Publications
32 results found
Korman A, Aframian A, Domos P, 2024, Operative versus non-operative treatment of extra-articular distal humeral shaft fractures: a retrospective comparative study evaluating clinical and radiological outcomes., Eur J Orthop Surg Traumatol, Vol: 34, Pages: 1327-1332
PURPOSE: There is limited evidence for comparing operative and non-operative management of closed, extra-articular distal humeral shaft fractures. This study aims to evaluate these outcomes. METHODS: A comparative retrospective study was performed for patients who underwent either operative fixation or conservative management with a humeral brace, with clinical and radiological outcomes at minimum 2-year follow-up. RESULTS: Forty-two patients with median 4.6 years follow-up were included; 24 had surgical fixation and 18 were managed with humeral brace. Assessment of clinical and radiological outcomes demonstrated few statistically significant functional differences between the two groups. Surgical patients achieved faster union for non-comminuted fractures. All patients maintained functional range of motion, with similar complication rates. CONCLUSION: This study suggests that similar outcomes can be achieved with both managements, though faster union times may be seen in the operative group. Further studies are recommended to evaluate the impact of fracture comminution causing delayed unions.
Borges FK, Devereaux PJ, Cuerden M, et al., 2022, Accelerated Surgery Versus Standard Care in Hip Fracture (HIP ATTACK-1): A Kidney Substudy of a Randomized Clinical Trial, AMERICAN JOURNAL OF KIDNEY DISEASES, Vol: 80, Pages: 686-689, ISSN: 0272-6386
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Park C, Sugand K, Aframian A, et al., 2022, Impact of COVID-19 pandemic on hip fractures: the central London experience COVID-related urgent geriatric hip trauma (COUGH) study COVERT ( COVid Emergency-Related Trauma and orthopaedics) collaborative, Irish Journal of Medical Science, Vol: 191, Pages: 1005-1012, ISSN: 0021-1265
Introduction:COVID-19 has been recognized as the unprecedented global health crisis in modern times. The purpose of this study was to assess the impact of COVID-19 on treatment of neck of femur fractures (NOFF) against the current guidelines and meeting best practice key performance indicators (KPIs) according to the National Hip Fracture Database (NHFD) in two large central London hospitals.Materials and methodsA multi-center, longitudinal, retrospective, observational study of NOFF patients was performed for the first ‘golden’ month following the lockdown measures introduced in mid-March 2020. This was compared to the same time period in 2019.Results:A total of 78 cases were observed. NOFFs accounted for 11% more of all acute referrals during the COVID era. There were fewer overall breaches in KPIs in time to theatre in 2020 and also for those awaiting an orthogeriatric review. Time to discharge from the trust during the pandemic was improved by 54% (p < 0.00001) but patients were 51% less likely to return to their usual residence (p = 0.007). The odds ratio was significantly higher for consultant surgeon-led operations and consultant orthogeriatric-led review in the post-COVID era. There was no significant difference in using aerosol-generating anaesthetic procedures or immortality rates between both years.Conclusion:The impact of COVID-19 pandemic has not adversely affected the KPIs for the treatment of NOFF patients with significant improvement in numerous care domains. These findings may represent the efforts to ensure that these vulnerable patients are treated promptly to minimize their risks from the coronavirus.
