Purpose: To find the incidence of Periprosthitic fracture following Birmingham Hip Resurfacing over the age of 65 yrs – in Ashford & St. Peters Hospitals.

Method: We have done an audit to study the total number of patients who had Femoral neck fractures following Birmingham Hip Resurfacing, comparing them with the incidence of Femoral neck fracture in the age group of 65 yrs & above, from the period of March 2000 to January 2006 in Ashford & St. Peters Hospitals (NHS & Private)

Between March 2000 and January 2006, 327 Birmingham hips were inserted by 8 surgeons. Fracture of the neck of the femur occurred in 5 patients, an incidence of 1.53%.

Results:

1 Intra op fracture & 4 post op fractures.

Conclusion: Incidence of Femoral neck fracture is NIL in the age group of 65 yrs & above compared to 1.53% over all.

Aims: To demonstrate that the double incision technique produces a signiþcant reduction in pillar pain and an earlier return to work. Methods: A randomised controlled trial of twenty-four patients (32 wrists), 18 wrists being allocated to the single incision group (S) and 14 to the double incision group (D), was carried out between 1996 and 1999, after clinical evaluation and complimentary EMG studies. Mean ages were 49.6 (32 to 69) and 45.8 (30 to 54) in the S and D groups respectively. Results: There was a difference in pillar pain in the two groups, being signiþcantly less in the D group (Chi-squared = 8.22) (P = 0.004). There were also differences in the return to work, being much less in Group D Ð Mean = 2.6 weeks (1 to 12) cf. 5.6 weeks (2 to 16). (Willcoxon Rank Sum Test P = 0.0004). There were no differences in the post-operative clinical symptoms (P > 0.05), scar sensitivity (Chi-squared = 1.025) (P = 0.506) or grip strength (P =0.506). The tourniquet time was longer for the double incision technique D = 15.3 minutes (12 to18) cf. S = 12.2 minutes (10 to 18). Conclusions: The Double incision technique is a simple and safe procedure for uncomplicated carpal tunnel syndrome, producing a signiþcant reduction in pillar pain and and earlier post-operative rehabilitation and an earlier return to work.

Aim: To demonstrate that external þxation cannot be used alone to treat unstable distal radial fractures associated with a combination of dorsal and volar comminution. Methods: 17 patients with a mean age of 47.5 years, sustaining Frykman grades VII and VIII fractures of the distal radius associated with high energy trauma between 1996 and 1998, treated solely with external þxation were assessed. The mean time to operation was 3.4 days. The mean time to review was 15.8 months. There was dorsal comminution in 7 patients with additional volar comminution in 10 cases. Results: Excellent functional outcome results were obtained with a mean mass grip strength of 79.6%. However, when comparing patients with a combination of dorsal and volar comminution with those sustaining dorsal comminution alone, loss of radiographic parameters resulted in the former at review. Post-operative and review mean volar tilt values were + 1.5¡ and Ð 3.6¡ respectively cf. + 2.3¡ and 6.6¡, whilst the mean post-operative and review radial length values were 13.9 mm and 10.7 mm respectively cf. 11.6 mm and 11.4 mm. Comparison of the two groups for volar tilt and radial length gave P values of 0.004 and 0.02. Conclusion: External þxation is not an effective sole modality of treatment in cases associated with both dorsal and volar comminution. It is also highly recommended that when considering the use of external þxation, the degree and type of comminution is appreciated on the pre-operative radiographs.

