Wrexham Maelor Hospital

Femoral head fractures are complex injuries often associated with high-energy trauma and hip dislocation. Surgical hip dislocation (SHD), particularly the Ganz trochanteric flip osteotomy, was developed to provide extensive intra-articular access while preserving the femoral head's vascular supply. However, a consolidated synthesis of its outcomes is needed. This systematic review aims to evaluate the clinical and radiological outcomes, complication profiles, and key technical considerations of SHD for the management of femoral head trauma.A systematic literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines across five databases (PubMed, Scopus, Embase, Web of Science, and Cochrane Library) on October 2, 2025. Studies reporting functional or radiological outcomes of SHD for femoral head trauma were included. The risk of bias was assessed using the ROBINS-I tool. Data on study characteristics, functional scores, and complications were extracted and synthesized narratively due to heterogeneity.Ten studies involving 267 patients were included. The majority of studies reported good to excellent functional outcomes, with mean modified Harris Hip Scores and Merle d'Aubigné scores indicating satisfactory recovery. The rate of avascular necrosis (AVN) was consistently low to moderate, ranging from 0% to 8.3% in most studies, a rate notably lower than historically reported for traditional posterior approaches. However, Pipkin type IV fractures were associated with a poor prognosis, with one study reporting an 87.5% rate of post-traumatic arthritis and a 57.1% conversion to total hip arthroplasty. Heterotopic ossification was a common but often asymptomatic finding. The comparative analysis underscored that early hip reduction (less than six hours) significantly improved outcomes. The overall risk of bias was low for all included prospective and retrospective cohort studies, while the two case series were appropriately judged to have a serious risk of bias inherent to their design.SHD is a safe and effective approach for femoral head trauma, facilitating anatomical reduction and yielding good functional outcomes with a low risk of AVN. The Ganz trochanteric flip osteotomy is the cornerstone technique. Prognosis is highly dependent on fracture type, with Pipkin IV injuries posing the greatest challenge, and the timing of surgical intervention is a critical modifiable factor for success.

IntroductionThe focus of this article is on developing and operationalising shared mental models in elite sports teams, using a Decision-Making Framework.The Decision-making Framework innovatively integrates Cognitive Task Analysis (CTA) methods into off-field after action review meetings (AAR) to enhance on-field performance.MethodsUsing a mixed method approach, fourteen international players and three expert coaches participated in this study. CTA methods were employed during a 31 day training period, to capture development in individual and team decision-making.ResultsBoth qualitative statements and inferential statistics indicate that DM can be accelerated when a slow, deliberate, reflective, off-field digital environment (AAR) is integrated with competitive ‘in-action’, on-field contexts.ConclusionThe DM Framework accelerated and enhanced individual and team decision-making.

Artificial intelligence (AI) is affecting the practice of orthopedic surgery, offering innovative solutions from preoperative planning to intraoperative guidance and real-time adaptation. This review highlights current advancements in AI-driven imaging analysis, anatomical segmentation, and implant selection, highlighting improvements in surgical precision, efficiency, and patient-specific customization. Intraoperatively, AI enables real-time image processing, integration with robotic systems, and adaptive feedback mechanisms that enhance accuracy, reduce complications, and personalize care. Clinical applications span joint replacement, spine, and trauma surgery, where AI supports diagnosis and offers support in decision-making, often surpassing conventional methods. Despite these promising developments, challenges remain regarding data quality, model generalizability, transparency, and ethical considerations. Future directions emphasize explainable AI, multimodal data integration, and closer synergy between AI, robotics, and digital health to advance personalized orthopedic care.

Effective communication is vital for informed consent in clinical practice, especially since the Montgomery v Lanarkshire ruling, yet NHS resource pressures demand more efficient patient–clinician interactions. We therefore evaluated four large language models—ChatGPT-O1, Deepseek, Gemini and Copilot—by asking each to draft two clinic letters for six common elective orthopaedic operations, using uniform, patient-friendly prompts that mirrored real consultations. Across the 48 letters generated, GPT-O1 most faithfully incorporated the gold-standard complication profile for each procedure (compliance 0.923 ± 0.104, P < 0.001), with Gemini next at 0.860 ± 0.079. All models produced drafts pitched at a roughly 7th-to-8th-grade reading level according to composite Flesch-Kincaid scores (range 6.850–8.517). On secondary readability metrics, Gemini's outputs were judged easiest to digest, achieving the lowest Gunning-Fog and SMOG grades (10.657 ± 1.291 and 11.583 ± 1.191, respectively; P < 0.001), whereas GPT-O1's letters were comparatively dense (8.830 ± 0.570 and 9.983). Understandability assessed by three blinded clinicians using the Patient-Education Materials Assessment Tool also favoured Gemini (PEMAT 0.826 ± 0.054) over GPT-O1 (0.718 ± 0.071, P < 0.005). Collectively, these results suggest that contemporary LLMs can produce concise, comprehensible clinic correspondence that preserves essential risk information, thereby supporting shared decision-making while lessening clerical load. Future research should explore integrating real-time electronic health-record data, refining model retrieval to capture uncommon complications, and developing governance frameworks that address data privacy, clinical accountability and bias, so that this technology can be responsibly embedded in routine orthopaedic practice. In parallel, stakeholder education about the capabilities and limitations of generative AI will be crucial to maintain patient trust and ensure clinicians remain central arbiters of personalised expert surgical advice.