Chan G, Narang A, Aframian A, et al., 2022, Medium-term mortality after hip fractures and COVID-19: A prospective multi-centre UK study, Chinese Journal of Traumatology, Vol: 25, Pages: 161-165, ISSN: 1008-1275
PurposeThe COVID-19 pandemic has caused 1.4 million deaths globally and is associated with a 3–4 times increase in 30-day mortality after a fragility hip fracture with concurrent COVID-19 infection. Typically, death from COVID-19 infection occurs between 15 and 22 days after the onset of symptoms, but this period can extend up to 8 weeks. This study aimed to assess the impact of concurrent COVID-19 infection on 120-day mortality after a fragility hip fracture.MethodsA multi-centre prospective study across 10 hospitals treating 8% of the annual burden of hip fractures in England between 1st March and 30th April, 2020 was performed. Patients whose surgical treatment was payable through the National Health Service Best Practice Tariff mechanism for “fragility hip fractures” were included in the study. Patients’ 120-day mortality was assessed relative to their peri-operative COVID-19 status. Statistical analysis was performed using SPSS version 27.ResultsA total of 746 patients were included in this study, of which 87 (11.7%) were COVID-19 positive. Mortality rates at 30- and 120-day were significantly higher for COVID-19 positive patients relative to COVID-19 negative patients (p < 0.001). However, mortality rates between 31 and 120-day were not significantly different (p = 0.107), 16.1% and 9.4% respectively for COVID-19 positive and negative patients, odds ratio 1.855 (95% CI 0.865–3.978).ConclusionHip fracture patients with concurrent COVID-19 infection, provided that they are alive at day-31 after injury, have no significant difference in 120-day mortality. Despite the growing awareness and concern of “long-COVID” and its widespread prevalence, this does not appear to increase medium-term mortality rates after a hip fracture.
Sugand K, Aframian A, Park C, et al., 2022, The impact of COVID-19 on acute trauma and orthopaedic referrals and surgery in the UK during the first wave of the pandemic: a multicentre observational study, BMJ Open, Vol: 12, ISSN: 2044-6055
Objective: This is the first British multi-centre study observing the impact of the COVID-19 pandemic on orthopaedic trauma with respect to referrals, operative caseload and mortality during its peak. Design: A longitudinal, multi-centre, retrospective, observational, cohort study was conducted during the peak 6 weeks of the first wave from March 17, 2020 compared to the same period in 2019. Setting: Hospitals from six major urban cities were recruited around the UK, including London.Participants: A total of 4840 clinical encounters were initially recorded. 4668 clinical encounters were analysed post-exclusion.Primary and secondary outcome measures: Primary outcomes included the number of acute trauma referrals and those undergoing operative intervention, mortality rates, and the proportion of patients contracting COVID-19. Secondary outcomes consisted of the mechanism of injury, type of operative intervention and proportion of aerosolising-generating anaesthesia utilised. Results: During the COVID-19 period there was a 34% reduction in acute orthopaedic trauma referrals compared to 2019 (1792 down to 1183 referrals), and 29.5% less surgical interventions (993 down to 700 operations). The mortality rate significantly (both statistically and substantially) more than doubled for both risk and odds ratios during the COVID period in all referrals (1.3% vs 3.8%, p=0.0005) and in those undergoing operative intervention (2.2% vs 4.9%, p=0.004). Moreover, mortality due to COVID-related complications (versus non-COVID causes) had greater odds by a factor of at least 20 times. For the operative cohort during COVID, there was a greater odds of aerosolising-generating anaesthesia (including those with superimposed regional blocks) by three-quarters as well as doubled odds of a Consultant acting as the primary surgeon. Conclusion: Although there was a reduction of acute trauma referrals and those undergoing operative intervention, the mortality rate still more than doubled in od
Morgan C, Sugand K, Ashdown T, et al., 2022, Impact of the National Lockdown Due to the COVID-19 Pandemic On Upper Limb Trauma Workload in Central London: A Multi-Centre Longitudinal Observational Study During Implementation and Ease of National Lockdown, ARCHIVES OF BONE AND JOINT SURGERY-ABJS, Vol: 10, Pages: 23-31, ISSN: 2345-4644
Narang A, Chan G, Aframian A, et al., 2020, Correction to: Thirty-day mortality following surgical management of hip fractures during the COVID-19 pandemic: findings from a prospective multi-centre UK study, International Orthopaedics, Vol: 44, Pages: 2819-2819, ISSN: 0341-2695
Narang A, Chan G, Aframian A, et al., 2020, Thirty-day mortality following surgical management of hip fractures during the COVID-19 pandemic: findings from a prospective multi-centre UK study, International Orthopaedics, Vol: 45, Pages: 23-31, ISSN: 0341-2695
PurposeThirty-day mortality of patients with hip fracture is well researched and predictive; validated scoring tools have been developed (Nottingham Hip Fracture Score, NHFS). COVID-19 has significantly greater mortality in the elderly and comorbid patients which includes hip fracture patients. Non-operative treatment is not appropriate due to significantly higher mortality, and therefore, these patients are often exposed to COVID-19 in the peri-operative period. What is unclear is the effect of concomitant COVID-19 infection in these patients.MethodsA multicentre prospective study across ten sites in the United Kingdom (responsible for 7% of hip fracture patients per annum in the UK). Demographic and background information were collected by independent chart review. Data on surgical factors included American Society of Anesthesiologists (ASA) score, time to theatre, Nottingham Hip fracture score (NHFS) and classification of fracture were also collected between 1st March 2020 and 30th April 2020 with a matched cohort from the same period in 2019.ResultsActual and expected 30-day mortality was found to be significantly higher than expected for 2020 COVID-19 positive patients (RR 3.00 95% CI 1.57–5.75, p < 0.001), with 30 observed deaths compared against the 10 expected from NHFS risk stratification.ConclusionCOVID-19 infection appears to be an independent risk factor for increased mortality in hip fracture patients. Whilst non-operative management of these fractures is not suggested due to the documented increased risks and mortality, this study provides evidence to the emerging literature of the severity of COVID-19 infection in surgical patients and the potential impact of COVID-19 on elective surgical patients in the peri-operative period.
