Imperial College London

Mr Oliver Boughton

Faculty of MedicineDepartment of Surgery & Cancer

Honorary Clinical Research Fellow
 
 
 
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Contact

 

o.boughton

 
 
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The MSk LabCharing Cross HospitalCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
to

35 results found

Abel R, Behforootan S, Boughton O, Hansen U, Cobb J, Huthwaite Pet al., 2021, Ultrasound and Bone Disease: A Systematic Review, World Journal of Surgery and Surgical Research

Journal article

Boughton O, Cobb J, owyang D, Bakhsh A, brewer Det al., 2021, Patient and Public Involvement Within Orthopaedic Research: A Systematic Review, Journal of Bone and Joint Surgery: American Volume, ISSN: 0021-9355

Journal article

Grigoras M, Boughton O, Cleary M, McKenna P, Rowan FEet al., 2021, Short-term outcomes of total knee arthroplasty performed with and without a tourniquet., SICOT J, Vol: 7, ISSN: 2426-8887

INTRODUCTION: Not using a tourniquet could improve early postoperative pain, range of motion (ROM), length of stay (LOS), and thromboembolic risk in patients undergoing total knee arthroplasty (TKA). Our aim was to compare these factors, intraoperative blood loss, and gender-related outcomes in patients undergoing primary TKA with or without a tourniquet. METHODS: We performed a retrospective cohort study of 97 patients undergoing TKA with or without tourniquet from 2018 to 2020. Revisions and bilateral TKAs were excluded. Blood loss was estimated using a validated formula. Postoperative pain was tested using the visual analogue scale (VAS). ROM and quadriceps lag were assessed by a physiotherapist on a postoperative day 2 and discharge. The index of suspicion for a thromboembolic event was defined as the number of embolic-related investigations ordered in the first 6 months post-surgery. The Shapiro-Wilk test was used to assess the distribution of the data, Mann-Whitney for the continuous variables, and Fischer's test for the categorical ones. RESULTS AND DISCUSSION: There was a significant difference in blood loss. The non-tourniquet group lost on average 32% more blood (1291 mL vs. 878 mL, p<0.001 two-tailed). We found no difference in pain, ROM, LOS, and quadriceps lag on day 2 and at discharge. There was one thromboembolic event in the tourniquet group, but the thromboembolic index of suspicion did not differ (p=0.53). With tourniquet use, women had a significantly lower day 2 maximum flexion than men (71.56° vs. 84.67°, p=0.02). In this retrospective cohort study, the results suggest that tourniquet use is associated with lower blood loss and similar postoperative pain, range of motion, quadriceps lag, length of stay, and thromboembolic risk. There might be some differences between how men and women tolerate a tourniquet, with women having worse short-term outcomes compared to men.

Journal article

Ma S, Goh EL, Tay T, Wiles C, Boughton O, Churchwell J, Wu Y, Karunaratne A, Bhattacharya R, Terrill N, Cobb J, Hansen U, Abel Ret al., 2020, Nanoscale mechanisms in age-related hip-fractures, Scientific Reports, Vol: 10, Pages: 1-14, ISSN: 2045-2322

Nanoscale mineralized collagen fibrils may be important determinants of whole-bone mechanical properties and contribute to the risk of age-related fractures. In a cross-sectional study nano-and tissue-level mechanics were compared across trabecular sections from the proximal femora of three groups(n=10 each): ageing non-fractured donors (Controls);untreated fracture patients (Fx-Untreated); bisphosphonate-treated fracture patients (Fx-BisTreated).Collagen fibril, mineral and tissue mechanics were measured using synchrotron X-Ray diffraction,of bone sections under load. Mechanical data were compared across groups, and tissue-level data were regressed against nano. Compared to controls fracture patients exhibited significantly lower critical strain, max strain and normalized strength, with lower peak collagen and mineral strain. Bisphosphonate-treated exhibited the lowest properties. In all three groups, peak mineral strain coincided with maximum tissue strength (i.e. ultimate stress), whilst peak fibril strain occurred afterwards(i.e. higher strain). Tissue strain and strength were positively and strongly correlated with peak fibril and mineral strains. Age-related fractures were associated with lower peak fibril and mineral strain irrespective of treatment. Indicating earlier mineral disengagement and the subsequent onset of fibril sliding is one of the key mechanisms leading to fracture. Treatments for fragility should target collagen-mineral interactions to restore nano-scale strain to that of healthy bone.

