The aim was to compare the initial pull out strengths of various interference screw devices used for tibial fixation of hamstring grafts and the effect of concentric or eccentric screw position.

Quadrupled tendon grafts were harvested from freshly killed sheep. The grafts were then prepared and fixed in the distal femur using various devices (Intrafix, RCI screw, Wedge screw +/− transfix pin, screw and post) in both concentric and eccentric positions. A single load to failure test was then performed.

The highest pull out strength was with the Intrafix device inserted concentrically (mean 941N). This was significantly higher than the wedge screw inserted concentrically (737N) (p=0.015). This in turn had significantly greater initial pull out strength than the wedge eccentric with post or pin (p=0.03) and the RCI screw (464N) (p=0.00036).

In this sheep model the Intrafix device inserted concentrically had a significantly greater initial pull-out strength than the other interference screws tested. Concentric positioning of an interference screw gave significantly greater initial pullout strength of a quadruple hamstring graft than eccentric positioning. Addition of a cross pin or post made no difference to initial pullout strength.

We describe a previously unreported technique of Z-lengthening for the treatment of refractory trochanteric bursitis and review the long-term outcomes for this procedure.

Fifteen patients (17 hips) were diagnosed with trochanteric bursitis based on clinical criteria. These patients were found to be unresponsive to conservative treatment including multiple corticosteroids injections. “Snapping Hips” were excluded. All went on to have bursectomy and Z- lengthening of the iliotibial band.

Harris Hip Scores were evaluated for before and after their operation as well as a standardised baseline questionnaire and examination.

At mean follow up of 47 months following Z-lengthening, eight patients reported excellent results with complete resolution of symptoms, eight had good results with symptoms improved and one had a poor result. One patient required secondary repair of a tear in the tendon of gluteus minimus with a subsequent excellent result. The mean Harris Hip Score improved from 46 to 82 (p< 0.05).

Bursectomy and Z-lengthening has been shown to be an effective and long-term operative solution for the treatment of refractory trochanteric bursitis when conservative measures have failed. Although the majority of patients had a successful outcome, not all respond well to this procedure and careful patient selection is recommended as well as a pre-operative MRI to rule out concomitant pathology such as a tear in the Gluteus medius or Gluteus minimus.

The purpose of this study was to document difficulties encountered by orthopaedic surgeons with the removal of titanium implants.

A postal questionnaire was sent to all members of the New Zealand Orthopaedic Association seeking to document difficulties with the removal of titanium implants: screws, plates or intramedullary nails. The questionnaire included length of device implantation, estimated increase in theatre operating time over the expected time for the procedure, and complications encountered during the device removal.

Twenty six surgeons responded to the study. Six reported no difficulties in removing implants, 18 reported significant difficulties, and 2 had not had to remove titanium implants. Of the 18 surgeons reporting difficulties, 10 had problems with intramedullary nails, 4 with plates, 6 with screws and 1 with another device. The estimated increase in operating time varied between 20 and 140 minutes. Major complications reported included breaking intramedullary nails, screw heads shearing off, and damage to the underlying bone.

This survey demonstrates significant problems in removing titanium implants. Surgeons need to be aware that when using these devices difficulties with their removal can be encountered and patients should be warned that further injury may be sustained during device removal.

The purpose of this study is to review the current treatment of Colles fractures by long term follow up and to compare these results with a similar paper published in 1965 by G.B. Smail. And secondly, to evaluate the degree of bone density in these patients and to see what, if any, treatment is being received in those with evidence of osteopenia.

The records and radiographs of 82 patients treated at Hutt Hospital between January 1997 and January 1998 were reviewed. Of these, thirty-two attended for re-examination. Subjective measures of pain, appearance and functional limitations were recorded, as were complications and whether the wrist had reached a stable state.

Anterior-posterior and lateral radiographs of both wrists were taken, from which measurements of residual dorsal tilt and shortening of radius were made.

Of the thirty two patients that presented for re-examination twenty went on to have bone density measurements.

When comparing results from two similar studies, spaced thirty seven years apart, subjective findings show that from a functional and appearance perspective there appears to be little difference between the two cohorts. With respect to pain, patients treated in 1997 complained of a lot less residual pain compared to those treated in 1960.

Objectively, the range of movement in the wrist joint was once again found to be similar in the two cohorts, as was the range of movement in shoulder, elbow appeared to be similar. Finger movement was difficult to compare.

Radiologically the degree of ventral dorsal tilt does not correlate with range of movement at the wrist.

Bone density scan results suggest that the majority of patients with evidence of osteoporosis are not been treated appropriately.

Overall conclusion is that the outcome for treatment of Colles’s fractures has not changed significantly in the past thirty seven years.