Aim: To demonstrate that early open reduction and dorsal wedge corticocancellous bone grafting is an effective modality of treatment in the younger population with inherently unstable distal radial fractures sustained by high energy trauma. Methods: 17 patients with an average age of 53.7 years sustaining Frykman grades VII and VIII underwent open reduction and dorsal wedge cortico-cancellous bone grafting between 1994 and 1998. The study included eight men and nine women; the right wrist being affected in eight cases and the left in nine. There was dorsal comminution in 10 wrists with additional volar comminution in the remaining 7 cases. The mean time to operation was 6.5 days and the time to review averaged 16.5 months. Results: Good functional outcome results with a mean mass grip strength of 68.8% (Range = 40 to 100%) and patient satisfaction (94%) were obtained. A signiþcant improvement of radiographic parameters were observed postoperatively (Mean radial length = 11.7mm; Mean volar tilt = + 1.4¡) and remained so at the time of assessment (Mean radial length = 11.0mm; Mean volar tilt = -0.1¡) indicating structural support of the cortico-cancellous graft. Conclusion: Open reduction and dorsal wedge cortico-cancellous bone grafting is an effective modality of treatment of unstable fractures of the distal radius in the younger population. Donor site morbidity was not a disadvantage.

Aim: To demonstrate that a novel tricalcium phosphate bone cement (Biobon) could be effectively used to þll the dorsal metaphyseal defect after unstable distal radial fractures in the osteopenic wrist, and to conþrm with biomechanical studies that its mechanical properties were incompatible with its sole use. Methods: Compression and Biaxial ßexure testing was performed under both dry and wet conditions of physiological Saline and Ringers Lactate solutions at 37ûC. 9 female patients with a mean age of 65 years sustaining Frykman grade VIII fractures of the distal radius between 1999 and 2000 underwent open reduction and internal þxation with supplementation of the dorsal metaphyseal defect with Biobon. Results: Youngs Modulus (E) and the Ultimate compressive strength (UCS) for the two solutions were identical at 10 hours (406 MPa and 3.24 MPa respectively), reaching a maximum for Ringers Lactate solution. The Biaxial ßexure stress also reached a maximum value at 10 hours for Saline at 37û C (3.96 MPa). A signiþcant improvement of radiographic parameters were observed post-operatively (Mean volar tilt = + 1.1û; Mean radial length = 10.4mm: Mean radial inclination = 20.5û) and remained so at the time of assessment (Mean volar tilt = +2.5û; Mean radial length = 10.4 mm; Mean radial inclination = 21.8û).Conclusion: The use of a tri-calcium phosphate bone cement is an effective means of addressing the dorsal comminution sustained after unstable distal radial fractures. Its biomechanical properties precludes its sole use for the treatment of distal radial fractures.

A randomised controlled trial involving 24 patients ( 32 wrists ), 18 wrists being allocated to the single incision group ( S ) and 14 to the double incision group ( D ), was carried out between 1996 and 1999, after clinical evaluation and complimentary EMG studies. Randomisation was performed by one of the orthopaedic secretaries using an envelope technique on the morning of admission. Mean ages were 49.6 ( 32 to 69 ) and 45.8 ( 30 to 54 ) in the S and D groups respectively. The male to female ratios were 2/12 and 5/7 respectively. The pre- and post-operative mass grip strength was measured by a Jamar dynanometer and assessment of post-operative parameters included pillar pain, scar sensitivity, nerve compression symptoms and return to work.

Pillar pain was significantly less in Group D ( Chi-squared = 8.22; P = 0.004 ).

Return to work was less in Group D ( average = 2.6 weeks ( 1 to 12 weeks )) cf. to Group S ( average = 5.6 weeks ( 2 to 16 weeks ) ). ( Wilcoxon Rank Sum Test P = 0.0004 ). No differences occurred in post-operative clinical symptoms ( P > 0.05 ), scar sensitivity ( Chi-squared = 1.025 ; P = 0.506 ) or mass grip strength ( P= 0.506 ).

The tourniquet time was longer for the double incision technique ( average = 15.3 minutes ( 12 to 18 minutes )) cf. to the single incision technique ( average = 12.2 minutes ( average = 10 to 18 minutes )).

The double incision technique is a safe and easy technique for uncomplicated carpal tunnel syndrome resulting in a significant reduction in pillar pain and a more rapid return to work.