Journal article

Ghouse S, Reznikov N, Boughton O, Babu S, Ng KCG, Blunn G, Cobb J, Stevens M, Jeffers Jet al., 2019, The design and in vivo testing of a locally stiffness-matched porous scaffold, Applied Materials Today, Vol: 15, Pages: 377-388, ISSN: 2352-9407

An increasing volume of work supports utilising the mechanobiology of bone for bone ingrowth into a porous scaffold. However, typically during in vivo testing of implants, the mechanical properties of the bone being replaced are not quantified. Consequently there remains inconsistencies in the literature regarding ‘optimum’ pore size and porosity for bone ingrowth. It is also difficult to compare ingrowth results between studies and to translate in vivo animal testing to human subjects without understanding the mechanical environment. This study presents a clinically applicable approach to determining local bone mechanical properties and design of a scaffold with similar properties. The performance of the scaffold was investigated in vivo in an ovine model.The density, modulus and strength of trabecular bone from the medial femoral condyle from ovine bones was characterised and power-law relationships were established. A porous titanium scaffold, intended to maintain bone mechanical homeostasis, was additively manufactured and implanted into the medial femoral condyle of 6 ewes. The stiffness of the scaffold varied throughout the heterogeneous structure and matched the stiffness variation of bone at the surgical site. Bone ingrowth into the scaffold was 10.73 ± 2.97% after 6 weeks. Fine woven bone, in the interior of the scaffold, and intense formations of more developed woven bone overlaid with lamellar bone at the implant periphery were observed. The workflow presented will allow future in vivo testing to test specific bone strains on bone ingrowth in response to a scaffold and allow for better translation from in vivo testing to commercial implants.

Journal article

Boughton O, Ma S, Cai X, Yan L, Peralta L, Laugier P, Marrow J, Giuliani F, Hansen U, Abel R, Grimal Q, Cobb Jet al., 2019, Computed tomography porosity and spherical indentation for determining cortical bone millimetre-scale mechanical properties, Scientific Reports, Vol: 9, ISSN: 2045-2322

The cortex of the femoral neck is a key structural element of the human body, yet there is not a reliable metric for predicting the mechanical properties of the bone in this critical region. This study explored the use of a range of non-destructive metrics to measure femoral neck cortical bone stiffness at the millimetre length scale. A range of testing methods and imaging techniques were assessed for their ability to measure or predict the mechanical properties of cortical bone samples obtained from the femoral neck of hip replacement patients. Techniques that can potentially be applied in vivo to measure bone stiffness, including computed tomography (CT), bulk wave ultrasound (BWUS) and indentation, were compared against in vitro techniques, including compression testing, density measurements and resonant ultrasound spectroscopy. Porosity, as measured by micro-CT, correlated with femoral neck cortical bone’s elastic modulus and ultimate compressive strength at the millimetre length scale. Large-tip spherical indentation also correlated with bone mechanical properties at this length scale but to a lesser extent. As the elastic mechanical properties of cortical bone correlated with porosity, we would recommend further development of technologies that can safely measure cortical porosity in vivo.Introduction

Journal article

Uemura K, Boughton O, Logishetty K, Halewood C, Clarke S, Harris S, Sugano N, Cobb Jet al., 2019, A single-use, size-specific, nylon arthroplasty guide: a preliminary study, Hip International, ISSN: 1120-7000

Journal article

Boughton O, Uemura K, Tamura K, Takao M, Hamada H, Cobb J, Sugano Net al., 2019, Gender and Disease Severity Determine Proximal Femoral Morphology in Developmental Dysplasia of the Hip, Journal of Orthopaedic Research, ISSN: 0736-0266

Journal article

Reznikov N, Boughton O, Ghouse S, Weston AE, Collinson L, Blunn GW, Jeffers J, Cobb J, Stevens Met al., 2019, Individual response variations in scaffold-guided bone regeneration are determined by independent strain- and injury-induced mechanisms, Biomaterials, Vol: 194, Pages: 183-194, ISSN: 0142-9612

