Hallux valgus is a common condition and surgical correction has remained a challenge. Scarf osteotomy with Akin procedure is well accepted method. Akin procedure gives spurious correction of the distal alignment of big toe. This study was performed to see alternative way to get best correction without additional phalangeal procedure. Senior author used innovative Y-V medial capsulorraphy with standard Scarf osteotomy. This technique allows reduction of MP joint along with correction of pronation deformity and reduction of sesamoids.

We report the use of a modified Y-V medial capsular repair in association with Scarf osteotomy for Hallux valgux in 45 patients (55 feet) aged 18 to 76 years (mean 43 years) between October 2004 and December 2005. Clinical follow up was both subjective and objective. Patients were asked about rating of their satisfaction and objective assessment was done in form of AOFAS score. Using this technique none of the patients required an additional proximal phalangeal osteotomy with metatarsal osteotomy. At six months follow up American Orthopaedic Foot and Ankle Society score improved from 46 to 87. Intermetatarsal (IM) angle and the hallux valgus (HV) angle improved from 16° to 9° and from 31° to 16° respectively (p< 0.05). At final follow up 8 patients were very satisfied, 12 were satisfied while 5 were not satisfied.

Of the 55 procedures 51 did not develop any complications. Two had superficial infections, treated successfully with oral antibiotics only. Two patients had recurrence, one was treated with Akin and second patient declined surgery as she was not bothered with it.

We recommend the use of this modified ‘Y-V’ medial capsular repair to reduce the need for an additional procedure to augment the correction achieved during Scarf osteotomy for hallux valgus. This reduces hallux valgus angle and maintains it.

Introduction: Cementing technique is one of the important factors which determines the longevity of cemented joint replacements. There are a number of variables which determine good cementation. We hope to standardise one of the variable which is cement working and setting time.

Methods: Cement was stored in a controlled temperature refrigerators at 20 degree centigrade and brought out just before mixing.

Theatre temperature, cement mixing start time and time at which cement was set were recorded for 20 hip and knee replacements. These recordings were also done for 20 hip and knee replacements where cement was stored in the theatre and was used as a control.

Results: Cement stored in the controlled temperature refrigerator had a more predictable working and setting time as opposed to controls.

Discussion: Cement stored in the controlled temperature refrigerator eliminates one of the variables in cemented arthroplasty and may prevent complication which could occur if cement sets unpredictably.

The authors report the use of a modified ‘Y-V’ medial capsular repair in association with Scarf osteotomy for Hallux valgus in 55 patients (62 feet) aged 18 to 61 years (mean 43 years) between July 2004 and July 2005. All patients were followed up for minimum 6 months by questionnaire, physical examination (American Orthopaedic Foot and Ankle Society score) and comparison of preoperative and post operative x rays.

Using this technique none of the patients required an additional proximal phalangeal osteotomy (Akin Oste-otomy). At six months follow up American Orthopaedic Foot and Ankle Society score improved from 46 to 87. Intermetatarsal (IM) angle and the hallux valgus (HV) angle improved from 16 degree to 9 degree and from 31 degree to 16 degrees respectively (p less than 0.05).

Of the sixty two procedures 59 did not develop any complications. Two had superficial infections which required oral antibiotics only. One partial loss of correction of hallux valgus occurred for which the patient refused a second operation. Seven cases had some residual pronation deformity of the big toe identified by the patients who felt the deformity was ‘about 50%’ compared to before the operation.

Akins osteotomy achieves an apparent correction of hallux valgus without addressing subluxation of meta-tarso-phalangeal joint. Our technique reduces the meta-tarso-phalangeal joint and corrects the hallux valgus angle anatomically.

We recommend the use of this modified ‘Y-V’ medial capsular repair to correct the hallux valgus angle and reduce the need for an additional procedure to augment the correction achieved during Scarf osteotomy for hallux valgus.

We wish to report the use of a modified ‘Y-V’ medial capsular repair in association with Chevron osteotomy fixed rigidly with Barouk screw for Hallux valgus in 45 patients (52 feet) aged 16 to 70 years (mean 47 years) between July 2004 and September 2005. All patients were retrospectively reviewed by questionnaire, physical examination (American Orthopaedic Foot and Ankle Society score) and comparison of preoperative and post operative x rays.

Using this technique none of the patients required additional immobilization apart from wool and crepe bandage following surgery. All osteotomies healed without any problem. There was no deep infection reported in this series. There were two superficial infection treated with oral antibiotics. There is no recurrence of deformity so far. At an average of six months follow up American Orthopaedic Foot and Ankle Society score improved significantly. Intermetatarsal (IM) angle and the hallux valgus (HV) angles were also improved considerably.

