Background

In suspected scaphoid fracture the initial scaphoid series plain radiographs are 84-94% sensitive for scaphoid fractures. Patients are immobilised awaiting diagnosis. Unnecessary lengthy immobilisation leads to lost productivity and may leave the wrist stiff. Early accurate diagnosis would improve patient management. Although Magnetic Resonance Imaging (MRI) has come to be regarded as the gold standard in identifying occult scaphoid injury, recent evidence suggests Computer Tomography (CT) to be more accurate in identifying scaphoid cortical fracture. Additionally CT and USS are frequently a more available resource than MRI.

We hypothesised that 16 slice CT is superior to high spatial resolution Ultrasonography (USS) in the diagnosis of radiograph negative suspected cortical scaphoid fracture and that a 5 point clinical examination will help to identify patients most likely to have sustained a fracture within this group.

Purpose: to determine the effect of physiotherapy following arthroscopic subacromial decompression (ASD) for impingement syndrome

Methods: 50 patient undergoing ASD with or without excision of the distal clavicle (EDC) were randomized to have physiotherapy (physio group), or mobilize as tolerated and self exercise (no physio group). Patients in the physio group had an average of 7.4 sessions of physiotherapy under the guidance of a physiotherapist. Exercises included scapula stabilizer, passive, active-assisted, active and strengthening exercises developed at the Nuffield Orthopaedic Centre in Oxford. Patients in the no physio group were encouraged to mobilize their shoulders as tolerated and were given a leaflet with shoulder exercises. Patients were followed-up by postal Oxford shoulder questionnaires at 6 weeks, 3 months 6 months and 1 year. Time to return to work was used as secondary outcome measure.

Results: Our data showed that there was a significant difference between the average Oxford shoulder scores of the two groups at 6 weeks with the no physio group doing better (physio group: 34.3 vs. no physio group: 27.4, p=0.01) No difference was found between the two groups at 3 months, 6 months and 1 year in any of the outcome measures.

Conclusion: Patients not having formal physiotherapy seemed to have done better in the first 6 weeks after surgery with physio patients catching up later resulting in no difference in the final outcome between the groups. New therapy protocols should be developed to see if outcomes can be improved, but physiotherapy may not be necessary after ASD at all.

Background: Although hip fracture is often the first presentation of osteoporosis, prophylactic measures are not routinely prescribed. Aims: To investigate whether the second hip fracture has a significant further impact on walking and social independence and to identify which patients are most likely to benefit from currently available prophylactic measures. Method: Information on walking ability and social independence was obtained approximately 3 months following discharge for 49 consecutive patients admitted with a second hip fracture. Results: Fewer patients maintained their ability to walk without the help of an able-bodied assistant after the second fracture compared with the first fracture (53% and 91% respectively p< 0.0005). A similar proportion of patients admitted from their own homes remained socially independent after the first and second fractures (64% and 54% respectively). Social independence was determined by mental status after the first fracture but by ability to walk unassisted after the second fracture. The median time to second fracture was 31 months (3–302). The median time to second fracture for patients aged 80 and below and patients without a history of recurrent falls was more than 2 years. Conclusion: The second fracture had a significant further impact on patients. Bisphosphonates given over a 2 year period can decrease the rate of hip fracture and should be given to patients who sustain a hip fracture aged 80 or less and patients who do not have a history of multiple falls. Hip protectors should be considered in other patients.