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Bupa

Cigna

Aviva Health

Vitality Health

AXA PPP Healthcare

english

Knee Replacement

Mr Childs explained everything that would happen in the theatre, along with the epidural and afterwards.  He put me at ease with his manner, a very pleasant gentleman 

General Medical Council

Royal College of Surgeons

British Association of Surgery for the Knee (BASK)

British Orthopaedic Association (BOA)

General Medical

Allianz Worldwide Care

Dupuytrens Fasciectomy

Dupuytren's Contracture

From first assessment to my operation, 
was first class. Mr A,court and his team
we're absolutely brilliant 👏 I cannot thank them enough. 

Journal of Shoulder and Elbow Surgery

Does the stemless reverse arthroplasty compare to a conventional stemmed implant? Clinical and radiographic evaluation at 2 years’ minimum follow-up

British Society for Surgery of the Hand (BSSH)

arabic

ACL (Anterior Cruciate Ligament) Injury

I recently had an appointment with Mr Zeiton and I was thoroughly impressed with the quality of care and professionalism throughout the consultation.
From the moment I arrived, I was treated with courtesy and respect. He took the time to explain my condition in clear, understandable terms and answered all of my questions fully. I felt reassured and confident in the proposed treatment plan.

Mr Zeiton was able to combine clinical precision with genuine compassion. I never felt rushed during the appointment, and it was clear that patient well-being was his top priority.
Overall, this was an outstanding experience. I am very grateful for the thorough evaluation and thoughtful approach. I would highly recommend Mr Zeiton to anyone seeking Orthopaedic care. 

Purpose: In the case of stemmed implants for lower limb joint arthroplasty procedures, implant stability and survivorship generally rely on the strength of fixation in the medullary canal regardless of whether the procedure is primary or revision surgery. This study aimed to investigate the relationship between the proximal (Dorr classification) and distal (Citak classification) femoral canal geometry classification systems. 
Methods: A total of 200 patients who received standing long leg radiographs (hip to ankle) at our institution were identified using our institutional electronic radiology database. Patients were recruited into 4 groups. There were 100 male and 100 female patients with each of those being split into 50 right-sided and 50 left-sided long-leg standing anteroposterior (AP) radiographs. Two independent, blinded observers reviewed each radiograph on two separate occasions, with a minimum of a one-week interval between sittings to review each respective radiograph. 
Results: No statistically significant correlation was found between demographic data and clinical measurements. A statistically significant correlation was found between the patient's age and BMI results and Citak and Dorr measurements. There was excellent inter-observer and intra-observer agreement for the Citak and Dorr Classifications. The mean Cronbach’s α coefficient was 0.96 (range 0.93–0.98) for the Citak Classification and 0.95 (range 0.83–0.97) for the Dorr Classification. There was also an excellent intra-observer agreement with 95% average pairwise per cent agreement for the Citak Classification and 95% average pairwise per cent agreement for the Dorr classification. A statistically significant positive correlation was found between Dorr Calcar Isthmus and Citak Ratio (p &lt; 0.05). 
Conclusion: In this study, the Dorr and Citak classifications are put into relation to each other for the first time. The morphology of the femur was investigated in its entirety and it was shown that there was a positive correlation between the anatomical shape of the proximal and distal medullary canals.

The anatomical shape of the proximal femur correlates with the distal femur anatomy - Archives of Orthopaedic and Trauma Surgery

As patella height can affect the outcome of total knee arthroplasty (TKA) in a number of ways, this study aimed to investigate whether factors such as region, sex and age play a role in causing differences in patella height. 
Methods: Between the 1st of March and the 31st of December 2022, 2000 patients from 7 different countries (Turkey, Saudi Arabia, Germany, Austria, Italy, Spain, and the United Kingdom) awaiting elective TKA were enrolled in this study. Lateral radiographs of the knee with the femoral condyles fully overlapped were used to measure the Insall-Salvati index. The patella height measurements were then correlated with age, sex and region to see if there were any patterns of distribution. Results From ten different hospitals across seven countries, 2,000 patients were collected. Approximately, 50% of the groups were female and 50% were male with a median age at surgery of 59 years (± 20 years). There were no significant differences in patella position based on age, region or sex between the different study populations, although there were significant differences between patients from different countries. 
Conclusion: Patella height showed significant variability within our patient cohort, even between different populations within the same country of origin. However, it should be noted that age, sex and country of origin do not appear to influence patella height in the preoperative planning of knee surgery.

