Patients with spinal injuries are very vulnerable to early complications or secondary spinal cord injuries before and during transfer, which may delay their rehabilitation. We designed transfer guidelines following concerns raised in a pilot study of the transfer of 16 patients. We then examined the effectiveness of the guidelines in 100 consecutive patients and completed the cycle by re-auditing a further 254 consecutive admissions after incorporating changes from the initial audit.

The transfer guidelines addressed ten areas of clinical concern. We recorded a 50% improvement in airway monitoring and management. There was also improvement in anti-ulcer therapy and thromboprophylaxis (from 50% to 96%). We saw a 50% improvement in the use of appropriate support staff during the transfer.

The re-audit showed that initial improvements were maintained and further improvements were noted in the transfer of relevant documentation and investigations. Improvement was also noted in the use of a vacuum mattress for the transfer of spinal injury patients and subsequently reduced incidence of pressure sores by a statistically significant level, which helped in the early rehabilitation of these patients. The majority of transfers were safe.

The transfer guidelines were easy to use and improved patient care by ensuring that common problems had been addressed before and during transfer. This system reduced the risk of preventable complications during inter-hospital transfer. There may be wider application of similar guidelines to other trauma patients who require inter-hospital transfer, where there is a possibility of preventable secondary injury.

Introduction We have evaluated the early outcome of arthroscopic excision of the distal clavicle (Mumford procedure) for acromioclavicular joint pathology.

Method Forty-one patients with acromioclavicular joint pathology underwent arthroscopic distal clavicle resections between 2002 and 2004. Preoperatively, all patients had acromioclavicular joint tenderness, 90% had a positive horizontal adduction test and 62% had a positive O’Brien’s AC compression test. All provocative signs were abolished on re-examination after acromio-clavicular joint injection. Surgery was indicated with failure of conservative management. Surgery was performed through a subacromial approach to the acromio-clavicular joint, using a Acromionizer (Smith-Nephew Dyonics, Andover, MA) burr through the anterosuperior portal. A supplementary Neviaser portal was used in 9 cases. Patients were clinically assessed at average of 18 months post surgery (range; 9–36). Functional rating was obtained with the Constant Score, WORC score and the Oxford Score. Results

Thirty-five patients (85%) reported none or minimal pain. 81% were negative for provocative AC signs. Internal rotation increased by average of 5 vertebrae levels. The Constant, the WORC and Oxford Scores were improved by 23 points, 674 points and 16 points respectively (p< 0.05). 71% reported good or excellent function by the 3^rd post-operative month.

Conclusion The arthroscopic Mumford procedure effectively treats acromioclavicular joint pathology. The procedure has low associated morbidity and high patient satisfaction.

Background: Developmental dysplasia of the hip (DDH) is a common paediatric orthopaedic problem. Open reduction and debridement of the hip joint in neonates is necessary to ensure a congruent reduction in some patients. Despite advances in the treatment of DDH, the various surgical approaches are not without limitations and risks. The development of hip arthroscopy is a new science, which we believe could be applied to the treatment of DDH.

Aims: To date there have been no reports in the literature of the use of hip arthroscopy in either the neonatal hip or in infantile hips with DDH. The purpose of this study was: (a) to design a suitable animal model of DDH for the purpose of designing and evaluating hip arthroscopy, (b) to document the pathoanatomy of the dysplastic hip arthroscopically and (c) to define the methodology of performing hip arthroscopy in neonates with DDH.

Method: A novel model of producing hip dysplasia in large white cross piglets has been created. 4-week-old piglets undergo surgical fixation of the knee by retrograde passage of a 3.5mm diameter steinmann pin. After free ambulation, progressive hip dysplasia is produced. We have monitored the development of hip dysplasia at 4 and 6 weeks post fixation by plain radiographs, MRI and Hip Arthroscopy using a 2.7mm diameter arthro-scope.

Results: We have successfully produced hip dysplasia in an animal model of comparable size and anatomy to that seen in infants. Hip arthroscopy was performed in 20 animals. Documentation of a lax capsule, elongated ligamentum teres and pulvinar has been made. In addition arthroscopic debridement of the joint has been performed. We believe that arthroscopic debridement of the impediments to reduction in DDH is possible using the techniques learned from this model.