Publications by authors named "Kevin Wembridge"

5 Publications

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The orthopaedic waiting list crisis : two sides of the story.

Bone Jt Open 2021 Jul;2(7):530-534

Rotherham District General Hospital, Rotherham NHS Foundation Trust, Rotherham, UK.

Aims: Due to widespread cancellations in elective orthopaedic procedures, the number of patients on waiting list for surgery is rising. We aim to determine and quantify if disparities exist between inpatient and day-case orthopaedic waiting list numbers; we also aim to determine if there is a 'hidden burden' that already exists due to reductions in elective secondary care referrals.

Methods: Retrospective data were collected between 1 April 2020 and 31 December 2020 and compared with the same nine-month period the previous year. Data collected included surgeries performed (day-case vs inpatient), number of patients currently on the orthopaedic waiting list (day-case vs inpatient), and number of new patient referrals from primary care and therapy services.

Results: There was a 52.8% reduction in our elective surgical workload in 2020. The majority of surgeries performed in 2020 were day case surgeries (739; 86.6%) with 47.2% of these performed in the independent sector on a 'lift and shift' service. The total number of patients on our waiting lists has risen by 30.1% in just 12 months. As we have been restricted in performing inpatient surgery, the inpatient waiting lists have risen by 73.2%, compared to a 1.6% rise in our day-case waiting list. New patient referral from primary care and therapy services have reduced from 3,357 in 2019 to 1,722 in 2020 (49.7% reduction).

Conclusion: This study further exposes the increasing number of patients on orthopaedic waiting lists. We observed disparities between inpatient and day-case waiting lists, with dramatic increases in the number of inpatients on the waiting lists. The number of new patient referrals has decreased, and we predict an influx of referrals as the pandemic eases, further adding to the pressure on inpatient waiting lists. Robust planning and allocation of adequate resources is essential to deal with this backlog. Cite this article:  2021;2(7):530-534.
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http://dx.doi.org/10.1302/2633-1462.27.BJO-2021-0044.R1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8325974PMC
July 2021

The effects of a UK lockdown on orthopaedic trauma admissions and surgical cases: A multicentre comparative study.

Bone Jt Open 2020 May 21;1(5):137-143. Epub 2020 Jul 21.

Trauma and Orthopaedics, Rotherham General Hospitals NHS Trust, Rotherham, UK.

Aims: The current global pandemic due to COVID-19 is generating significant burden on the health service in the UK. On 23 March 2020, the UK government issued requirements for a national lockdown. The aim of this multicentre study is to gain a greater understanding of the impact lockdown has had on the rates, mechanisms and types of injuries together with their management across a regional trauma service.

Methods: Data was collected from an adult major trauma centre, paediatric major trauma centre, district general hospital, and a regional hand trauma unit. Data collection included patient demographics, injury mechanism, injury type and treatment required. Time periods studied corresponded with the two weeks leading up to lockdown in the UK, two weeks during lockdown, and the same two-week period in 2019.

Results: There was a 55.7% (12,935 vs 5,733) reduction in total accident and emergency (A&E) attendances with a 53.7% (354 vs 164) reduction in trauma admissions during lockdown compared to 2019. The number of patients with fragility fractures requiring admission remained constant (32 patients in 2019 vs 31 patients during lockdown; p > 0.05). Road traffic collisions (57.1%, n = 8) were the commonest cause of major trauma admissions during lockdown. There was a significant increase in DIY related-hand injuries (26% (n = 13)) lockdown vs 8% (n = 11 in 2019, p = 0.006) during lockdown, which resulted in an increase in nerve injuries (12% (n = 6 in lockdown) vs 2.5% (n = 3 in 2019, p = 0.015) and hand infections (24% (n = 12) in lockdown vs 6.2% (n = 8) in 2019, p = 0.002).

Conclusion: The national lockdown has dramatically reduced orthopaedic trauma admissions. The incidence of fragility fractures requiring surgery has not changed. Appropriate provision in theatres should remain in place to ensure these patients can be managed as a surgical priority. DIY-related hand injuries have increased which has led to an increased in nerve injuries requiring intervention.
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http://dx.doi.org/10.1302/2633-1462.15.BJO-2020-0028.R1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7684391PMC
May 2020

Accuracy and reliability of knee goniometry methods.

J Exp Orthop 2018 Oct 19;5(1):46. Epub 2018 Oct 19.

Rotherham General Hospital, Rotherham, UK.