This study explored the regenerative osteogenic response in the distal femur of sheep using scaffolds having stiffness values within, and above and below, the range of trabecular bone apparent modulus. Scaffolds 3D-printed from stiff titanium and compliant polyamide were implanted into a cylindrical metaphyseal defect 15 × 15 mm. After six weeks, bone ingrowth varied between 7 and 21% of the scaffold pore volume and this was generally inversely proportional to scaffold stiffness. The individual reparative response considerably varied among the animals, which could be divided into weak and strong responders. Notably, bone regeneration specifically within the interior of the scaffold was inversely proportional to scaffold stiffness and was strain-driven in strongly-responding animals. Conversely, bone regeneration at the periphery of the defect was injury-driven and equal in all scaffolds and in all strongly- and weakly-responding animals. The observation of the strain-driven response in some, but not all, animals highlights that scaffold compliance is desirable for triggering host bone regeneration, but scaffold permanence is important for the load-bearing, structural role of the bone-replacing device. Indeed, scaffolds may benefit from being nonresorbable and mechanically reliable for those unforeseeable cases of weakly responding recipients.

Journal article

Doyle R, Boughton O, Plant D, DeSoutter G, Cobb J, Jeffers Jet al., 2019, An in vitro model of impaction during hip arthroplasty, Journal of Biomechanics, Vol: 82, Pages: 220-227, ISSN: 0021-9290

Impaction is required to properly seat press-fit implants and ensure initial implant stability and long term bone ingrowth, however excessive impaction or press-fit presents a high fracture risk in the acetabulum and femur. Current in-vitro impaction testing methods do not replicate the compliance of the soft tissues surrounding the hip, a factor that may be important in fracture and force prediction. This study presents the measurement of compliance of the soft tissues supporting the hip during impaction in operative conditions, and replicates these in vitro. Hip replacements were carried out on 4 full body cadavers while impact force traces and acetabular/femoral displacement were measured. Compliance was then simulated computationally using a Voigt model. These data were subsequently used to inform the design of a representative in-vitro drop rig. Effective masses of 19.7 kg and 12.7 kg, spring stiffnesses of 8.0 kN/m and 4.1 kN/m and dashpot coefficients of 595 N s/m and 322 N s/m were calculated for the acetabular and femoral soft tissues respectively. A good agreement between cadaveric and in-vitro peak displacement and rise time during impact is found. Such an in-vitro setup is of use during laboratory testing, simulation or even surgical training.

Journal article

Ma S, Goh EL, Karunaratne A, Wiles C, Wu Y, Boughton O, Tay T, Churchwell J, Bhattacharya R, Terrill N, Cobb J, Hansen U, Abel Ret al., 2018, The Effects of Bisphosphonate at the Nanoscale: Effects on Bone Collagen, Mineral Strain and Collagen-Mineral Interaction, Annual Meeting of the American-Society-for-Bone-and-Mineral-Research, Publisher: WILEY, Pages: 410-411, ISSN: 0884-0431

Conference paper

Zhao S, Arnold M, Ma S, Abel R, Cobb J, Hansen U, Boughton ORet al., 2018, Standardising compression testing for measuring the stiffness of human bone: a systematic review, Bone and Joint Research, Vol: 7, Pages: 524-538, ISSN: 2046-3758

Objectives: The ability to determine human bone stiffness is of clinical relevance in many fields, including bone quality assessment and orthopaedic prosthesis design. Stiffness can be measured using compression testing; an experimental technique commonly used to test bone specimens in vitro. This systematic review aims to determine how best to perform compression testing of human bone. Methods: A keyword search of all English language articles up until December 2017 of compression testing of bone was undertaken in Medline, Embase, PubMed and Scopus databases. Studies using bulk tissue, animal tissue, whole bone or testing techniques other than compression testing were excluded. Results: 4712 abstracts were retrieved with a total of 177 papers included in the analysis. 20 studies directly analysed the compression testing technique to improve the accuracy of the testing technique. Several influencing factors should be considered when testing bone samples in compression. These include the method of data analysis, specimen storage, specimen preparation, testing configuration and loading protocol. Conclusions: Compression testing is a widely used technique for measuring the stiffness of bone but there is a great deal of inter-study variation in experimental techniques across the literature. Based on best evidence from the literature, suggestions for bone compression testing are made in this review, though further studies are needed to help establish standardised bone testing techniques to increase the comparability and reliability of bone stiffness studies.

