Spire Healthcare Group PLC · LSE:SPI

Spire Healthcare — Investor Presentation (June 2012)

51 slides from Spire Healthcare's investor presentation, Jun 22, 2012

  1. Slide 1: Elbows: when to refer, new developments

    Elbows when to refer new developments Simon Lambert Consultant Orthopaedic Surgeon The Shoulder and Elbow Service Royal National Orthopaedic Hospital NHS Trust Friday, 22 June 12 1

  2. Slide 2: Emergencies

    emergencies ‣injury ‣infection ‣cancer Friday, 22 June 12 2

  3. Slide 3: Acute injury: acute dislocation

    acute injury acute dislocation associated nerve / blood vessel injury at any age 0 5 14 25 40 acute dislocation : skateboards, roller-blades, sports proximity of median and ulnar nerves referral urgent Friday, 22 June 12 3

  4. Slide 4: Acute injury: special case - the infant

    acute injury : special case (1) - the infant acute dislocation associated nerve / blood vessel injury at any age “pulled elbow” subluxation of the radial head 0 5 14 25 40 acute dislocation : referral urgent (?NAI) Friday, 22 June 12 4

  5. Slide 5: Acute injury: dislocation and fracture

    acute injury acute dislocation associated nerve / blood vessel injury at any age fracture (simple) fracture (complex) capacity to remodel diminishes with age extra-articular intra-articular (supracondylar) 0 5 14 25 40 acute dislocation : referral urgent fracture : referral immediate Friday, 22 June

  6. Slide 6: Acute injury: special case - the older skate-boarder

    acute injury: special case (2) - the (older) skate-boarder acute dislocation associated nerve / blood vessel injury at any age fracture (simple) fracture (complex) capacity to remodel diminishes with age radial head fracture 0 5 14 25 40 fracture :consider aspiration of the joint the posterolateral

  7. Slide 7: Lateral epicondyle, radial head, olecranon

    lateral epicondyle radial head olecrannon Friday, 22 June 12 7

  8. Slide 8: Lateral epicondyle, radial head, olecranon

    lateral epicondyle radial head olecrannon Friday, 22 June 12 8

  9. Slide 9: Acute injury: special case - the older weight-lifter

    acute injury: special case (3) - the older weight-lifter acute dislocation associated nerve / blood vessel injury at any age fracture (simple) fracture (complex) capacity to remodel diminishes with age biceps tendon rupture / avulsion 0 5 14 25 40 rupture /avulsion : reverse “pop-eye” sign referral

  10. Slide 10: R elbow anatomy

    R elbow lateral epicondyle medial epicondyle biceps tendon Friday, 22 June 12 10

  11. Slide 11: R elbow nerves and vessels

    R elbow radial brachial nerve artery median lateral nerve epicondyle medial epicondyle biceps tendon Friday, 22 June 12 11

  12. Slide 12: No pulse, no feeling, no power: refer immediately

    No pulse + no feeling + no power : refer immediately acute dislocation associated nerve / blood vessel injury at any age fracture (simple) fracture (complex) capacity to remodel diminishes with age supracondylar fracture in children 0 5 14 25 40 acute dislocation : referral urgent fracture : referra

  13. Slide 13: Hot, exquisitely painful, can't move: infection

    Hot, exquisitely painful, can’t move, possibly swollen 0 5 14 25 40 infection: haematogenous meningococcus coliform bursitis referral : immediate Friday, 22 June 12 13

  14. Slide 14: Warm, somewhat painful, won't move

    Warm (?), somewhat painful, won’t move, possibly swollen 0 5 14 25 40 infection : specific (SA) inflammation: specific (RA, sero-ve, gout, pseudo-gout) referral : urgent Friday, 22 June 12 14

  15. Slide 15: Lateral epicondyle, radial head, olecranon

    lateral epicondyle radial head olecrannon Friday, 22 June 12 15

  16. Slide 16: Other acute reasons to refer

    other acute (non-elbow and painful) reasons to refer neuro- : neck (C5) 0 5 14 25 40 neuro- : XR/MR/CT + EMG/NCS + physiotherapy + osteopathy + rheumatologist + neurologist + spinal surgeon Friday, 22 June 12 16

  17. Slide 17: C5 and radial nerve symptoms

    C5 “Dr, I have…... achey pain ‘numbness’ radial pins and needles nerve (thumb and index)” forearm hand Friday, 22 June 12 17

  18. Slide 18: Take your time

    take your time ‣tendon disease ‣arthritis Friday, 22 June 12 18

  19. Slide 19: The 3 ages of abnormal elbow function

    the 3 ages of abnormal elbow function instability tendon disease arthritis rcj, uhj, pruj 0 5 14 25 40 Friday, 22 June 12 19

