There is no consensus on the management of TA rupture. For operative management, TA have been repaired under general/spinal anaesthetic (GA) or LA. LA repair may be at least as effective and can reduce anaesthetic complications. LA can be performed as a day case and could have significant cost savings.

We retrospectively reviewed 80 patients (sample size 120), during the five year period 2001–2005 at Nelson Hospital, who’s ruptured TA was repaired under general anaesthetic (GA) or local anaesthetic (LA). All patients reviewed were at least six months post-op. We assessed at a clinic their long-term outcome, including pain and function. This included their range of motion and strength. Epidemiological data including risk factors was collected. Patients completed a Foot and Ankle questionnaire developed by the American Academy of Orthopaedic Surgeons. Complications such as infection or nerve damage were noted. Further patients are currently being seen to increase sample size.

Of the 80 TA that were repaired, 51 (64%) were repaired under GA, 29 (36%) under LA. Results thus far show similar levels of patient satisfaction. 82% of GA patients and 83% of LA patients reported no pain. Patient-reported weakness was 27% (GA) and 24% (LA). Single leg hop distance comparing injured with uninjured was 94% (GA) and 91% (LA). Maximum calf raises in 30 seconds comparing injured with uninjured was 84% (GA) and 82% (LA). Calf diameter on the injured side was 97% (GA) and 96% (LA) compared with the uninjured. The average theatre time was 38 minutes (LA) compared with 65 minutes. LA patients spent on average 0.26 days in hospital compared with 1.2 days, reflecting a greater proportion of day cases. LA patients had a quicker return to work, average 21 days versus 30. Complications in the GA group, included two deep vein thromboses and two pulmonary emboli. One patient from each group had a re-rupture. Results will be reviewed and further statistical analysis done once further patients have been seen.

There is no disadvantage in repairing a ruptured TA under LA with regards to long-term pain, function and patient satisfaction. LA repair avoids anaesthetist involvement and anaesthetic complications. Repair under LA results in significant cost savings due to less theatre time, a shorter hospital stay and a quicker return to work.

The aim of this study was to evaluate a new joint arthroplasty clinical priority scoring tool.

A new arthroplasty scoring tool based on pain, function, social limitation, potential of benefit from surgery and consequence of more than 6 months delay was developed and evaluated using 16 patient scenarios (vignettes) related to hip and knee osteoarthritis. Sixteen orthopaedic surgeons were asked to score the vignettes using clinical ranking, ISS tool and the new tool.

Significant variation in ranks allocated by surgeons was recorded for all three tools. Vignettes at either end of the scale ie. those who are severely or minimally disabled had less variability compared to a large group in the middle range. Comparing the three tools there did not appear to by any advantage of one over the other. Most of the variations occurred in the interpretation of benefit from the operation and consequence of delay.

Scoring tools rely heavily on judgement based decisions. More work is required to understand judgement processes used by surgeons and audit/feedback mechanisms may help in reducing the variations in priority assignment.

This study explores the outcomes of a pilot project involving five Orthopaedic services in developing approaches to improve the consistency and equity of clinical decision-making for access to treatment.

The pilot was conducted in two phases; the first involved development of retrospective and prospective data collection and analysis tools including use of:

The Orthopaedic Integrated CPAC tool:

Large variations in internal equity were found within most services. Additionally a significant, systemic equity issue is apparent between patients prioritised for major joints versus other conditions. The pilot has made useful progress in developing improvement tools and processes targeting electives service management, improvements in prioritisation and clinical decision making, and funding and planning decisions. The pilot has also raised issues for further CPAC development and national service policy.

The aim of this retrospective study was to assess the long-term results (minimum ten years) following treatment of medial compartment osteoarthrosis of the knee with high tibial osteotomy using a simple, reproducible technique with minimal internal fixation and early mobilisation.

Between 1980 and 1993, seventy-five lateral, closing wedge osteotomies were performed in sixty-five patients by a single surgeon (ALP). A lateral approach was utilised, with stabilisation achieved using two staples and no use of external splints. Twenty-three patients had died prior to this review (twenty-six knees) and the remaining forty-two patients were invited to attend for independent review. The patients were assessed using the Knee Society Knee Score, Tegner and Lysholm activity score, a patient self-assessment questionnaire and radiological review.

The average age of the patients at surgery was sixty-two years (range twenty-six to seventy-seven years), reviewed between ten and twenty-three years (average seventeen years) following the procedure. Results will be presented with end-points of conversion to arthroplasty and patient dissatisfaction and complications discussed. There were no major complications observed during conversion to total knee joint replacement.

The current role of high tibial osteotomy for the treatment of medial compartment osteoarthrosis will be discussed.

A review of 61 patients with dislocation of the lunate (some with and some without fracture of the scaphoid) showed that the majority had satisfactory results at an average follow-up of three and a half years. Most patients with a simple dislocation had a good or satisfactory result; radiological instability was noted in a quarter of the wrists but was not often associated with symptoms. Two-thirds of the patients with an associated fracture of the scaphoid had a good or satisfactory result. Immediate percutaneous wire fixation of the reduced scaphoid, whether it is fractured or not, is the best way of maintaining normal anatomical relationship while the ligaments and fracture heal; this may further improve the prognosis. In most cases extreme dorsiflexion of the wrist appeared to be the mechanism of injury.

Children with congenital focal deficiency of the proximal femur present many problems that are but rarely encountered by the individual surgeon who is thus unable to accumulate a wide experience. This paper reviews the literature and analyses the treatment of twenty-three cases at the Royal Children's Hospital, Melbourne, with the object of producing a rational plan of treatment. The management of instability of the hip, malrotation, inadequate proximal musculature and leg length inequality are separately considered for five grades of deficiency. Milder forms are amenable to subtrochanteric osteotomy to correct varus deformity. Exploration and grafting of the pseudarthrosis is indicated where progressive deformity develops. In the more severe deficiency, conservative management of the proximal bony defect provides a better result with an operation only rarely indicated. The gross leg length inequality may be most successfully overcome by Syme's amputation with subsequent fusion of the knee to create an above-knee amputee with an end-bearing stump allowing ready fitting of a prosthesis.