Traditionally, spinal surgeons placed radiographs on viewing boxes in a manner (PA) to replicate the view they would have at surgery. The introduction of digital Picture Archiving and Communications System (PACS) appears to have had marked impact upon this convention. Some Units have the ability to lock digital radiographs such that they are always viewed in the same manner and cannot be reversed.

Following ‘two near misses’ we carried out a survey to confirm the previous practice with radiographs; to ascertain the current practice with PACS and to find out whether the variation in practice could lead to clinical mishaps and harm to patients.

Questionnaires were completed by practicing spinal surgeons.

Previous and current practice of viewing radiographs. Either actual or potential wrong side surgery. Opinions as to whether a single convention was important were recorded.

78 % Spine surgeons used to flip radiographs over prior to introduction of PACS. With PACS, 56 % spine surgeons flip the radiographs over in clinic and 72 % in theatre so to resemble viewing spine from behind. 56% Surgeons had nearly operated on the wrong side of the spine while 94 % have seen or heard of a patient operated on the wrong side. 72 % Spine surgeons agree that the radiographs should be flipped over so as to resemble the spine as viewed intraoperatively.

There is need for a single convention in spine surgery to view radiographs to avoid potential clinical mistakes.

Aims: To assess the usefulness of wrist arthroscopy in the assessment of symptomatic scaphoid non-unions and associated injuries and to evaluate the implications on the definitive treatment.

Methods: A prospective cohort study of patients undergoing wrist arthroscopy with established scaphoid non-union was performed between January 2006 and April 2009. This study included 17 men and 6 women with a mean age of 39 years.

Results: Majority of the study population (61%) had normal radiocarpal articular cartilage. Articular cartilage wear was mostly limited to the radial styloid and could be effectively debrided. Injuries to the TFCC (39%) followed by the LT joint (35%) and the SL joint (26%) were the most common arthroscopic findings. Other identified pathologies included: Loose bodies, protruding Herbert screw from previous fixation, Chondrocalcinosis, Distal Radio-ulnar joint (DRUJ) instability, Capitohamate (CH) instability and Ulnar styloid fracture non-union. Assessment of the state of the fracture union was best done from the mid carpal joint rather than the radiocarpal joint due to a more prominent fibrocartilage covering of the fracture site from the radiocarpal side Concomitant procedures performed during the wrist arthroscopy included debridement of synovitis (48%) and TFCC repair (4%). Post wrist arthroscopy 6 patients (26%) required a further course of conservative treatment (Physiotherapy +/− local anaesthetic and steroid injection) prior to discharge. In the remaining patients, based upon clinical and arthroscopic findings, a range of other therapeutic and salvage procedures were performed.

Conclusion: This study demonstrates an important role for the wrist arthroscopy in patients with symptomatic scaphoid non-union and in assessing the true extent of the articular cartilage wear and associated carpal injuries. Further it helped in most cases with the decision making in choosing the appropriate definitive surgical option when required.

Split tendons are widely used for reconstructive procedures around wrist and hand. Different materials are used to split the tendons. There is no consensus about the most suitable material for splitting a live tendon. We compared a range of commonly available suture materials to find the best material for the purpose.

11 different suture materials (Vicryl 2/0, Ethibond 0, Ethibond 2/0, Prolene 2/0, Prolene 3/0, Silk 2/0, Steel Wire 2/0, Steel Wire 3/0, Steel Wire 4/0, PDS 2/0, Fibrewire 2/0) were used to split the flexor tendons of pig’s trotters. They were assessed for

their ablity to split the tendon successfully,

Each material was tested on 3 different tendons at different times. Quality of split tendons were assessed by 2 independent and blinded observers.

All suture materials except Vicryl 2/0 were successful in splitting the tendon. Silk produced a poor quality split whilst steel wire and fibre wire resulted in excellent quality grafts. The rest produced intermediate results. The force required to split the tendon was the least for PDS 2/0 followed by Fibrewire. Steel wire and silk required higher forces to split the tendon.