Sugand K, Park C, Morgan C, et al., 2020, Impact of the COVID-19 pandemic on paediatric orthopaedic trauma workload in central London: a multi-centre longitudinal observational study over the "golden weeks" The COVid Emergency Related Trauma and orthopaedics (COVERT) Collaborative, Acta Orthopaedica, Vol: 91, Pages: 633-638, ISSN: 0001-6470
Background and purpose — The COVID-19 pandemic has been recognised as an unprecedented global health crisis. This study assesses the impact on a large acute paediatric hospital service in London, evaluating the trends in the acute paediatric orthopaedic trauma referral caseload and operative casemix before (2019) and during (2020) COVID-19 lockdown.Patients and methods — A longitudinal retrospective observational prevalence study of both acute paediatric orthopaedic trauma referrals and operative caseload was performed for the first 6 “golden weeks” of lockdown. These data were compared with the same period in 2019. Statistical analyses included median (± median absolute deviation), risk and odds ratios as well as Fisher’s exact test to calculate the statistical significance, set at p ≤ 0.05.Results — Acute paediatric trauma referrals in 2020 were reduced by two-thirds compared with 2019 (n = 302 vs. 97) with a halving risk (RR 0.55) and odds ratios (OR 0.43) of sporting-related mechanism of injuries (p = 0.002). There was a greater use of outpatient telemedicine in the COVID-19 period with more Virtual Fracture Clinic use (OR 97, RR 84, p < 0.001), and fewer patients being seen for consultation and followed up face to face (OR 0.55, RR 0.05, p < 0.001).Interpretation — The impact of the COVID-19 pandemic has led to a decline in the number of acute paediatric trauma referrals, admissions, and operations during the COVID period. There has also been a significant change in the patient pathway with more being reviewed via the means of telemedicine to reduce the risk of COVID-19 transmission and exposure. More work is required to observe for similar trends nationwide and globally as the pandemic has permanently affected the entire healthcare infrastructure.
Morgan C, Ahluwalia AK, Aframian A, et al., 2020, The impact of the novel coronavirus on trauma and orthopaedics in the UK, BRITISH JOURNAL OF HOSPITAL MEDICINE, Vol: 81, ISSN: 1750-8460
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Borges FK, Bhandari M, Guerra-Farfan E, et al., 2020, Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial, LANCET, Vol: 395, Pages: 698-708, ISSN: 0140-6736
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- Citations: 133
Aframian A, Iranpour F, Cobb J, 2020, Medical devices and artificial intelligence, Artificial Intelligence in Healthcare, Pages: 163-177, ISBN: 9780128184387
There is near infinite potential for artificial intelligence (AI) in medical devices, with almost all current technologies having the potential for improvement using AI. We discuss here some examples of how it is already being used and we have divided these into physical hardware devices and software or virtual devices, in part because they are different and also because the regulatory requirements vary for different medical devices. These devices have in turn been divided into community and specialist center (such as hospital) uses to provide context. The increasing use of medical devices has led to the need for new regulations in both Europe and worldwide and these too are discussed.
