Royal Shrewsbury Hospital

Ankle fractures are common injuries, with a significant proportion requiring surgical intervention. Despite established treatment principles, the optimal timing for open reduction and internal fixation (ORIF) remains debated. Concerns regarding wound infection risk have led some surgeons to delay fixation, while others advocate for early intervention. This study aimed to assess the impact of surgical timing on postoperative wound infections. A retrospective review was conducted on 1130 patients with surgically treated closed ankle fractures at a single institution between 2000 and 2022. Patients were categorised into three groups based on time to surgery: Early (<48h), Intermediate (48h to 5 days), and Delayed (>5 days) with timing determined pragmatically according to soft-tissue condition, theatre availability, and both surgeon and patient preference. Postoperative complications, including superficial and deep wound infections, were recorded. The chi-squared test was used to assess associations between surgical timing and infection rates. There was no significant association between surgical timing and the incidence of superficial wound infections (p=0.274). However, a significant difference was observed in deep wound infection rates (p=0.014). Diabetes, particularly Type 1, was significantly associated with both superficial (p<0.001) and deep infections (p=0.019). Patients over 60 years had an increased risk of superficial infections (p=0.016) but not deep infections (p=0.261). Superficial wound infections required longer hospital stay (p<0.001) due to the need for intravenous antibiotics and monitoring purposes, while the number of procedures significantly correlated with both superficial (p<0.001) and deep infections (p<0.001). In this study, the timing to surgery did not influence postoperative superficial wound infection rates following ORIF for ankle fractures. However, differences were observed in deep wound infection rates. Patient-related factors including diabetes and age are predictors of wound complications. Length of hospital stay was longer in patients with infections. IV.

A 75-year-old lady presented to Accident and Emergency (A&E) with acute worsening shortness of breath and new palpitations. On assessment, she was found to have fast atrial fibrillation, signs of heart failure, and bilateral peripheral oedema. Investigations revealed pulmonary embolism and an incidental hepatic lesion on CT imaging, suspicious for malignancy. Multidisciplinary discussion led to liver biopsy, which confirmed a benign sclerosed haemangioma. The patient was managed conservatively for cardiac and thromboembolic complications. This case highlights the difficulty in differentiating sclerosed haemangiomas from malignant liver lesions on imaging alone and underscores the importance of biopsy and multidisciplinary decision-making in elderly patients with comorbidities. Learning points include diagnostic vigilance, safe management of anticoagulation, and avoidance of unnecessary surgery.

IntroductionEffective communication within the multidisciplinary team (MDT) is critical to safe patient care. Whilst electronic health records have improved legibility, the widespread use of non-standardised abbreviations continues to cause misinterpretation, risking delays, errors, and compromised patient safety. Abbreviations are often used for efficiency, yet their meanings vary between specialties, creating barriers for rotating staff, cross-disciplinary colleagues, and patients reviewing discharge summaries.Quality improvement projectWe conducted a closed-loop quality improvement (QI) project structured around the SQUIRE 2.0 guidelines for QI initiatives. The project took place in a UK district general hospital to assess and improve understanding of commonly used ear, nose, and throat (ENT) specialty abbreviations. Eighty-two common abbreviations were identified and used in a written expansion test. In cycle one (n = 45), mean accuracy was 24.3%, with no participant exceeding 77%. Following targeted interventions (educational seminars and a printed reference guide displayed in shared spaces), a second assessment cycle was conducted with a new cohort. Post-teaching scores improved by a relative 40% to a mean of 35% (range 24%-52%). Mann-Whitney U testing confirmed statistical significance (p < 0.05).Implications and discussionFindings revealed a substantial baseline knowledge gap, highlighting a safety risk. Low-cost, high-visibility measures, such as reference posters and induction-based teaching, improved comprehension and could be readily adopted in other departments. However, residual gaps suggest the need for upstream interventions, including integration of documentation clarity training into medical education and continued departmental reinforcement.ConclusionClinicians’ baseline abbreviation comprehension was poor, but targeted education significantly improved understanding. Whilst no participant achieved complete proficiency, results show that simple, resource-light strategies can enhance communication clarity and support safer care. Broader adoption, alongside curricular change, offers a sustainable path to reducing abbreviation-related risks.