From our study we concluded that fibre wire is the best material to split a live tendon as it produced a high quality split with excellent handling characteristics and required minimal strength. Wire suture produced a high quality split, however they were awkward to use as they necessitated use of a holder due to the higher forces required to split the tendon.

We describe a new technique for fixing the proximal pole scaphoid fractures both in acute and chronic setting and present our preliminary results.

We prospectively studied fixation of 25 proximal pole scaphoid fractures (1 acute displaced and 24 non unions) with this technique between 1999 and 2007. Mean age of patients was 25 years and mean time to the operation was 6 months.

The technique involves making a transverse dorsal incision over the radius along the radio-carpal junction. The retinaculum is split in line with its fibres. Access to the radio-carpal joint is achieved through the third extensor compartment. The ligament attachment to the scaphoid is preserved by using a modified Mayo approach. A window is created initially at the proximal end of the dorsal ridge. The fracture is reduced and stabilised with an appropriate length Herbert screw. The fracture site is curetted through this window and cancellous bone graft from the distal radius is packed into the fracture site. The capsule and extensor retinaculum is then closed in layers.

Radiological union was achieved in 23 cases, one case required refixation and one case was lost to follow up. Our technique is tendon sparing, capsule retaining, and ensures maintenance of articular surface congruity. So far this technique has led to excellent results.

Scaphoid non-union usually requires surgical treatment in form of reconstructive or salvage procedure. Imaging helps in planning the surgical procedure. Wrist arthroscopy may also be helpful in the pre-operative assessment. This study was conducted to find the usefulness of wrist arthroscopy in formulating a management plan to treat scaphoid non-union.

We prospectively studied 17 patients of scaphoid non-unions by wrist arthroscopy. Non-union was assessed; and site and extent of any articular wear if present was noted. Some patients had additional procedures such as synovial debridement, removal of loose bodies or debridement of TFC tears. It was possible to formulate the further management plan at the same time.

Our study included 14 men and 3 women with a mean age of 34.5 years (range 18 to 49). Arthroscopic findings included mild radiocarpal wear in 3 cases and severe articular wear in 1. Additionally, in two thirds of cases there was some degree of wear present over the radial styloid region. 6 cases had TFCC tears. 4 patients had synovial debridement and in 5 cases loose bodies were removed. Based on the arthroscopic findings, it was decided to proceed to a reconstructive procedure in 12 cases and a salvage procedure in remaining 5.

We concluded that in scaphoid non-unions:

Articular surface wear is often less than suggested by imaging.

Introduction: We performed a prospective cohort study to investigate the comparability of subjective and objective assessment scores of shoulder function following surgery for rotator cuff pathology.

Materials and Methods: A consecutive series of 372 patients underwent surgery for rotator cuff disorders with post-operative follow up over 24 months. 248 patients solely underwent subacromial decompression, whereas 124 had additional rotator cuff repair (93 arthroscopic; 31 open). Assessments were made pre-operatively, and at 3, 6, 12, and 24 post-operative months using the Disabilities of the Arm, Shoulder, and Hand (DASH) score; Oxford Shoulder Questionnaire (OSQ); and the Constant score, which was used as a reference. Standardisation calculations were performed to convert all scores into a 0 to 100 scale, with 100 representing a normal shoulder. The student’s t test was used to compare the mean score for each subjective tool (DASH and OSQ) with the objective score (Constant) at each time point. Correlation coefficients (Pearson’s) were used to analyse the changes with time (post-operative course). Each statistical test was used for all surgeries collectively and for the individual surgery types.

Results: The relationship between the DASH and the Constant score was robust in all types of surgery. The relationship between the Oxford and Constant was generally robust, except in the open rotator cuff group. There was no statistical difference between the mean DASH and Constant scores for all interventions at each time point. A significant difference was seen between the mean Oxford and Constant scores for at least one time point in all but the open rotator cuff repair group.

Conclusion: We demonstrate the DASH and Oxford scoring systems would be useful substitutes for the Constant score, obviating the need for the trained investigator and specialist equipment required to perform the Constant score, alongside the associated cost benefits.