Does sex and region affect the patella position? A multi-center study of 2000 cases - Archives of Orthopaedic and Trauma Surgery

Introduction: Tibial slope is a parameter that is important to recognize in knee kinematics and knee surgery. A very wide range of values governing posterior tibial slope exist in the literature. This study is based on the hypothesis that age, gender and region may have an effect on the tibial slope. 
Materials and methods: A total of 1800 lateral knee radiographies from five different countries [Turkey, Germany, Italy, Spain, and the United Kingdom (UK)] were utilized to measure the native posterior tibial slope. Participants were categorized in deciles with each decade of age after 40 years determined as a separate age group. Accordingly, four different age categories were formed in total, namely, the 40- to 49-, 50- to 59-, 60–69, and 70- to 79-year-old groups. Patients with severe knee osteoarthritis, those with a history of arthroscopic and open surgery around the knee, and those with severe morbid obesity and those outside the specified age group were excluded from the study. The angle between the line tangential to the medial tibial plateau and the proximal anatomical axis of the tibia was measured. Results The tibial slope values of both males and females in the Turkish population were found to be higher than those in other populations. It was observed that tibial slope values increased with age in females in all populations, except for those in the Spanish and UK populations. In the male population, it was found that tibial slope values increased with age in all populations except in the Spanish population. 
Conclusions: Region, age, and gender affect tibial slope in different populations in various ways. Our study shows that the region an individual lives in and living conditions affect the tibial slope.

Do age, gender, and region affect tibial slope? A multi-center study - Archives of Orthopaedic and Trauma Surgery

Forty patients (mean age, 82.6 years) sustained an injury while being treated in hospital for an unrelated cause between January 2012 and June 2013. Case notes and incident reports were analyzed retrospectively.

Results 

Thirty-three (82.5%) of 40 patients had at least 1 fall screen on admission, with 27 patients (81.8%) identified as a fall risk. Fifteen patients (37.5%) had at least one fall before sustaining a FNOF. Fifteen falls occurred between midnight—0500 hours and only 4 falls were witnessed. Thirty-nine of 40 falls were reported, but none were rated as “severe” injuries. Twenty-eight (71.8%) of 39 patients had a root cause analysis performed for the injury, but only 10 root cause analyses (25.6%) produced an action plan. Fifty percent of patients died within 1 year of injury.

Conclusion 

Accurate fall risk assessments and adequate patient supervision are essential to minimize risks of falls, as the inpatient FNOF is linked to a higher mortality rate than patients injured in the community. A standardized method of analyzing such incidents and dissemination of the results of investigation are also required to reduce the risk of similar incidents from occurring within the hospital environment....

Acute Fracture Neck of Femur Among Inpatients: Severe Injuries Which Need to be Taken Seriously

