Introduction

Nerve conduction studies are considered to be the investigation of choice for the diagnosis of Carpal Tunnel Syndrome. However they are expensive and can be painful.

We scored patients based on a ten point scoring system; four symptoms (Katz Hand Diagram – Classic and Probable pattern for tingling and numbness, nocturnal paresthesia, bilateral symptoms), four signs (weak thumb abduction test, Tinel sign, Phalen sign, Hypoalgesia in median nerve territory) and two risk factors (age more than 40 years and female sex). This was done in an effort to predict the severity of carpal tunnel syndrome and to correlate it with nerve conduction studies.

Aim: To assess whether stable undisplaced ankle fractures treated conservatively with a below knee non weight bearing cast ever displace.

Methods: Retrospective case notes analysis was performed. Between August 2007 and August 2009, one hundred and twenty one patients sustained a stable undisplaced ankle fracture which was treated conservatively. Their age range was from 16 to 86 years. Male to female ratio was 74:47. The mean number of clinic follow ups was 3.7. These patients were classified according to the Danis-Weber Classification for analysis. Thirty (25%) patients had Weber A1 fractures, seventy two (60%) had Weber B1 fractures, five patients (4%) had Weber B2 fractures, three patients (2%) had Weber C1 fractures, ten patients (8%) had isolated medial malleolus fracture and one patient suffered an isolated posterior malleolus fracture.

Results: An average of 4.7 x-rays were performed on each patient from the time of diagnosis to discharge from clinic. None of these fractures displaced on follow up x-rays.

Conclusion: Stable undisplaced ankle fractures treated conservatively with a below knee non weight bearing cast do not displace. Hence these patients do not require to be followed up frequently with serial x-rays as they may be exposed to unnecessary harmful radiation and follow up appointments thereby saving time, money and resources.

Introduction: Dynamic Hip Screw (DHS) fixation is one of the most common orthopaedic surgical procedures. Tip Apex Distance (TAD) is a well recognised method of evaluating the screw position of the DHS. We studied the adequacy of fixation of DHS by assessing TAD and type of reduction.

Materials and Methods: We selected a random cohort of 102 patients who had DHS fixation and had the requisite clinico-radiologic data. TAD is defined as sum of the distance, in millimeteres, from the tip of the lag screw to the apex of femoral head, as measured on AP radiograph and Lateral radiograph, after correction has been made for radiological magnification. Tip apex distance of 25 mm or less is considered as good, 26–30mm as acceptable, 31–35mm as poor and more than 35mm as unacceptable.

Quality of reduction was assessed as per Sernbo. Good, if alignment was normal on AP and maximum 20 degrees angulation on lateral radiograph and less than 4mm of displacment of any fragment. To be labelled acceptable, a reduction had to meed the criteria of a good reduction with respect to either alignement or displacement, but not both. A poor reduction met neither.

Results: Mean TAD in our series was 24mm. (9.84 – 37.6). Our of this 58.82% were 25mm or less indicating good, 25.49% of them were 26–30mm indicating acceptable, 8.82% were 30–35mm indicating poor and 6.8% were more than 35mm indicating unacceptable. 39.21% patients had good reduction. 43.13% had acceptable reduction and 17.64% had poor reduction.

Conclusion: This study shows that only 58.82% of all patients having DHS fixation had good placement of the fixation device and only 39.21% had a good reduction. We conclude that complacency must not set in on DHS fixation and that we must endeavour for good reduction and placement in as many cases as possible.

Introduction There is no consensus on the superiority of either Chevron or Mitchell osteotomy in the treatment of hallux valgus. In the literature Chevron osteotomy is recommended for the mild and Mitchell’s for the moderate hallux valgus (HV) deformities. We reviewed outcomes of two of the most common distal first metatarsal osteotomies.

Aims To compare the results of Chevron vs Mitchell osteotomy in the treatment of HV.

To evaluate the co-relation between clinical outcome and radiological correction achieved after the two osteotomies.

Method We reviewed clinical notes and pre- and postoperative radiographs of a total of 111 operations including 61 Chevron and 50 Mitchell osteotomies in 90 patients.

We designed a patient-focused questionnaire to evaluate clinical outcomes that addressed the main functional outcomes concerning patients after bunion surgery. These included pain, usage of footwear postoperatively, cosmoses, development of transfer metatarsalgia and the repeatability of the procedure they had undergone. These questions were point based and a final clinical score was calculated for comparison with the radiological correction. This was also used as a measure of success of the procedure.

Conclusion There is a statistically significant radiological difference in HV angle correction and the loss of first metatarsal height as seen post-operatively between patients treated with Chevron and Mitchell osteotomies for HV correction (p=0.03 and p=0.0004 respectively). There is no statistically significant difference (p=0.6) in the clinical outcomes based on the newly designed patient-focused questionnaire with either Chevron or Mitchell osteotomies at a mean follow-up of 27 months post-operatively. Clinical outcome determined by patient-focused questionnaire remains the same in-spite of radiological differences noticed post-operatively between the two osteotomies.

Aim: The aim of this study was to evaluate the results of the Co-ordinate revision knee prosthesis (Depuy Ltd, Johnson and Johnson, Warsaw, In) between 1995–2001.

Methods: One hundred and thirty-three knees (126 patients) undergoing revision total knee replacement between 1995–2001 were followed up prospectively. Surgery was performed by one surgeon (senior author). The patients were scored pre-operatively and postoperatively with SF-12 and WOMAC score. Surgery was performed for aseptic loosening (92%) and infection (8%). The changes in SF-12 physical score and the WOMAC score between pre and post operation were significant (SF-12 p < 0.0018, WOMAC pain p< 0.0001, WOMAC stiffness p< 0.0001, WOMAC Function p< 0.0001)). The prosthesis produced reliable relief of pain and improved range of movement with minimal complications.

Conclusion: This modular knee revision system produced satisfactory results in dealing with bone loss and instability in the medium term.