Stabilization of Chevron osteotomy with k wires, plaster of Paris is well known but these techniques have problems of infection and stiffness. Osteotomies carried out without any stabilization has high recurrence rate. Fixation of osteotomy with Barouk screw is a very simple procedure, which not only gives stability and compression to osteotomy but also reduces need for any plaster immobilization thus speed up rehabilitation. This also gives extra confidence to surgeon to allow patient for early weight bearing and mobilization.

We also recommend the use of modified ‘Y-V’ medial capsular repair to correct the hallux valgus angle and reduce the meta tarso-phalangeal joint leading to reduction in possibility of recurrence.

We retrospectively reviewed 19 femoral non-unions. Age group ranged from 17–72 yrs with mean of 40 yrs. 12 were men and 7 were women. 11 fractures involved diaphysis and 8 involved supracondylar area. 5 cases were infected non-unions. Time from fracture to defini-tive treatment varied from 5 to 88 months (mean 21 months). Open technique was used in 18 cases. In 8 cases we have used autogenous cancellous bone graft and in 3 cases BMP7 was used in addition to bone graft. 9 cases were treated with Ilizarov frame without bone graft, 6 with plate & bone graft, 3 with intramedullary nail and 1 with bone graft alone. Internal bone transport was carried out in 5 cases to achieve limb length equality. Fracture union was achieved in 16 patients with 7 excellent and 8 good results as per ASAMI criteria. 15 cases achieved excellent to good functional results. Because of persistent infection, 2 distal femoral non-unions required transfemoral amputation. Treatment was discontinued due to psychiatric illness in 1 patient with Ilizarov frame. Two of the patients in Supracondylar group developed knee stiffness. Pin tract infection is a common complication in Ilizarov group.

Adequate reduction & stabilization is key to success. Non-unions without any complications can be treated with exchange nail or open reduction and plating. Ilizarov method is effective for non-unions complicated by distal location, infection and bone loss. Psychological assessment is important before considering Ilizarov method of treatment.

Study Purpose To assess clinical cognitive function and measure cerebral embolic load following primary cemented hip arthroplasty.

Methods 34 primary cemented hip arthroplasty patients (mean age 69.9 (SD 11.0)0 and no history of cerebrovascular disease, underwent cognitive assessment before and after (day 4) surgery. Testing included: Verbal fluency and speed (Control Oral Word Association Test); Working memory to assess immediate and delayed recall (Weschler Memory Scale III); Attention and mental processing speeds (Colour Trails 1& 2). A one sample Wilcoxon signed rank test compared median differences before and after surgery. A sub-group of 20 patients had intra-operative transcranial Doppler ultrasound monitoring of the middle cerebral artery for embolic signals. A marker of neuronal injury (S-100B protein) was measured pre-operatively and at 0, 24 and 48 hours following surgery.

Results A significant difference was noted in Colour Trails tests 1& 2 following hip arthroplasty with P values (C.I.) of 0.002 (−21, −4) and 0.023 (−15.5, −1.0) respectively.

Using established emboli criteria 10 (50%) patients had true cerebral emboli with a range from 1 to 550 signals (median 2.5 interquartile range (IQ) 2 to 12.5). S-100B levels increased from a pre-operative median (IQ) of 0.15 microg/L (0.12 to 0.20) to a peak immediately following surgery of 1.88(1.36 to 4.24) returning to 0.26(0.18 to 0.37) by 48 hours (normal range: 0.03–0.15). Plotted scatter charts indicated no correlation between embolic load and cognitive dysfunction or with S-100B levels following surgery.

Conclusion Cognitive testing indicates deterioration in early measured attention, visual searching and mental processing speed shortly following hip arthroplasty. No direct correlation was found between cognitive dysfunction and cerebral embolic load.

Introduction: Following surgical discectomy for pro-lapsed lumbar intervertebral disc, a proportion of patients develop leg symptoms on the side contra-lateral to the original surgery. Among other causes, subsequent disc space narrowing together with on-going degenerative changes may cause root entrapment in the lateral recess or in the intervertebral canal at the level of the previous disc prolapse.

It has been previously reported that the results of discectomy are less successful in patients with pre-existing spinal stenosis. It may be argued that patients with a narrow spinal canal would be more prone to the development of contra-lateral symptoms. The aim of this study was to determine whether any measurement on the pre-operative CT scan could predict the development of contra-lateral symptoms, or provide an indication for prophylactic decompression of the contra-lateral side at the time of the original surgery.

Materials & Methods: In a retrospective cohort of 43 patients following lumbar discectomy, eight subsequently developed symptoms on the contra-lateral side of whom three required subsequent contra-lateral surgery. A relationship was demonstrated between a measurement taken on the pre-operative CT scan (the oblique sub-facet distance) and the occurrence of contra-lateral symptoms following discectomy.

Conclusion: An oblique sub-facet distance of 8mm or less predicted the development of contra-lateral symptoms with a sensitivity of 75 % and a specificity of 74%.

Aim and methods: We present our results on the treatment an outcome of femoral non-unions in our institution as tertiary referral centre. Retrospective analysis was performed using the ASAMI criteria.