Tran K, Bøtker JP, Aframian A, et al., 2020, Artificial intelligence for medical imaging, Artificial Intelligence in Healthcare, Pages: 143-162, ISBN: 9780128184387
An image may be defined as a two-dimensional function f(x, y) where x and y represent the spatial coordinates and the function (f) represents the amplitude at any given pair of coordinates (x, y). The amplitude (f) is also often referred to as the gray level or the intensity of that point in the image. A digital image is thus composed of a finite number of these x, y elements where all of them have an exact location and value. These picture elements are often referred to as pixels. 3D images may subsequently be defined by a three-dimensional function (x, y, z) and the individual elements are often referred to as voxels. The image quality is an important parameter in the field of radiology and the term spatial resolution refers to the capability of differentiating two neighboring objects in the image. Another important resolution property is the temporal resolution, which refers to the quality of the imaging with respect to time.
Rivière C, Dhaif F, Shah H, et al., 2018, Kinematic alignment of current TKA implants does not restore the native trochlear anatomy, Orthopaedics and Traumatology: Surgery and Research, Vol: 104, Pages: 983-995, ISSN: 1877-0568
INTRODUCTION: Preserving constitutional patellofemoral anatomy, and thus producing physiological patellofemoral kinematics, could prevent patellofemoral complications and improve clinical outcomes after kinematically aligned TKA (KA TKA). Our study aims 1) to compare the native and prosthetic trochleae (planned or implanted), and 2) to estimate the safety of implanting a larger Persona® femoral component size matching the proximal lateral trochlea facet height (flange area) in order to reduce the native articular surfaces understuffing generated by the prosthetic KA trochlea. METHODS: Persona® femoral component 3D model was virtually kinematically aligned on 3D bone-cartilage models of healthy knees by using a conventional KA technique (group 1, 36 models, planned KA TKA) or an alternative KA technique (AT KA TKA) aiming to match the proximal (flange area) lateral facet height (10 models, planned AT KA TKA). Also, 13 postoperative bone-implant (KA Persona®) models were co-registered to the same coordinate geometry as their preoperative bone-cartilage models (group 2 - implanted KA TKA). In-house analysis software was used to compare native and prosthetic trochlea articular surfaces and medio-lateral implant overhangs for every group. RESULTS: The planned and performed prosthetic trochleae were similar and valgus oriented (6.1° and 8.5°, respectively), substantially proximally understuffed compared to the native trochlea. The AT KA TKAs shows a high rate of native trochlea surface overstuffing (70%, 90%, and 100% for lateral facet, groove, medial facet) and mediolateral implant overhang (60%). There was no overstuffing with conventional KA TKAs having their anterior femoral cut flush. CONCLUSION: We found that with both the planned and implanted femoral components, the KA Persona® trochlea was more valgus oriented and understuffed compared to the native trochlear anatomy. In addition, restoring the lateral trochlea facet height by increasing t
Rivière C, Dhaif F, Shah H, et al., 2018, Kinematic alignment of current TKA implants does not restore the native trochlear anatomy, Revue de Chirurgie Orthopedique et Traumatologique, Vol: 104, Pages: 673-685, ISSN: 1877-0517
Riviere C, Iranpoura F, Harris S, et al., 2018, Differences in trochlear parameters between native and prosthetic kinematically or mechanically aligned knees, Revue de Chirurgie Orthopedique et Traumatologique, Vol: 104, Pages: 124-130, ISSN: 1877-0517
Riviere C, Iranpour F, Harris S, et al., 2018, Differences in trochlear parameters between native and prosthetic kinematically or mechanically aligned knees, ORTHOPAEDICS & TRAUMATOLOGY-SURGERY & RESEARCH, Vol: 104, Pages: 165-170, ISSN: 1877-0568
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- Citations: 35
Rivière C, Iranpour F, Harris S, et al., 2017, The kinematic alignment technique for TKA reliably aligns the femoral component with the cylindrical axis, Revue de Chirurgie Orthopedique et Traumatologique, Vol: 103, Pages: 773-777, ISSN: 1877-0517
Rivière C, Iranpour F, Auvinet E, et al., 2017, Mechanical alignment technique for TKA: Are there intrinsic technical limitations?, Revue de Chirurgie Orthopedique et Traumatologique, Vol: 103, Pages: 762-772, ISSN: 1877-0517
Riviere C, Iranpour F, Harris S, et al., 2017, The kinematic alignment technique for TKA reliably aligns the femoral component with the cylindrical axis, ORTHOPAEDICS & TRAUMATOLOGY-SURGERY & RESEARCH, Vol: 103, Pages: 1069-1073, ISSN: 1877-0568
