News

ZimmerBiomet Lower Limb Travelling Fellowship

Haris Naseem

The ZimmerBiomet Lower Limb Fellowship, awarded to Haris Naseem, was spent at the Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics in Kurgan, Russia, where Gavriil Abramovich Ilizarov discovered and applied the principle of ‘tension-stress.’ I aimed to gain experience of this method in a high volume centre, understand the scope of its application, meet surgeons from a variety of international backgrounds, gain historical perspective in an area of interest to me and ultimately use this to benefit patients in the UK.

This was a four week structured Fellowship that was comprised of theatre time, case discussions, lectures and workshops with Saturday mornings reserved for sawbone work, with the opportunity to scrub in and assist with cases in theatre. Surgeons were extremely experienced with techniques and circular frames were applied efficiently with a heavy reliance on knowledge of anatomical landmarks over intra-operative radiography. They were supported by a multi-disciplinary team, with patients often staying at the centre for their entire duration of time in circular frames, giving them access to optimised nursing care and rehabilitation.

The pathology observed was varied and included traumatic and elective conditions in both the paediatric and adult population. Examples included limb lengthening, non-union surgery, acute fracture fixation in the upper and lower limbs, the management of the diabetic foot and bone infection. Whilst the majority of the work performed at the centre uses the Ilizarov apparatus, internal fixation is available for certain cases, as is joint replacement surgery.

In summary I felt that my objectives for going were achieved and also that the visit took place at the right time as I had attained CCT and had Fellowship experience in this technique prior to the visit. I would like to thank the Ilizarov Scientific Centre for hosting me and also the BOA for the generous award of the Zimmer Travelling Fellowship.

Please visit www.boa.ac.uk/travellingfellowships to read Haris’ full report and other reports by BOA Travelling Fellows.

British Hip Society (BHS) update

Andy Hamer

The British Hip Society has not been immune to the effects of the pandemic and has made the difficult decision to move its traditional March Annual Scientific Meeting to a fully virtual meeting in June 2021. By the time you read this, the meeting will have taken place with a number of Topic in Focus sessions, free papers, guest lecturers and industry seminars. A summary of the meeting will appear in a future edition of the JTO.

The BHS has continued to help its members during these difficult times by holding a number of webinars looking at the development of Revision Hip Networks and plan an ongoing educational webinar series titled ‘The BHS Midweek Special: Every Day is a School Day’. This series of case based discussions with experts in the field is the brainchild of Vikas Khanduja and will be held monthly throughout 2021-22.

The BHS have also established a Culture and Diversity Committee who are developing a mentorship programme, engaging with Doctors of Tomorrow, creating inspirational videos and establishing a network of research mentors who can advise junior doctors on research projects.

The BHS are closely involved in a national project looking at the improvements that can be made to revision hip surgery prompted by Professor Tim Briggs and the GIRFT process. The society has produced four BOASTs for revision for infection, dislocation, aseptic loosening and instability which will be published via the BOA. In addition, the BHS have developed a democratically elected Revision Hip Network National Advisory Panel with representatives from across the UK, to bring local expertise and knowledge to the question of how Revision Hip networks might look.

Please visit the BHS website for more information, https://britishhipsociety.com.

British Society for Surgery of the Hand (BSSH) update

Sue Fullilove

Despite the pandemic, the BSSH has gone from strength to strength.

Scientific Meetings

Weary of the loss of study leave and CPD to COVID-related cancellation, BSSH has run a very successful virtual Spring Scientific Meeting, with full main and parallel sessions, and as many registrations as the face-toface meeting attracts. The next meeting is in Oxford (let’s hope not our offices again), followed by a Christmas meeting in Exeter.

International Meetings

BSSH is Guest Society at the Indian meeting in Chennai in August (either face to face or virtually) and at the American meeting in San Francisco in October, with many UK surgeons contributing to the scientific programmes of each meeting. We are also on the podium during the European (FESSH) virtual meeting in June.

European Journal of Hand Surgery (JHSE)

BSSH continues to run the JHSE, which maintains its position as the highest impact factor Hand Surgery Journal in the world. We recently started an on-line International Journal club which is proving extremely popular.

BSSH International Travelling Fellows

This prestigious Fellowship launches in August 2021 and will run annually thereafter. Its aim is to foster international links and friendships across the speciality, to facilitate sharing of education, research and best practice in Hand Surgery. Four International Hand Societies have each been invited to select and nominate an eligible candidate. The four successful Fellows, this year from France, India, America and Australia will travel to three UK hand surgery centres. The Visiting Fellowship culminates at the BSSH Autumn Scientific Meeting with attendance at the Society Dinner.

Education – Home and Overseas

All of our educational programmes are being delivered virtually now, including that to the LMICs that we support. Remote consultation continues to be provided to surgeons in our LMICs.

Mentoring of Hand Surgeons

BSSH has identified a need for mentoring of young hand surgeons. In June, a Mentoring Programme launches, with professional training of the first BSSH Mentors.

Research

BSSH continues to punch above its weight. Two more NICE guidelines are in production, and several million pounds worth of funded research is now underway, in the areas of Hand and Wrist surgery identified as priority by the BSSH / James Lind Association partnership.