Journal article

Zhao S, Arnold M, Ma S, Abel RL, Cobb JP, Hansen U, Boughton Oet al., 2018, Standardizing compression testing for measuring the stiffness of human bone, BONE & JOINT RESEARCH, Vol: 7, Pages: 524-538, ISSN: 2046-3758

Journal article

Wiik AV, Brevadt M, Johal H, Logishetty K, Boughton O, Aqil A, Cobb JPet al., 2018, The loading patterns of a short femoral stem in total hip arthroplasty: gait analysis at increasing walking speeds and inclines., Journal of Orthopaedics and Traumatology, Vol: 19, ISSN: 1590-9921

BACKGROUND: The purpose of this study was to examine the gait pattern of total hip arthroplasty (THA) patients with a new short femoral stem at different speeds and inclinations. MATERIALS AND METHODS: A total of 40 unilateral THA patients were tested on an instrumented treadmill. They comprised two groups (shorter stemmed THA n = 20, longer stemmed THA n = 20), both which had the same surgical posterior approach. The shorter femoral stemmed patients were taken from an ongoing hip trial with minimum 12 months postop. The comparative longer THR group with similar disease and severity were taken from a gait database along with a demographically similar group of healthy controls (n = 35). All subjects were tested through their entire range of gait speeds and inclines with ground reaction forces collected. Body weight scaling was applied and a symmetry index to compare the implanted hip to the contralateral normal hip. An analysis of variance with significance set at α = 0.05 was used. RESULTS: The experimental groups were matched demographically and implant groups for patient reported outcome measures and radiological disease. Both THA groups walked slower than controls, but symmetry at all intervals for all groups were not significantly different. Push-off loading was less favourable for both the shorter and longer stemmed THR groups (p < 0.05) depending on speed. CONCLUSIONS: Irrespective of femoral stem length, symmetry for ground reaction forces for both THA groups were returned to a normal range when compared to controls. However individual implant performance showed inferior (p < 0.05) push-off forces and normalised step length in both THR groups when compared to controls. LEVEL OF EVIDENCE: III.

Journal article

Boughton OR, Ma S, Zhao S, Arnold M, Lewis A, Hansen U, Cobb J, Giuliani F, Abel Ret al., 2018, Measuring bone stiffness using spherical indentation, PLoS ONE, Vol: 13, ISSN: 1932-6203

ObjectivesBone material properties are a major determinant of bone health in older age, both in terms of fracture risk and implant fixation, in orthopaedics and dentistry. Bone is an anisotropic and hierarchical material so its measured material properties depend upon the scale of metric used. The scale used should reflect the clinical problem, whether it is fracture risk, a whole bone problem, or implant stability, at the millimetre-scale. Indentation, an engineering technique involving pressing a hard-tipped material into another material with a known force, may be able to assess bone stiffness at the millimetre-scale (the apparent elastic modulus). We aimed to investigate whether spherical-tip indentation could reliably measure the apparent elastic modulus of human cortical bone.Materials and methodsCortical bone samples were retrieved from the femoral necks of nineteen patients undergoing total hip replacement surgery (10 females, 9 males, mean age: 69 years). The samples underwent indentation using a 1.5 mm diameter, ruby, spherical indenter tip, with sixty indentations per patient sample, across six locations on the bone surfaces, with ten repeated indentations at each of the six locations. The samples then underwent mechanical compression testing. The repeatability of indentation measurements of elastic modulus was assessed using the co-efficient of repeatability and the correlation between the bone elastic modulus measured by indentation and compression testing was analysed by least-squares regression.ResultsIn total, 1140 indentations in total were performed. Indentation was found to be repeatable for indentations performed at the same locations on the bone samples with a mean co-efficient of repeatability of 0.4 GigaPascals (GPa), confidence interval (C.I): 0.33–0.42 GPa. There was variation in the indentation modulus results between different locations on the bone samples (mean co-efficient of repeatability: 3.1 GPa, C.I: 2.2–3.90 GPa). No cle

Journal article

Lazic S, Boughton OR, Kellett C, Kader D, Villet L, Riviere Cet al., 2018, Day-case surgery for total hip and knee replacement: how safe and effective is it?, EFORT Open Reviews, Vol: 3, Pages: 130-135, ISSN: 2058-5241

Multimodal protocols for pain control, blood loss management and thromboprophylaxis have been shown to benefit patients by being more effective and as safe (fewer iatrogenic complications) as conventional protocols. Proper patient selection and education, multimodal protocols and a well-defined clinical pathway are all key for successful day-case arthroplasty. By potentially being more effective, cheaper than and as safe as inpatient arthroplasty, day-case arthroplasty might be beneficial for patients and healthcare systems.

