AimsTo compare the efficacy of decompression alone (DA) with i) decompression and fusion (DF) and ii) interspinous process device (IPD) in the treatment of lumbar stenosis with degenerative spondylolisthesis. Outcomes of interest were both patient-reported measures of postoperative pain and function, as well as the perioperative measures of blood loss, operation duration, hospital stay, and reoperation.MethodsData were obtained from electronic searches of five online databases. Included studies were limited to randomised-controlled trials (RCTs) which compared DA with DF or IPD using patient-reported outcomes such as the Oswestry Disability Index (ODI) and Zurich Claudication Questionnaire (ZCQ), or perioperative data.Patient-reported data were reported as part of the systematic review, while meta-analyses were conducted for perioperative outcomes in MATLAB using the DerSimonian and Laird random-effects model. Forest plots were generated for visual interpretation, while heterogeneity was assessed using the I2-statistic.ResultsA total of 13 articles met the eligibility criteria. Of these, eight compared DA with DF and six studies compared DA with IPD. Patient-rated outcomes reported included the ODI and ZCQ, with mixed results for both types of comparisons. Overall, there were few statistically significant and no clinically significant differences in patient-rated outcomes. Study quality varied greatly across the included articles.Meta-analysis of perioperative outcomes revealed DF to result in greater blood loss than DA (MD = 406.74 ml); longer operation duration (MD = 108.91 min); and longer postoperative stay in hospital (MD = 2.84 days). Use of IPD in comparison to DA led to slightly reduced operation times (MD = –25.18 min), but a greater risk of reoperation compared to DA (RR = 2.70).ConclusionCurrently there is no evidence for the use of DF or IPD over DA in both patient-rated and perioperative outcomes. Indeed, both procedures can potentially lead to greater cost and risk of complications, and therefore, a stronger evidence base for their use should be established before they are promoted as routine options in patients with degenerative spondylolisthesis.

Aim Amid COVID pressures, standards of surgical practices need constant reviewing to maintain patient safety and streamline care pathways. Newly published BOAST (British Orthopaedic Association Standards for Trauma and Orthopaedics) guidelines for paediatric supracondylar fractures became a benchmark against which a restructured DGH trauma unit's performance can be appraised. Method Theatre records were analysed between April-2020 and September-2020. Data were collected to reveal time to theatre, operative techniques, documentations of ulnar nerve protection, complications, follow-up plans, time to first post-op radiograph and to wire removal. Results 90% of patients underwent operations within 24–48 hour. Although there was no incidence of iatrogenic nerve injury, documentation of ulnar nerve protection was not identified in 45% of crossed wire fixations. Wire size was not mentioned in 14%. 33% did not have first follow-up with radiograph within 4–10 days, and 43% of patients did not have the wires removed till 4 weeks post op. Conclusion This re-audit highlights the need to improve in documentation for ulnar nerve protection and to identify the delays in follow-up appointments. Although BOAST no longer recommends a fixed timeframe for follow-up plan, first radiograph within 4–10 days and wire removal within 4 weeks are still reasonable locally.