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BACKGROUND: The knee joint assessment to detect anterior cruciate ligament (ACL) injury after trauma involves clinical examination and radiography. The gold standard method is doing arthroscopy. We did this study seeking to evaluate the effectiveness of other non-invasive diagnostic methods, including the Anterior Drawer test, Lachman test and magnetic resonance imaging (MRI) in detecting ACL tears after trauma, compared to the reference standard method (the arthroscopy). METHODOLOGY: This descriptive cross-sectional study was conducted in the Orthopaedic Department of the Khyber Teaching Hospital, Peshawar, for six months. A total of 86 participants with knee injuries fulfilling the inclusion criteria were recruited for the study. Mechanism of injury, side of injury and body weight were recorded. The Anterior Drawer test and Lachman test for ACL injury were performed by orthopaedic surgeons with at least five years of post-fellowship experience in orthopaedic surgery. Sensitivities, specificities and accuracy of the clinical tests and MRI were calculated. RESULTS: The statistical analysis revealed that the mean age of participants was 35.73 (SD 12.7) years, with a range from 18 to 55 years. Among the participants, 67 (77.91%) were male and 19 (22.09%) were female. The side of injury was predominantly right in 50 (58.14%) and left in 36 (41.86%) participants. Road traffic accidents (RTAs) were the leading cause of knee injury, accounting for 63.95% (55) of cases, followed by sports injuries at 23.26% (20). Regarding diagnostic accuracy, MRI showed a sensitivity of 98.57%, specificity of 87.50% and diagnostic accuracy of 96.51% in detecting ACL tears. The Lachman test demonstrated a sensitivity of 90%, specificity of 87.5% and diagnostic accuracy of 89.53% compared to arthroscopy. Similarly, the anterior Drawer test exhibited a sensitivity of 88.57%, specificity of 87.50% and diagnostic accuracy of 88.37% against the gold standard of arthroscopy. These findings underscore the effectiveness of these diagnostic modalities in identifying ACL injuries. CONCLUSIONS: All three tests (MRI, Lachman test and anterior Drawer test) can be used for the diagnosis of anterior cruciate ligament injury with optimal results.
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Objective To compare the role of paper-based versus digital record keeping in the orthopaedic ward in terms of staff satisfaction, education of staff, and adherence to British Orthopaedic Association (BOA) guidelines. Materials and methods Forty-four participants including nurses, senior house officers, foundation year trainees, and consultants completed a questionnaire. The first survey was done to introduce electronic records keeping to the participants and the second survey was conducted to review the collected record. Three parameters were assessed, which were adherence to BOA guidelines, staff satisfaction, and effect of education for both paper-based and electronic records. Comparison between two methods of record keeping was done by independent t-test for continuous data and chi-square test for categorical. Results For all four questions about staff satisfaction, the score of the electronic method was higher than paperwork statistically. The score for 'opportunity to learn images in ward round' was higher in electronic (3.9±0.8) than paperwork (2.6±1.3) statistically (p<0.001). Comparable results were found for 'educational usefulness of ward round' and 'typing time affecting learning time'. For adherence to guidelines, the electronic record keeping was more effective in storing the patient's ID and name (p=0.05), details of documenting clinician (p<0.001), time of ward round ((p=0.005), whom to contact in case of concern (p=0.050), and grade of ward round clinician (<0.001). Conclusion Electronic records in the orthopaedic ward were deemed better than paperwork in terms of staff satisfaction, positive effect on the education of doctors, and adherence to BOA guidelines.
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Background Recent studies have shown a decline in theatre efficiency and productivity coinciding with the coronavirus disease 2019 (COVID-19) pandemic. In this study, we evaluate trauma theatre task efficiency in three different time periods (April 2019, April 2020, and November 2020), and analyse if productivity has altered since the start of the pandemic. Methods The records of a total of 320 patients who underwent orthopaedic trauma surgery at a large district general hospital in April 2019, April 2020 (during the first wave of the pandemic) and November 2020 (during the second wave of the pandemic) were analysed. Primary outcomes measured include time to get to the theatre, anaesthetic preparation time, the sum of time of anaesthesia and surgical preparation time, duration of surgery and time to transfer to recovery. Patient demographics as well as the type of surgery were also analysed. Results The time to get to the theatre and anaesthetic preparation time significantly increased in April 2020 (p<0.05) but fell in November 2020 with no significant difference in comparison to before the pandemic in April 2019 (p>0.05). The duration of surgery and time to transfer to recovery significantly increased in April 2020 (p<0.05) and though reduced in November 2020, was still significantly greater in comparison to April 2019 (p<0.05). In April 2020, the proportion of patients aged 18-65 was just 26% as compared to 35% in April 2019. This figure rose again to 45% in November 2020. The number of hip fracture procedures remained similar during the three time periods, with 32, 32 and 36 hip fracture operations in April 2019, April 2020 and November 2020, respectively. Conclusion While operating theatres' efficiency decreased during the first wave of the COVID-19 pandemic, it increased again in the second wave, coming close to the 'normal' levels before the pandemic struck.