Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · Apr 2008
Comparative StudyInjury to the lateral femoral cutaneous nerve during minimally invasive hip surgery: a cadaver study.
A smaller skin incision as part of minimally invasive surgery (MIS) for total hip arthroplasty (THA) is thought to reduce local tissue trauma. Preservation of cutaneous nerves may reduce postoperative pain and improve rehabilitation. The standard lateral approach (SLA) and two MIS approaches (anterolateral [ALA] and posterior [PA]) were compared to determine which incision preserved cutaneous nerves. ⋯ There is little evidence of the benefit of one MIS approach over another in the literature. The ALA preserved significantly more cutaneous nerves in this study. These results need corroboration with clinical outcomes to determine their significance.
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Ann R Coll Surg Engl · Apr 2008
Survey of general paediatric surgery provision in England, Wales and Northern Ireland.
A survey was carried out to ascertain the current provision of general paediatric surgery (GPS) in all hospitals in England, Wales and Northern Ireland with 100% return rate. The provision of GPS is at a crossroads with a drift of these cases to the overstretched, tertiary referral hospitals. ⋯ Almost 10 years ago, a change in the training of young surgeons took place. An increase in training posts in Tertiary centres was made available following advice from the British Association of Paediatric Surgeons (BAPS) but these posts were often not taken up. Many DGH surgeons became uncertain whether they should continue GPS training. A subtle change in the wording of the general guidance by the Royal College of Anaesthetists altered the emphasis on the age at which it was appropriate to anaesthetise children. Change in clinical practice, reducing need, and a drift towards tertiary centres has reduced DGH operations by 30% over a decade. Young surgeons are now seldom exposed to this surgery, and are not being trained in it. The large volume of these low-risk operations in well children cannot be absorbed into the current tertiary centres due to pressure on beds. The future provision of this surgery is at risk unless action is taken now. This survey was carried out to inform the debate, and to make recommendations for the future. The principal recommendations are that: (i) GPS should continue to be provided as at present in those DGHs equipped to do so; (ii) GPS training should be carried out in the DGHs where a high volume of cases is carried out; (iii) management of these cases should use a network approach in each region; (iv) hospital trusts should actively advertise for an interest in GPS as a second subspecialty; and (v) the SAC in general surgery develop a strategy to make GPS relevant to trainee surgeons.
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Ann R Coll Surg Engl · Mar 2008
Review Case ReportsExtensor tendon injury to the index and middle finger secondary to Kirschner wire insertion for a distal radial fracture.
We describe a case with the highly unusual complication of attritional ruptures to both the extensor tendons to the index and middle finger following Kirschner wire placements for a distal radial fracture. This particular complication has never been previously described in the literature. We also review the literature, identifying certain techniques in the management of distal radial fractures with Kirschner wires which are considered to increase the risk of tendonous or neurovascular injury. Finally, recommendations are made that should reduce the complications of iatrogenic soft tissue injury associated with this very common procedure.
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Ann R Coll Surg Engl · Mar 2008
Comparative StudyThe dedicated emergency surgeon: towards consultant-based acute surgical admissions.
The management of an efficient acute surgical service with conflicting pressures of managing elective and emergency work, compounded by waiting list targets and the maximum 4-h wait for patients in accident and emergency poses a significant challenge. We assess the impact of appointing a dedicated emergency surgeon on the delivery of our emergency surgery service. ⋯ The appointment of a dedicated emergency surgery consultant has resulted in an increase in day-time consultant-supervised operating, shorter hospital stay for emergency admissions, improved training for surgical trainees, as well as providing potential financial savings for the trust.
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Ann R Coll Surg Engl · Mar 2008
Mobile phones, in combination with a computer locator system, improve the response times of emergency medical services in central London.
The aim of this study was to determine whether mobile phones and mobile phone locating devices are associated with improved ambulance response times in central London. ⋯ Since the introduction of the mobile phone locating system, there has been an improvement in ambulance response times. Mobile locating systems in urban areas across the UK may lead to faster response times and, potentially, improved patient outcomes.