  20. Slide 20: Abnormal elbow function

    abnormal elbow function instability tendon disease arthritis rcj, uhj, pruj 0 5 14 25 40 + poor muscles = impingement odd motions Friday, 22 June 12 20

  21. Slide 21: Abnormal elbow function

    abnormal elbow function instability tendon disease arthritis rcj, uhj, pruj 0 5 14 25 40 + poor muscles “over-use” = impingement weakness odd motions instability Friday, 22 June 12 21

  22. Slide 22: Abnormal elbow function

    abnormal elbow function instability tendon disease arthritis rcj, uhj, pruj 0 5 14 25 40 + poor muscles “over-use” synovitis = impingement weakness stiffness odd motions instability “catching” Friday, 22 June 12 22

  23. Slide 23: Non-acute referral patterns: when, to whom

    non-acute referral patterns: when, to whom instability tendon disease arthritis rcj, uhj, pruj 0 5 14 25 40 immediately: A&E (NAI, “sports” injury) Friday, 22 June 12 23

  24. Slide 24: Non-acute referral patterns: when, to whom

    non-acute referral patterns: when, to whom instability tendon disease arthritis rcj, uhj, pruj 0 5 14 25 40 <1-2/52: orthopaedic surgeon immediately: A&E (NAI, “sports” injury) Friday, 22 June 12 24

  25. Slide 25: Non-acute referral patterns: when, to whom

    non-acute referral patterns: when, to whom instability tendon disease arthritis rcj, uhj, pruj 0 5 14 25 40 <3/52: sports; rheum ; physio ist <1-2/52: orthopaedic surgeon immediately: A&E (NAI, “sports” injury) Friday, 22 June 12 25

  26. Slide 26: Non-acute referral patterns: when, to whom

    non-acute referral patterns: when, to whom instability tendon disease arthritis rcj, uhj, pruj 0 5 14 25 40 <3/52: rheumist <3/52: sports; rheum ; physio ist <1-2/52: orthopaedic surgeon immediately: A&E (NAI, “sports” injury) Friday, 22 June 12 26

  27. Slide 27: Non-acute shoulder conditions: investigations (1)

    non-acute shoulder conditions: investigations (1) instability tendon disease arthritis rcj, uhj, pruj 0 5 14 25 40 XR USS none Friday, 22 June 12 27

  28. Slide 28: Non-acute shoulder conditions: investigations (2)

    non-acute shoulder conditions: investigations (2) instability tendon disease arthritis rcj, uhj, pruj 0 5 14 25 40 XR, CTA USS, LA + steroid injection, MRI none, MRA, EMG, EUA Friday, 22 June 12 28

  29. Slide 29: Emerging treatments: neural control systems

    emerging treatments : neural control systems instability tendon disease arthritis 0 5 14 25 40 specialised physiotherapy Friday, 22 June 12 29

  30. Slide 30: Emerging treatments: the importance of XS imaging

    emerging treatments : the importance of XS imaging instability tendon disease arthritis 0 5 14 25 40 PRP, MSC, imaging specialised physiotherapy Friday, 22 June 12 30

  31. Slide 31: R elbow lateral view

    R elbow lateral view Friday, 22 June 12 31

  32. Slide 32: Emerging treatments: Platelet-rich plasma

    emerging treatments : Platelet-rich plasma PRP 33 patients with CEO degeneration on USS failed non-surgical treatment ; 10/09-10/11 12 (33%) : enthesophyte 26 (79%) : tears Friday, 22 June 12 32

  33. Slide 33: Emerging treatments: Platelet-rich plasma results

    emerging treatments : Platelet-rich plasma PRP 33 patients with CEO degeneration on USS failed non-surgical treatment ; 10/09-10/11 12 (33%) : enthesophyte 26 (79%) : tears OES + MEPS : better post-PRP (p<0.001) no correlation with pathology 6 (18%) : no improvement no complications of PRP/injection

  34. Slide 34: Emerging treatments: materials science

    emerging treatments : materials science instability tendon disease arthritis 0 5 14 25 40 new techgy materials PRP, MSC approaches specialised physiotherapy Friday, 22 June 12 34

  35. Slide 35: Lateral elbow pain

    Lateral elbow pain <5 5 - 10 10 - 15 15 - 25 25 - 60 >60 epiphyseal radial head intra-articular Injury pulled elbow extra-articular fracture fracture fracture fracture Specific lateral epicondylar NAI osteomyelitis tumour arthritis epicondylitis tenderness Spreading congenital sero-ve synovitis / po

