Introduction: The advent of digital radiological technology affords orthopaedic surgeons with the opportunity to better assess prosthetic alignment. The purpose of this study was to determine whether a post-operative digitalised 3-foot standing film better helps the surgeon than the standard weight-bearing short analogue antero-posterior film.

Materials and Methods: A single surgeon’s series of 68 consecutive patients were included in this prospective study. The axial alignment, mechanical, anatomical axes and distance of the post-operative mechanical axis from the centre of the knee, of 71 total knee replacements were determined using computer software on digital 3 feet standing films (Agfa ADC-2S system). These results were compared to similar measures determined using a goniometer and standard short standing analogue antero-posterior films. Both sets of results were compared to the intra-operative distal femoral valgus cut used by the surgeon.

Results: Sixty-eight patients, 71 knees, average 68.1 (range 42–85) years were included in this study. The average length of time from surgery to complete radiological evaluation was 18.9 (range 2–40 months). A mean difference of 1.20 degrees was found between the valgus angles measured on digital long and standard short radiographs. This difference was statistically significant p< 0.05. Comparing both sets of films revealed a Pearson correlation co-efficient of 0.65. Comparing the valgus angle determined on the digital 3 foot standing film to the intra-operative valgus cut revealed a Pearson correlation co-efficient of 0.388, this figure compares to a correlation co-efficient of 0.240 when the standard short films are used. The postoperative mechanical axis was found to be on average 7.34 (range 0.0 – 30.6) mm from the centre of the knee and the implants were positioned on average 89.8° to the mechanical axis on digitalised films, both these measures were indeterminable on the short standard films.

Conclusion: Three-foot digital standing antero-posterior films are more accurate and better correlate with the surgeon’s pre-operative aims than standard short antero-posterior standing radiographs. Only digital films allow for accurate determination of the post-operative mechanical axis. Despite not using expensive computer aided navigation systems intra-operatively, implant positioning was very satisfactory. Short films are adequate for routine assessment of total knee replacements postoperatively but digital 3-foot standing films afford better accuracy and are preferable for research purposes.

Introduction: The management of humeral diaphyseal fractures is in a state of flux, with humeral plating becoming more popular than humeral nailing. This change of opinion has been stimulated primarily by the American literature, which quotes significant complication rates associated with humeral nailing.

Methods: We undertook a retrospective study, over a consecutive seven year period, to evaluate the complication rate and the functional outcome (American DASH scoring system) following humeral nailing. The study group was composed of 91 patients, with an average age of 50 years (22–90). All cases were performed by a consultant or under their direct supervision. The minimum follow-up was one year.

Results: Of the 91 cases, 7 were lost to follow-up. Non-union was seen in 4 cases, all requiring removal of nail with additional surgical procedures. Delayed union was seen in 2 cases. Nail prominence causing impingement pain was seen in 4 cases, necessitating nail removal. In 3 cases, the proximal screws loosened and in 1 case the distal screw loosened, necessitating removal. One case required an exchange nailing to improve stability and one nail became infected, again demanding removal. Thus significant complications were seen in 16 of 84 (19%) cases. The functional outcome was good to excellent in 51 cases and poor to moderate in 33 cases.

Conclusion: Based on our results, we agree with the current move away from humeral nailing as the procedure of choice for humeral diaphyseal fractures. We are supportive of the move towards humeral plating.