The study was designed to look at canine related injuries presenting to the orthopaedic department at a small rural district general hospital and to assess their cost to the NHS.

A retrospective review of case notes and x-rays of all dog related injuries presenting to the orthopaedic services at our hospital over a one year period starting January 2011 was undertaken. The injuries involved and the treatment provided along with the direct financial cost of these services were calculated from trust tariffs.

Dog related injuries accounted for 84 out of a total of 48,405 patients presenting to the accident and emergency services over the index period. Of these, 29 required orthopaedic input with 57% of injuries resulting from trying to restrain a dog and the rest from being attacked by a dog. 14 patients were admitted to the wards with 11 among them requiring orthopaedic interventions ranging from wound wash outs and debridement to open reduction and internal fixation of fractures. These procedures cost £38,951 to the NHS. There were a total of 38 inpatient days involved costing another £9,196. A further 28 clinic visits were billed at £4,032. The total cost for the orthopaedic services provided was £52,179. There were no mortalities associated with these injuries over the time period.

Canine related injuries are costly and avoidable. General public awareness of the problem coupled with appropriate legislation and its strict enforcement may be necessary to protect people from our canine companions.

Background

Volar locking plates have revolutionised the treatment for distal radius fractures. The DVR (Depuy) plate was one of the earliest locking plates which were used and they provided fixed angle fixation. Recently, newer volar locking plates, such as the Aptus (Medartis), have been introduced to the market that allow the placement of independent distal subchondral variable-angle locking screws to better achieve targeted fracture fixation. The aim of our study was to compare the outcomes of DVR and Aptus volar locking plates in the treatment of distal radial fractures.

Aims: Chronic wrist pain has always been a diagnostic challenge. With the introduction of wrist arthroscopy and MRI, previously used techniques such as arthrography and cineradiography were made redundant. However the gold standard of wrist arthroscopy can still fail to diagnose the problem in some patients with chronic wrist pain. The aim of this study was to demonstrate that the combination of arthroscopy with arthrography gives more information, therefore permitting a clearer diagnosis in these patients.

Methods: A retrospective cohort study of 40 consecutive patients who underwent wrist arthroscopy for chronic wrist pain, between November 2003 and October 2005. All patients had their investigation and management by a single upper limb consultant orthopaedic surgeon. All had plain x-rays, 42.5% had MRI prior to surgery, and all but one had an intra-operative arthrogram, performed under the same anaesthetic as for the wrist arthroscopy. All demographic data was collected along with history of the patient’s wrist pain, examination, investigations and management.

Results: The results showed a ratio of patients 21M: 19F with mean age of 38 years in males and 40 years in females. On examination 15% demonstrated pain with carpal instability. 55% showed pathological findings on their X-rays. 82% of those who had an MRI, had a pathological finding. 97.5% had wrist arthrograms intra-operatively. 56% of these showed pathological findings on wrist arthrogram. In 18%, it altered the differential diagnosis prior to performing the arthroscopy and 38% it reinforced our diagnosis.

The final diagnoses after wrist arthrogram and arthroscopy were 42.5% with TFCC injuries, 20% with SNAC pathology, 20% with synovitis with no other pathology, 10% with carpal ligamentous pathology and 7.5% with radiocarpal osteoarthritis.

Conclusions: Performing an arthrogram initially provided more information, thereby allowing the surgeon to undertake the arthroscopy with increased accuracy. It also permitted the diagnosis of more subtle findings.

Therefore, the arthrogram is another tool in the diagnosis of wrist pathology, and should not be forgotten. It is especially useful in patients with chronic wrist pain, where the diagnosis may be more complicated.

Background: There is a huge controversy regarding the period of immobilization after Bankart stabilisation. This ranges from 2 days to 5 weeks for open repair and from 3 to 6 weeks for arthroscopic Bankart repair. We believe it is inappropriate to immobilise the operated shoulder after Bankart repair. In our study all the patients were allowed to use their arm, the same day, pain permitting. No restrictions were imposed for the type and range of movement for those who had open repair. With arthroscopic repair they were asked to limit their shoulder abduction upto 45-degreee and external rotation to neutral.

Method: In this retrospective study (1998–2003) we have analyzed the outcome of mobilisation of operated shoulder on the same day.43 primary stabilisations were performed by the senior author.one patient was uncontactble. We reviewed the records of 42 patients. Subsequently the General Practitioners were contacted to collect information about these patients and the patients were contacted, if needed. Out of 42 patients 34 were males and 8 females. 35 patients had an average of 7 episodes of anterior shoulder dislocations (range 2–25), 7 had unstable shoulder pre-operatively.30 had open repair, 12 had arthroscopic stabilisation. The average follow-up is 3.5years(1–6 years).

Result: 41 patients did hot have any further episode of frank anterior shoulder dislocation and they had returned to their previous level of activities. Only one patient injured his operated shoulder year later while playing football. He underwent arthroscopic capsular shrinkage for traumatic deformation of the capsular and inferior glenohumeral ligament.

Conclusion: In primary straightforward Bankart stabilisation, same day mobilisation does not increase the risk of anterior shoulder dislocation