Introduction: In September 2007, the Health Service Executive implemented a new employment control policy, due to budgetary constraints. The health ministry and the HSE state that there are no adverse effects on patient care as a result of implementing this policy. In our regional orthopaedic unit, these cutbacks resulted in closure of 12 orthopaedic beds and consequently, a loss of a minimum of 40 joint replacements per month. Most of these patients are having their replacements carried out under the NTPF scheme at a rate, which is three times the local cost.

Aim: The aim of this study was to evaluate the impact of bed closure and consequent reduction in elective orthopaedic workload on a regional orthopaedic unit.

Materials and Methods: A comparative review of elective joint arthroplasty was undertaken with regard to theatre workload, length of time on waiting lists and referrals to the national purchase treatment fund from September 2007 to December 2007. This data was compared with same timeframe in 2006.

Results: Since the implementation of the HSE policy, the elective bed capacity was reduced by 66%. Elective joint replacements performed from September–December 2007 have reduced by 72 patients (109 to 37) compared with the same timeframe in 2006, a reduction in workload of 66%. 107 patients added to waiting list since bed closures, which constitutes a 6-fold increase in time on waiting list.

Conclusion: Following the recent implementation of the HSE policy in September 2007 we have objectively quantified a significant negative impact on elective orthopaedic services in our unit. This false economy also has a negative impact on training opportunities as only more urgent and complex cases are performed in the public sector, while routine cases are carried out in the private sector. Should this trend continue, the impact on surgical and hence future patient care may be detrimental to the public health care system in Ireland.

Introduction: Distal radius metaphyseal fractures in children are not uncommon, but when they occur proximal to the insertion of the pronator quadratus muscle, reduction and maintenance of reduction can be challenging. The deforming forces at the fracture site result in pronation and shortening of the distal fragment. Manual manipulation of this fracture often results in tearing of the dorsal periosteum and hence renders this fracture highly unstable.

Aim: We present a novel easily reproducible mini-open surgical technique and functionally and radiologically evaluate a series of eleven patients who have undergone this technique.

Materials and Methods: The surgical technique consists of a mini-open intrafocal image intensifier guided reduction technique with percutaneous k-wiring fixation. Five males and six females with an average age of 8.8 years (range 5 to 13 years), who sustained a pronator quadratus distal radius fracture and subsequently underwent this surgical technique from 2005 to 2007, were evaluated both radiologically in terms of radial length, radial tilt and volar tilt compared with the contralateral limb and functionally using the Mayo Modified wrist score and the patient related wrist evaluation questionnaire.

Results: Patients were followed up for an average of 18 months (range 2–31 months). All patients achieved clinical and radiological union. No patient required remanipulation for loss of reduction. Radiological outcome measures similar to contralateral limb with good functional scores. No complications were noted. All patients returned to preoperative level of function

Conclusion: This minimally invasive technique has been shown to be technically easy, reliable and reproducible with excellent results and low risk of displacement compared to other techniques used to treat this potentially challenging fracture.

The purpose of this study was to evaluate functional outcome in patients with combined pelvic and acetabular fractures and to identify factors associated with outcome. One hundred and fifteen patients were identified. 63% were male; mean age was thirty-seven years; mean ISS was thirty. Three patients died from their injuries. At a mean follow-up of 3.5 years, patients exhibited profound functional deficits compared to the normal population. Those with an acetabular fracture involving the posterior wall or an associated lower extremity injury have a particularly poor prognosis. Combined pelvic and acetabular injuries are associated with high mortality and functional morbidity irrespective of treatment.

To evaluate functional outcome in patients with combined pelvic and acetabular fractures and to identify factors associated with outcome.

Combined pelvic and acetabular injuries are associated with high mortality and functional morbidity irrespective of treatment.

These results will allow us to further investigate which injury is dictating prognosis in the combined injury – the pelvic or the acetabular fracture.

One-hundred and fifteen patients with combined pelvic and acetabular injuries were identified at a level One trauma centre. 63% were male; mean age was thirty-seven years (13–88); mean ISS was thirty (16–75). Three patients died from their injuries. 16% involved bilateral pelvic fractures; 7% bilateral acetabular fractures; and for 2%, both were bilateral. 64% were Tile B and 34% were Tile C. Most acetabular fractures involved the anterior column or both column. Only 18% were treated with ORIF for both injuries. 25% had ORIF of their acetabulum and 14% had ORIF on their pelvis. Sixty-five patients completed validated functional outcome questionnaires at a mean follow-up of 3.5 (one to eleven) years. Patient function was significantly compromised with a mean MFA score of 33.8 (SD 21.8). Function was worse for all 8 SF-36 domains and the two component scores compared to the health status of the Canadian normal population (p< 0.001). Those individuals with an acetabular fracture involving the posterior wall or an associated lower extremity injury have a particularly poor prognosis. There was no relationship found between treatment or the pre-defined stability groups and functional outcome.