  36. Slide 36: Lateral elbow pain

    Lateral elbow pain <5 5 - 10 10 - 15 15 - 25 25 - 60 >60 epiphyseal radial head intra-articular Injury pulled elbow extra-articular fracture fracture fracture fracture Specific lateral epicondylar NAI osteomyelitis tumour arthritis epicondylitis tenderness Spreading congenital sero-ve synovitis / po

  37. Slide 37: Medial elbow pain

    Medial elbow pain <5 5 - 10 10 - 15 15 - 25 25 - 60 >60 Injury epiphyseal fracture extra-articular fracture intra-articular fracture Specific medial epicondylar NAI osteomyelitis tumour arthritis epicondylitis tenderness Spreading sero-ve posteromedial septic arthritis ulnar neuralgia arthritis arth

  38. Slide 38: Medial elbow pain

    Medial elbow pain <5 5 - 10 10 - 15 15 - 25 25 - 60 >60 Injury epiphyseal fracture extra-articular fracture intra-articular fracture Specific medial epicondylar NAI osteomyelitis tumour arthritis epicondylitis tenderness Spreading sero-ve posteromedial septic arthritis ulnar neuralgia arthritis arth

  39. Slide 39: Overview: diagnosis and referral

    overview : diagnosis and referral referral feature investigation <14 <25 <40 >40 to whom pattern A&E/ Fracture can’t move XR urgent orth surg A&E/ Dislocation can’t move - urgent orth surg A&E/ Infection won’t move - urgent orth surg London Tumour won’t move - urgent Sarcoma Service Instability odd

  40. Slide 40: Overview: diagnosis = wobbly = physiotherapist

    overview : diagnosis = wobbly = physiotherapist referral feature investigation <14 <25 <40 >40 to whom pattern A&E/ Fracture can’t move XR urgent orth surg A&E/ Dislocation can’t move - urgent orth surg A&E/ Infection won’t move - urgent orth surg London Tumour won’t move - urgent Sarcoma Service In

  41. Slide 41: Overview: diagnosis = tendon = USS / MRI

    overview : diagnosis = tendon = USS / MRI referral feature investigation <14 <25 <40 >40 to whom pattern A&E/ Fracture can’t move XR urgent orth surg A&E/ Dislocation can’t move - urgent orth surg A&E/ Infection won’t move - urgent orth surg London Tumour won’t move - urgent Sarcoma Service Instabil

  42. Slide 42: Overview: diagnosis = capsule / joint = XR

    overview : diagnosis = capsule / joint = XR referral feature investigation <14 <25 <40 >40 to whom pattern A&E/ Fracture can’t move XR urgent orth surg A&E/ Dislocation can’t move - urgent orth surg A&E/ Infection won’t move - urgent orth surg London Tumour won’t move - urgent Sarcoma Service Instab

  43. Slide 43: When does a surgeon need to be involved?

    when does a surgeon need to be involved? inflammation 6/52 Friday, 22 June 12 43

  44. Slide 44: Repair, inflammation

    repair inflammation 6/52 3/12 Friday, 22 June 12 44

  45. Slide 45: Remodelling, repair, inflammation

    remodelling repair inflammation 6/52 3/12 6/12 Friday, 22 June 12 45

  46. Slide 46: Functional restoration

    functional restoration remodelling repair inflammation 6/52 3/12 6/12 12/12 Friday, 22 June 12 46

  47. Slide 47: Endurance restoration

    endurance restoration functional restoration remodelling repair inflammation 6/52 3/12 6/12 12/12 24/12 Friday, 22 June 12 47

  48. Slide 48: Expected recovery curve

    expected recovery curve endurance restoration functional restoration remodelling repair inflammation 6/52 3/12 6/12 12/12 24/12 Friday, 22 June 12 48

  49. Slide 49: Expected recovery curve not happening

    expected recovery curve not happening…. endurance restoration functional restoration remodelling repair inflammation 6/52 3/12 6/12 12/12 24/12 Friday, 22 June 12 49

  50. Slide 50: Expected recovery curve: surgical intervention

    expected recovery curve : surgical intervention endurance restoration functional restoration remodelling repair inflammation 6/52 3/12 6/12 12/12 24/12 Friday, 22 June 12 50

  51. Slide 51: When does a surgeon need to be involved?

    when does a surgeon need to be involved? this within 3 before 3 at 3 urgent investigation to do what week weeks months months Fracture rest in sling / after A&E analgesic OPD non-union mal-union XR / CT fix / graft / correct Dislocation rest in sling / prognosis / after A&E analgesic OPD MRA stabili

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