Can patients really make an informed choice? An evaluation of the availability of online information about consultant surgeons in the United Kingdom.

Objectives - The National Health Service (NHS) 'Choose and Book' online scheme, which allows patients to select the location and time of hospital appointments, has now been extended to include the option for patients to select a specific consultant to carry out any necessary treatment. The aim of this study was to determine whether there is sufficient online information about consultants or consultant-led teams for patients to make an informed choice regarding a specific consultant. Design - A web-based analysis of the availability of information. Setting - North of England. Participants - Two hundred websites of orthopaedic surgeons. Main outcome measures - The websites were analysed using a bespoke template that took into account recommendations of the 2010 UK Government white paper. Each website was scored in relation to the availability of specific content relating to each surgeon. Results - The majority of websites detailed authorship information (73.2%), level of professional qualification (98.5%) and area of general (73.7%) and specialist (93.3%) interest. However, approximately 50% of websites provided no information in relation to update cycle, involvement in teaching or research and patient satisfaction. Only five (2.6%) of the websites presented death rates, and none indicated morbidity rates. Conclusions - For patients to be able to make informed choices about their healthcare, surgeons need to ensure that sufficient information is available online, according to the identified limitations of the websites investigated in this study

Fractured Inferior Pubic Ramus with Ipsilateral Total Hip Replacement: A Case Report and Review of the Literature

Pubic rami fractures are common. They are associated with significant morbidity and mortality. These fractures are usually classified as stable injuries and traditionally receive limited orthopaedic input. Management typically involves hospital admission and early input from physiotherapists and occupational therapists. Early mobilisation is advocated as a central part of managing these patients, with emphasis on secondary prevention. We report a case diagnosed as minimally displaced inferior pubic ramus fracture in a patient with an ipsilateral total hip replacement (THR). The patient was mobilised early and despite analgesia continued to complain of groin pain. Repeat radiographs showed a fracture of the acetabulum with displacement of the acetabular component of the hip replacement. We advocate early orthopaedic input for all pubic rami fractures, particularly in patients with hip arthroplasty, and thorough investigation including a CT scan of the pelvis to exclude acetabular extension prior to mobilisation

One Week of Unilateral Ankle Immobilisation Alters Plantarflexor Strength, Balance and Walking Speed: A Pilot Study in Asymptomatic Volunteers.

Context - Ankle immobilisation is often used following ankle injury. Objective - To determine the influence of one week's unilateral ankle immobilisation on plantarflexor strength, balance and walking gait in asymptomatic volunteers. Design - Repeated measures laboratory study. Setting - University laboratory. Participants - Six physically active male participants with no recent history of lower limb injury. Interventions - Participants completed a one week period of ankle immobilisation achieved through wearing a below knee ankle cast. Before the cast was applied, as well as immediately following cast removal, at 24 hours after cast removal, and at 48 hours after cast removal, their plantarflexor strength was assessed isokinetically, and they completed a single leg balance task as a measure of proprioceptive function. An analysis of their walking gait was also completed. Main outcome measures - Peak platarflexor torque and balance were used to determine any effect on muscle strength and proprioception following cast removal. Ranges of motion (3D) of the ankle, knee and hip, as well as walking speed were used to assess any influence on walking gait. Results - Following cast removal, plantarflexor strength was reduced for the majority of participants (p=0.063, CI=-33.98-1.31) and balance performance was reduced in the immobilised limb (p<0.05, CI=0.84-5.16). Both strength and balance were not significantly different to baseline levels by 48 hours. Walking speed was not significantly different immediately following cast removal, but increased progressively above baseline walking speed over the following 48 hours. Joint ranges of motion were not significantly different at any time point. Conclusions - The reduction in strength and balance after such a short period of immobilisation suggested compromised central and peripheral neural mechanisms. This suggestion appeared consistent with the delayed increase in walking speed which could occur as a result of the excitability of the neural pathways increasing towards baseline levels