Introduction: Spinal stenosis may present as intermittent claudication and may be indistinguishable from vascular claudication as both could co exist. These patients often required expertise from both the speciality. Combined Vascular and spinal clinic after primary screening with the help of MRI scan may reduce the waiting time to the appropriate speciality.

Aim: We prospectively reviewed all the patients referred to senior author from vascular unit to assess the final outcome and evaluate whether primary to referral to vascular surgeon was unnecessary.

Study Design: Prospective study from November 2004 to May 2005

Methodology: Review of Hospital case notes – 23 patients were referred to us from one of the vascular surgeons’ unit after excluding vascular etiology as the cause of the leg pain and MRI confirmation of spinal stenosis.

Result: Mean waiting time to see the spine consultant 103 days [20–195] from the date of referral by the vascular team. The waiting time to primary referral to vascular team was 164 days [43–194]. 43.5% of the referred patients required to have spinal decompression.

Conclusion: To improve the waiting time primary physician should have access of MRI scan to delineate the pathology and combined vascular and spinal clinic may achieve waiting time target.

Introduction: Sliding screws has been described to use in hip fractures since 1950s. Failure of fixation varies from 16 – 23%. We aim to assess the effect of audit and re auditing the failure rate after introduction of the Tip apex distance concept since January 2000 to December 2004.

Methodology: We measured the tip apex distance in 161 (93 in the audit group and the rest re audit patients, 140 available for analysis. Their mean age at diagnosis 82.2 years [range 56.2–100.6 years] and male and female ratio was 1:6. Average time to Operation 1.7 days form the day of admission. The average Hospital Stay was 15.8 days

Result & discussion: We found that Patients had recorded Lag screw length 92.6mm [75–115], Side plate: 4 hole:6 hole = 4:1, Measured TAD 27.6 mm [6.3–66.4] in 140 patients,

The mean radiation time was 38.27 sec (7–71) and the dosage 0.68 Cgycm2 (0.93–2.06),

The mean Tip Apex Distance in the failed fixation group of 16 patients with cut out screw (13 in the audit group and 3 in the re audit group) is 43.05 [27.2–65.8]

Conclusion: We found the auditing and re auditing could potentially improve the surgical outcome. Although the Risk of cut out depends on many variable such as increasing age, Unstable fracture, poor reduction, high angle side plate 150deg, TAD is the stronger predictor than any other variable. This variable can be controlled by regular audit of the surgical practice.