Introduction

The purpose of this study was to assess the rate of revision subacromial decompression and identify different pathologies.

The recognition of the role of TFCC as a major distal radioulnar joint stabilizer and a buffer to compressive forces indicates the importance of preserving as much of this structure as possible.

We developed arthroscopic technique for repair of Palmer I B tears of TFCC using a hypodermic needle which obviates the need of any additional skin incision.

With wrist under traction important landmarks like radial styloid process, ulnar styloid process, Lister's tubercle and extensor tendons are marked using skin marker. For placement of the arthroscope, 3–4 portal is used and for instruments 6 R and 6 U portals are used.

An outside-in technique is used. A 19 G needle is inserted upward from 5mm proximal to the level of the 6 R portal through skin, subcutaneous tissue, capsular tissue and then through the 2mm inner side of detached area of TFCC, while stabilizing it with probe.

A 2–0 polydioxanone-PDS suture is passed through needle and caught by grasper placed in the 6 R portal. Now needle is withdrawn and then suture is retrieved out of the joint through the 6 R portal. The procedure is repeated for required number of sutures for dorsal part of peripheral tear.

Thus we have stitches with one limb exiting the joint through portal and the other limb entering the joint percutaneously. A small mosquito forceps is passed through the 6 R portal undermining subcutaneous area and these percutaneously passing limbs of sutures are withdrawn through the portal. Now we have sutures entering and exiting through the 6 R portal. Similar procedure is done for ulnar part of peripheral tear through the 6 U portal. Knots are tied and slid beneath the subcutaneous tissue.

It offers advantages of a lower risk of neurovascular damage, reduced postoperative pain, faster rehabilitation and better cosmesis

Aim: To assess the long-term treatment outcome following conservative treatment of wrist ganglions by aspiration and steroid injections.

Materials and Methods: Between December 2001 and November 2003, 49 patients with wrist ganglions were seen and treated by one surgeon*. There were 20 males and 29 females with an average age of 37 years (range 13 to 70 years). Anatomically we had 41 dorsal wrist, 5 volar wrist and 3 digital ganglions. Diagnosis was made on clinical examination, explained to patients about the condition and given three options of treatment.

Reassurance,

39% (14) were satisfied with reassurance alone, 69%(34) had aspiration and steroid injection and one opted for surgery.

Those who opted for aspiration and steroid injection are included in the study.

The aspiration was carried out under sterile technique, area infiltrated with 1% lignocaine, followed by aspiration of ganglion content using 16 G needle and injection of Methyl-prednisolone Acetate BP 40 mg/ml. The patients were advised to carry out their normal activities and followed up at 6 weeks, 3 months and 6 months.

Follow up period range between 6 weeks to 6 months (average of 3.8 months).

Results: 34 ganglia treated with aspiration and steroid injection had a cure rate of 47%(16), 31%(10) and 12%(4) respectively after 1,2 and 3 treatments with a cumulative success rate of 88%(30 of 34). We had recurrence rate of 12% (4 of 34) after 3 injections and two patients with skin discoloration.

Conclusion: Treatment options should be given to patients with wrist and digital ganglions. Conservative treatment is quite successful, which will avoid surgery and associated complications. Even though our sample size is too small to make any statistical significance, cumulative success rate of 88% following multiple treatments of aspiration and steroid injections are in comparable with other studies.

Aim: To determine the surgical site infection (SSI) rates for prosthetic hip and knee replacement surgery.

Materials and Methods: Between April 2002 and March 2003 the Infection Control team in conjunction with the Orthopaedic Department had participated in national surveillance project to determine the surgical site infection rates for prosthetic hip and knee replacement surgery. Information was collected relating to surgeon specific data and patient risk index. Each surgeon was given a unique confidential code and patients intrinsic risk of infection calculated based on ASA grade, wound class and the duration of surgery.

Results: During the first year of surveillance 455 prosthetic hip replacements were undertaken (i.e. hemiarthroplasty, primary and revision surgery). A total of 12 patients were identified with an SSI giving an average of 2.6% compared with national figure of 3.0%. Out of this 25% (3) superficial and 75%(9) deep-seated infection with Methicillin Sensitive Staphylococcus Aureus (MSSA) and MRSA being the commonest organisms.

234 prosthetic knee replacements (Primary and Revisions) were carried out over the same period of time with 7 cases identified with SSI, an average incidence of 3% compared with national average of 1.6%. Three were superficial and four with deep infection with MRSA, MSSA and coagulase negative staphylococci being the commonest organisms.

MRSA containment policy was introduced in November 2002 with pre operative screening,” ring fencing” orthopaedic patients and improved awareness of cross infection. Since then over the last 4 months of this study the incidence of SSI has fallen from 3.3% to 1.9% in prosthetic hip surgery and 5.8% to 0.7% in prosthetic knee surgery in comparison to previous quarter.

Conclusion: Significant cost and morbidity are associated with infection of the prosthetic joint. With simple measures like improved awareness of cross infection among the staff and relatives, ”ring fencing” orthopaedic patients and pre operative screening surgical site infection rate can be reduced.