In the belief that many of the barriers that patients face when deciding upon an ankle or hindfoot fusion procedure stem from inadequate information about the procedure and its outcomes, the novel concept of a “Fusion forum” has been developed: a nurse-led informal group meeting to facilitate patients’ understanding and perception of fusion procedures. The aims were to provide more in-depth information than it is possible to deliver during the limited time of an initial doctor-patient consultation, to get the patient to meet and question a guest (an expatient who has previously had a fusion procedure) and to allow patients time to reflect upon their choices.

The value of the fusion forum has been evaluated by a questionnaire which was completed by the first 48 patients who attended the forum. 96% (46/48) of respondents felt that the quality of information that they were given was excellent or good. No respondent thought that the information was unsatisfactory. Patients were asked how valuable they had found meeting the guest. Four patients did not respond to this question. All of the respondents thought that meeting another patient who had already undergone the procedure was excellent or good

The mechanics of setting up a foot and ankle fusion forum is discussed, along with the lessons learnt from the first cohort of patients. This process has been found to greatly increase patient understanding of arthrodesis. It has been found during the consent process in pre-admission clinic that patients demonstrate a more in-depth understanding of the operative procedure, a more comprehensive knowledge of what the whole process involves, as well as the relative risks and benefits and the expected time of recovery.

Introduction: The Distal metatarsal articular angle (DMAA) is a radiographic measure of orientation of the first metatarsal articular surface, it is frequently used in the management of hallux valgus. There is a great deal of conflict regarding accuracy, reproducibility and validity of the DMAA within the literature. This study aims to test the validity of the measurement of the DMAA from standard radiographs, to explore the trigonometric relationship of first metatarsal rotation and the DMAA and to assess inter-observer reliability.

Materials/Methods: 34 seperate dry cadaveric first metatarsal bones were mounted onto a customized light-box/protractor allowing controlled incremental changes in rotation and inclination. A series of 39 digital photographs were taken of each metatarsal in 5 degree increments of rotation between 30 degrees supination and 30 degrees pronation and 10, 20 and 30 degrees of inclination. Three reviewers performed blinded DMAA measurements from each image; the data was collated for statistical analysis.

Results: The data was analysed using a mixed effects linear model comparing the DMAA with rotation of the first metatarsal. A strong statistically significant trend of increasing score with increasing pronation is observed, the relationship of which is approximately linear. There is a strong effect of inclination, but the strength of this varies with rotation this is amplified at higher inclinations. Inter-observor error was noted in line with other studies, the linear relationship is maintained.

Discussion: This study has shown that the distal metatarsal articular angle varies significantly, in an almost linear pattern, with axial rotation of the first metatarsal. Inclination of the first metatarsal is also shown to affect the magnitude of the angle.

This study does not refute the distal metatarsal articular angle as an entity, but does confirm the inaccuracy of extrapolating the DMAA from plain AP radiographs.

Aims: To compare incidence of abductor dysfunction using two direct lateral approaches, a more conventional approach and a new modified approach that reliably identifies and separately detaches gluteus minimus from the greater trochanter to allow its subsequent secure repair. Methods: We followed-up 73 patients who had undergone total hip arthroplasty by a single senior surgeon using one of two direct lateral approaches. With the more conventional approach (33 patients) medius and minimus were not reliable detached separately from the trochanter; minimus was either detached en mass with the anterior half of medius or detached during capsulotomy/capsulectomy. The new modified approach (40 patients), developed after careful study of the anatomy of the attachments of the glutei, involved division of the anterior half of medius leaving a 1 cm cuff of tissue attached to the trochanter and allowed reliable identification and separate detachment of minimus. Stay sutures were used in a novel way to achieve a more secure reattachment to try and reduce the risk of failure of the repair. Abductor function was assessed by Trendelenberg testing at 1-year post-arthroplasty. Results: The incidence of abductor dysfunction was 12% with the more conventional approach and 2.5% with the new modified approach. Conclusions: A significantly reduced incidence of abductor dysfunction occurred with our new modified approach and we believe this provides evidence for the importance of separate identification of gluteus minimus and its careful reattachment in ensuring good abductor function.