Greg Neal-Smith

Trauma and Orthopaedic Registrar - Wessex Deanery. Love travel and all things rugby.

[Greg Neal-Smith @GregNealSmith1]

Great conference! @britdaysurgery

[Joanna Higgins @jo_higgins]

Prize winner Mr Greg Neal-Smith at #BADS2024 for @UHD_NHS T&O Hand Hub @RCSnews @BSSHand @britdaysurgery @GregNealSmith1 @WessexOrtho

[Greg Neal-Smith @GregNealSmith1]

@ndorms @JCRWormald @SITU_Oxford Congrats Justin! Huge achievement

[Fundamentals of Orthopaedics @funorthopaedics]

A massive thank you to our awesome faculty who delivered the Lower Limb session on Wednesday night 🙏😊
⁦
@LuckyJeyaseelan @JaisonPPatel @DrAChara @amitpatelortho @GregNealSmith1 @AustineJose_10 @LEDAortho @OrtholoveLife

⁩ #orthotwitter #st3 #interviews #funortho

[Fundamentals of Orthopaedics @funorthopaedics]

Join us tomorrow for our ST3 Lower Limb viva session! 😊

https://t.co/Qe1aFtyRe0

⁦@LuckyJeyaseelan⁩ ⁦@JaisonPPatel⁩ ⁦@DrAChara⁩ ⁦@amitpatelortho⁩ ⁦@LEDAortho⁩ ⁦@OrtholoveLife⁩

#orthotwitter #st3 #interviews #funortho

[HMRC Press Office @HMRCpressoffice]

Big congrats to Luke on his fantastic run to the final. We can confirm the existence of income tax.

[Greg Neal-Smith @GregNealSmith1]

When Ortho meets Christmas…

[Greg Neal-Smith @GregNealSmith1]

@harryclax Well done mate 👏🏼 will you wear this in theatre?

[OrthoEvidence @OrthoEvidence]

🦶Chronic Ankle Instability: A Meta-Analysis of Randomized Controlled Trials
An OE Original

Roughly 20% of ankle sprains become chronic. When surgery is needed, lateral ligament augmentation is the go-to.

The modified Brostrom-Gould procedure (MBG) is the most common approach but is associated with reduced ligament strength.

Could the use of suture tapes as an internal brace provide a superior alternative?

🏗️METHODS
We searched the MEDLINE, EMBASE, Cochrane CENTRAL, and OE MIND databases for randomized controlled trials (RCTs) on chronic ankle instability comparing:

1⃣ Modified Brostrom-Gould Procedure
2⃣ Suture Tape Augmentation

Outcomes of interest included
- Pain
- Foot function & quality of life (on the Foot and Ankle Outcome Score)
- Complications

We also assessed the quality of the evidence using the Cochrane Risk of Bias tool & the GRADE approach.

🔎RESULTS
Our search resulted in 5 RCTs, including a total of 328 patients.

The majority of included trials didn't provide info on blinding of outcome assessors or selective reporting.

Pain
We found no difference in pain scores between the two surgical procedures at 6-12 months and 24-36 months follow-up!

Foot Function & Quality of Life
No differences in pooled Foot and Ankle Outcome Scores were observed between the two groups at 6-12 months and 24-36 months follow-up!
Complications
The risk of instability and wound infection was similar in both groups.

✅INTERPRETATION
The results of this study suggest that suture tape augmentation provides similar outcomes to the modified Brostrom-Gould procedure for chronic ankle instability!

However, the quality of the evidence was low as per GRADE, and more rigorously designed trials are needed!

[Nev Davies @nevtheknee]

@aclwfc I do 2-3 ACL reconstructions EVERY week on my operating list in patients as young as 11 and 12 - this is a HUGE problem… Simple Injury Prevention Programs or ‘Performance Training Programs’ reduce risk by up to 50% - help us integrate these into youth sport 💥 @PowerUpToPlay

[OrthoEvidence @OrthoEvidence]

Surgical vs. Non-Surgical Treatment for ACL Tears
An OE Original

Pain. Lost training time. Risk of Osteoarthritis.

