Complete rupture of the Achilles tendon is a well described injury. Assessment of outcome and rehabilitation post surgery is difficult to qualify objectively.

We undertook a prospective evaluation of patients who had surgical repair of their ruptured Achilles tendon at our institution over a five year period. All patients underwent clinical and functional assessment. Objective function was evaluated using isokinetic testing on a Biodex dynamometer. Measurements included peak torque/body weight, average power, deficits, total work and range of movement. Studies were repeated at 60, 120 and 240 degrees/second. This was correlated with average time off work and time of return and level of sporting activities.

Although 53 patients were entered into the study, only 24 returned for full isokinetic testing. Males (16) were more commonly affected than females (9). Peak incidence was in the fourth and fifth decades of life. Mean hospital stay was 1.8 days. There were no problems with wound healing, and there were no infections.

22 of 25 patients returned to their pre-injury level of activity after an average of 6 months. Time off work averaged 14 weeks. 16 of 25 patients were the same or better when comparing peak torque/body weight, average power, maximum average peak torque and total work/body weight when compared with the unaffected limb.

Rehabilitation following Achilles tendon repair can be monitored clinically, however isokinetic testing can provide a more objective assessment of progress.

The management of three or four-part fractures of proximal Humerus remains difficult. Controversy still persists concerning the preferred treatment of these fractures. The aim of our study was to review the functional outcome and factors influencing the outcome after shoulder hemi arthroplasty in acute fractures of proximal humerus.

Material and Methods: Retrospective review of a consecutive series of 23 patients with three/four-part proximal humerus fractures, treated with shoulder hemi-arthroplasty between 1999 – 2002. Nineteen patients (one bilateral) were available for study. The mean follow-up period was 12 months. All fractures, 16 cases were Neer’s four-part fractures, while one case was fracture with posterior dislocation. Post operative pain, range of motion and function evaluated using Visual analogue score, Pain scale and UCLA functional score. The average age was 64 years (range 50–85).

Results: At follow-up pain relief was satisfactory in 15 of 20 cases. Patient’s satisfaction was 75%. Functional evaluation was good/fair in 14 cases. One patient developed chronic inferior subluxation post-operatively. We have found that age (75 years +) at the time of surgery, securing of tuberosities t the implant and compliance with the post-operative rehabilitation program are significant factors affecting the outcome.

Conclusion: We recommend careful patient selection, proper positioning of patient during surgery, use of x-ray screening of the implant prior to cementing and meticulous surgical technique to achieve optimal results.