To compare outcome between the medial and posterior approaches for the surgical treatment of supracondy-lar fractures when performed by two experienced surgeons.

A retrospective analysis of 45 children, mean age of 5.5 years (2.5-11 years), treated for closed Wilkins IIB/III supracondylar fractures without vascular deficit between January 1999 and December 2004. Twenty-one and twenty-four children were treated using the medial and posterior approaches respectively. The medial approach is quicker but technically demanding. The posterior approach is easier but cuts through the intact posterior structures. In both groups the fracture was stabilised using crossed K-wires and the arm was immobilised in an above elbow backslab for 3 to 4 weeks. Follow-up was at 3 to 4 weeks, 3, 6, and 9 months, and at 1 year. The results were assessed clinically using Flynn’s classification and radiologically using the metaphyseal-diaphyseal and humerocapitellar angles.

There was no post-operative infection or redisplace-ment. Clinically, the medial approach gave 18 excellent, 2 good, and one fair result, and the posterior approach gave 21 excellent, 2 good, and one fair result (P> 0.50). Radiologically, the medial approach gave 18 excellent and 3 good results, and the posterior approach gave 20 excellent and 4 good results (P> 0.50).

We found no significant difference in outcome between the two approaches, both giving mostly excellent long term results. Each approach has its known merits and drawbacks. This type of fracture needs an experienced surgeon comfortable with his preferred approach.

Introduction: Tennis Elbow affects 2% of the general population. 90% respond well to conservative management. Different surgical options are available for the treatment of recalcitrant Tennis Elbow. One of the most simple is percutaneous lateral release.

Methods: Prospective analysis of 31 patients, who failed a trial of conservative treatment, and underwent a lateral release of the common extensor origin under local anaesthetic as a day case. The symptoms had been present for an average of 21 months. Patients were scored for pain, activity and satisfaction.

Results: Pain relief was achieved in 90.3%, patient satisfaction in 90.3% and a return to full activity in 93.5%. The results were good in 28, fair in 2 and poor in 1. Return to work was on average after 4 weeks.

Conclusion: It is a simple, safe and effective procedure. It should be offered at an earlier stage, in those who failed conservative treatment. If all other procedures are equally effective, it is logical to choose the simplest.

Introduction: Locked posterior dislocations of the shoulder, with humeral head defects are rare injuries. It constitutes less than 2% of all posterior dislocations of the shoulder and 60% are misdiagnosed. There have only been a few articles describing the treatment of such injuries either by bone graft or Mc Laughlin’s procedure.

Patients: The first patient is a 23 year-old who presented as a missed diagnosis three weeks after a seizure. The second is a 35 year-old male referred four weeks after a traumatic dislocation. The third is a 55 year-old, known epileptic, who was diagnosed on admission. CT scan revealed a locked humeral head against the posterior glenoid rim, with defects of 30%, 20% and 30% respectively.

Treatment: All underwent reconstruction of the defect. The first using freeze-dried allograft, the second and third using iliac autograft.

Results: Each patient was assessed using the Constant and Murley score. The first patient scored 76 points at 30 months, the second patient scored 95 at 12 months and the third scored 97 after 12 months post-operatively.

Conclusion: Early diagnosis is important in management and prognosis of such injuries. Using bone graft in the reconstruction of the humeral head defect restores the normal anatomy, rather than distorting it by using McLaughlin’s procedure.

Introduction: We conducted a retrospective study at our institution to see what effect, if any, the use of impacted morsellised bone allograft technique had on the incidence of early and late infection in revision hip arthroplasty where contemporary measures were taken.

Patients and Methods: This study included 120 patients.

Patients were 36 male and 84 females with the mean age at the time of revision surgery was 71.4 years (range 42 – 89 SD 9.7).

In all the patients their indication for revision surgery was aseptic loosening.

All the patients had impacted morsellised bone allograft as part of the reconstruction used with cemented prostheses.

Clinical and radiological assessments of all patients were conducted for average of four years follow up.

Results: At mean follow up period of 4 years the early infection rate was 0.8% and late infection rate was 0%.

Conclusion: In our study the use of morsellised bone allograft does not appear to have added risk effect on the incidence of early or late hip joint infection provided contemporary measures are taken.

