Aim: To evaluate the morbidity and mortality in the perioperative period of patients with aortic stenosis following fractures of the proximal femur.

Patients and Methods: A retrospective review was undertaken of medical notes of all patients (n=20) admitted to our trauma unit over an 18 month period with fractures of the proximal femur and concomitant aortic stenosis confirmed by transthoracic echocardiography. Assessment was made of perioperative factors thought to be important in influencing outcomes in such patients as highlighted in the 2001 Report of the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) “Changing the way we operate”. These included previous history of angina or ischaemic heart disease, preoperative optimisation by an anaesthetist or physician, maximum pressure gradient across the aortic valve and ventricular ejection fraction on transthoracic echocardiography, seniority of anaesthetist and surgeon performing the procedure, intraoperative invasive monitoring, postoperative high dependency care and complications and outcomes.

Results: Prior to surgery three patients (15%) were seen by a physician and nine patients (45%) by an anaesthetist for medical optimisation. The mean maximum pressure gradient across the aortic valve on transthoracic echocardiography was 38.6 mmHg (range: 12 to 111 mmHg), and five patients (25%) were confirmed as having severe aortic stenosis. Anaesthesia was performed by consultant anaesthetists in 85% of cases with the remaining 15% carried out by trainees. No patients had intraoperative central venous pressure (CVP) monitoring, and only three of the 20 (15%) patients had intra-arterial blood pressure (IABP) monitoring. Only two patients spent one day in the High Dependency Unit postoperatively. The remainder of the patients were discharged back to the general ward where the mean length of stay was 28 days (range: 0 to 135). Postoperatively two patients (10%) developed arrhythmias, three (15%) experienced an episode of acute left ventricular failure and four (20%) developed hypotension. There were two deaths (10%).

Conclusion: It is evident that patients with proximal femoral fracture and concomitant aortic stenosis are still not benefiting from the recommendations of the NCEPOD report in the perioperative period. The authors suggest the introduction of a dedicated multidisciplinary team for the management of patients with proximal femoral fractures and concomitant aortic stenosis.

Background Adhesive capsulitis of the shoulder is a painful condition that results in gradual loss of joint movement. Numerous treatment modalities have been utilised with variable benefits. Because of the risk of brachial plexus injury and fracture, manipulation under anaesthesia is considered with caution.

Aim To determine the rate of manipulation under anaesthesia (MUA) following primary distension arthrogram for adhesive capsulitis of the shoulder.

Patients and Methods The case notes of 40 patients (42 shoulders) between 1998 to 2004 at Glenfield Hospital, Leicester under the care of one consultant with adhesive capsulitis of the shoulder treated with distension arthrogram by using intra-articular injection of local anaesthetic, corticosteroid, contrast media and air were reviewed.

Results Capsular disruption into the subscapular bursa was demonstrated in all cases. 15 of 42 (36%) shoulders underwent MUA following distension arthrogram. The average period of pain prior to distension arthrogram for these patients was 42 weeks (range: 7–156). 35 of 40 (88%) patients were pain free following primary distension arthrogram.

One patient experienced a vasovagal episode during the distension arthrogram.

Conclusion Distension arthrogram can be used as a therapeutic procedure for achieving symptomatic pain relief in the early phase of adhesive capsulitis and decreasing the risk of MUA of the shoulder.