The second group underwent departmental teaching and VR FIIT. We assessed the doctors via two methods. First, time taken to complete tasks correctly in trauma simulations was compared. Second, the doctors completed a self-reported level-based assessment questionnaire regarding anxiety and stress around trauma calls. Results The VR FIIT intervention group were able to complete each task on average 118s faster than the standard group. The standard group missed essential tasks such as C-spine immobilisation. The VR FIIT group self-reported significantly lower levels of anxiety related to trauma calls. Conclusion VR teaching improves foundation doctor performance at managing simulated major trauma patients and decreases foundation doctor anxiety towards management and exposure of these clinical situations.
The disruption caused by COVID-19 significantly affected national recruitment for national training numbers across all specialties. Within Trauma and Orthopaedics this led to a drop in the number of jobs offered and will likely lead to an increase in competition for the 2021 recruitment cycle. This article considers the key steps of the application process and five interview stations. Preparation for the interview is key and starts taking place months before the interview itself. Preparation can take place in a variety of formats whether on your own or in a group. Multiple courses and websites are available to aid preparation to ensure you can perform to the highest standard and obtain a national training number.
Turf toe is used to describe an injury occurring at the plantar aspect of the metatarsophalangeal-sesamoid complex of the hallux.1 Typically seen in athletes, it occurs due to hyperdorsiflexion and axial loading of the hallux metatarsophalangeal joint with the foot fixed in equinus. The injury causes pain and joint instability, missed athletic activity and potentially end careers Turf toe can be managed conservatively or operatively, with controversy regarding the indications for operative intervention. This study aims to conduct a systematic review to determine whether and in what circumstances operative intervention is superior to conservative management of turf toe in adults. A systematic review of the literature was performed using PubMed, Embase, Cochrane and Scopus databases. The search terms used were ‘turf toe’, ‘first metatarsophalangeal joint injury’, ‘conservative’, ‘non-operative’, and ‘operative’. All articles published in English reporting on the management of turf toe were reviewed. The primary outcome measure was the time to return to pre-injury activity with the secondary outcome of the time to symptom resolution. Seven studies met the inclusion criteria. Three patients were successfully managed conservatively returning to athletic activity, on average at 12 weeks. Seventeen patients underwent surgical intervention with an average return to athletic activity at 18 weeks. Operative intervention was shown to give a successful outcome in patients with grade three turf toe injuries or those who have failed conservative management. However, there is insufficient evidence to determine whether operative intervention is superior to conservative management.
Introduction Historically, patients undergoing an elective hip, knee or shoulder arthroplasty regularly required blood transfusions. Improved surgical techniques and perioperative optimisation have significantly decreased the requirement for blood transfusions. Currently, our patients have two group and save samples taken: one six weeks preoperatively and one on admission. This study aims to determine whether a second group and save is required prior to primary elective hip, knee or shoulder arthroplasty. Methods All cases of elective arthroplasty from a single centre were retrospectively analysed over a 16-month period. Each case was reviewed to determine those who had a group and save at preassessment, group and save at the time of the operation and the timing and number of blood products transfused. Results A total of 711 elective arthroplasty procedures were completed with 48 patients requiring a transfusion during their admission. 9.9% of hip arthroplasty patients, 3.8% of knee arthroplasty patients and 4.9% of shoulder arthroplasty patients required a transfusion. The majority of the transfusions occurred at least 24 hours postoperatively with 0.84% of patients requiring an intraoperative transfusion. Discussion The vast majority of transfusions were delivered more than 24 hours following the procedure, demonstrating that routinely cross-matched blood products are superfluous to requirements. It is our suggestion that a formal group and save be completed only if the need for a blood transfusion is formally established, leading to a significant cost saving, a reduction in clinical work load and patients having to undergo fewer procedures.
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