Short scarf osteotomy (SSO) retains the versatility of standard scarf in treating moderate and severe hallux valgus deformity with the added benefit of less invasiveness translated into less soft-tissue stripping, reduced exposure, less metalwork, less operative time and reduced cost. We present our medium-term clinical, radiographic and patient satisfaction results.

All patients who underwent SSO between January 2015 and December 2017 were eligible (98). Exclusion criteria were: follow up less than a year, additional 1st ray procedures, inflammatory arthropathy, infection, peripheral vascular disease and hallux rigidus. Eighty-four patients (94 feet) were included: 80 females / 4 males with average age of 51-year-old (24–81). Minimum follow up was 12 months (12–28). Weight-bearing x-rays and AOFAS score were compared pre- and postoperatively. Non-parametric Mann-Whitney U test assessed statistical significance of our results.

Hallux valgus angle (HVA) improved from preoperative mean of 30.8° (17.4°–46.8°) to 12° (4°–30°) postoperatively (p=0.0001). Intermetatarsal angle (IMA) improved from preoperative mean of 15.1° (10.3°–21.1°) to 7.1° (4°–15.1°) postoperatively (p=0.0001). Average sesamoid coverage according to Reynold's tibial sesamoid position improved from average grade 2.18 (1–3) to 0.57 (0–2) (p=0.0001). Average AOFAS score improved from 51.26 (32–88) to 91.1 (72–100) (p=0.0001). Ninety percent of patients were satisfied and 83% wound recommend the surgery. No troughing phenomenon or fractures. Four overcorrections were found 3 of which did not require surgery. One recurrence at 18 months was treated with standard scarf.

We believe that this technique offers a safer, quicker and equally versatile way of dealing with Hallux Valgus.

Introduction: Accurate pre-operative templating is important in primary and revision hip replacement surgery. Most manufacturers supply templates at 120% magnification, but magnification of radiographs varies markedly and this is further complicated by the use of digital systems, where radiographs can be printed at various magnifications. We have produced a simple protocol to allow radiographs to be routinely produced at a magnification of 120%.

Methods: We positioned a marker, of known size, at various distances from the x-ray tube using both conventional and digital (PACS) machines and noted when 120% marker magnification was achieved. With digital machines, we also looked at the effect of varying the magnification of the printed radiograph. We set the film-focus distance (distance between source and plate) to the optimal distance discovered in patients undergoing pelvic and hip radiographs and used a marker, placed at the mid portion of the greater trochanter, to verify the magnification of the hip joint. We compared the known marker size with the measured size on the radiographs of 35 patients. Our protocol was separately tested on 5 different x-ray machines in our hospital.

Results: The optimal film-focus distance required to achieve 120% magnification was 100 cm. With digital systems it was important to print the radiographs at “true size” (100%), rather than “best fit” (the usual default mode). In the 25 patients tested, the mean magnification achieved was 118.8%,with a SD of 1.295. Our protocol was reproducible on all five different x-ray machines in our department.

Discussion: We consistently and reproducibly achieved radiographs magnified at 120% using our simple protocol, allowing standard templates to be used for accurate pre-operative planning.

Introduction: We describe a novel, innovative and inexpensive method of producing a reinforced articulating cement spacer using a commercially available hip cement mould.

Methods: After adequate debridement and removal of original implants during the first of a two-stage revision procedure, an articulating cement spacer is created using a conventional mould and is reinforcing using a central stainless steel rod extending from the head to the tip using a novel technique that will be described in detail.

Results: We currently have a cohort of six consecutive patients in whom this novel cement spacer has been used. All patients were able to at least partially weight bear and none of the spacers fractured. Five have been explanted at second stage surgery after a minimum of 8 weeks in situ. One patient has been unable to undergo a second stage due to medical co morbidities and continues to mobilise with walking aids on the spacer 1-year post implantation.

Discussion: The articulating cement spacer described is produced using a technique that is simple, reproducible and allows a reinforced spacer to be created inexpensively without the need for special equipment. The spacer described provides a number of advantages over previously described or currently available commercial cement spacers. As it is reinforced it provides increased strength and allows partial weight bearing without risk of spacer fracture, a recognised complication of unreinforced spacers. As it uses a mould the surface remains smooth allowing easier insertion and minimising further bone loss with articulation. As it is fabricated intra-operatively, rather than being premanufactured, antibiotics can be added to the cement used to make the spacer according to known organism sensitivities.

Conclusion: We describe the first ever smooth, articulating, moulded cement spacer that can be inexpensively fabricated intra-operatively without the requirement for special equipment.

Dislocation of the distal radioulnar joint (DRUJ) in association with fractures of both bones of the forearm has received relatively little attention in the literature. The purpose of this study was to evaluate the integrity of DRUJ and evaluate the association between the level of fracture and instability of DRUJ following fracture both bones of forearm.

This was a prospective study of 65 patients, over 3 years followed up for 12 months. All patients were treated with open reduction and internal fixation of radius and ulna. The mean age of the patients was 34.8 years (15–68 yrs). There were 51 males and 14 females. There were 18 fractures involving distal third of forearm, 42 fractures in the middle third and 5 fractures of the proximal third. 38 fractures (58.4%) had subluxation of the DRUJ and 27 had no DRUJ subluxation. All subluxations were dorsal. Post-operatively, 30 of the 38 fractures (78.9%) had persistent DRUJ subluxation. Of the 27 fractures, which had no pre-operative DRUJ subluxation, 10 fractures (37%) revealed dorsal subluxation in the post-operative radiographs. All fractures were immobilised in above elbow plaster casts for 6 weeks. All patients were followed up at 3, 6 and 12 months. Patients were assessed clinically, radiologically with standardised radiographs and functional assessment of grip and pinch strength using Jamar dynamometer. At 12 months, 12 patients had significant symptoms associated with DRUJ. Of these, 4 had functional restriction, which were related to complex DRUJ dislocations.

DRUJ dislocations are more common in fractures, which are in the direction of the interosseous membrane (p< 0.002). They are commonly associated in fractures involving the middle and distal third of the forearm. There is a tendency for under-reporting of DRUJ dislocations in fractures of both bones of forearm and hence, more attention should be paid to this entity.