Fractured neck of femur (FNOF) is an increasing problem for the National Health Service (NHS) with 61,508 recorded on the National Hip Fracture Database (NHFD) in 2012–2013 and treatment of such patients is estimated to cost the NHS £1.5 billion per year. Inpatients falling in hospital and sustain a FNOF have rarely been studied as a separate group of patients to assess standards of patient care, time to operative management, and patient mortality.
Of 694 patients sustaining an acute FNOF at a single trust between January 2012 and June 2013, 40 patients (5.8%) sustained an inpatient FNOF. 19 patients (47.5%) were male and 15 patients (37.5%) had an ASA grade of 4 or 5, compared to 153 patients (23.4%) and 127 patients (19.4%) respectively of “community” FNOF. 39 of 40 patients received operative management.
Patients with an “inpatient” FNOF were less likely to be admitted to an orthopaedic ward within 4h (30%) and receive operative management within 48h (65%) according to “Blue Book” standards. Results according to best practice tariff (BPT) were also significantly reduced for the “inpatient” FNOF group, with 23 patients (57.5%) receiving operative management within 36h and only 19 patients (47.5%) achieving BPT compared to 76.5% and 72.5% respectively for “community” FNOF patients. Mortality among inpatients reached 40% at 120 days and 50% at 1 year, significantly higher than community FNOF patients after multivariate analysis.
Patients sustaining an “inpatient” FNOF are more likely to have significant medical co-morbidity and require aggressive medical and surgical management, especially due to their increased risk of mortality post-operatively. Such injuries have direct and indirect financial implications to a health care trust, which can be minimised by prompt management of these patients. This study highlights the need for a standardised protocol of management of this important subgroup of patients and for further work on falls prevention strategies within the National Health Service.

The inpatient fracture neck of femur: An important subgroup of patients

Introduction: Following injury and immobilisation in a cast, patients often seek advice from clinicians on air travel. Our objectives were: Evaluation of current advice from airline carriers, survey of GPs on current advice given to patients, literature review on available evidence
Methods: Systematic search of current advice supplied by commercial airlines/tour operators. Survey of GPs on current advice being supplied to patients with casts.
Literature review on studies investigating complications of air travel with limbs immobilised in a cast.
Results: Out of 56 airlines/tour operators, 86% provided medical information to passengers on their websites. Of those, 34% provided advice for patients travelling with limbs immobilized in a cast. 84% specified limitations including a 24-48 hour limit from application of the cast. 22% of GPs had been asked for travel advice from patients with casts. 56% stated that they wouldn't give advice and would direct patients to their orthopaedic team/airline. 8% had issued a doctor's note to a patient confirming they are ‘fit to fly’.
Conclusions: Airlines are providing conflicting medical advice, which does not always correspond with the best available evidence.
Reliable studies of robust methodology are needed to address this. In their absence, the evidence linking compartment syndrome and air travel is circumstantial.

Air travel with limbs immobilised in casts

Introduction: Better Training Better Care (BTBC) pilots are a Health Education England (HEE) initiative to maximise junior doctor learning in the time available. We report a 12-month pilot (August-July 2013) aimed to improve surgical training through dedicated and supervised Core Surgical Trainee (CST) lists.
Methods: Appropriate operating lists were ring-fenced. CSTs led these from pre to post-operative care. Supervising Consultants were always present, either scrubbed (STS) or unscrubbed (STU). The amount of supervised training (STS or STU) in the pilot was compared to the previous year using logbooks (with consent). Statistical analysis was performed (Chi-squared). Educational value was evaluated using mini-surgical theatre educational environment measure (mini-STEEM).
Results: During the 12-month pilot, eight CSTs in General Surgery completed 734 cases, 242 (33%) being supervised training. The previous year, 803 cases were completed, 163 (20%) being supervised. This is a significant increase in number and proportion of supervised training cases delivered (31.7, p &lt;0.01). Significant increases were also seen in Plastics, Breast and Orthopaedics. Overall mini-STEEM score of 38 (&gt;2 standard deviations above midpoint of 27), demonstrated a ‘strongly positive educational experience'.
Conclusions: Amount, proportion and experience of surgical training was improved by this BTBC pilot, through dedicated and supervised CST lists.