A 51-year-old Indian man presented with a 2-month history of foot ulcers causing pain on exertion. Examination revealed two shallow, oval ulcers on the right dorsal foot with central eschars (Figure 1a). Inspection of the surrounding skin showed atrophic scarring, suggesting previously healed lesions. The patient had no systemic symptoms and no palpable lymphadenopathy. A diagnosis of vasculitis was considered. The patient presented 3 months later with four new ulcerated and crusted plaques on the right anterior shin (Figure 1b). The previously identified lesions on the right foot had resolved. A skin biopsy of one of the new lesions was performed. Histology revealed widespread epidermal and dermal necrosis with central ulceration. In the dermis, histiocytes, eosinophils, and infiltrates of atypical lymphocytes were found in an angiocentric pattern (Figure 1c). Lymphocytes invading the vessel walls had led to angiodestruction. Immunohistochemical investigations showed that CD2, CD3, CD4, CD5 and CD7 were positive. Additionally, CD30 and CD8 were focally positive (Figure 1d). These findings supported a diagnosis of lymphomatoid papulosis (LyP) type E and treatment was commenced with methotrexate. The ulcers resolved within 6 weeks. Treatment was continued for 12 months and no further lesions were observed. Lymphomatoid papulosis is a rare lymphoproliferative disorder characterized by recurrent papulo-nodular lesions.1 Despite low disease-specific mortality rates, LyP carries a 20% risk of developing secondary lymphoid malignancy.2 Lymphomatoid type E is an uncommon subtype, making up less than 5% of cases.3 It is characterized clinically by lesions that rapidly break down to form large, eschar-like, necrotic ulcers; the other five subtypes differ as smaller superficial ulceration is seen. Ulceration typically resolves spontaneously within 3–6 weeks leaving atrophic varioliform scarring. Histopathological distinction is based on angiocentric CD30+ and CD8+ atypical infiltrates.4 Contradictory to its aggressive presentation, LyP type E has an excellent prognosis; only 5% of patients develop a secondary malignant lymphoma.1 The authors thank Dr. Murugusundaram Sundaram of Chennai Skin Foundation, Chennai and Dr. Sadaf from Apollo Specialties Hospital, Chennai for their work on this case. None declared. Informed consent was provided by the patient for the use of clinical images.

Abstract BackgroundTherapeutic management of hair loss is frequently complicated by a lack of high‐quality evidence and reliant on the use of unlicensed therapies. Treatment decision‐making is predominantly based on expert opinion, local availability, personal experience, and cost, which make informed choices challenging for clinicians and patients in this area.ObjectivesThe aims were to determine prescribing patterns amongst UK Dermatologists with a special interest in hair disorders, when treating mild‐moderate alopecia areata (AA), severe AA (including alopecia totalis/alopecia universalis), female pattern hair loss (FPHL) and frontal fibrosing alopecia (FFA).MethodsConsultant members of the British Hair and Nail society, a special interest group affiliated to the British Association of Dermatologists, were invited to participate from across the United Kingdom. Participants were questioned on their current prescribing patterns in both NHS and private practice, were asked to rank their first‐to‐fifth line treatments for each condition and highlight the treatment they perceive as most effective for each disorder.ResultsTwenty‐six Consultant Dermatologists completed the questionnaire, from twenty‐three institutions. For treatment of mild‐moderate AA, topical corticosteroids were used first line amongst 65% (n = 17) of respondents, and 82% (n = 23) reported that intralesional corticosteroids were the most effective treatment. For severe AA, oral corticosteroids were used first line amongst 38% (n = 10) of respondents, and 25% (n = 8) reported that oral corticosteroids were the most effective treatment. For FPHL, topical minoxidil was used first line amongst 84% (n = 25) of respondents, and 42% (n = 10) reported that oral minoxidil was the most effective treatment. For FFA, topical corticosteroids were used first line amongst 62% (n = 16) of respondents, and 37% (n = 14) reported that hydroxychloroquine was the most effective treatment.ConclusionsThis study reports real‐world prescribing practices amongst dermatologists treating common hair loss conditions. These results aim to support clinicians with decision making for managing hair loss conditions.

BACKGROUND:Familial chylomicronemia syndrome (FCS) is a rare autosomal recessive disorder. This study aimed to study the genotype distribution of FCS-causing genes in the United Kingdom, genotype-phenotype correlation, and clinical differences between FCS and multifactorial chylomicronemia syndrome (MCS).METHODS:The study included 154 patients (FCS, 74; MCS, 80) from the UK FCS national registry and the UK arm of the FCS International Quality Improvement and Service Evaluation Project.RESULTS:FCS was relatively common in non-Europeans and those with parental consanguinity (P<0.001 for both). LPL variants were more common in European patients with FCS (European, 64%; non-European, 46%), while the genotype was more diverse in non-European patients with FCS. Patients with FCS had a higher incidence compared with patients with MCS of acute pancreatitis (84% versus 60%; P=0.001), recurrent pancreatitis (92% versus 63%; P<0.001), unexplained abdominal pain (84% versus 52%; P<0.001), earlier age of onset (median [interquartile range]) of symptoms (15.0 [5.5–26.5] versus 34.0 [25.2–41.7] years; P<0.001), and of acute pancreatitis (24.0 [10.7–31.0] versus 33.5 [26.0–42.5] years; P<0.001). Adverse cardiometabolic features and their co-occurrence was more common in individuals with MCS compared with those with FCS (P<0.001 for each). Atherosclerotic cardiovascular disease was more prevalent in individuals with MCS than those with FCS (P=0.04). However, this association became nonsignificant after adjusting for age, sex, and body mass index. The prevalence of pancreatic complications and cardiometabolic profile of variant-positive MCS was intermediate between FCS and variant-negative MCS.CONCLUSIONS:The frequency of gene variant distribution varies based on the ethnic origin of patients with FCS. Patients with FCS are at a higher risk of pancreatic complications while the prevalence of atherosclerotic cardiovascular disease is lower in FCS compared with MCS. Carriers of heterozygous pathogenic variants have an intermediate phenotype between FCS and variant-negative MCS.