The objective of this study was to ascertain knowledge of the normal anatomy and appreciation of components of an “adequate” or “acceptable“ reduction by the medical staff responsible for management of distal radius fractures in the emergency departments (A& E) in UK. A nation wide structured questionnaire survey based on literature review was performed on 138 doctors. Of the 100 (72%) respondents, only 40% could cite the correct values for volar tilt, radial inclination, and ulnar variance, there being a significant difference between orthopaedic n=16(64%) and A& E staff n=24(32%); p=0.031; c2 = 12.17. Only 18% respondents were aware of the acceptable ranges of adequate reduction; with orthopaedic staff n=12 (48%) being more aware than A& E staff, n=6 (8%); p=0.002; c2 = 6.38. Only 19% formally measure the key parameters before decision making [52% Orthopaedic versus 8% A& E staff; p=0.018; c2 = 7.31]. Only 14% of respondents from hospitals equipped with picture archive navigation system (PACS) stated that they used the angle measurement function.

A lack of knowledge of the normal anatomical values and implementation of generally accepted measurement criteria predictive of fractures unlikely to benefit from repeat manipulations is evident. It is important to emphasize the influence of factors reported to affect stability such as age, functional demands of the patient and extent of initial fracture displacement in decision making. The introduction of a set of guidelines and further education of the medical staff could reduce the number of inappropriately treated distal radial fractures in the A& E setting with significant economic implications.

Introduction: Rapidly destructive arthrosis of the hip (RDHD) is a rare and incompletely understood disorder with scarce literature about variations in natural history within a population. A series of cases from North Wales with rapid progressive joint destruction and extensive subchondral bone loss in the femoral head and acetabulum are presented.

Methods: A retrospective review of patients with a clinical profile and serial radiographs suggestive of a rapidly progressive hip disease was undertaken. This revealed 15 patients who met our criteria for RDHD. A retrospective analysis of clinical and radiographic records was performed. Radiographic findings mimicked those of other disorders such as septic arthritis, rheumatoid and seronegative arthritis, primary osteonecrosis with secondary osteoarthritis, or neuropathic osteoarthropathy, but none of the patients had clinical, pathologic, or laboratory evidence of these entities.

Results: Rapid progression of hip pain and disability was a consistent clinical feature. The average duration of symptoms was 1.4 years. Radiographs obtained at various intervals before surgery (average 14 months) in 15 patients documented rapid hip destruction, involvement being unilateral in 10 cases. All patients underwent total hip arthroplasty, and osteoarthritis was confirmed at pathologic examination. Histology of femoral heads failed to show the findings typical of primary osteonecrosis & no evidence of sepsis.

Discussion: The authors postulate that these cases represent an uncommon subset of osteoarthritis and regular review, both clinically and radiologically, are required to assess speed of progression and prevent rapid loss of bone stock without the surgeon being aware. These cases are unsuitable for being placed on long waiting list due to technical difficulties in delayed surgery and compromised outcome following surgery. The decisions about the need for surgery and the selection of cases should be made purely on clinical grounds and not on their rank in the waiting lists.(295)