In this study we reviewed all Total Elbow Replacements (TER) done in our hospital over eight years period (1997 – 2005), 21 patients (16 females, 5 males) were available for follow up and four were lost (two died and two moved out of the region) with average age of 65 years (range 44 – 77), all procedures were done by two upper limb surgeons (CHB & RGW). 16 patients (14 females, 2 males) had the procedure for Rheumatoid Arthritis and 5 patients (3 males, 2 females) undergone the procedure for post-traumatic arthritis.

The average follow up was 61 months (range 12 – 120 months), the Mayo Clinic performance index, the DASH scores and activities of daily living (adopted from Secec Elbow Score) assessment tools were used. In addition, all patients were assessed for loosening using standard AP and lateral radiographs. Sixteen patients had Souter-Starthclyde prosthesis whilst three had Kudo and two had Conrad-Moorey prosthesis.

All procedures were done through dorsal approach and all were cemented, the ulnar nerve was not transposed in any of the cases. The average elbow extension lag was 27 degrees (range 15 – 35) with flexion up to 130 degrees (range 110 – 140). Supination was 65 degrees (range 15 – 90) and pronation was 77 (range 55 – 90). The average DASH score was 51.3 (range 19 – 95), the Mayo elbow score was 82 (range 55 – 100) and the average Activities of daily living Secec Score was 17 (range 10 – 20).

There were four complications, three ulnar nerve paresis which recovered and one wound complication which needed a flap cover. Two needed revision surgery, one for a periprosthetic fracture and one for loosening. Two patients showed radiological signs of loosening but were asymptomatic. The survival rate with revision as the end point is 95% for aseptic loosening and 90% for any other reason.

Our study proves TER has good medium term results with good functional outcome and high patient satisfaction rate.

Aims: The aims of this study were to evaluate the biomechanical properties and mode of failure of four methods of fixation of hamstring anterior cruciate ligament (ACL) grafts. The fixation methods investigated included titanium round headed cannulated interference (RCI) screws, bioabsorbable RCI screws, Endobuttons and Bollard fixation. A 2-strand equine extensor tendon graft model was used because a previous study has shown it to have equivalent biomechanical properties to that of 4-strand human semitendinosus and gracilis tendon grafts.

Method: Thirty-two stifle joints were obtained from skeletally mature pigs, the soft tissues were removed and the ACL and PCL were sacrificed. Tibial tunnel preparation was standardised using the Mayday rhino horn jig to accurately position a guide wire over which an 8mm tunnel was drilled. A 2-strand equine tendon graft was then introduced into the tibial tunnel and secured with either a titanium RCI screw, a bioabsorbable RCI screw, an Endobutton or an expansile Bollard. The proximal part of the graft was attached to the crosshead of a materials testing machine using the Soffix. Five of each method of fixation were tested mechanically to ultimate failure and under cyclical loading.

Results: The mean ultimate tensile loads (UTL) were: titanium RCI screw = 444 N, bioabsorbable RCI screw = 668 N, Endobutton = 999 N and Bollard = 1153 N. The mode of failure for all RCI screws involved progressive tendon slippage past the screw. Under cyclic loading conditions the titanium and bioabsorbable RCI screws rapidly failed after several hundred 5 to 150 N cycles due to tendon damage and slippage. Both the Bollards and Endobuttons survived 1500 cycles at 50–450N, with less tendon slippage.

Conclusion: Titanium and bioabsorbale RCI screws provide poor initial fixation of tendon grafts used for ACL reconstruction and fail rapidly under cyclic loading. Both Bollards and Endobuttons provide sufficiently high UTL’s and survive cyclic loading to allow early postoperative mobilisation and rehabilitation. Caution must be used in the early postoperative period when using interference screws to secure a hamstring tendon graft because early progressive tendon slippage may result in excessive graft elongation and early clinical failure.

This study was undertaken to assess the long term results of treatment of club foot by modified Turco’s Procedure.

Thirty patients with 50 feet were treated by serial casting and postero-medial release for club feet, by modified Turco’s procedure. All patients treated from January 1980 to January 1983 were included in the study. Eighteen patients with 33 club feet were available for the final follow-up. They were followed up for an average of 13.8 years, range of 10 – 16 years. There were two females while the remaining 16 males. Only three patients had unilateral affection and all were males. Only patients with idiopathic club feet were chosen for this study. All patients underwent serial plaster correction after birth till undergoing surgical correction. All procedures were carried by the senior surgeon, using the same technique. All patients were operated between the ages of 6 – 9 months, depending on the severity of deformity and correction achieved with serial plaster. A modified Turco’s technique was used. A longer incision extending to the lateral border of tendoachilles was used. The abductor hallucis was completely excised. All patients had a subtalar release as well. No K wire was used for holding the correction. All children were left in plaster till they started walking. No Dennis-Browne Splint was used, but a modified splint and correction shoes were used in the postoperative period. There were no wound problems in any cases, either at the time of wound closure or later on. They were followed with clinical and radiological examinations. There were no wound problems which is a frequent problem in most series. Three (9%) cases each had recurrence of heel varus and forefoot adduction. The forefoot adduction was less than as compared to other studies. Three cases had some cavus deformity while four cases had flat foot. All patients were noted to have calf muscle wasting. The results were assessed using Ponseti’s score. The average Ponseti’s score was 87.2 (range 49 – 98). Two feet out of 33 had recurrence of all the deformities. There were 27 good to excellent results. The most common problem was terminal restriction of dorsiflexion, but most of the patients were happy with the results. We believe that our treatment is safe, simple, giving satisfactory results in more than 80% and with minimal complications. The results are maintained over a long follow up period. We think that this modified approach helped reduce one of the common deformities to recur.