Results: 19 patients, 12 men and 7 women were retrospectively assessed. Mean age was 40 years (range 17–72). 11 fractures were in the diaphysiseal area and 8 were in the supracondylar area. 5 cases were infected non-unions. Time from fracture to definitive treatment varied from 5 to 88 months (mean 21 months).

Open technique was used in 18 cases. In 8 cases we have used autogenous cancellous bone graft and in 3 cases BMP7 was used in addition to bone graft. 9 cases were treated with Ilizarov frame without bone graft, 6 with plate and bone graft, 3 with intramedullary nail and 1 with bone graft alone. Internal bone transport was carried out in 5 cases to achieve limb length equality.

Fracture union was achieved in 16 patients with 7 excellent and 8 good results as per ASAMI criteria. 15 cases achieved excellent to good functional results. Because of persistent infection, 2 distal femoral non-unions required transfemoral amputation. Treatment was discontinued due to psychiatric illness in 1 patient with Ilizarov frame. Two of the patients in supracondylar group developed knee stiffness. Pin tract infection is a common complication in Ilizarov group.

Conclusion: Adequate reduction and stabilization is key to success. Non-unions without any complications can be treated with exchange nail or open reduction and plating. Ilizarov method is effective for non-unions complicated by distal location, infection and bone loss. Psychological assessment is important before considering Ilizarov method of treatment.

Introduction and Aims: We describe the survival at 10 years of 134 consecutive JRI Furlong H.A.-coated uncemented total hip replacements.

Method: The follow-up was a minimum of 10 years (10.5–12 years). Patients were assessed by clinical and radiological means. We used Merle d’Aubigné and Postel (MDP) clinical score.

Radiological assessments identified radio-lucent lines, spot welding, pedestal formation and migration in order to assess fixation and stability of the femoral stem according to Engh’s criteria. DeLee and Charnley zones were used to assess loosening of the ace tabular cup. Subsidence, migration and cup-angle were also measured. The criteria for failure was revision or impending revision due to either pain, septic or aseptic loosening.

Results: The mean results of the MDP score were 7.4 pre-operation, and 15.9 post-operation. None of the acetabular cups in this series were revised. No femoral stem was revised for loosening. Six patients were lost to follow-up. Of the 128 femoral stems reviewed, only one was revised for periprosthetic fracture following a fall.

Aims: For the scaphoid, several views are needed to visualise the whole bone. These sets of views are routinely called “scaphoid views”. However certain views are better than others for imaging particular parts of the scaphoid. The authors believe that asking for scaphoid views from the radiology department often leads to a wide variety and number of radiographic views being taken, even when a protocol is in place. Methods: 50 radiographers from 4 London teaching hospitals were asked which and how many views of the scaphoid they would take, at initial presentation and in the outpatient setting. They were also asked to describe and demonstrate exactly how they would take the view(s) chosen. Results: We found a wide variation in the descriptive terms used by radiographers for particular views. There was also little agreement on how many and which views to take despite protocols being in place. Conclusion: Not only is their complete lack of agreement on what “scaphoid views” should be, it was also discovered that there was little agreement on the nomenclature of the individual views themselves. This can lead to loss of information from the wrong views being taken as well as unnecessary radiation exposure. The lack of nomenclature also leads to confusion between radiologists, radiographers and surgeons.

To compare hallux valgus surgery performed by orthopaedic surgeons and podiatrists within the same Health Authority, a consecutive series of 50 patients operated on within the orthopaedic department for hallux valgus was compared with a group operated on by the podiatry surgeons within the same time period.

This retrospective study was performed by analysis of the case notes and radiographs. Data was collected on patient age, sex, comorbidity, anaesthetic, surgery, surgeon grade, post-operative rehabilitation and complications. Pre and post operative hallux valgus and intermetatarsal angles were measured.

Patient demographics showed no significant difference between the 2 groups. All but one patient in the orthopaedic group had a general anaesthetic whilst regional anaesthesia (ankle block) performed by the operating surgeon was used in all cases in the podiatry group.

There were 4 different operations in the orthopaedic group (Mitchells, Chevron, bunionectomy, Wilsons) compared with 2 in the podiatry group (Scarf, Kellers). Pre-operative radiological measurements revealed comparable groups with the correction obtained better in the podiatry group (HV angle 15° vs 10°; IM angle 7° vs 4°).

There were 13 complications in the podiatry group compared with 8 in the orthopaedic group.

9 patients in the podiatry group underwent re-operation to remove metalwork whilst no patients in the orthopaedic group required further surgery.

Within our region, orthopaedic and podiatry surgeons operate on the same type of patients with hallux valgus in respect to age, sex, comorbidity and radiological abnormality. There is marked difference in the anaesthetic techniques used. Correction obtained in the podiatry group was slightly better but at the expense of a higher complication and re-operation rate.