Background: Measuring knee range of motion is important in examination and as a post-operative outcome. It is therefore important that measurements are accurate. Knee angles can be measured by traditional goniometers, smartphone apps are readily available and there are also purpose made digital devices. Establishing the minimum difference between methods is essential to monitor change. The purpose of this study was to assess reliability and minimum significant difference of visual estimation, short and long arm goniometers, a smartphone application and a digital inclinometer.

Methods: Knee angles were assessed by 3 users: one consultant orthopaedic surgeon, one orthopaedic surgical trainee and an experienced physiotherapist. All 5 methods were used to assess 3 knee angles, plus full active flexion and extension, on 6 knees. The subjects had knee angles fixed using limb supports during measurement, whilst maintaining appropriate clearance to allow a reproduction of assessment in clinic. Users were then blinded to their results and the test was repeated. A total of 300 measurements were taken.

Results: Inter-rater and intra-rater reliabilities were high for all methods (all > 0.99 and > 0.98 respectively). The digital inclinometer was the most accurate method of assessment (6° minimum significant difference). The long arm goniometer had a minimum significant different of 10°, smartphone app 12° and both visual estimation and short arm goniometry were found to be equally inaccurate (14° minimum significant difference).

Conclusion: The digital inclinometer was the most accurate method of knee angle measurement, followed by the long arm goniometer. Visual estimation and short goniometers should not be used if an accurate assessment is required.
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http://dx.doi.org/10.1186/s40634-018-0161-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6195503PMC
October 2018

Three-dimensional analysis of different first metatarsal osteotomies in a hallux valgus model.

Foot Ankle Int 2008 Jun;29(6):606-12

Northern General Hospital, Sheffield Foot & Ankle Unit, UK.

Background: This study evaluates and compares three-dimensional (3-D) changes in geometry of the first metatarsal (MT1) independent of soft tissue corrections of 5 common osteotomies: three distal (Chevron, Mitchell, and Wilson), one proximal (Stephens basal), and one combined proximal/distal (Scarf), using standardized synthetic bone models.

Materials And Methods: A digitizing system was used to measure and record points on the synthetic bone models in 3-D space. Computer vector analysis calculated 3-D rotations and translations of the MT1 head plus the conventional intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA).

Results: The Wilson and Mitchell's osteotomies produced significant shortening (p < 0.001) in contrast to the three other osteotomies. All the osteotomies produced a reduction in the 3-D IMA. The Scarf and Stephens basal osteotomies reduced the DMAA. All of the osteotomies resulted in lateral translations and depression of the MT1 head. While there were no significant (p > 0.05) translational differences between the Scarf and Stephens basal osteotomies, there were rotational differences, with the Stephens basal producing significantly more plantar flexion (p = 0.000) and pronation (p < 0.001) than the Scarf.

Conclusion: This geometric study indicated many of the MT1 head changes following metatarsal osteotomy to be out-of-plane translational and multiplanar rotations which cannot be determined using AP radiographs alone.

Clinical Relevance: We advocate judicious choice of osteotomy to achieve the desired correction of hallux valgus in each individual.
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http://dx.doi.org/10.3113/FAI.2008.0606DOI Listing
June 2008

A prospective comparison of cement restrictor migration in primary total hip arthroplasty.

J Arthroplasty 2006 Jan;21(1):92-6

Lower Limb Arthroplasty Unit, Northern General Hospital, Sheffield, UK.

Pressurization techniques are used to improve the cement/bone interface at hip arthroplasty. Ultra-high-molecular-weight polyethylene (UHMWPE) cement restrictors leave particulate debris at insertion; biodegradable restrictors may therefore be preferable. We compared the migration behavior of 2 such cement restrictors. A prospective randomized study with 16 patients per group using either a UHMWPE or a biodegradable restrictor was performed. Comparison of intraoperative measurements and postoperative radiographs determined restrictor migration. Mean migration was 3.0 vs 0.5 cm (biodegradable vs UHMWPE, Mann-Whitney U test, P < .002); median, 2.9 vs 0.4; SD, 1.8 vs 0.4; and range, 0.6 to 6.4 vs 0 to 1.2. Our study found that the biodegradable restrictor allowed significantly more migration than the UHMWPE restrictor. Although there are theoretical advantages in avoiding UHMWPE restrictors, the current biodegradable alternative is actually inferior and its use cannot be endorsed.
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http://dx.doi.org/10.1016/j.arth.2005.04.010DOI Listing
January 2006
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