This study aimed to describe the morphology of the coracoid process and determine the frequency of commonly observed patterns. The second purpose was to determine the location of inferior tunnel exit with superior based tunnel drilling and the superior tunnel exit with inferior based tunnel drilling.

A sample of 100 dry scapulae for the morphology aspect and 52 cadaveric embalmed shoulders for tunnel drilling were used. The coracoid process was described qualitatively and categorized into 6 different shapes. A transcoracoid tunnel was drilled at the centre of the base. Twenty-six shoulders were used for the superior-inferior tunnel drilling approach and 26 for the inferior-superior tunnel drilling approach. The distances to the margins of the coracoid process, from both the entry and exit points of the tunnel, were measured.

Eight coracoid processes were of convex shape, 31 of hooked shape, 18 of irregular shape, 18 of narrow shape, 25 of straight shape, and 13 of wide shape. The mean difference for the distances between superior entry and inferior exit from the apex was Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation 3.65+3.51mm (p=0.002); 1.57+2.27mm for the lateral border (p=0.40) and 5.53+3.45mm for the medial border (p=0.001). The mean difference for the distances between inferior entry and superior exit from the apex was 16.95+3.11mm (p=0.0001); 6.51+3.2mm for the lateral border (p=0.40) and 1.03+2.32 mm for the medial border (p=0.045).

The most common coracoid process shape observed was a hooked pattern. Both superior to inferior and inferior to superior tunnel drilling directed the tunnel from a more anterior and medial entry to a posterior-lateral exit. Superior to inferior drilling resulted in a more posteriorly angled tunnel. With inferior to superior tunnel drilling cortical breaks were observed at the inferior and medial margin of the tunnel.

Purpose of the study:

Recent literature raised concern on the adverse effects, incidence of pseudo tumours and raised blood and urine Chromium and Cobalt levels in patients with a metal on metal articulation. The purpose of this study was to follow up a cohort of patients that received a metal on metal total hip replacement with minimum follow up of ten years and to compare the results with the literature.

The Versajet Hydrosurgery system (Smith & Nephew) offers a unique way of performing debridement using a high pressure fluid jet parallel to the surface to draw devitalised soft tissues into a cutting chamber for excision and evacuation.

The Versajet™ Hydrosurgery system (Smith & Nephew) offers a unique way of performing debridement using a high pressure fluid jet parallel to the surface to draw devitalized soft tissues into a cutting chamber for excision and evacuation. The aim of this study was to assess the outcome of the Versajet hydrosurgery system in the treatment of Gustilo and Anderson grade III A and III B open tibial fractures using a pilot scale prospective randomized controlled trial against conventional surgery. The primary variable was the total number of debridements until wound closure.

A total of 40 patients were recruited: 16 patients Versajet Plus™ (Smith & Nephew) hydrosurgery vs patients 24 standard surgical debridement. Baseline characteristics were well balanced with respect to the age, mechanism of injury, contamination, wound area, depth, and displacement of the bone. There was some imbalance between treatment groups where more (68.8%) Versajet patients had III A classification; vs. (37.5%) standard surgical debridement patients.

The number of debridement procedures before wound closure was for Versajet: 1 debridement procedure for 11 patients (69%), 2 for 3 patients (19%) and 3 for 2 patients (12.5%). For standard surgical patients: 1 debridement procedure for 1 patient (4.3%), 2 for 19 patients (83%) and 3 for 3 patients (13%). There was significant evidence (p<0.001) that Versajet patients required fewer debridement procedures than standard surgical debridement prior to wound closure (ratio Standard: Versajet=1.747). There was no evidence that the number of debridement procedures to achieve wound closure differed between the Gustilo and Anderson grade IIIA and grade IIIB classifications (p=0.692). The median time to wound closure was 3 days (95% CI 3 days, 5 days) for Versajet and 5 days (95% CI 4 days, 8 days) for standard surgically debrided wounds, but the difference was not statistically significant (p=0.275). There was no evidence (p=0.397) of a difference in the total number of surgical sessions (debridement or debridement with closure) required to close the wound (ratio Standard: Versajet=1.040; 95% CI (0.950, 1.137). There were no instances of post operative infection.

This pilot study has shown that on average only a single Versajet Plus hydrosurgery debridement is needed before IIIA or IIIB wounds are ready for closure and there is a trend (not significant) towards the possibility of earlier closure following the use of Versajet compared with standard surgery.

This prospective study was conducted to evaluate patient satisfaction and survival rate after metal-on-metal (MOM) THA.

A single surgeon operated on 13 young active patients. Follow-up was for 3 to 5 years and included radiological and clinical examination. Hip scores were assessed preoperatively and postoperatively.

Postoperative complications included one case of DVT, one case of heterotopic ossification and one periprosthetic fracture.

Although these are only short-term results, they correlate well with longer studies and confirm that MOM THA gives satisfactory results in young and more active patients.