Aim: To study mRNA expression in ruptured biceps tendon.

Methods: Our study was carried out in the University College of Medicine. We took the biceps tendon of 5 patients who had traumatic ruptures. The age of the patients ranged from 35–53. The tendons were processed for RNA isolation and reverse-transcription-polymerase chain reaction (RT-PCR) carried out in order to investigate the mRNA gene expression in ruptured biceps tendon of extra cellular matrix (ECM) components (e.g. proteoglycans and collagens); ECM degradative components (e.g. aggrecanases and MMPs); inflammatory components (e.g. cytokines and cyclooxygenases); and factors involved in the apoptotic response.

Results: Our results showed that in the samples of ruptured biceps tendon there was a good mRNA expression of ECM structural components, especially aggrecan and the small proteoglycans biglycan and decorin. Interestingly, these samples also showed a high expression for the enzymes commonly involved in articular cartilage degradation and turnover, the aggrecanases (ADAMTS-4 and –5) and the matrix metalloproteinases (MMP-3 and –13). As has been recently reported for Achilles tendon rupture (Cetti et al, 2003), an inflammatory reaction was also observed in these ruptured bicep tendons with expression of the inflammatory cytokines IL-1α and TNFα and the enzyme cyclooxygenase-2.

Conclusion: We know clinically that patients can rupture their biceps tendon either due to trauma if not due to degenerative conditions. In our study we wanted to know if the subset of patients who ruptured their tendons traumatically had any pre-existing degenerative conditions leading on to the rupture compared to the normal subjects. Interestingly our study has shown that there is mRNA expression of degradative enzymes (aggrecanases and MMPs) in the samples of ruptured biceps tendon. Whether these mRNA levels equate to increased enzyme activity of these molecules warrants further investigation. Furthermore, our samples also showed mRNA expression for factors involved in the inflammatory response. In conclusion, mRNA expression of the factors involved in degradation and inflammation may suggest a phenotype that predisposes the bicep tendon to rupture, although further studies are required in order to investigate this further.

Aim: To ascertain the accuracy of partial weight bearing.

Method: 6 healthy volunteers with a below knee plaster cast, 10 patients with uncemented hip replacements and 12 patients with lower limb fractures were trained to partial weight bear. They were asked to place the affected leg on a bathroom scale and to press on it till the prescribed limit. This process was repeated till the subject formed a mental image of the amount of load they must put through the limb. The ability to partial weight bear was tested in a gait lab by making them walk on a walkway incorporating a Bertec force platform. Exact magnitude of weight bearing was calculated from the vertical ground reaction forces produced.

Results: 4 out of 6 volunteers exerted mean weight of 20.3 kg above and the remaining 2 exerted 5.6 kg below that prescribed. Of the 22 patients, 19 exerted mean weight of 24.3 kg above and 3 patients exerted mean weight of 7.5 kg below that prescribed. As per Spearmanñs rank correlation test, the relationship between the prescribed weight bearing and the actual weight bearing was non-signiþcant (p=0.399) i.e., there is little relationship between the prescribed and actual weight bearing.

Conclusions: Neither patients nor healthy volunteers could partial weight bear to the extent required. They were either above or below the prescribed level of partial weight bearing. Current method of teaching partial weight bearing is inaccurate and has poor reproducibility. Such methods use static loading situations whereas walking is a dynamic activity. An inexpensive, easy to use, dynamic device is required to train patients to partial weight bear.

Aims: Neutrophil (PMN) dysfunction is implicated in both acute respiratory distress syndrome (ARDS) and sepsis. We aimed to determine the PMN response following isolated long-bone/pelvic fracture by investigating temporal changes in PMN migration and surface receptor expression (CXCR1, PECAM- 1, & CD18/ CD11b) following injury. Methods: Of the 20 patients consented to enter the study, 14 underwent reamed nailing/ORIF within 24 hours, and 6 were treated with an Ex-Fix or conservatively. 11 normal volunteers (NLV) were used as controls. Blood samples were obtained within 2 hours of admission, at 24 hours, at day 3 and day 5. PMN were isolated and the number of PMN migrating across porous collagen IV coated tissue culture inserts, in response to IL-8 were quantitated by myeloperoxidase activity. PMN surface receptor expression was assessed by whole blood FACScan analysis. Results: Signiþcantly greater numbers of fracture patient PMN migrated on admission as compared with NLV. In the Ex-Fix group the numbers migrating declined steadily and showed a hypo-response on day 5. In the reamed nailing group there was a further elevation in the PMN numbers migrating post-operatively. CXCR1 & CD18 expression was signiþcantly increased on admission. PECAM-1 was signiþcantly down-regulated on admission.

Conclusions: Following isolated long-bone/pelvic fracture PMN are primed for increased migration in response to IL-8. This is associated with up-regulation of CXCR1 and CD18, and down-regulation of PECAM-1. Treatment by reamed nailing and ORIF confers a Ç second hit È manifest as a further increase in IL-8 mediated PMN migration.

We reviewed 25 patients with rheumatoid arthritis who had failure of 26 primary total elbow arthroplasties causing pain and loss of function. Most revision cases required special custom implants to treat varying bone loss and soft-tissue disruption. Assessment showed satisfactory functional results in the patients treated by revision at a mean follow-up period of 35 months. Our review suggests that revision surgery produces short- to medium-term painfree function, and is the treatment of choice for a failed total elbow arthroplasty in the absence of infection.

We performed arthrodesis of the ankle in eight patients by arthroscopic joint excision and fixation with crossed tibiotalar compression screws. Two patients had rheumatoid arthritis and six had post-traumatic osteoarthritis. None had a serious deformity of the ankle. Clinical ankylosis was achieved in all cases and there was radiological evidence of bone fusion in four.

We reviewed the long-term results of the Dillwyn Evans procedure for club foot in 60 feet of 45 patients with an average age of 29 years, using four different scoring systems. The results at 12 to 38 years were compared with those of an earlier study of the same group of patients. Function was satisfactory in 68% of feet; 90% of the patients were able to perform all desired activities. Mild residual deformity was compatible with satisfactory function, and poor function was related to ankle and subtalar stiffness. Our results suggest that this procedure has a low rate of deterioration and degenerative change with time.