Background

There are multiple documented advantages of undertaking total knee arthroplasty (TKA) without tourniquet, however, increased rates of blood loss and transfusion are often cited as contraindications to this approach. The aim of this study was to examine the effect of intra-operative TA administration on blood loss and transfusion rates in TKA without pneumatic tourniquet, using Rivaroxaban as thrombo-embolic prophylaxis.

The Proximal Humeral Internal Locking System (PHILOS) is being used increasingly in the treatment of proximal humeral fractures. Improvements in operative technique since its first use may represent improved functional results. We analysed 28 cases performed in the two years following October 2006. There were 22 females and 6 males. Mean age was 65 years (Range 37–79 years). There were five 2-part, nineteen 3-part, and four 4-part fractures. Functional results were measured using the Oxford Shoulder Score, American Shoulder and Elbow Surgeons’ Score (ASES) and Constant Score (Age and sex matched). This provided objective and subjective scores of function after a mean follow-up period of 15 months (Range 3–27 months). These results were compared to the patient’s non-operated shoulder to determine loss in function.

Following PHILOS fixation, function of the operated arm was decreased both subjective and objective scoring. This change was significant for all three scores (p-values < 0.01). Sub-analysis comparing patients aged < 60 years with those > 60 years and 2-part fractures with 3- and 4-part fractures showed no significant difference.

We conclude that our results show that function in the operated arm is lost. Our data confirms previously published function scores and shows no impact of the patient’s age and fracture configuration on the results of this implant.

The Proximal Humeral Internal Locking System (PHILOS) is being used increasingly in the treatment of proximal humeral fractures. Improvements in operative technique since its first use may represent improved functional results.

We analysed 28 cases performed in the two years following October 2006. There were 22 females and 6 males. Mean age was 65 years (Range 37–79 years). There were five 2-part, nineteen 3-part, and four 4-part fractures. Functional results were measured using the Oxford Shoulder Score, American Shoulder and Elbow Surgeons’ Score (ASES) and Constant Score (Age and sex matched). These results were compared to the patient’s non-operated shoulder to determine loss in function.

Following PHILOS fixation, the Oxford Score increased by a mean of 11 points, the ASES decreased by a mean of 25 points, and the Constant Score decreased by a mean of 31. This change was significant for all three scores (p-values < 0.01). Sub-analysis comparing patients aged < 60 years with those > 60 years and 2-part fractures with 3- and 4-part fractures showed no significant difference.

We conclude that our results confirm previously published functional data and show the patient’s age, and fracture configuration, have no impact on the results of this implant.

The management of closed ankle fractures requiring open reduction and internal fixation is dependent upon soft tissue swelling to determine the timing of the surgery. At Exeter in 2001 one third of all trauma cases were operated on “out of hours”, in 2007 less than ten percent were principally because of the lack of anaesthetic staff. The senior author has developed a technique of percutaneous ankle fixation that may be undertaken at an early stage despite the presence of swelling.

A retrospective study of four years focusing on time to surgery, time to discharge and complications was compared with a cohort selected at random that had undergone open fixation from the same period. Patients undergoing percutaneous fixation were extracted using the Plato database and all patients were included. Admission documentation, operation notes and subsequent clinic letters were used to ascertain the outcomes. Pre and post-operative imaging was evaluated.

Over a four year period two consultants and four specialist registrars performed the technique on a total of 22 patients. The mean time to surgery was 2.04 days for the percutaneous cohort (range 0–5 days) compared with 4.04 for the open cohort (range 1–10). Time to discharge was 4.6 days to 5.8 in favour of percutaneous. No complications were experienced in the percutaneous cohort compared with 6 patients in the open.

Preliminary results demonstrate a reduced waiting time for surgery and a quicker discharge. Percutaneous fixation is an option when swelling precludes open fixation.

There is debate regarding the most appropriate treatment of calcific tendinitis. Minimally-invasive techniques with image-guided needling of the deposits have been developed to provide an alternative solution. We present the results of fluoroscopically-guided barbotage in 100 patients. One hundred patients with acute or chronic shoulder pain, visible on plane radiographs or ultrasound scan, were referred from the Orthopaedic Department for barbotage over a six-year period. This study is a retrospective review of the results of barbotage in these patients, using a patient-based questionnaire. Forty three patients ultimately required arthroscopy of their painful shoulder. However, at surgery, the calcific deposits were noted to have dispersed in the majority of these patients. In addition there was often a long symptom-free period between the initial barbotage and recurrence of pain. In many cases the nature of their symptoms had changed and at arthroscopy signs of impingement or rotator cuff tears were common. Barbotage eliminated the need for more invasive surgery in over half of the patients in this study. It should be considered in all patients with calcific tendinitis refractory to non-operative treatment.