The aim of the study was to measure the Quality of Life of young patients sustained fracture neck of femur.

This is a retrospective study of 50 patients who suffered different types of hip fractures. 67 patients underwent surgeries for hip fractures between 1998-2002 were sent the ‘EUROQOL EQ-5D’ questionnaire, out of which 50 replied back. Different parameters of EQ-5D including mobility, self-care, usual activities, pain / discomfort, anxiety / depression and the overall health status were graded by these patients. The overall scores were calculated. We compared those values with calculated EQ-5D values of control groups of the same age from the general population of the UK. Information about The type of fractures, the type of operation, complications, and the mechanism of injury were recorded and their effect on the quality of life was correlated.

Out of 50 patients, there were 29 male and 21 female, with a mean age of 48.52 yrs (16 to 60 yrs). There were 32 patients with intra-capsular neck of femur fractures, (16 undisplaced & 16 displaced) 17 intertrochanteric and one with a subtrochanteric extension. 16 patients underwent Internal fixation (AO Screws), 15 had a hemiarthroplasty, 18 had Dynamic hip screws and 1 had THR. The mean hospital stay was 7.14 days (3 to 28 days). 70% of the patients reported some problems with mobility, 44% had problems in self-care, 58% had a restriction of their usual activities, and 70% had pain & discomfort at an average of 4 years of follow up. When compared with same age groups from the general population there was statistically significant difference in the EQ-5D index and EQ-5D state with p value of [p=< . 05] in the patient aged between 30 and 60 and no statistical differences between the EQ-5D index or EQ-5D state in the age groups between 20 and 39. We also found an association between poor life quality and development of complications.

Complications included one dislocated hemiarhtro-plasty, one patient had AO screws removed.

Conclusions We concluded that fracture neck of femur in young patient lead to significant deterioration in patient quality of life when compared with the same age groups from he general population. More research is required to improve the current treatment methods.

Aim: Severity of knee osteoarthritis (OA) can be defined clinically, radiologically, or pathologically. The Système Française D’Arthroscopie (SFA) is a validated method of grading and scoring the severity of changes on the articular surface as observed through the arthroscope. We have validated a modification of the SFA system for use with digital photographs of pathological samples.

Material and Method: After Ethics Committee approval, both tibial plateaux and femoral condyles were collected from 84 patients undergoing total knee replacement or at post mortem. Extent and grading of cartilage changes were documented for the 4 compartments of each sample on a diagram using direct visualisation and probing (Pathological Scores). In addition, each sample was digitally photographed at standard magnification and illumination, archived, graded and scored (Photographic Scores). A second observer (AY) also graded and scored photographic images for 72 compartments of the first 18 cases.

Data analysis: Repeatability was measured as Repeatability Coefficients (Bland and Altman, Lancet1986; 1; 307–10). 95% of the differences between 2 measurements of a case are expected to fall within the Repeatability Coefficient. Associations between compartments are expressed as Pearson correlation coefficients.

Results: For each of the 4 compartments studied, scores ranged from -2.2 to +717.8, representing the full range of possible scores. Allocation of scores to diagrams was highly repeatable (Repeatability Coefficient = 50). There was good agreement between Pathological and Photographic Scores (Repeatability Coefficient = 88). There was moderate agreement between Photographic Scores allocated by the 2 observers, with greatest agreement for low (< 200) and high (> 500) scores. Scores for each compartment correlated with scores for each of the other 3 compartments (R values 0.7 to 0.9, all P < 0.005).

Conclusion: Our modified SFA system permits scoring of OA severity using digital photographs of pathological samples. Our data support the view that OA affects the entire joint, and that a single compartment (e.g. medial tibial plateau) can be taken as broadly representative of the tibiofemoral joint as a whole.

Aim: The Système Française D’Arthroscopie (SFA) is a validated method of arthroscopic grading and scoring the knee OA. We have validated a modification of the SFA system for use with digital photographs of pathological samples.

Material and Method: After Ethics Committee approval, both tibial plateaux and femoral condyles were collected from 84 patients undergoing total knee replacement or at post mortem. Extent and grading of cartilage changes were documented for the 4 compartments of each sample on a diagram using photographs at standard magnification and illumination, archived, (Photographic Scores). Validation obtained by direct visualisation and probing (Pathological Scores). Radiographic and Histological scoring In addition, each sample was digitally. A second observer (AY) also graded and scored photographic images for 72 compartments of the first 18 cases.

Results: For each of the 4 compartments studied, scores ranged from -2.2 to +717.8, representing the full range of possible scores. A statistically significant correlation observed in the study between radiological variables and the severity of chondropathy assessed by our (SFA-path) [ P < 0.005] suggests satisfactory extrinsic validity of this scoring system. And statistically significant correlation [p> 0.0001] between the SFA Path scores of the medial compartment tibial plateau OA and Histologi-cal grade [Minkin] of the same samples. Allocation of scores to diagrams was highly repeatable (Repeatability Coefficient = 50). There was good agreement between Pathological and Photographic Scores (Repeatability Coefficient = 88). There was moderate agreement between Photographic Scores allocated by the 2 observers, with greatest agreement for low (< 200) and high (> 500) scores. Scores for each compartment correlated with scores for each of the other 3 compartments (R values 0.7 to 0.9, all P < 0.005).

Conclusion: We validated our modified SFA system which permits scoring of OA severity using digital photographs of pathological samples. SFApath is reliable and repeatable scoring system Our data support the view that OA affects the entire joint, and that a single compartment (e.g. medial tibial plateau) can be taken as broadly representative of the tibiofemoral joint as a whole.