Introduction: Diagnosis of rotator cuff tears by clinical examination and MRI is not always accurate. If the extent of the tear could be predicted pre-operatively, both the patient and the surgeon would be better equipped for the subsequent operation and rehabilitation.

Aim: To assess the accuracy of clinical examination and MRI in detecting the presence of rotator cuff tears.

Method and Results: Retrospective analysis of 86 patients with symptoms and signs of rotator cuff disease. All underwent clinical examination of the shoulder followed by an MRI scan. The diagnosis was confirmed intra-operatively.

Sensitivity of clinical examination for all tears was 69%, with a specificity of 64% and a positive predictive value of 80%. Individual sensitivities were as follows: grade I 50%, II 76%, III 100%. MRI had a sensitivity of 82.8% for all tears, specificity of 57% and a positive predictive value of 80%. Individual sensitivities: I 69%, II 90%, III 100%.

Conclusion: In some patients clinical examination remains uncertain, MRI is helpful but the diagnosis is not always reliable.

Introduction: The Royal College of anaesthetists in 2000 issued its recommendations about raising the standard in postoperative pain management.

It recommended that 100% patients should be satisfied with the management of their pain and any side effects of analgesic treatment.

We conducted this prospective study to compare effectiveness of combining local nerve blocks with PCA (patient controlled analgesia) morphine to PCA morphine only in controlling acute post operative pain among total knee arthroplasty patients.

Patients and Methods: Prospective study from January 2002 till November 2003.

It involves 50 Patients underwent total knee replacement.

Average patient age 71y (range 53–83y)

Patients divided into two groups: (A) – PCA (patient controlled analgesia) Morphine only and (B) – PCA

Morphine + local nerve Blocks

Data collected:

Pain score at 1,3,6,12,24 hrs after operation, Morphine used, Supplementary analgesia, Side effects (vomiting score), Patients satisfaction, Patients’ knee joint early range of movement and Patients average period of hospital stay.

Results: Optimum pain control was 94% in group B compared with 78% in group A

Side effects was seen in 30% in group B compared to 45% in group A

There was no difference in the knee joint early range of movement

There was no difference in the patients’ average period of hospital stay.

Conclusion: This study concludes that the pain relief, morphine usage, side effects and patient satisfaction are much better with PCA when combined with local nerve blocks than with PCA alone.

We recommend that more total knee arthroplasty patients should be offered local nerve blocks in addition to their standard anaesthesia.

Introduction & Aim: The usual clinical presentation in Fibular hemimelia involves equinovalgus deformity of the foot and ankle instability with absence of the lateral rays of the foot. The aim of this study is to evaluate the results of ankle joint reconstruction, using remnants of the fibula, fibular analge or contra lateral fibular graft, in conjunction with the Ilizarov Technique.

Methods: We reviewed 13 limb segments in 12 patients with fibular hemimelia, with an average age of 4.7 years. According to Catagni’s classification 2 limbs were type I, 1 limb was type II and 10 limbs were type III. The ankle joint was reconstructed using remnants of the fibula if present in type I, fibular analge or a contra lateral fibular graft. The Ilizarov technique was then used to correct limb length discrepancy and any concomitant deformities.

Results: The results were assessed by the satisfaction of patients and families, the functional outcome in terms of daily activities and clinical examination of the patients. A satisfactory stability of the ankle foot complex was achieved in all patients. The average lengthening achieved using the frame was 5.6 cm and all limbs were equalized to within 2 cm.

Conclusion: Reconstruction of the ankle joint bring the foot in good position, preserves the ankle joint motion, facilitate fitting shoes and stabilize the joint in a more normal way compared to distal tibial osteotomies. The ilizarov technique corrects the concomitant deformity and achieves an equal limb length. The combination of both techniques provides a better outcome compared to other treatment modalities.

Introduction: Different surgical options are available for the treatment of Tennis Elbow. One of the most simple is percutaneous lateral release.

Patients and methods: This prospective study consists of 24 patients; who had persistent symptoms of tennis elbow for an average of 21 months before being operated. All patients received conservative treatment before surgery; only those who did not improve were surgically treated. All of them had percutaneous lateral release of the common extensor tendon under local anaesthetic as a day case.