BackgroundPosterior malleolus fractures (PMFs) are common in distal tibial shaft fractures yet are frequently occult on plain radiographs. Accurate preoperative characterization on CT may improve surgical planning and functional recovery.MethodsWe conducted a retrospective cohort study of consecutive adults (≥18 years) with mid- or distal tibial shaft fractures treated at a major trauma center (January 2022-December 2024). Demographics, imaging, fracture characteristics, management, and outcomes were abstracted. PMF detection was compared across radiography, CT, and intraoperative findings. Predictors of a posterior malleolus (PM) fragment being missed on radiography were evaluated with multivariable logistic regression. Among operatively treated cases, the effect of fixation strategy on postoperative full weight‑bearing (FWB) was analyzed with a logistic model including fixation, PM status, and their interaction; pairwise, covariate‑adjusted contrasts (emmeans with Tukey correction) compared strategies. An exploratory random forest provided permutation‑importance rankings.FindingsPMFs were present in 147/387 fractures (38.0%), more often in women (60.5%), closed injuries (76.9%), and distal fractures (98.0%). Radiography identified 116/147 PMFs (78.9%), and CT 120/147 (81.6%); 29/147 (19.7%) fragments were missed on radiographs but detected on CT or intraoperatively. Missed fragments were most frequent in undisplaced and intermediate‑sized (33-50%) fragments; CT identified all posteromedial and >50% fragments. In adjusted analyses, fracture morphology was the principal correlate of radiographic omission: oblique patterns were less likely to be missed (adjusted odds ratio 0.18, 95% CI 0.04-0.60), whereas other demographic and injury variables were not significant. Among operatively managed fractures, intramedullary nailing was associated with the highest likelihood of achieving FWB and was statistically superior to plate and external fixation in pairwise, covariate‑adjusted comparisons; the relative ranking of fixation methods did not differ by PM involvement. Neither PMF location (posteromedial, posterolateral, or undisplaced) nor fragment size independently predicted FWB, infection, or mal‑/non‑union.ConclusionsApproximately two in five distal tibial shaft fractures harbour a PM fragment, and nearly one in five PMFs are occult on initial radiographs, particularly when undisplaced or of intermediate size. CT modestly increases detection and ensures complete characterisation of posteromedial and large fragments, supporting a low threshold for pre‑operative CT in distal tibial fractures.

Abstract Introduction Acute diverticulitis is one of the most common causes for surgical emergency hospital admissions in the UK. The guidelines for endoscopic follow-up for patients with diverticulitis has changed over the last few years. This study aimed to assess the local follow-up of patients who present with diverticulitis. The objective was to identify the outcome of patients with diverticulitis and establish the new local guidelines for endoscopic follow-up. Methods A single-centre retrospective study was done for all patients who had CT proven diverticulitis at the Royal Shrewsbury Hospital in 2022. Data was collected about the patient demographics, vital statistics on presentation, Hinchey Classification, mode of management, previous admissions with diverticulitis, readmissions in one year, surgery in one year, and their follow-up results. Results There were 193 patients in the study with a median age of 61 (IQR: 51-73) and 37.8% were male. Follow-up endoscopy was done in 45.6% (87/193) of the patients, amongst which 85.1% (74) had uncomplicated diverticulitis. There was one cancer detected in colonoscopy and one in flexible sigmoidoscopy both of which were suspicious on the initial CT scan. 13 patients had a follow-up CT scan within 1 year, of which 2 confirmed cancer. Median time for endoscopy and CT scan was 10 and 26 weeks from discharge, respectively. Conclusion Diagnosis of cancer on an isolated follow-up colonoscopy or flexible sigmoidoscopy after uncomplicated diverticulitis is rare. These investigations should be reserved for patients with complicated diverticulitis or suspicious features of cancer on the initial CT scan.