Journal article

Riviere C, Lazic S, Boughton OR, Wiart Y, Villet L, Cobb Jet al., 2018, Current concepts for aligning knee implants: patient-specific or systematic?, EFORT Open Reviews, Vol: 3, Pages: 1-6, ISSN: 2058-5241

Journal article

Arnold M, Zhao S, Ma S, Giuliani F, Hansen U, Cobb JP, Abel RL, Boughton ORet al., 2017, Microindentation: a tool for measuring cortical bone stiffness? A systematic review, Bone & Joint Research, Vol: 6, Pages: 542-549, ISSN: 2046-3758

Objectives: Microindentation hasthe potential to measuretheelasticity(stiffness)of individualpatients’bone. Bone elasticity plays a crucial role in the press-fit stability of orthopaedic implants.Arming surgeons with accuratebone elasticityinformation may reduce surgical complicationsincluding peri-prosthetic fractures. The question we address with this systematicreview is whether microindentation can accurately measure cortical bone stiffness.Methods: A systematic review of all English language articles using a keyword search was undertaken in Medline, Embase, PubMed, Scopus and Cochrane databases. Studies thatonly used nanoindentation, cancellous boneoranimal tissue were excluded.Results: 1094abstracts were retrieved and 32papers were included in the analysis, 20 of which used reference point indentation and 12of which used traditional depth sensing indentation.There are a number of factors thatmust be taken into account when using microindentation such as tip size, depth and method of analysis.Only two studies validated microindentation againsttraditional mechanical testing techniques. Bothstudies used reference point indentation(RPI) with one showing that RPI parameters correlate well with mechanical testing, butanother suggestedthatthey do not. Conclusion: Microindentation has been used in various studies to assess bone elasticity but only two studies with conflicting results compared microindentation to traditional mechanical testing techniques. Further research,includingmore studies comparingmicroindentationto other mechanical testing methodsare needed,before microindentation can be reliably used to calculate cortical bone stiffness.

Journal article

Arnold M, Zhao S, Ma S, Giuliani F, Hansen U, Cobb JP, Abel RL, Boughton Oet al., 2017, Microindentation - a tool for measuring cortical bone stiffness?, BONE & JOINT RESEARCH, Vol: 6, Pages: 542-549, ISSN: 2046-3758

Journal article

Wiik AV, Logishetty K, Boughton O, Aqil A, Cobb JPet al., 2017, Letter to the Editor regarding 'How symmetric are metal-on-metal hip resurfacing patients during gait? Insights for the rehabilitation'., Journal of Biomechanics, Vol: 63, Pages: 203-203, ISSN: 0021-9290

Journal article

Ridzwan M, Sukjamsri C, Pal B, van Arkel R, Bell A, Khanna M, Baskaradas A, Abel R, Boughton O, Cobb J, Hansen Uet al., 2017, Femoral fracture type can be predicted from femoral structure: a finite element study validated by digital volume correlation experiments, Journal of Orthopaedic Research, Vol: 36, Pages: 993-1001, ISSN: 1554-527X

Proximal femoral fractures can be categorized into two main types: Neck and intertrochanteric fractures accounting for 53% and 43% of all proximal femoral fractures, respectively. The possibility to predict the type of fracture a specific patient is predisposed to would allow drug and exercise therapies, hip protector design, and prophylactic surgery to be better targeted for this patient rendering fracture preventing strategies more effective. This study hypothesized that the type of fracture is closely related to the patient-specific femoral structure and predictable by finite element (FE) methods. Fourteen femora were DXA scanned, CT scanned, and mechanically tested to fracture. FE-predicted fracture patterns were compared to experimentally observed fracture patterns. Measurements of strain patterns to explain neck and intertrochanteric fracture patterns were performed using a digital volume correlation (DVC) technique and compared to FE-predicted strains and experimentally observed fracture patterns. Although loaded identically, the femora exhibited different fracture types (six neck and eight intertrochanteric fractures). CT-based FE models matched the experimental observations well (86%) demonstrating that the fracture type can be predicted. DVC-measured and FE-predicted strains showed obvious consistency. Neither DXA-based BMD nor any morphologic characteristics such as neck diameter, femoral neck length, or neck shaft angle were associated with fracture type. In conclusion, patient-specific femoral structure correlates with fracture type and FE analyses were able to predict these fracture types. Also, the demonstration of FE and DVC as metrics of the strains in bones may be of substantial clinical value, informing treatment strategies and device selection and design.