Results: Patients returned to work after an average of four weeks. Pain relief was achieved at an average of eight weeks. Patient satisfaction was 91.6%. The clinical results were evaluated according to pain relief, level of activity and patient satisfaction. The results were good in 22 patients, fair in 1 and poor in 1.

Conclusion: We believe that percutaneous release should be offered at an earlier stage for patients who failed conservative treatment. It is a simple, reliable and cost effective surgical procedure.

Introduction: The usual clinical presentation of fibular hemimelia is of leg discrepancy, an equinovalgus deformity of the foot, ankle instability and the absence of the lateral rays of the foot. The aim of this study is to evaluate the results of ankle joint reconstruction, using remnants of the fibula, fibular analge or contra lateral fibular graft, in conjunction with the Ilizarov Technique.

Methods: Thirteen limb segments in 12 patients with fibular hemimelia were reviewed, with an average age of 4.7 years. According to Catagni’s classification 2 limbs were type I, 1 limb was type II and 10 limbs were type III. The ankle joint was reconstructed using remnants of the fibula if present in type I, fibular analge or a contra lateral fibular graft. The Ilizarov technique was the used to correct limb length discrepancy and any concomitant deformities.

Results: The functional outcome was assessed by the ability to undertake daily activities. All cases were clinically examined and the satisfaction of the patients and family were assessed. A satisfactory stability of the ankle foot complex was achieved in all patients. The average lengthening achieved using the frame was 5.6 cm and all limbs were equalized to within 2 cm of the contralateral side.

Discussion: Reconstruction of the ankle joint brings the foot into a good position, preserves the ankle joint motion, facilitates fitting shoes and stabilizes the joint in a more normal position compared to distal tibial osteotomies. The Ilizarov technique corrects the concomitant deformity and achieves a near normal limb length. The combination of both techniques provides a better outcome compared to other treatment modalities.

Aim: This study is describes the clinical and radiological results of 28 hips with Paprosky Type 3 acetabular defects treated by impacted morsellised bone allograft technique and followed up for a mean period of 72 months. Method: The complete cohort of 27patients (28 hips) classiþed as severe acetabular deþciencies (Paprosky type 3) and got treated by impacted morsellised bone allograft technique was available for clinical and radiological review at mean follow up of 72 months (range 48 to 91 months). All the patients were assessed clinically according to the Harris hip-score. All radiographs were digitised using high resolution digitiser. Measurements of subsidence and migration were done using image analysis software. All the radiographs were examined for evidence of radiolucent lines in the three zones of DeLee and Charnley and graft incorporation was assessed from serial radiographs. Results: The results of revision surgery using this technique showed a clinical survival of 96.4% and radiological survival rate 92.85%. Conclusion: Our results have shown that the clinical and radiological results using impacted morsellised allograft technique have been extremely gratifying. The morphological changes seen in these grafts would indicate that the bone grafts utilised have not only incorporated but continue to function in a stable manner. The technique of impaction bone allograft using morsellised fresh frozen allograft appears to be a valuable biological option in revising cases with severe acetabular deþciencies with superior mid-term results.

Aim: To assess intra and inter observer variability in classiþcation of cement bone demarcation around a cemented acetabular component. Method: We collected 46 random triplets of radiographs taken six weeks, one year and a mean of 9.5 years post-operatively. Each of the three observers (1,2,3) evaluated all radiographs independently, and the evaluations were repeated by two observers (a, b) after 2 to 4 weeks. Inter and intra-observer variation was evaluated using the kappa coefthorn;cient of agreement. The strength of agreement was interpreted according to the Landis and Koch method. Results: There was substantial agreement in classiþcation of zone 1 for all time points and of all three zones for the þnal radiographs. Classiþcation of zones 2 and 3 were not reliable until after one year of follow-up. Conclusion: We have shown that zone 1 can be assessed reliably by different observers from the þrst follow-up radiograph. Therefore we recommend that zone 1 demarcation should be used as an index of performance comparable between cemented sockets especially where follow up has been less than ten years.

The BOA recommends clinical and radiological follow-up at þve-yearly intervals in order to detect failing implants. We support this recommendation and have shown that with longer followÐup the assessment of demarcation in all three zones has substantial agreement