The Achilles tendon is the strongest and largest tendon in the body. Rupture of this tendon usually occurs in the third and fourth decade and can be significantly debilitating. Repair of neglected ruptures of Achilles tendon pose a challenge to the orthopaedic surgeon due to the retraction and atrophy of the ends of the tendon. Various surgical procedures have been described which include VY plasty, fascia lata, peroneus brevis, plantaris tendon, flexor digitorum longus, flexor hallucis longus, allograft, and synthetic materials.

We carried out a prospective study to compare the results of peroneus brevis transfer with flexor hallucis longus transfer in the management of neglected ruptures of Achilles tendon. Forty-seven patients who had neglected ruptures of Achilles tendon were included in this study. They were randomly divided into two groups; the first group underwent peroneus brevis transfer (24 patients) and the second group had flexor hallucis longus transfer (23 patients). Patients were assessed using the Quigley's scoring system.

We conclude that Flexor hallucis longus transfer is better than peroneus brevis transfer as it is a long, durable tendon which is much stronger when compared to other tendon transfers. Flexor hallucis longus acts in the same axis as the Achilles tendon, is in the same gait phase and is in close proximity, making harvesting of the tendon easy.

Aims: Most centres cross-match blood preoperatively for primary joint arthroplasty operations. But is it really necessary? Background of study: We did a audit involving 110 primary hip and 105 knee arthroplasty operations 5 years ago. Results showed that only 35% of our patients used cross-matched blood. Around 7% were transfused on the day of surgery and none urgently. After this we changed our practice to cross-match only those patients with preoperatively haemoglobin less than 10 or ones with antibodies in blood. We re-audited our practice this year in a study. Methods: We looked prospectively at 100 primary total hip and 100 primary total knee arthroplasty operations in a audit. None of these patients were cross-matched. Exclusion criteria were bilateral operations, Pre-operative haemoglobin of less than 10, antibodies in blood. Risk factors included taking drugs like NSAIDS, steroids or aspirin or those suffering from diseases causing vascular fragility like Rheumatoid arthritis or those with any blood coagulation disorders. Results: Blood loss was increased by various risk factors however our study did not prove its (signiþcant) effect on blood transfusion requirement. None of our patients required urgent transfusion. 5% of our patients required transfusion within 24 hours of surgery and in all 20% required post-operative transfusion. Blood transfusion requirements are increased by increased intra-operative blood loss but it does not correlate with post-operative drainage. Conclusions: We advocate a routine practice of only group and save of blood in a standard unilateral joint arthroplasty surgery. This method is advocated by British Transfusion Society, validated in literature and is cost effective.