129 knees suitable for a standard PCL retaining cemented total knee replacement were randomised into two groups, one in which PCL was retained in the normal way, the other group having the PCL fully resected. Both groups received a PCL retaining implant. The two groups were well matched with a predominance of females and a mean age of 67 years.

There was no statistically significant difference in the HSS scores at an average of 57 months (range 56–60 months) in the two groups. Pain relief, deformity correction, range of motion, stability and strength were comparable in the two groups. A radiological assessment revealed femoral rollback in approximately 20% of cases with a slightly higher incidence in the PCL sacrificed group. There was no significant loosening detected in either of the categories at two years review.

At five years one TKR in the PCL retained group has been revised due to an infection and one each in the two groups are awaiting revision surgery for loosening. Our findings have shown that there is no significant difference in the 5 year results of a PCL-retaining total knee replacement if the PCL is excised or preserved. This suggests two significant points:

the PCL is not functional in most patients with a total knee replacement even when retained:

Introduction: Carpal tunnel decompression is the most commonly performed procedure in hand surgery. This study was done to assess the effectiveness and acceptability by patients of open carpal tunnel release under local anaesthetic and compare our results with previous published work from our department following alterations to our operative techniques.

Methods: 92 carpal tunnel releases were performed on 80 patients over a four year period, 2001 to 2004. 55 were females and 25 were males. A patient satisfaction survey was done by a postal questionnaire which addressed opinion regarding preference for LA over GA, pain due to LA infiltration, effectiveness of LA, patient comfort during surgery, outcome of surgery and overall satisfaction with the procedure. In this cohort of patients we did not use a tourniquet which caused severe pain in 29% of cases in the previous study. We also administered LA with adrenaline using a dental syringe to reduce pain which was previously reported as severe in 20% of cases.

Results: 62 patients replied to the questionnaire, a response rate of 77.5%. Preference for LA over GA was 90% as compared to 70% in the previous study. Pain due to tourniquet use was previously reported as severe in 29% of cases but this did not apply in this subset of patients. Pain due to infiltration of LA with a dental syringe was severe in 9% of cases compared to 20% with a 25G needle. Effectiveness of LA, outcome of surgery and overall satisfaction with the procedure remained unchanged.

Conclusion: Carpal tunnel decompression is a quick, convenient, inexpensive and safe method of treatment. We have demonstrated that injecting LA with adrenaline using a dental syringe obviates the need for tourniquet and improves patients’ acceptability and tolerance of this procedure.

Aims: Treatment options for proximal humeral fractures are not very clear, specially in osteoporotic bones. Non operative treatment if on one hand leads to unpredicted and poor outcomes, the operative treatment on the other hand leads to devascularization of fractured fragments and implant failure leading to unacceptable results. Newer interlocking plates, which are applied with minimum soft tissue stripping of fractured fragments and better fixation abilities seems a promising alternative. We present our experience with such plates.

Patients and Methods: Over a period of two years 2002 and 2003, we used 50 plates to treat Neer’s two and three parts and surgical neck of humerus fractures. We reviewed our clinical results with PHILOS plates, which is in interlocking plate. Average age was 34 (24–82). 21 Male and 29 Females. We followed them clinically and radiologically for healing. The shoulder function was assesses with DASH scoring system. The DASH system questionnaire was filled by patients before the fracture and after healing of the fractures. We used a regimen of progressive rehabilitation of shoulder from immediate post operative period. All the complications including union issues, shoulder function, wound problems, nerve injuries, infection and implant failure were noted. Two different techniques were used to fix the fracture with the plate.

Statistical analysis was performed on the data collected through DASH questionnaires along with multivariate and univariate analysis and t-tests.

Results: We were able to follow all the patients who filled the pre fracture and post healing DASH system questioner. X-rays and clinical findings were available for all the patients in the study. All the patients united with average length of 6 weeks (5–12 weeks). All the fractures united. There were no deep infections; however, two patients had to have a week of oral antibiotics for superficial wound infection. There were no permanent nerve injuries. Eight patients had transient axillary nerve paresis, which resolved after 10–15 days. Patient satisfaction with the procedure was high.

48 % of patients showed a rise in DASH scores after the fracture healing, indicating decrease shoulder function. This was statistically analysed and failed to reach any significance p=0.867. There was no difference between the two techniques in terms of complications and union rates.

Conclusions: PHILOS interlocking plates in our study showed 100% union rate with no or minimal complications and preservation of shoulder function. They are technically not difficult to apply and allow immediate post operative mobilization. Hence we recommend their use in primary fixation of proximal humerus fractures.

Aims: We performed a prospective randomised controlled clinical trial of a comparison of PCL excison and PCL retention whilst using a standard PCL retaining cemented PFC knee relacement in order to answer two questionsòa) is the PCL functional if retained in PCL retaining TKRs. b) does PCL excison affect the results of a standard PCL retaining knee replacement. Methods: 129 knees suitable for a standard PCL retaining cemented total knee replacement were randomised into two groups, one in which the PCL was retained in the normal way, the other group having the PCL fully resected. Both groups received a PCL retaining implant. The two groups were well matched with a predominance of females and a mean age of 67 years. Results: There was no statistically significant difference in the HSS scores at an average of 57 months in the two groups. Pain relief, deformity correction, range of motion, stability and strength were comparable in the two groups. A radiological assessment revealed significant rollback in approximately 20% of cases with a slightly higher incidence in the PCL sacrificed group. There was no significant loosening detected in either of the categories at two years review. At five years one TKR in the PCL retained group has been revised due to an infection and one each in the two groups are awaiting revison surgery for loosening. Conclusions: Our findings have shown that there is no significant difference in the 5 year results of a PCL retaining total knee replacement if the PCL is excised or preserved. This suggests two significant points –a) the PCL is not functional in most patients with a total knee replacement even when retained. b) patients with excised PCLs show good results with PCL retaining implants, thereby questioning the need for posterior stabilised designs in all such cases.

Clinical and radiographic data on 47 hips in 45 patients with Developmental Hip Dysplasia who underwent either a Salters Innominate Osteotomy or a Femoral Derotation Varus Osteotomy by a single operator were reviewed. The average age of patients at the time of osteotomy was 21 months (range 12–108 months). Clinical evaluation was performed with use of the lowa hip rating score and the Harris hip score. Radiographs were evaluated pre=operatively, post-operatively and at final review.

The mean duration of follow-up was 15 years 9 months (range 10–21 years). Thirty-five patients had a Salter innominate osteotomy, 11 a derotation varus osteotomies and one a Klisic.

Al last follow-up examination the Iowa hip rating averaged 96.6 (range 62 to 100) and the modified Harris Hip Score averaged 96.8 (range 48 to 100). Forty seven percent of patients reported abductor fatigue after sport. Forty-one patients had excellent result with a Severin class I hip on radiographic evaluation. All of these patients had an Iowa index > 95 and a mean Centre-Edge angle of 35.5 (range 25–40).

Six patients had a poor radiological outcome with 5 Severin class IV hips and one class V. Clinical outcome scores did not correlate with poor radiological outcome; Iowa hip score 92 (range 62–100). One patient required a Ganz periactabular osteotomy. The age at which primary osteotomy was performed was significantly higher in the poor outcome group with a mean of 50.8 months.

When the anatomy of the hip is restored to normality at an early age with out the development of avascular necrosis excellent long-term results can be expected.