Journal article

Ma S, Goh EL, Jin A, Bhattacharya R, Boughton O, Patel B, Karunaratne A, Vo NT, Atwood R, Cobb J, Hansen U, Abel Ret al., 2017, Long-term effects of bisphosphonate therapy: perforations, microcracks and mechanical properties, Scientific Reports, Vol: 7, Pages: 1-10, ISSN: 2045-2322

Osteoporosis is characterised by trabecular bone loss resulting from increased osteoclast activation and unbalanced coupling between resorption and formation, which induces a thinning of trabeculae and trabecular perforations. Bisphosphonates are the frontline therapy for osteoporosis, which act by reducing bone remodelling, and are thought to prevent perforations and maintain microstructure. However, bisphosphonates may oversuppress remodelling resulting in accumulation of microcracks. This paper aims to investigate the effect of bisphosphonate treatment on microstructure and mechanical strength. Assessment of microdamage within the trabecular bone core was performed using synchrotron X-ray micro-CT linked to image analysis software. Bone from bisphosphonate-treated fracture patients exhibited fewer perforations but more numerous and larger microcracks than both fracture and non-fracture controls. Furthermore, bisphosphonate-treated bone demonstrated reduced tensile strength and Young’s Modulus. These findings suggest that bisphosphonate therapy is effective at reducing perforations but may also cause microcrack accumulation, leading to a loss of microstructural integrity and consequently, reduced mechanical strength.

Journal article

Boughton OR, Zhao S, Arnold M, Ma S, Cobb JP, Giuliani F, Hansen U, Abel RLet al., 2017, Measuring bone stiffness using microindentation, British Orthopaedic Research Society (BORS) 2016 Conference, Publisher: British Editorial Society of Bone and Joint Surgery, Pages: 31-31, ISSN: 2049-4416

Conference paper

Ma S, Goh EL, Patel B, Jin A, Boughton O, Cobb J, Hansen U, Abel RLet al., 2016, Are the cracks starting to appear in bisphosphonate therapy?, British Orthopaedic Research Society (BORS) 2016 Conference, Publisher: British Editorial Society of Bone and Joint Surgery, Pages: 53-53, ISSN: 2049-4416

Conference paper

Ma S, Boughton O, Karunaratne A, Jin A, Cobb JP, Hansen U, Abel RLet al., 2016, Synchrotron imaging assessment of bone quality, Clinical Reviews in Bone and Mineral Metabolism, Vol: 14, Pages: 150-160, ISSN: 1559-0119

Bone is a complex hierarchical structure and its principal function is to resist mechanical forces and fracture. Bone strength depends not only on the quantity of bone tissue but also on the shape and hierarchical structure. The hierarchical levels are interrelated, especially the micro-architecture, collagen and mineral components; hence analysis of their specific roles in bone strength and stiffness is difficult. Synchrotron imaging technologies including micro-CT and small/wide angle X-Ray scattering/diffraction are becoming increasingly popular for studying bone because the images can resolve deformations in the micro-architecture and collagen-mineral matrix under in situ mechanical loading. Synchrotron cannot be directly applied in-vivo due to the high radiation dose but will allow researchers to carry out systematic multifaceted studies of bone ex-vivo. Identifying characteristics of aging and disease will underpin future efforts to generate novel devices and interventional therapies for assessing and promoting healthy aging. With our own research work as examples, this paper introduces how synchrotron imaging technology can be used with in-situ testing in bone research.

Journal article

Aframian A, Boughton OR, Auvinet E, Iranpour Boroujeni F, Harris S, Hing CB, Cobb JPet al., 2015, Patellofemoral pain is a symptom, not a diagnosis, British Medical Journal, Vol: 351, ISSN: 1468-5833

Journal article

Khatib M, Soukup B, Boughton O, Amin K, Davis CR, Evans DMet al., 2015, Plastic Surgery Undergraduate Training: How a Single Local Event Can Inspire and Educate Medical Students, Annals of Plastic Surgery, Vol: 75, Pages: 208-212, ISSN: 0148-7043

Journal article

Boughton OR, Bernard J, Szarko M, 2015, Odontoid process fractures: the role of the ligaments in maintaining stability. A biomechanical, cadaveric study, SICOT-J, Vol: 1, ISSN: 2426-8887