Patients

Like all MSK surgeons, we are concerned about the delays to treatment that many of our patients are experiencing and we are initiating several workstreams to raise the profile of hand surgery and help ensure it is adequately resourced. We are also driving to improve the patient resources on our website. n

Orthopaedic Trauma Society (OTS) update

Michael Kelly

The last year has been transformative and the Orthopaedic Trauma Society has embraced this impetus. The pandemic highlighted the individualised burdens and contingencies across the country and the inherent potential learning, particularly in orthopaedic trauma. Observing this, the OTS made membership free to all those undertaking orthopaedic trauma on-call at consultant level. The society has always advocated for advancing practice, particularly in contentious areas through networking, lively debate and sharing of ideas by those invested in orthopaedic trauma. The previous annual meetings have been testament to this and invited faculty have been amazed by the level of discussion, the intensity and the ability to effect palpable change on a national scale. This year, with a free membership, the meeting will combine all the elements of discussion and consensus. Although there will be a slightly diminished live audience, there are over 1,200 enrolled remote attendees, making it the best ever representation of those undertaking fracture care across the UK. The Society remains determined to be representative and responsive to the real-world concerns and this year marks a massive step. The programme developed by Jayne Ward and the Education Committee is a direct response to questions and feedback and looks very exciting (www.orthopaedictrauma. org.uk/index.php).

For those who have not already joined, please consider. Going forwards, the Society will facilitate an increasingly active and pertinent repository of discussion, expertise and sharing to keep the UK and Ireland at the forefront of orthopaedic trauma innovation. This complements Bob Handley’s year as President and the Trauma Group initiatives such as the BOA Trauma Exchange. It also adds to the commitment to training through BOTA as well as the ongoing Trauma Revalidation programme at the annual Congress in placing orthopaedic trauma front and centre with solutions rather than problems.

British Society for Children’s Orthopaedic Surgery (BSCOS) update

Colin Bruce and Dan Perry

Research continues to grow within BSCOS, with collaboratives really leading the way

Under cover of COVID-19 restrictions the postponed 2020 joint meeting of BSCOS and IPOS (Israeli Paediatric Orthopaedic Society) was conducted virtually on 1st February 2021. It was a great success, not least thanks to two keynote speakers in the shape of Professor Chris Colton presenting ‘Observations on the structure and function of the growth plate’ and Sharon Eylon, the President of IPOS, presenting her experience of ‘Rehabilitation after Major Trauma’. Access to the recorded meeting is available to BSCOS members: https://bscos.talkingslideshd.com/home.

BSCOS has consumed much of its energy in recent years promoting our research agenda. The SCIENCE study (medial epicondyles) and CRAFFT study (severe wrist fractures) are going from strength to strength, with SCIENCE recently surpassing 100 recruits and CRAFFT surpassing 50. More than 70 hospitals are now involved in these studies – including almost every big children’s hospital in the UK. In addition, hospitals in New Zealand and Australia are now joining these studies, with a separate US bid to mirror them in North America.

The FORCE (torus fractures) study has now completed, and results are awaited. This managed to recruit nearly 1,000 torus fractures to an RCT – even in the midst of a global pandemic proving just how common these injuries are.

The BOSS study has presented the results to BSCOS, and we now await the publication of the final papers summarising this work – BOSS was the start of the BSCOS research journey.

The expansion of the cerebral palsy CPIPS pathway continues to deliver high-quality evidence in a difficult area to research.

There remain more studies ahead, with severe stable SCFE, Salter Harris II fractures of the ankle, the identification of osteomyelitis and the treatment of cerebral palsy all identified by NIHR as areas for imminent funding.

Children’s orthopaedics was a research free zone, though now is a leading light in NIHR research. This is thanks to the collaborative efforts between BSCOS and the OTS, and all surgeons with a thirst to treat children with high quality evidence.

BritSpine 2021 update

Patrick Statham - UKSSB Chair

BritSpine is a meeting of clinicians and scientists involved in the care of people with spinal conditions, promoting collaboration and understanding between them. This is reflected in the diverse subjects that were addressed at the biennial BritSpine, on 10th – 12th March 2021, with speakers from China, Singapore, Australia, Egypt, Europe North and South America. The meeting was all virtual, due to COVID-19 restrictions, so all talks were pre-recorded, but speakers were online to answer questions, articulated by the attendees channelled through the moderators.

The conference started with what we had learnt from COVID; particularly benefits and limitations of technology to assess patients virtually. Professor Sallie Lamb talked on the aging spine and the BOOST trial; Professor Sahota showed evidence for intervention and management of vertebral and sacral osteoporotic fractures. Professor Alison Macgregor showed the detailed personal management of the British Olympic rowing team, and how she brought science to the sport.

Professor Joost van Middendop gave a critical analysis of ‘time is spine’, concluding that there is no good current evidence favouring early spinal cord decompression in acute traumatic spinal cord injury, but significant publication bias. Cauda equina syndrome was discussed from the perspective of first symptoms and triage, and from the difficulties in rehabilitation. There were illuminating talks on protecting professional rugby players from injury (James Robson), and surgery for cervical spine injuries in sport (Rick Nelson). A wonderful personal account of spinal cord injury from Dr Gwyn Jones taught us not to tell people they are ‘lucky’ when they are not! The future management of back pain was discussed fully, including the shape of future clinical trials.

Two important trials; NERVES (Martin Wilby) spinal injections vs microsurgery, and SCOPIC (Professor Nadine Foster) (targeted physiotherapy for radicular pain) publicised their results.

The meeting was filled with politics, papers and posters, and finished with an excellent session on spinal oncology; protons, genomics, and enbloc spinal resections, courtesy of the wonderful Professor Stefano Boriani. Best presentations prizes followed, after which we all made the journey back from the meeting to home in record time!