TORC 2024 Abstracts
Medical Student Podium Abstracts
Devising a New Classification System for Pelvic Reshaping Osteotomies: The Aberdeen Bony Osteotomy Simplified Index (ABOSI)
Donald Tsang, Mr Tim Gardner, Mr Mike Reidy
Introduction: The Aberdeen Bony Osteotomy Simplified Index (ABOSI) is a novel classification system that replaces commonly used eponyms for reshaping pelvic osteotomies. ABOSI allows surgeons to reliably document the location of bony cuts and the placement of bone graft on both tables.
Aim: This study evaluates the inter- and intraobserver reliability of the ABOSI system.
Method: A digital form was developed, consisting of 10 two-dimensional diagrams that depict a range of pelvic reshaping osteotomies. Each diagram illustrates a bony cut and the presence of bone graft. 10 observers with various levels of orthopaedic experience classified the diagrams using the ABOSI classification system on two occasions, with a two-week interval between assessments. Inter- and intraobserver reliability was assessed through statistical analysis using Fleiss’ Kappa and Cohen’s Kappa, respectively. Kappa (κ) values were interpreted as none (<0), fair (0.21-0.40), moderate (0.41-0.60), substantial (0.61-0.80), and almost perfect (0.81-1.00).
Results: The overall interobserver agreement across all diagrams demonstrated an almost perfect Fleiss’ kappa value. Four of the 10 diagrams demonstrated almost perfect agreement, with Fleiss’ κ values ranging from 0.865 to 0.977. The six other diagrams showed substantial agreement among observers, with Fleiss’ kappa values ranging from 0.631 to 0.807. The mean overall Cohen’s kappa for intraobserver reliability was almost perfect, indicating high consistency. There was no statistically significant difference between the responses of orthopaedic surgeons and non-orthopaedic surgeons.
Conclusions: Having demonstrated substantial to almost perfect inter- and intraobserver agreement, the ABOSI system is shown to be highly reliable. Furthermore, similar κ values between orthopaedic surgeons and non-orthopaedic trainees indicate that orthopaedic experience does not significantly impact agreement outcomes. The ABOSI classification system has demonstrated excellent potential in reliably recording the procedure performed, reducing miscommunication among healthcare professionals when describing pelvic reshaping osteotomies.
Investigating the Validity of Inertial Measurement Units for the Biomechanical Analysis of Dynamic Movement.
Charlotte Cobb
This study aimed to investigate the validity of inertial measurement units (IMUs) for the biomechanical assessment of dynamic, high impact movement. The current project will compare force plates, the gold standard instrument for measuring force, to the IMUs, for the biomechanical analysis of gymnastics skills.
With ethical approval, five gymnasts (males n = 1, females n = 4; age 19.6 ± 1.1 years; body mass 58.6 ± 7.5kg) were recruited for the study. This project utilised two AMTI BP600400 force plates sampled at 1000 Hz, and Vicon’s Blue Trident IMUs. IMUs were attached to the participants upper limbs, and the participants were asked to perform several backflips with one hand landing on each force plate.
Raw data were obtained from the force plates and the low-g accelerometer. Multiple parameters were extracted from the force plate data and accelerometer data. For all variables, left-to-right symmetry indices were calculated. For the left forearm, there was a statistically significant, moderate positive correlation between the peak resultant force and peak resultant acceleration (rs = .408, p = .04). For the right forearm, there was a statistically significant, strong positive correlation between the peak resultant force and the peak resultant acceleration (rs = .719, p < .001). This implies the existence of a relationship between the two data sets, and that in this instance the IMUs were capturing similar data to that of the force plates. For the remaining parameters, none of the correlations reached statistical significance, suggesting that there was no relationship between the force plate and IMU data.
This study provides a perspective on the place of IMUs in the field of biomechanical research. It is essential to consider that the use of this technology is still in its infancy, and further research is merited based on the findings of this study.
Parental Compliance with Boots and Bar Treatment for Clubfoot: A Retrospective Study of Outcomes
Lucy Austin, Mr Donald Campbell
Introduction: Parental compliance with boots and bar treatment is the most important risk factor for relapse in clubfoot. Compliance, defined as failure to use boots and bar for the set time as required by the Ponseti method, is usually measured by patient surveys enquiring about duration of use, however there is no data regarding clinician suspicion of poor compliance or how appointment attendance affects outcomes. In NHS Tayside it was noted that patients were repeatedly not attending appointments or cancelling on the day, prompting questions as to whether this was affecting the risk of relapse for a patient’s clubfoot and need for further treatment.
Aims: To identify factors affecting compliance with boots and bar treatment for clubfoot and the effect of poor compliance on rates of further treatments to correct relapse.
Methods: Data of prospective clubfoot outcomes, including periods of recasting and additional surgeries, between April 2013 – November 2019 was collected retrospectively, alongside appointment outcomes and indications of compliance in patient letters. Patients were scored in three areas (clinician indication of compliance, parental reported compliance, and appointment history) and a total score was given between 0 and 6; 0 being perfect compliance 6 being worst.
Results: 58 feet received boots and bar treatment during this period. Patients with a compliance score of 4 were 2.8 times as likely to relapse and 2.45 times as likely to need recasting than those with a compliance score of 0. They were also 2.8 times as likely to need a tibialis anterior transfer than those with a compliance score of 0 (P=0.038).
Conclusion: These results show that the compliance scores this study generated can be used as prognostic indicators for risk of relapse, recasting and tibialis anterior transfer.
Volar Rim Locking Plates; A Local Cohort Study. Should We Routinely Remove Them?
Miss K Hoban, Ms H A Vyas, Prof A Jariwala
Introduction: Distal radius fractures (DRFs) are the most common orthopaedic injuries seen in the western world, primarily affecting young males and post-menopausal females (1-4). In this study, we focus on fixation with variable angle LCP (VA-LCP) volar rim plates (VRP). Multiple studies suggest there is no increase in flexor tendon rupture 7-8 however, locally, surgeons report post-operative flexor tendon issues.
Aims: This study aims to evaluate the post operative complications, specifically FPL ruptures in patients treated with these plates to determine if we should be routinely removing metal hardware.
Methods: A retrospective cohort study of all adult patients with DRFs, treated using VA-LCP VRP in NHS Tayside between 01/01/2021 to date. Data was extracted from trauma lists, order summary sheets with clinical information collected from National Picture Archiving and Communication Systems (PACS), Clinical Portal and ICE software systems.
Results: 49 patients had fixation with the VA-LCP VRM (mean age 52.6 years). n=18 (36.7%) experienced post-operative complications, comprising NV symptoms ( n=8, 44.4%), tendon issues (n=5, 27.8%) or both (n=3, 16.6%). Only 2 patients had pre-existing NV symptoms. 14.3% of the cohort underwent hardware removal due to complications including FPL tendonitis and one case of FPL rupture. Flexor carpi radialis (FCR) involvement and scarring around the carpal tunnel were also observed. The mean time to plate removal was 235 days (range 119 – 354).
Discussion/ Conclusion: This study reports a higher incidence of flexor tendon complications than the literature of 0.3-0.5%. In patients that return to theatre for hardware removal – it appears the median nerve, FPL and FCR are affected. Surgeons should consider metalwork removal for patients with VA-LCP volar rim plates to mitigate tendon injuries.