Aims: We wished to investigate the role of the cervical ligaments in maintaining atlantoaxial stabilityafter fracture of the odontoid process.Methods: We dissected eight fresh-frozen cadaveric cervical spines to prepare the C1 and C2 vertebrae for biomechanicalanalysis. The C1 and C2 blocks were mounted and biomechanical analysis was performed to test the stabilityof the C1-C2 complex after cutting the odontoid process to create an Anderson and D’Alonzo type II fracture thensuccessive division of the atlantoaxial ligaments. Biomechanical analysis of stiffness, expressed as Young’s modulus,was performed under right rotation, left rotation and anterior displacement.Results: The mean Young’s modulus in anterior displacement decreased by 37% when the odontoid process was fractured( p = 0.038, 95% confidence interval 0.04–1.07). The mean Young’s modulus in anterior displacement decreasedproportionally (compared to the previous dissection) by the following percentages when the structures were divided:facet joint capsules (bilateral) 16%, ligamentum flavum 27%, anterior longitudinal ligament 10%. These differencesdid not reach statistical significance ( p > 0.05).Discussion: We have found that the odontoid process itself may account for up to 37% of the stiffness of the C1-C2complex and that soft tissue structures account for further resistance to movement. We suggest magnetic resonanceimaging (MRI) of the soft tissues in the acute setting of a minimally displaced odontoid process fracture to plan managementof the injury. If the MRI determines that there is associated ligament injury it is likely that the fracture isunstable and we would suggest operative management.

Journal article

Boughton O, Jones GG, Lavy CBD, Grimes CEet al., 2015, Young, male, road traffic victims: a systematic review of the published trauma registry literature from low and middle income countries, SICOT-J, Vol: 1, ISSN: 2426-8887

– Background: Trauma contributes significantly to the global burden of disease. We analysed publishedtrauma registries to assess the demographics of those most affected in low and middle-income countries (LMICs).Methods: We performed a systematic review of published trauma registry studies according to PRISMA guidelines.We included published full-text articles from trauma registries in low and middle-income countries describing thedemographics of trauma registry patients. Articles from military trauma registries, articles using data not principallyderived from trauma registry data, articles describing patients of only one demographic (e.g. only paediatric patients),or only one mechanism of injury, trauma registry implementation papers without demographic data, review papersand conference proceedings were excluded.Results: The initial search retrieved 1868 abstracts of which 1324 remained after duplicate removal. After screeningthe abstracts, 78 full-text articles were scrutinised for their suitability for inclusion. Twenty three papers from14 countries, including 103,327 patients, were deemed eligible and included for analysis. The median age of traumavictims in these articles was 27 years (IQR 25–29). The median percentage of trauma victims who were male was75 (IQR 66–84). The median percentage of road traffic injuries (RTIs) as a percentage of total injuries caused by traumawas 46 (IQR 21–71).Conclusions: Young, male, road traffic victims represent a large proportion of the LMIC trauma burden. This informationcan inform and be used by local and national governments to implement road safety measures and other strategiesaimed at reducing the injury rate in young males.

Journal article

Lazic S, Boughton O, Hing C, Bernard Jet al., 2014, Arthroscopic washout of the knee: A procedure in decline, The Knee, Vol: 21, Pages: 631-634, ISSN: 0968-0160

BackgroundOsteoarthritis (OA) of the knee is a chronic, progressive condition which often requires surgical intervention. The evidence for the benefits of arthroscopic debridement or washout for knee OA is weak and arthroscopy is currently only indicated in the UK if there is a history of mechanical locking of the knee.ObjectivesTo investigate whether there has been any change in the number of arthroscopies performed in the UK since the 2007 NICE guidance on knee arthroscopy and the 2008 Cochrane review of arthroscopic debridement for OA of the knee.MethodsWe interrogated data from the Hospital Episodes Statistics (HES) database with Office of Population Censuses and Surveys-4 (OPSC-4) codes pertaining to therapeutic endoscopic operations in the 60–74 year old and 75 and over age groups.ResultsThe number of arthroscopic knee interventions in the UK decreased overall from 2000 to 2012, with arthroscopic irrigations decreasing the most by 39.6 per 100,000 population (80%). However, the number of arthroscopic meniscal resections increased by 105.3 per 100,000 (230%) population. These trends were mirrored in both the 60–74 and 75 and over age groups.ConclusionsKnee arthroscopy in the 60–74 and 75 and over age groups appears to be decreasing but there is still a large and increasing number of arthroscopic meniscal resections being performed.

Journal article

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