PURPOSE: Methicillin Resistant Staphylococcus Aureus (MRSA) is a bacterium we all encounter at some point in our lives. Recently, it has received significant amount of press coverage and has been a clinical and political concern. It has no predilection and affects both young and old alike. Control of MRSA spread is multi-factorial and current selective screening has become less useful. Hence, our orthopaedic department in a district general hospital setting has carried out an audit to find cost-effective ways to control the spread of MRSA.

METHOD: 686 patients were screened over a period of 3 months in 2005. Nasal and perineum swabs were taken within 24 hours of admission. Patients who developed MRSA infection in wounds were identified from hospital records. All hospital events (hardware) recorded were costed.

RESULTS : Of the 686 patients screened, 27 developed MRSA wound infections. 14 were new cases identified through screening. The costing for the period of 3 months for 10 patients (medical notes of 4 patients were not located) is £96 000. The total cost from MRSA infection when extrapolated is £384 000 per year. These figures are grossly underestimated as some surgical equipments were not costed.

DISCUSSION: We recommend 8 additional auxillary staff to cover 2 wards. This will enable nurse cohorting and cost £120 000 per year. Our department should have a positive pressure dressing room which cost £20 000 to build. This will ensure wounds are inspected in a clean controlled environment. A PCR rapid MRSA detection device plus staffing and culture media cost £149 000 per year. This should be used on emergency admissions. A cheaper detection kit can be used on elective patients which cost £12 000 per year. Hence total running cost will be £301 000 a year and subsequent years will cost £261 000. Compare that to £384 000 bearing in mind it was extrapolated from 3 months study on 14 newly identified MRSA positive orthopaedic patients who developed wound infection. Apart from that, we also recommend a holding bay for suspected cases whilst awaiting PCR results. Colonisers should be treated with Aquacept or Bactroban. At induction, teicoplanin and gentamicin iv should be used. MRSA patients should be nursed in side rooms. Beds should also be ring fenced.

CONCLUSION: It is much more cost-effective for a hospital trust to implement our recommendations to combat the spread of MRSA than to continue with the current practice.

Introduction. The aim of this study was to retrospectively evaluate the efficacy of the SpineCor bracing treatment in all forms of scoliosis, between 2000–2006.

Methods. Over the past 6 years 56 skeletally immature and 1 skeletally mature patients with progressive scoliosis have been treated with the Spine-Cor bracing system. They were divided into the following groups; infantile 3; juvenile 19; adolescent 29; adult 1; “other” 5.

Results. 20 were deemed to have achieved a correc-tion, 24 stabilised 3 worsened and the progression of 4 patients was not recorded. To date 11 patients have gone on to surgery.

Discussion. Various bracing systems utilised in the past have shown what appeared to be a lasting degree of protection for scoliosis but subsequent long term follow ups have demonstrated progression of curves. The newer SpineCor system may offer a good short term outcome.

Conclusion. Early diagnosis and rapid treatment at a young skeletal age may offer an alternative to surgery with this relatively new bracing system. A further prospective study continues at S.C.H. and will be ready to present in 2011. Far longer term follow up will be required to validate apparent successes in the short term.

Aim To assess the reliability of Stainsby’s operation for dislocated lesser toe metatarsophalangeal (MTP) joints.

Method Seventy-four patients underwent this operation between 1998–2003. Sixty-nine patients (93%) were reviewed at mean follow up of 32 months (range 10–67) post-operatively. Forty-eight patients had rheumatoid arthritis, two had psoriatic arthropathy, 19 had other causes. Ninety-four feet were reviewed, 73 had had multiple lesser toe operations, 21 had single lesser toe operations, 52 feet had surgery to the hallux. Assessments were made of pre- and post-operative pain, shoe problems, callosities, alignment and function.

Results Out of 94 feet, 89 (95%) had severe or moderate pain pre-operatively. Only 19 (20%) had significant pain at review. Pain under operated toes was relieved in 78 feet (83%). Tender plantar callosities were reduced from 76 feet pre-operatively (81%) to 31 feet (33%) at review, these mainly under un-operated metatarsal heads. Shoe problems were reduced from 89 feet (95%) pre-operatively to 61 feet (65%) at review. American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores were increased from a mean of 19 pre-operatively to 52 at review.

Residual valgus of big toe more than 25 degrees persisted in 33 feet (35%). Corrective osteotomy of 44 first metatarsals failed to prevent recurrent valgus in 16 feet (36%).

Conclusions The Stainsby operation was effective in relieving pain and skin callosities from under dislocated lesser metatarsal heads, and in reducing shoe problems but we found that varus osteotomy was unreliable in correcting valgus of the big toe. This was probably due to stretching of the repaired medial ligament.