Background and aim Patient information leaflets (PILs) printed in paper form are a commonly used adjunct tool in urology clinics. These help to facilitate the information transfer between doctor and patient. They are detrimental to the environment and costly. Quick response (QR) codes can be used as another option for delivering the leaflets and would reduce the environmental burden.The aim of this paper is to evaluate patient response to the introduction of QR codes as a replacement for paper-based PILs. Methods This pilot study followed the introduction of QR codes of commonly used leaflets sourced from the British Association of Urological Surgeons (BAUS). The study was conducted in a urology clinic at the Hereford County Hospital over a one-month period. The acceptability of the QR codes was recorded. Data such as patient demographics and the type of leaflet were also documented and tabulated. Results Thirty-one patients required PILs, out of which 80% agreed to PILs via QR codes. The mean age of the participating patients was 76. The replacement of paper with QR codes for the one-month period reflects an average estimated saving of 1.88 kg of carbon dioxide emissions and around 238 sheets of paper. Discussion The introduction of QR codes has seen an increase in most sectors, including, more recently, the medical industry. They can be used with a wide range of functions within the industry ranging from medical education to patient identification. These can also be more easily distributed in various forms to cater to all needs. Limitations, such as the currently limited variety of urology PILs available, also need to be considered. Conclusion QR codes of the PILs are a generally accepted alternative. The widespread introduction of QR codes reduces the total environmental impact of paper documents while also reducing production costs.

Abstract Hair loss in women is associated with profound psychological distress, affecting mental health, self-esteem and social functioning. This systematic review consolidates findings from qualitative studies to explore the psychological burden of hair loss and evaluate the efficacy of supportive interventions. The aim is to inform best practices for holistic, patient-centred management in dermatology clinics, aligning with National Institute for Health and Care Excellence guidelines and international protocols. This review adhered to the PRISMA guidelines, with a comprehensive search of the PubMed, MEDLINE, PsycINFO and Embase databases for qualitative studies published between 2010 and 2023. Keywords included ‘psychological impact’, ‘hair loss’, ‘women’, ‘qualitative studies’ and ‘supportive interventions’. Inclusion criteria encompassed studies on the emotional and psychological burden of hair loss in women, with or without supportive interventions. Mixed-methods studies were included if qualitative data could be extracted. Single-case studies and those without a psychological focus were excluded. Data were thematically synthesized to identify psychological impacts and assess the effectiveness of interventions such as counselling, peer support and cosmetic solutions. Twenty-six studies involving 1450 participants met the inclusion criteria. The key findings are reported here. (i) Emotional distress: hair loss caused significant emotional distress, with 78% of women reporting feelings of shame, anxiety or depression. Younger women and those with more extensive hair loss experienced greater psychological burdens. (ii) Impact on self-image: self-esteem was negatively affected in 85% of participants, with themes of loss of femininity and perceived diminished attractiveness. (iii) Social withdrawal: over 60% of women avoided social interactions due to embarrassment, compounding isolation and low self-worth. (iv) Supportive interventions: psychosocial therapies such as cognitive behavioural therapy (CBT) and peer support groups reduced anxiety and improved coping in 68%, while cosmetic solutions such as wigs, scalp micropigmentation and hairpieces enhanced confidence and social reintegration for 72%. Emerging themes underscored the importance of empathic clinician–patient communication, with patients emphasizing the need for guidance and emotional support alongside clinical care. Hair loss in women exerts a profound psychological impact on mental health, self-esteem and social functioning. Supportive interventions, including CBT, peer support and cosmetic solutions, effectively alleviate distress and enhance quality of life. A multidisciplinary approach integrating psychological support into routine care pathways is essential. Recommendations for practice are (i) to implement psychological assessments to identify at-risk patients; (ii) to develop integrated care models combining dermatological and psychological support; (iii) to create age-specific, culturally sensitive interventions and (iv) to educate patients on supportive therapies, fostering proactive engagement. This review highlights the critical need for dermatologists to address both the physical and psychological dimensions of hair loss, offering practical insights for patient-centred care. By incorporating psychological screening, empathetic communication and evidence-based supportive interventions, dermatology clinics can significantly improve patient outcomes.