The aim of the study was to assess the medium term outcome for complex proximal humeral fractures treated with the long proximal humeral internal locking system (PHILOS) plate fixation.

All patients who had long PHILOS plate fixation of proximal humerus fractures with metaphyseal or diaphyseal extension over a three year period at our institution were included in the study. Patients had their case notes and radiographs reviewed. Patients were also contacted to assess functional outcome using the Visual Analogue Scale (VAS) for pain, DASH, Oxford shoulder score (OSS) and Stanmore Percentage of Normal Shoulder Assessment (SPONSA).

Out of an initial cohort of 34 patients, 1 died, 2 patients had unrelated illnesses resulting in them being unable to complete the assessment and 6 were lost to follow-up, leaving 25 patients (74%) for review. All patients had proximal humeral fractures with metaphyseal or diaphyseal extension requiring long plate osteosynthesis. One patient had the procedure for non union following initial treatment with an intra medullary nail and the rest were acute injuries. The patients were followed up after a mean of 27 months (range 11–60). The length of plate used varied from 5 to 12 holes for the shaft region.

There was 1 wound infection. 3 patients had non unions which required bone grafting and revision internal fixation. At final follow-up, mean pain was 3.6 (95% Confidence Interval 2.5–4.8) with only 4 patients having residual pain greater than 5 on the VAS scale. Mean DASH score was 41.2 (95% CI 32.0–50.4), mean OSS was 29.1 (95% CI 24.3–33.9) and mean SPONSA was 63.9% (95% CI 50.8–77.2)

The long PHILOS plate appears to represent a good treatment option for complex proximal humerus fractures with favourable medium term results and few complications.

The aim of the study was to assess the rate of greater tuberosity non union in reverse shoulder arthroplasty performed for proximal humerus fractures and to assess if union is related to type of fracture or the intraoperative reduction of the greater tuberosity.

All cases of reverse shoulder arthroplasty for proximal humerus fractures at our institution over a three year period were retrospectively reviewed from casenotes and radiologically and the position of the greater tuberosity was documented at immediate post op, 6 months and 12 months. Any malunion or non union were noted.

A total of 27 cases of reverse shoulder arthroplasty for proximal humeral fractures were identified. 4 cases did not have complete follow up xrays and were excluded from analysis. The average age at operation of the cohort of the 23 remaining patients was 79 years (range 70–91). The greater tuberosity was anatomically well positioned intraoperatively in 17 of the 23 cases.

At the end of 12 months there were 4 cases of tuberosity non union (17%), all except one occurring in poorly intraoperatively positioned greater tuberosity. 50% (3 out of 6) of greater tuberosities displaced further and remained ununited if the intraoperative position was poor. Only 6% (1 out of 17) greater tuberosities did not unite if the greater tuberosities was reduced anatomically. Intra operatively position of the greater tuberosity was strongly associated with their union (Fischer's exact test p<0.05). Union of greater tuberosity was not statistically associated with fracture pattern (Fischer's exact test p=0.48).

Our case series show a low rate of tuberosity malunion after reverse shoulder arthroplasty for proximal humerus fracture. Good positioning and fixation of the greater tuberosity intra operatively is a strong predictor of their uneventful union to shaft.

Aim

The purpose of the study was to evaluate the results of Expert tibial nailing for distal tibial fractures.

Oxford medial uni compartmental knee replacement is a common and widely accepted procedure that relies on accurate positioning and alignment of the implants for optimal outcome and longevity. Posterior slope of the tibial base plate has been shown to be an important factor affecting long term survivorship.

The aim of the study was to evaluate whether navigation increased the accuracy of Oxford knee replacements using the posterior slope of the tibial component as an index measure.

The posterior slope of tibial trays from 58 sequential Oxford medial unicondylar knee replacements over a two year period was checked on standard lateral x-rays against the recommended range.

There were 12 cases in the navigated and 46 in the conventional group across six Orthopaedic firms. The mean posterior slope for navigated and conventional implantations was 4.75 and 3.3 degrees respectively with the difference not being statistically significant. However, when considering the data for low volume surgeons, the mean posterior slope with and without navigation was 4.75 and 1.83 degrees respectively which was significant with a p value of 0.017. Navigation was also found to significantly decrease the chance of implanting the knee with the posterior slope outside the acceptable range (p=0.024). In both analyses the navigated cohort had a narrower data spread and fewer outliers compared to the conventional group. No other factors were found to significantly correlate with the posterior slope.

The study suggests that navigation might help low volume surgeons in increasing the accuracy and decreasing the incidence of extreme variations from the desirable range of implant positioning for unicompartmental knee replacements.

Background: Hip fracture is a serious injury mainly affecting the elderly population. The injury has a high mortality of 30% at 1 year and also has a major impact on the quality of life of the survivors. The Scottish Hip Fracture Audit has identified significant difference in the level of care provided in hip fractures between different hospitals and regions. The study aims to assess the impact of the experience of the operating surgeon on the long term outcome of hip fractures taking a cemented bipolar hip arthroplasty as an index procedure.

Materials and Methods: All patients who had the index procedure carried out over an eight year period at the Dumfries and Galloway Royal Infirmary were included in the study. Their preoperative mobility and health status along with the experience of the surgeon performing the procedure were determined. The outcome assessment was carried out using a modified Harris hip score.

Results: 46 patients were followed up at a mean of 45 months (range 16 to 109). One patient required a revision for aseptic loosening. Of the remaining, 18 procedures were carried out by consultant surgeons and 27 by trainees unsupervised. There was no statistical difference in the age, sex, ASA grade, preoperative mobility level or duration of follow up between the two groups of patients. The mean hip score at the time of follow up for the consultant group was 67.2 and 52.6 for the trainee group. This was statistically significant with a P value < 0.05.

Conclusion: The proportion of hip fracture surgeries done by, or under the direct supervision of a consultant orthopaedic surgeon vary widely between various Scottish hospitals (20% to 90%). The significant difference in long term out come of the procedure based on the surgeon’s experience calls for greater supervision and training of juniors.