Aims: Hypokalemia is a common electrolyte imbalance with signficent effects. The aim of our study is to identify incidence, causes and prognostic implications of postoperative hypokalemia in elderly patients operated for fracture neck of femur.

Methods and material: Retrospective study, of 404 consecutive fracture neck of femur patients who were operated in our hospital between October 2001 and July 2003. Patients identified with postoperative hypo-kalemia the medical notes, fluid charts and anaesthetic notes were analysed for age, preoperative morbidities, medications, mechanism and type of injury, waiting time for operation, pre, peri and postoperative fluid management, type of anaesthesia, operative time, hospital stay and mortality.

Results: Out of the 404 patients, 54(13.3%) were hypokalemic (K< 3.5mmol/l) postoperatively. Of the 54 patients 16 (29.6%)had preoperative hypokalemia.

Among the hypokalemic group the mean preopera-tive potassium was 3.69mmol/l and the mean postoperative potassium was 3.19mmol/l. The t-test showed a statistically significant difference between mean pre and postoperative potassium levels (P< 0.0001). High association was found with hypokalemia and post-operative dextrose infusion (38%). 50% of patients on diuretics developed hypokalemia post operatively. Interestingly, only 18% of these were hypokalemic pre operatively.

In patients with multiple medical problems, like diabetes, hypertension and CVA, high incidence of hypokalemia was found. (38% had 2 or more medical problems).

No significance in the mortality rate was found in fracture neck of femur patients with and without postoperative hypokalemia (40% vs. 39% at 3yrs).

Conclusion: There is significant risk of hypokalemia following orthopaedic surgery, especially in the elderly. This avoidable condition, which has serious consequences, should be dealt with care in the orthopaedic units. Fluid infusion regimes and should be formulated and medications reviewed to prevent conditions like hypokalemia.

Aims: Hypokalemia is a common electrolyte imbalance with signficent effects. The aim of our study is to identify incidence, causes and prognostic implications of postoperative hypokalemia in elderly patients operated for fracture neck of femur.

Methods and material: Retrospective study, of 404 consecutive fracture neck of femur patients who were operated in our hospital between October 2001 and July 2003. Patients identified with postoperative hypo-kalemia the medical notes, fluid charts and anaesthetic notes were analysed for age, preoperative morbidities, medications, mechanism and type of injury, waiting time for operation, pre, peri and postoperative fluid management, type of anaesthesia, operative time, hospital stay and mortality.

Results: Out of the 404 patients, 54(13.3%) were hypokalemic (K< 3.5mmol/l) postoperatively. Of the 54 patients 16 (29.6%)had preoperative hypokalemia.

Among the hypokalemic group the mean preopera-tive potassium was 3.69mmol/l and the mean postoperative potassium was 3.19mmol/l. The t-test showed a statistically significant difference between mean pre and postoperative potassium levels. (P< 0.0001). High association was found with hypokalemia and post-operative dextrose infusion (38%). 50% of patients on diuretics developed hypokalemia post operatively. Interestingly, only 18% of these were hypokalemic pre operatively.

In patients with multiple medical problems, like diabetes, hypertension and CVA, high incidence of hypokalemia was found. (38% had 2 or more medical problems).

No significance in the mortality rate was found in fracture neck of femur patients with and without postoperative hypokalemia (40% vs. 39% at 3yrs).

Conclusion: There is significant risk of hypokalemia following orthopaedic surgery, especially in the elderly. This avoidable condition, which has serious consequences, should be dealt with care in the orthopaedic units. Fluid infusion regimes and should be formulated and medications reviewed to prevent conditions like hypokalemia.

Introduction: To compare soft cast (SC) with plaster of paris (POP) in treatment of greenstick fractures in children.

A prospective randomised study analysing and comparing the two types of treatment in terms of patient and medical staff satisfaction, duration of treatment, pain during treatment. Wrist movement after removal of plaster, and the cast quality . An approval to conduct the study obtained from trust ethic committee

Material and method: We identified 87 children (46 females and 41 males) referred to our clinic between September 1999 and June 2000 with forearm greenstick fractures. Patient and parents approached to participate and given written information about the trail if agreed consente obtained and patients randomised in to two groups using sealed envelopes. Those treated with a traditional hard cast (POP), and those treated with 3M soft cast tape (SC). A clinical details and progress form completed for each patient a questionnaire was completed by patients designed to score their overall satisfaction with treatment. Another questionnaire for clinicians score their satisfaction with cast quality and handling.

Results: A total of 61 patients completed the trail. 26 patients either declined the study after consent or lost during follow up. 29 patients had (SC) and 32 had (POP). The mean age was 8.88years for (SC) group and 8.34 years for (POP) group. The average treatment period was 22.7days for (SC) group and 23.1 for (POP) group. The average patient score for pain and satisfaction was 8.88 for (SC) group and 8.13 for the (POP) group with P value of 0.632. . [0 for Poor and 10 for excellent]. The average clinician satisfaction score was 8.7 for (sc) group and 8.03 for the (pop) group. With p value of 0.22. [0 for Poor and 10 for excellent]. 92% of the (SC) group achieved excellent wrist range of movement compared with 88% of the (POP) group.

Conclusion: We concluded that although each type of cast has its own advantages and disadvantage however when used in treatment of greenstick forearm fractures in children they produce comparable results. with on statistical differences.