Consultant-supervised, core surgical trainee-led theatre lists – Successfully maximising learning opportunities in the time available

To our knowledge and from our review of the literature, this is a previously unreported variant of a Bosworth fracture – total fibula dislocation. A 45 year old male presented after a high energy external rotation injury to his lower leg and was diagnosed with a total fibula dislocation with the distal fibula dislocated and incarcerated posteriorly to the tibia. Definitive management was operative with fixation of the proximal tibiofibular joint and repair of the posterolateral corner structures as well as fixation distally of the syndesmosis injury. A graded rehabilitation programme was followed and 6 months postoperatively the patient was hill walking and jogging. Bosworth fracture-dislocations are rare injuries that can often be missed during the initial presentation, especially when there is no fracture associated with a dislocation. An underappreciation for the severity of this injury can have major sequelae and the clinician should have a high index of suspicion when diagnosing this injury. An appreciation for Bosworth fracture dislocations and their variations are important for the trauma surgeon.

Total fibula dislocation: A rare variant of a Bosworth fracture-dislocation injury

The constitutions of many countries in the Arab world clearly highlight the role of governments in guaranteeing provision of health care as a right for all citizens. However, citizens still have inequitable health-care systems. One component of such inequity relates to restricted financial access to health-care services. The recent uprisings in the Arab world, commonly referred to as the Arab spring, created a sociopolitical momentum that should be used to achieve universal health coverage (UHC). At present, many countries of the Arab spring are considering health coverage as a priority in dialogues for new constitutions and national policy agendas. UHC is also the focus of advocacy campaigns of a number of non-governmental organisations and media outlets. As part of the health in the Arab world Series in The Lancet, this report has three overarching objectives. First, we present selected experiences of other countries that had similar social and political changes, and how these events affected their path towards UHC. Second, we present a brief overview of the development of health-care systems in the Arab world with regard to health-care coverage and financing, with a focus on Egypt, Libya, Tunisia, and Yemen. Third, we aim to integrate historical lessons with present contexts in a roadmap for action that addresses the challenges and opportunities for progression towards UHC.

The path towards universal health coverage in the Arab uprising countries Tunisia, Egypt, Libya, and Yemen

Better Training Better Care (BTBC) is a Health Education England (HEE) initiative to improve the quality of training and learning for the benefit of patient care by delivering the key recommendations from Sir John Temple’s Time for Training1 and Professor John Collins’ Foundation for Excellence.2 These include the recommendations that ‘service delivery must explicitly support training’ and to ‘make every moment count’.1
Technical skill acquisition is an essential part of surgical training, but there has been a gradual decline in the amount of operative training delivered, and discussion about the time needed to train a surgeon.3 Training opportunities have been lost owing to the reduction in hours for working, complexities of rotas and competing pressures on trainees’ time. There is ongoing debate about the impact of the European Working Time Directive (EWTD) on training4,5 and whether trainees have enough experience.6 Some of the reduction in operative training may be offset by innovative training methods and simulation, but workplace-based training in operative surgery is essential for competence progression to independent practice. Efforts to deliver more effective training within the time available are therefore of paramount importance.1
This study reports on one of the sixteen BTBC pilots selected by HEE. The aim of the pilot was to improve delivery of operative core surgical training by maximising learning opportunities using existing resources in the time available for training.

Maximising learning opportunities in the time available for surgical training

EPSG:4326

Minor Eyelid Procedures

Highly recommend Mr Young - successful minor issue resolved making a big difference to me. The whole experience from start to finish was excellent. Thank you 

Orbit  The International Journal on Orbital Disorders, Oculoplastic and Lacrimal Surgery

Combined neurosurgical and orbital intervention for spheno-orbital meningiomas - the Manchester experience

Journal of Clinical and Experimental Ophthalmology

The Effect of Lockdown due to COVID-19 on a Large Emergency Eye Department: The Manchester Experience

Paediatrics and International Child Health

Epidemiology of Burkitt’s lymphoma in Northwest Province, Cameroon, 2003–2010

Ophthalmology and Therapy

Clinical Effectiveness of Intravitreal Fluocinolone Acetonide (FAc) (ILUVIEN™) in Patients with Diabetic Macular Oedema (DMO) Refractory to Prior Therapy: The Manchester Experience - Ophthalmology and Therapy

Royal Bolton Hospital

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