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- Citations: 26
Rivière C, FarhadIranpour, Auvinet E, et al., 2017, Mechanical Alignment Technique For TKA: Are there Intrinsic Technical Limitations?, Orthopaedics and Traumatology: Surgery and Research, ISSN: 1877-0568
BACKGROUND: Mechanically aligned (MA) total knee arthroplasty (TKA) is affected by disappointing functional outcomes in spite of the recent improvements in surgical precision and implant designs. This might suggest the existence of intrinsic technical limitations. Our study aims to compare the prosthetic and native trochlear articular surfaces and to estimate the extent of collateral ligament imbalance which is technically un-correctable by collateral ligament release when TKA implants are mechanically aligned. STUDY HYPOTHESIS: conventional MA technique generates a high rate of prosthetic overstuffing of the distal groove, distal lateral trochlear facet and distal lateral femoral condyle (Hypothesis 1), and technically un-correctable collateral ligament imbalance (hypothesis 2)? Disregarding the distal femoral joint line obliquity (DFJLO) when performing femoral cuts explainsdistal lateral femoral prosthetic stuffing and un-correctable imbalance (hypothesis 3)? METHODS: Twenty patients underwent a conventional MA TKA. Pre-operative MRI-based 3D knee models were generated and MA TKA was simulated. Native and prosthetic trochlear articular surfaces were compared using in-house analysis software.Following the automatic determination by the planning software of the size of the extension and flexion gaps, an algorithm was applied to balance the gaps and the frequency and amplitude of technically un-correctable knee imbalance wereestimated. RESULTS: The conventional MA technique generateda significant slight distal lateral femoral prosthetic overstuffing (mean 0.6mm, 0.8mm, 1.25 mmfor the most distal lateral facet point, groove, and at the most distal point of lateral femoral condyle, respectively) and a high rate of type 1 and 2 un-corretable knee imbalance (30% and 40%, respectively). The incidence of distal lateral prosthetic overstuffing (trochlea and condyle) and un-correctable knee imbalance were strongly to very strongly correlated with the DFJLO (r=0.53 to 0.89).
Aframian A, Auvinet E, Iranpour F, et al., 2017, O95: An instrumented treadmill shows excellent reliability and repeatability at a range of speeds to maximal walking speedover a range of inclines and declines, Gait and Posture, Vol: 57, ISSN: 0966-6362
Auvinet E, Galna B, Aframian A, et al., 2017, O100: Validation of the precision of the Microsoft HoloLens augmented reality headset head and hand motion measurement, Gait & Posture, Vol: 57, Pages: 175-176, ISSN: 0966-6362
Nazruzov T, Van Der Straeten C, Iranpour Boroujeni F, et al., 2017, REGISTRATION OF PRE- AND POST-OPERATIVE CT DATA USING ICP FOR PATIENTS UNDERGOING TOTAL KNEE ARTHROPLASTY (TKA), Bone & Joint Journal, ISSN: 2049-4394
Aframian A, Smith TO, Tennent TD, et al., 2016, Origin and insertion of the medial patellofemoral ligament: a systematic review of anatomy., Knee Surgery, Sports Traumatology, Arthroscopy, Vol: 25, Pages: 3755-3772, ISSN: 0942-2056
PURPOSE: The medial patellofemoral ligament (MPFL) is the major medial soft-tissue stabiliser of the patella, originating from the medial femoral condyle and inserting onto the medial patella. The exact position reported in the literature varies. Understanding the true anatomical origin and insertion of the MPFL is critical to successful reconstruction. The purpose of this systematic review was to determine these locations. METHODS: A systematic search of published (AMED, CINAHL, MEDLINE, EMBASE, PubMed and Cochrane Library) and unpublished literature databases was conducted from their inception to the 3 February 2016. All papers investigating the anatomy of the MPFL were eligible. Methodological quality was assessed using a modified CASP tool. A narrative analysis approach was adopted to synthesise the findings. RESULTS: After screening and review of 2045 papers, a total of 67 studies investigating the relevant anatomy were included. From this, the origin appears to be from an area rather than (as previously reported) a single point on the medial femoral condyle. The weighted average length was 56 mm with an 'hourglass' shape, fanning out at both ligament ends. CONCLUSION: The MPFL is an hourglass-shaped structure running from a triangular space between the adductor tubercle, medial femoral epicondyle and gastrocnemius tubercle and inserts onto the superomedial aspect of the patella. Awareness of anatomy is critical for assessment, anatomical repair and successful surgical patellar stabilisation. LEVEL OF EVIDENCE: Systematic review of anatomical dissections and imaging studies, Level IV.
