Introduction

The trapezio-metacarpal joint (TMCJ) is subject to constant multiplanar forces and is stabilised by the bony anatomy and ligamentous structures. Ligament reconstruction can correct the hypermobility and potentially prevent osteoarthritis. Eaton and Littler proposed a surgical technique to reconstruct the volar ligamentous support of this joint. In our cadaveric biomechanical study, we aimed to evaluate the resultant effect of this technique on the mobility of the thumb metacarpal.

Carpal tunnel syndrome is the most frequent form of median nerve entrapment, accounting for 90% of all entrapment neuropathies. Routinely nerve conduction study (NCS) tests are ordered to confirm the diagnosis however; there are issues of long waiting periods and costs with it. We aimed to compare carpal tunnel questionnaire score (CTQS) by Kamath and Stothard (2003) to nerve conduction study result in the diagnosis of carpal tunnel syndrome.

This prospective study involved analysis of data from all the patients referred to NHS Tayside (Dundee) hand clinic with signs and symptoms of Carpal tunnel syndrome (CTS) from September 2016 to February 2017. Statistical analysis was done using SPSS and sensitivity and specificity was calculated. The questionnaires were filled in by a team of specialist physiotherapists. Nerve conduction study tests were done by a team of consultant neurophysiologists. Both the groups were blinded to each other's assessment.

We analysed 88 patients who filled in CTQS and also underwent NCS. We noted that CTQS of less than 3 correlated 100% to negative nerve conduction result. When the carpal tunnel questionnaire score was more than or equal to 5, 54 patients had positive NCS result and 6 patients had negative NCS result, giving a 90% predictability of a positive NCS result. Mean waiting period of carpal tunnel patients for NCS was 141 days.

We noted from this prospective study that CTQS was sensitive enough to exclude carpal tunnel syndrome when the questionnaire score was less than 3. In addition, the questionnaire revealed a 90% probability of having carpal tunnel syndrome when CTQS was more than or equal to 5. Based on the present study, we would recommend that patients in grey zone of 3 to 4 on questionnaire should undergo NCS, resulting in only 20% of patients (based on the figures from the current study) being referred for NCS. The questionnaire can be used in primary health care or specialist physiotherapy screening clinic as a tool for diagnosing CTS with implications of cost saving and avoiding long waiting periods.

Orthopaedics has been earmarked as one of the specialties that could make significant savings in the National Health Service. A large number of young adults are receiving total hip replacements and there has been a trend towards using uncemented implants. We describe the clinical and functional results at minimum 19 year follow up of cemented total hip replacements in patients under the age of fifty-five in our health region between 1990 and 1997.

104 cemented THRs performed in 100 patients under 55 years were included in this study. The follow-up data had been collected prospectively in the University database. 88.46% hips showed good to excellent results at final follow-up with a mean Harris hip score of 87.9±8.64. Revision was performed in 2 hips (1.92%), one for aseptic acetabular loosening and the other for late haematogenous infection. Probable radiological loosening was seen in 14 acetabular components (14.89%) and 4 femoral components (4.25%) at final follow-up. The mean rate of acetabular wear was 0.12mm/year and was not influenced by gender or diagnosis. The mean follow-up was 21.68±2.11 years (range 19 to 26 years) and the survivorship at 19 years was 98.07%.

The GIRFT report looked at the economic aspect of implant selection and found that the cost of uncemented implants was almost double that of the cemented implants. Savings of atleast £10 million a year can be made if cemented implants were used. We recommend that in a publically funded health system like the NHS, cemented implants can be used in patients under 55 with good long term functional outcomes and large savings in the healthcare costs.

The aim of this study was to compare the results of Matti-Russe (MR) procedure and interpositional techniques (IT) in the management of scaphoid non-union.

50 scaphoid non-unions were included in this retrospective study. Demographics, initial management of fracture, location of non-union, time to surgery, procedure done and immobilisation time were recorded. Radiographs were analysed for union and deformity correction. Functional outcome was analysed using the Herbert's grading system.

The mean age and time to surgery were 26.7 years and 15.9 months. Twenty-one patients had the MR procedure and twenty-nine patients had interpositional procedures with internal fixation. DISI was present in 17 patients. The mean postoperative change in the scapholunate angle with the MR procedure was 7.9° compared to 8.0° (p>0.05) for the IT procedures. Union rate was 76% for both procedures. The mean follow-up was 9.9 months. Functional results were Herbert 0 or 1 in 42 cases.

The only significant prognostic variables were location of non-union and time to surgery. Similar deformity correction was achieved using both IT and MP procedures. MP procedure can be used in the management of scaphoid non-union even in the presence of deformity with good functional results.

Background of study

Numbness around the surgical scar can be a source of discomfort in patients undergoing Total Knee Arthroplasty (TKA). Literature reports wide variation in its prevalence. The consequence of numbness on the functional outcome is not clear. We aimed to investigate the prevalence of numbness, along with factors affecting it, and assess its effect on the outcome of TKA.

Numbness around the surgical scar can be a source of discomfort or dissatisfaction in a proportion of patients undergoing Total Knee Arthroplasty (TKA). Literature reports wide variation in its prevalence and the consequence of numbness on the outcome of TKA is not clear. We aimed to investigate the prevalence of numbness, along with contributing factors, and assess its effect on the functional outcome of TKA.

A total of 258 patients were included in this prospective cross sectional patient reported outcome measure study. Demographic details, type and length of incision, and pre-operative and one year post-operative Knee Society Scores (KSS) were recorded and compared. A Dundee knee numbness classification was developed for the assessment of numbness. The prevalence of numbness at one year was 53%, with a female preponderance. Patients above 70 years were less affected. The BMI, laterality and incision length did not affect its occurrence. Discomfort due to numbness was recorded in 8.7% of patients, 75% of which were females. The incision length and numb area positively correlated. The KSS did not correlate with the presence or area of numbness.

Our findings indicate a high prevalence of numbness after TKA. Nevertheless, numbness does not affect the functional outcome.

Background

The optimal treatment for symptomatic elbow osteoarthritis remains debatable especially in patients still involved in heavy manual work. The Outerbridge-Kashiwagi (OK) procedure has been used when simple measures fail. The aim of this study is to analyse the results of the OK procedure in patients with symptomatic osteoarthritis.

Introduction

Recent studies have indicated that healthy and willing patients above 80 years have similar outcomes as younger patients following arthroplasty. We wished to investigate the outcomes in a cohort of patients above 80 years who underwent medial unicompartment knee replacement (UKA).

Introduction

Only a few studies have assessed the outcome of ulnar nerve decompression, most comparing various forms of decompression. A review of the case notes of patients undergone ulnar nerve decompressions was undertaken looking at the pre-op symptoms, nerve conduction studies, the co-morbidities, operative procedures and the post-operative outcomes.

Introduction

The aim of this study is to analyse the effect of the degree of coverage of the Total Elbow implant with cement and the significance of cementation index as a predictor of failure.

Introduction

Ulnar nerve entrapment is the second most common nerve entrapment syndrome of the upper extremity. Despite this, only a few studies have assessed the outcome of ulnar nerve decompression. The objectives of the study were to review the pre-operative symptoms, nerve conduction studies, the co-morbidities, operative procedures undertaken and the post-operative outcomes; and investigate and ascertain prognostic factors particularly in cases of persistence of symptoms after the surgery.