Aim: The SuperPATH approach has been in practice for almost a decade. There is no systematic review to date comparing the novel SuperPATH approach with conventional approaches. Therefore, it is important to conduct an up-to-date review to evaluate the benefits and drawbacks of the SuperPATH approach in comparison to widely accepted traditional approaches. Our primary aim was to compare the newer SuperPATH approach with the traditional approaches to the hip in terms of functional outcome and radiological parameters. We also aimed to identify any potential complications of the SuperPATH approach as it is a new surgical technique lacking any published sytematic reviews. Materials and methods: The review was conducted in accordance with the steps detailed in the Cochrane Handbook for Systematic reviews of intervention and will be reported bearing in mind the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PICO terms were independently searched in multiple databases. Studies that compared SuperPATH with traditional approaches were included in the analysis. Results: 7 studies including a total of 730 patients were available for final analysis. 3 studies were randomised control trials, 2 were prospective cohort studies and 2 were non-randomised case control studies. Patients in the SuperPATH group were discharged earlier (2 days difference in weighted mean). The operative time was 5 minutes longer (84.46 vs. 78.99) and there was a marginal decrease in blood loss (38 ml lesser) in the SuperPATH approach. VAS Score and HHS at the end of 1 year was comparable in both study groups. Cup abduction angle and anteversion angles were acceptable and comparable in both groups. Conclusions: The SuperPATH approach shows minimal improvement in length of hospital stay and blood loss with no significant improvement in pain or functional outcome score. There are no major complications reported and the radiological parameters are comparable.

This study shows that FCL screws in locking plates allow uniform callus formation and fracture union with minimal complication rates.

Introduction The significance of ring-fencing orthopaedic beds and protected elective sites has recently been highlighted by the British Orthopaedic Association and the Royal College of Surgeons. During the pandemic, many such elective setups were established. This study aimed to compare the functioning and efficiency of an orthopaedic protected elective surgical unit (PESU) instituted during the pandemic with the pre-pandemic elective service at our hospital. Methods We retrospectively collected data of all patients who underwent elective orthopaedic procedures in PESU during the pandemic and a similar cohort of patients operated on via the routine elective service immediately prior to the pandemic. To minimise the effect of confounding factors, a secondary analysis was undertaken comparing total hip replacements by a single surgeon via PESU and pre-pandemic ward (PPW) over 5 months. Results A total of 192 cases were listed on PESU during the studied period whereas this number was 339 for PPW. However, more than half of those listed for a surgery on PPW were cancelled and only 162 cases were performed. PESU had a significantly better conversion rate with only 12.5% being cancelled. Forty-nine percent (87 out of 177) of the cases cancelled on PPW were due to a ‘bed unavailability’. A further 17% (30/177) and 16% (28/177) were cancelled due to ‘emergency case prioritisation’ and ‘patient deemed unfit’, respectively. In contrast, only 3 out of the 24 patients cancelled on PESU were due to bed unavailability. Single-surgeon total hip replacement showed similar demographic features for the 25 patients on PESU and 37 patients on PPW. The patients on PESU also demonstrated a decrease in length of hospital stay with an average of 3 days.

Introduction: Bizarre parosteal osteochondromatous proliferation (BPOP) is a rare bone pathology affecting small bones of hand and feet. This benign lesion needs to be distinguished from many malignant bone tumors as it poses a diagnostic dilemma due to its clinical, radiological, and histological picture. We report three cases of BPOP affecting the hand and foot. Case 1: A 21-year-old gentleman presented with painful swelling in the long finger of the right hand. A plain radiograph showed a radio dense mass which was later excised and diagnosis confirmed in histopathology. There was no recurrence in 2 years of follow-up. Case 2: A 5-year-old boy presented with painful swelling over the right ankle with no history of antecedent trauma. Following radiological evaluation, the patient was successfully treated with excision. Case 3: A 35-year-old lady presented with a painful swelling on the dorsal aspect of her hand which was gradually increasing in size. After radiological evaluation, the patient was successfully treated with excision and lesion confirmed to be BPOP on histological examination. She was symptom free without recurrence in up to 2 years of follow-up. Conclusion: Nora’s lesion is a rare pathology requiring high index of suspicion. Excision is the recommended mode of treatment. All our cases responded well with excision with immediate pain relief following surgery and no recurrence in up to 2 years of follow-up. Keywords: Nora, bizarre parosteal osteochondromatous proliferation, neoplasm, tumor, benign.

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