Introduction and aims

Low back pain is a common complaint, affecting up to one third of the adult population costing over £1 billion to the NHS each year and £3.5 billion to the UK economy in lost production. The demand for spinal injections is increasing allowing for advanced spinal physiotherapists to perform the procedure. The objective of this study was to investigate outcome following spinal injections performed by consultant spinal surgeon (n=40) and advanced spinal physiotherapists (ASP) (n=40) at our centre.

The effect of head injury on systemic physiology, including bone healing is still a topic of vivid discussion. We aimed to investigate whether in patients with long bone fractures the presence of head injury is associated with excessive callus formation. Data on patients with head injury and femoral diaphyseal fracture admitted to our trauma unit between 1997- 2002 were collected and analysed. Patients with factors that could influence bone healing such as smoking, NSAIDs and hormonal disorders were excluded. The severity of head injury was quantified using GCS, AIS and CT scan reports. Patients matched for age, sex and ISS with femoral shaft fractures and no head injury formed the control group of the study. All the fractures were stabilised with reamed femoral nail. The quantification of fracture healing response was estimated by taking the radiological ratio of the largest diameter of callus formed into two planes and the adjacent normal diameter of femoral canal. The minimum follow-up of the patients was 12 months.

In total 42 patients were studied, 17 with head injury and femoral fracture and 25 with an isolated femoral fracture, (control group). Both groups were comparable in terms of age, sex, ISS. The difference between the mean callus to diaphyseal ratio was statistically significant for both the AP and Lateral projections (AP – mean difference 0.462, 95% CI 0.312 to 0.602, p<0.0001, LAT – mean difference 0.289, 95% CI 0.142 to 0.436, p<0.001) with the head injured patients having more florid callus compared to the control group.

This study supports the view that head injury leads to exuberant callus formation in patients with long bone fractures. The mechanisms of this response could be both central and local. Research is ongoing to elucidate the pathways involved in this biological phenomenon.

Introduction: Although the functional outcomes after severe lower limb injury ( Gustilo grade IIIb and IIIc ) managed with various surgical techniques is well described in the literature, there is limited information on appearance related psychological impact after complex lower limb reconstruction. We sought to determine the aesthetic problems in patients with open tibial fractures with extensive soft tissue injury.

Materials and methods: Data on patients with open tibial fractures managed with free flaps between 1999–2003 admitted to our trauma unit was collected and analysed. Patients who had finished their treatment at least one year ago with isolated leg injury were identified, patients with surgery related disability were excluded. we used Derriford Scale (DSA24) with additional questionnaire for analysis .

Results: In total 31 patients were contacted out of which 18 provided with completed questionnaires, 14 male and 4 female with mean age of 41.8(17–69) year. Appearance of the leg following surgery significantly effected relationships (3 divorced, 2 split up, 3 worse, 8 same and 2 better). Nine (56.2%) patients experienced poor sexual relationship following surgery and four (22.2%) reported to avoid undressing in front of partners. Five patients (27.7%) requested debunking and two under went surgery. Twelve (66.6%) patients were still taking pain killers. Ten (55.5%) patient complained of donor site weakness or painful scar. Six (33.3%) patients required to change jobs. Thirteen (72.2%) were unconfident in themselves, (66.6%) were distressed to see there legs in mirror. Nine (50%) felt hurt and irritable at home, (61.1%) patients avoided going to beach. Nine (50%) disliked using communal changing areas or even going for shopping and felt closed in a shell. Eight (44.4%) patients felt rejected and chose not to attend social events.

Conclusion: The psychological impact of trauma is generally neglected, sudden and unexpected nature of events and interventions have significant effect on post operative quality of life.

Objectives The objective of this study was to investigate accelerated bone healing in patients with femoral shaft fractures.

Methods Data on patients with diaphyseal femoral fractures admitted to our trauma unit between 1997 and 2002 was collected and analysed. Patients were categorised into three groups by the presence or absence of head injury, and the reamed or undreamed nailing technique used. Severity of head injury was quantified using abbreviated injury score (AIS) and Glasgow Coma Scale (GCS). Time to bony union was assessed from serial of x-rays and clinical examination.

Patients were followed to discharge in outpatient clinics until bony union.

Results Group 1 ( Patients with head injury)

In total 17 patients (14 male, 3 female)

mean age 29.4(14–53)

open fractures 2

Mean AIS 3.2 (2–5)

Fracture treatment was reamed femoral nail

Bony union 10.5(6–22)weeks

Group 2 ( Patients without head injury)

Intotal 25 patients(19 male, 6 female)

Mean age 32(16–81)

Open fractures 2

Fracture treatment was reamed femoral nail

Bony union 20.5(14–32)weeks

Group 3 ( Patients without head injury)

In total 24 patients(18 male, 6 female)

Mean age 47(17–83)

Open fractures 2

Fracture treatment was unreamed femoral nail

Bony union 26.9 (21–32) weeks

Conclusion This study supports rapid bone union in the presence of head injury. Further research is indicated to provide a definate answer, specially mesenchymal cell and their control pathways which could allow further development of their potential therapeutic uses.

Objective The aim of this study was to examine the minimum 10 year outcome of displaced and subsequently operatively reduced and anatomically fixed ankle fractures and report on the incidence of osteoarthritis.

Methods A total of 420 patients were treated with ORIF ankle at St James University Hospital from 1989–1994. Notes and x-rays of 112 patients were identified for analysis and 40 patients were traced to be available for this outcome study. Patients were interviewed and both ankles were examined. Plan radiographs of the affected ankle were taken. Scoring system for subjective, objective and radiographic criteria according to Baird and Jackson was used ( maximum 100) 96–100 excellent, 91–95 good, 81–90 fair and 0–80 poor.

Conclusion The long term results of ORIF of the ankle are poor as compared to those described in the literature and depend on the age of the patient and severity of the injury. The incidence of radiological osteoarthritis in this series was 67.5%.