Recent NICE guidelines suggest that Total Hip Arthroplasty (THA) be offered to all patients with a displaced intracapsular neck of femur fracture who: are able to walk independently; not cognitively impaired and are medically fit for the anaesthesia and procedure. This is likely to have significant logistical implications for individual departments.

Data from the National Hip Fracture Database was analysed retrospectively between January 2009 and November 2011. The aim was to determine if patients with displaced intracapsular neck of femur fractures admitted to a single tertiary referral orthopaedic trauma unit received a THA if they met NICE criteria. Case notes were then reviewed to obtain outcome and complication rates after surgery.

Five hundred and forty-six patients were admitted with a displaced intracapsular neck of femur fracture over the described time period. Sixty-five patients met the NICE criteria to receive a THA (mean age 74 years, M:F = 16: 49); however, 21 patients had a THA. The other patients received either a cemented Thompson or bipolar hemiarthroplasty. Within the THA cohort there were no episodes of dislocation, venous thromboembolism, significant wound complications or infections that required further surgery. Within the hemiarthroplasty cohort there was 2 mortalities, 2 implant related infections, 1 dislocation and 2 required revision to a THA.

There is evidence to suggest better outcomes in this cohort of patients, in terms pain and function. There is also a forecasted cost saving for departments, largely due to the relative reduction in complications. However, there were many cases (44) in our department, which would have been eligible for a THA, according to the NICE guidelines, who received a hemiarthroplasty. This is likely a reflection of the increased technical demand, and larger logistical difficulties faced by the department. We did note more complications within the hemiarthroplasty group, however, the numbers are too small to address statistical significance, and a longer follow up would be needed to further evaluate this. There is a clear scope for optimisation and improvement of infrastructure to develop time and resources to cope with the increased demand for THA for displaced intracapsular neck of femur fractures, in order to closely adhere to the NICE guidelines.

Aims

Malignant tumours of the foot and ankle are rare, but easily missed. NICE guidelines for bone and soft tissue tumours may be less appropriate for the foot and ankle than elsewhere. The purpose of this study was to identify the clinical features and treatment of malignant tumours arising in the foot and ankle to see if guidelines should be modified.

The growing interest in the development of spinal implants has led to an increasing need for biomechanical studies. Porcine spines are commonly used in such studies. Quantitative data of the normal porcine tho-racolumbar spine is lacking, yet these data are crucial to discussion of such studies. In this study we aim to provide such a database to highlight the differences between the porcine and human specimen with a view to help plan future studies contemplating their use.

6 adult (18-24 month old, 60-80 kilograms) male porcine spines were dissected of soft tissue. The lowest thoracic and all the lumbar vertebrae were studied (n=42). 15 anatomical parameters from each vertebra were measured by 2 independent observers using digital calipers (Draper PVC150D, accuracy ± 0.03mm). The mean, SD and SEM were calculated using Micro-soft Excel. Results were compared with available data on human vertebra (Zindrick et al 1987;Panjabi et al 1991,1992; Kumar et al 2000).

The inter class correlation coefficient for the observers was 0.997. The intra-observer agreement was statistically robust (0.994). The vertebral body height of the porcine vertebra was larger while both the upper and lower endplate depth and width were smaller than the human specimens. The pedicle width and depth was greater than the human specimen. The spinal canal length and depth of the porcine spine were smaller than humans indicating a narrow spinal canal. The spinous process length showed an increase from T16 to L1. This was in contrast to human spinous process. The results for the measured parameters and their comparison to human specimen will be presented.

Results from our study provides a database of anatomical measurements for the porcine vertebrae and highlights the differences with the human specimen. The data would help design future studies contemplating the use of pig spines. Biomechanical studies involving interbody cages, disc replacements and pedicle screw systems should take into account the differences and match implant size accordingly. It also provides valuable information for geometric and Finite Element Modelling of the porcine spine. Further, the results are useful in extrapolation of data from experiments which have used the porcine model.