Iranpour F, Aframian A, Cobb JP, 2016, The patellofemoral joint, Joint Preservation in the Adult Knee, Pages: 43-53, ISBN: 9783319418070
The patellofemoral joint has traditionally been poorly understood and interventions for patellofemoral joint problems have generally been less successful than those employed for the tibiofemoral joint. Pathologies affecting the patellofemoral joint in the adult can be largely divided into three groups: instability, osteochondral defects and osteoarthritis. These three conditions share a number of aetiological factors and all represent disorders of the normal mechanics of the patellofemoral articulation. As such, understanding the normal and abnormal anatomy and kinematics of the joint are vital to clinicians treating patellofemoral disorders. Treating the symptoms of these conditions without addressing the underlying disorder of kinematics will be likely to fail. In this chapter, the normal and abnormal anatomy and physiology of the joint are discussed as are the clinical features and treatments for the three commonly encountered pathologies of the patellofemoral joint.
Aframian A, Boughton OR, Auvinet E, et al., 2015, Patellofemoral pain is a symptom, not a diagnosis, British Medical Journal, Vol: 351, ISSN: 1468-5833
Aframian A, Johnson DS, Hing CB, 2015, BASK survey of The Knee readership 2015, KNEE, Vol: 22, Pages: 443-445, ISSN: 0968-0160
Green GL, Aframian A, Vinayakam P, et al., 2015, Macrophage activation syndrome or septic arthritis: a case of mistaken identity, JOURNAL OF PEDIATRIC ORTHOPAEDICS-PART B, Vol: 24, Pages: 330-335, ISSN: 1060-152X
Green G, Aframian A, bernard J, 2014, Ward round documentation in a major trauma centre: can we improve patient safety?, BMJ Quality Improvement Reports, Vol: 3, ISSN: 2050-1315
Our objective was to improve documentation and patient safety in a major trauma centre.A retrospective audit was undertaken in March 2014. Ward round entries for each orthopaedic patients on three dates were assessed against standards and analysed. The audit was repeated in April 2014, and again in August 2014.Thorough documentation is paramount in a major trauma centre. It forms a useful record of the patients hospital stay, is a legal document and is highlighted in national guidelines. It provides a basis for good handover, ensuring continuation of care and maintaining patient safety. Resultant poor compliance with Royal College guidelines in the initial audit led to the production of a new electronic based note keeping system. A meeting was held with all staff prior to introduction.Our initial results gained 75 entries, and none showed full compliance. Mean compliance per entry was 59% (0-81%). The second attempt gained 90 entries, with 30 from the weekend. Mean compliance per entry 97%. Third attempt received 61 entries, with 27 from the weekend. Mean compliance was 96%, meaning that the improvement was being maintained.Recent distressing reports regarding patient highlighted the importance of patient. Our initial audit proved there were many areas lacking in our documentation and improvement was necessary. Prior to introducing electronic systems, the implemented change has produced improvement in documentation, and provides a useful handover tool for staff.
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