ACL tears are one of the most common and troublesome injuries in sports.

Surgical treatment -- the ACL Reconstruction -- is a popular intervention for many patients and physicians. But is it better than non-surgical treatment?

We ran a series of analyses using our OE MIND platform to find out!

🏗️METHODS
We searched through the OE MIND database, which has close to 4,000 studies and over 1.7 million patients!

We included RCTs comparing ACL reconstruction vs. rehabilitation for the treatment of ACL tears.

We performed meta-analyses of clinical outcomes, pain, activity scores, stability, return to pre-injury activity levels, re-injury, and revision surgery.

We also performed a sequential meta-analysis, an assessment of ongoing trials, and an academic market analysis!

🔎RESULTS
We included 6 RCTs, with a total of 1,373 patients, comparing surgical and non-surgical treatment (rehabilitation) for the treatment of ACL tears.

Composite Clinical Outcomes
We found no difference in composite clinical outcomes between ACL reconstruction & rehabilitation

Pain
Similarly, we found no difference in pain scores between ACL reconstruction and rehabilitation!

Tegner
At >2 years follow-up, Tegner scores were significantly better in the reconstruction group!

Stability
Patients who received reconstruction had a significantly lower risk of giving way and rotational instability (pivot shift test) than rehabilitation patients!

Return to Pre-injury, Re-injury & Revision Surgery
The risk of revision surgery and re-injury was significantly lower in the reconstruction group! However, no difference in return to pre-injury levels was observed between the two groups.

🏁INTERPRETATION
ACL reconstruction was associated with a small positive effect in Tegner activity score, superior stability outcomes & lower risk of re-injury and revision surgery compared to rehabilitation!

[Liverpool Orthopaedic and Trauma Service @Liverpool_Ortho]

Big paper Thursday: The INSITE Trial. In a RCT of 850 patients, IMNs for the treatment of trochanteric fractures had similar 1-year outcomes compared with sliding hip screw. In summary, do a DHS, it's cheaper and you get the same outcome! @BritOrthopaedic
https://t.co/zcK4E38DIs

[Nicolas S. Piuzzi, MD @nspiuzzi]

Cementing TKA trick - Negative pressure pressurization @CleClinicArthGp @RobertMolloyMD #Orthographe @AAHKS @AAHKS_YAG @EFORTnet @AcaroArg @BritishHip @HipSocKneeSoc

[Greg Neal-Smith @GregNealSmith1]

@harryclax @aneelbhangu No DISrespect but it needs chasing

[Greg Neal-Smith @GregNealSmith1]

@harryclax @TharushaGunawa4 Orders routine scan and finishes rotation 👋

[The BMA @TheBMA]

Rishi Sunak said today at #PMQs that rising NHS waiting lists is down to industrial action.

Well how about the last 13 years of rising waiting lists?

[Sandy @CommandoSurgeon]

@drlaurenfaber Also have plan B and C. I also encourage people to have a preflight checklist. We found TULIPS help

https://t.co/hDpQqLl8JI

[The Bone & Joint Journal @BoneJointJ]

💁 COMPARING FIXATION TO REVISION SURGERY FOR GRADE B PERIPROSTHETIC FEMORAL FRACTURES AROUND CEMENTED POLISHED TAPER-SLIP STEMS 🔨

Read the paper now!

#Fracture #BJJ @samjain_nhs @dougie_dunlop @EdinburghKnee @HPandit_ortho @ASPHFT @EdinOrthopaedic

https://t.co/DNmmF1Wp3O

[Anaestheasier @Anaestheasier21]

I asked ChatGPT to write me a poem answering the following:

"Explain the pathophysiology and management of anaphylaxis during anaesthesia."

It didn't disappoint.

[Greg Neal-Smith @GregNealSmith1]

Day 5 🇳🇱 to round off the fellowship with sports injury specialist Joris de Kort. Minced cartilage implantation / Syndesmosis AiTFL repair with Internal Brace / Posterior ankle arthroscopy. Featuring some questionable poses from the team! Thanks for incredible week @FORTEORTHO 👊🏼