Funding: Grant funded from AO/ASIF

The purpose of this study was to evaluate functional outcome in patients with combined pelvic and acetabular fractures and to identify factors associated with outcome. One hundred and fifteen patients were identified. 63% were male; mean age was thirty-seven years; mean ISS was thirty. Four died from their injuries. Five patients had open injuries. Only 18% were treated with ORIF for both injuries. At a mean follow-up of 3.5 years, patients with combined pelvic and acetabular fractures exhibit profound functional deficits compared to the normal population. Combined pelvic and acetabular injuries are associated with high mortality and functional morbidity irrespective of treatment.

The purpose of this study was to evaluate functional outcome in patients with combined pelvic and acetabular fractures and to identify factors associated with outcome.

Combined pelvic and acetabular injuries are associated with high mortality and functional morbidity irrespective of treatment. Those individuals with an acetabular fracture involving the posterior wall and an associated lower extremity injury have a particularly poor prognosis.

Individuals who have sustained high energy combined injuries exhibit profound functional impairments compared to the general normal population even in the long term.

One hundred and fifteen patients with combined pelvic and acetabular injuries were identified using a trauma database at a level one trauma centre. 63% were male; mean age was thirty-seven years (13–8); mean ISS was thirty (9–5). 16% involved bilateral pelvic fractures; 7% bilateral acetabular fractures; and for 2%, both were bilateral. 64% were Tile B and 34% were Tile C. Most acetabular fractures were anterior column (31%) or both column fractures (26%). Only 18% were treated with ORIF for both injuries. 25% had ORIF of their acetabulum and 14% had ORIF on their pelvis. Sixty-five patients completed functional outcome questionnaires at a mean follow-up of 3.5 years (1–21). Function was significantly compromised with a mean MFA score of 33.8±21.8. Function was worse for all eight SF-36 domains and the two component scores compared to the Canadian normal population (p< 0.001). There was no relationship found between severity of pelvic or acetabular injury and patient function nor between treatment and functional outcome.

Funding: Grant funded from AO/ASIF

58 patients underwent treatment for Slipped Upper Femoral Epiphysis (SUFE) at our unit from 1984 to 2001. 4 (7%) patients had bilateral SUFE at the time of primary admission, 17 (29%) patients were diagnosed with a slip of the contralateral hip at review during adolescence. The remaining 37 patients whose contralateral hips were not operated upon at completion of growth were reviewed at an average follow-up of 8 years (range 2–17) after the primary admission. 13 patients were not available for review, so 24 patients were examined and their hips radiographed.

Iowa hip score was used to assess the function of the hips, Antero-posterior and lateral radiographic views were taken to look for evidence of epiphyseal slip and degenerative joint disease. The Calcar Femorale was used as a radiographic landmark to check for a slip. Ahlback’s score was used to grade osteoarthritis.

4 out of 24 patients at the follow-up examination showed displacement of the contralateral femoral head that was greater than 3 standard deviation and was consistent with previously unrecognised physiolysis. 4 contralateral hips showed evidence of butteressing at the site of physeal reminence but the displacement was less than 3 standard deviations and so they were not considered to have slipped. 3 of these hips with buttressing had evidence of Grade I osteoarthritis. Overall incidence of bilateral SUFE in our study, excluding the 13 patients who were not available for follow-up was 25 out of 45 (55%).

This real existence of unrecognised contralateral slip, the increased risk of OA in these hips and significant rate of bilaterality, stresses the need to readdress the current mode of management of the contralateral hips in patients treated for unilateral SUFE.

Percutaneous fixation of syndesmosis is an accepted treatment of isolated Weber C fractures of the ankle. However, the status of syndesmosis after removal of the screws has never been studied to our knowledge. We studied eight patients for any residual diastasis and its clinical significance. CT scan was used to study the residual diastasis of syndesmosis after the removal of screws by comparing with the normal side. Patients were clinically assessed using Maryland and International Foot Scoring systems. The talocrural angles were measured and were compared with the normal side.

Ten patients of isolated Weber C fractures were treated with percutaneous application of syndesmotic position scres from November ’97 to July ’99. Eight were available for follow up and two were lost to follow up. The average follow up was 427.9 days (14.26 months) with a range 167–744 days. There were 7 males and 3 females. The average age was 32.2 years (range 17–66). Left side was involved in 6 cases and right side in 4. The scres were removed after an average period of 78.3 days (11.8 weeks) with a range of 45–189 days.

All patients were found to be having diastasis ranging from 1 mm to 3 mm with an average of 2.06 mm. The Maryland score ranged from 76 to 100 with an average of 90. The international score ranged from 78 to 100 with an average of 87.62. The diastasis roughly paralleled with the Foot scores.

All patients who had percutaneous fixation of syndesmosis had residual diastasis following removal of the screws and this may be clinically significant.

Ulceration of the insensitive foot continues to cause great morbidity in diabetic patients. We treated 46 patients with neuropathic ulceration by applying total contact casts. Most neuropathic ulcers healed within six weeks but ischaemic ulcers did not heal. One patient developed gangrene and required partial amputation of the foot.