The consequences of the complications associated with the management of slipped upper femoral epiphysis are a major source of disability in young adults. Whilst the management of chondrolysis, avascular necrosis or malunion of the femoral neck is usually undertaken by paediatric orthopaedic surgeons the initial management of SUFE in many regions is as part of an adult trauma service. This retrospective audit assessed the outcome of the management of SUFE in one such health region in which treatment occurred at three sites by a number of surgeons of varying experience, during the period July 1994 to June 2004. The aim was to compare our outcomes with those published and to identify whether our service should be altered as a consequence.

The case notes and x-rays as recorded in theatre records were retrieved. Of the 64 cases that were treated during this period adequate records for 60 patients were available. Of these 60 patients there were 7 bilateral cases. Fixation in all 67 cases was by a single cannulated screw. In the 53 unilateral cases 17 underwent prophylactic pinning, the remaining 36 remained under observation. Of these nine patients presented with subsequent slips, eight of which were unstable and two had slip angles greater than 60° in which one developed avascular necrosis. Four other cases of avascular necrosis were observed (incidence 6%). Chondrolysis occurred in one patient with persistent pin penetration. In the remaining 73 cannulated screws used for stabilisation and 17 for prophylactic fixation no complications were observed.

The complication rates observed in this series are within those accepted in the literature. The high incidence of subsequent slips and the attendant severity of these when compared with the relative safety of contemporary cannulated screw fixation has led us to recommend prophylactic pinning in our region.

Introduction: The consequences of the complications associated with the management of slipped upper femoral epiphysis are a major source of disability in young adults. Whilst the management of chondrolysis, avascular necrosis or malunion of the femoral neck is usually undertaken by paediatric orthopaedic surgeons the initial management of SUFE in many regions is as part of an adult trauma service. This retrospective audit assessed the outcome of the management of SUFE in one such health region in which treatment occurred at three sites by a number of surgeons of varying experience. The aim was to compare our outcomes with those published and to identify any local issues.

Method: Review of case notes and xrays of all patients treated over a ten year period as recorded in theatre records. Fixation in all cases was by a single cannulated screw.

Results: Of the 64 cases that presented during this period adequate records for 60 patients were retrieved. 75 slips were recorded, 15 of which were bilateral. In 17 patients prophylactic pinning was performed in the remaining 43 patients nine presented with subsequent slips. Of these, eight were unstable of which two had slip angles greater than 60°, in one of these avascular necrosis developed. Three other cases of avascular necrosis occurred (incidence 5%) all in unstable slips. Chondrolysis occurred in one patient with persistent pin penetration. In the remaining 91 cannulated screws that were inserted no complications were observed.

Discussion: The complication rates observed in this series are within those accepted in the literature. The high incidence of subsequent slips and the attendant severity of these when compared with the relative safety of contemporary cannulated screw fixation has lead us to recommend prophylactic pinning in our region.

Disorders of the pisotriquetral joint can cause ulnar sided wrist pain. This joint is not usually seen during routine wrist arthrosopy because it often has a separate joint cavity. The senior author believes that it is more commonly seen from the 6R portal if looked for, than one would expect from the assumed anatomy.

This study assessed the frequency with which the pisotriquetral joint could be observed in 36 consecutive wrist arthroscopies. The connection between the radiocarpal and the pisotriquetral joint were found to vary from a complete membrane separating the two, to no membrane at all, with variations in between. The types of connections are described. The anatomy of the connections was also studied by dissecting the wrist joints of eight fresh frozen cadavers. The findings matched the arthroscopic observations.

In more than 50% of patients, the pisotriquetral joint could be clearly visualised by arthroscopy. The technique and findings have been recorded on video and form part of the presentation.

Osteoporosis, the disease of aging, is a major health problem and its clinical end point: – Fracture is a major cause of mortality and morbidity. Osteoporosis is a silent, relentlessly progressive disease that is best treated by early diagnosis and prevention. To elucidate the predictors of fracture proneness in patients with osteoporosis the following study was undertaken.

32 patients with fractures of the hip and spine due to osteoporosis were studied with a control group of 30 patients with osteoporosis but no fractures. Osteoporosis was established by using the gold standard: Dual Energy X-ray Absorptiometry. Of the biochemical parameters studied lower values of, hemoglobin, total serum proteins & albumin, and alkaline phosphatase were found along with higher values for serum tartarate resistant acid phosphatase, urinary hydroxy proline and acid phosphatase, in the fracture group when compared with the non fracture group. It was inferred that biochemical parameters are reliable indicators of fracture proneness in patients suffering with osteoporosis and also that in the treatment of osteoporosis, anemia and hypoproteinemia must also be considered and corrected.