Introduction: We studied the radiological and functional outcome in patients treated for complex femoral and tibial non unions with the Ilizarov method, specifically analysing the data for factors that may predict return to work.

Methods and Results: 78 patients were treated for femoral and tibial non-union at our institute between January 1992 and December 2003. Of these 40 patients (41 non-union) satisfied the criteria for complex non-union. 18 patients who were working at the time of injury failed to return to work and 7 had returned to work. 16 were not employed at the time of injury and were excluded from the analysis. Functional and radiological outcome was assessed using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria. The minimum follow up was 18 months after removal of the frame.

Qualitative data for age, time to Ilizarov treatment, number of surgical procedures and time to union did not differ between the two groups (Student t-test). Those returning to work were more likely to have had a hypertrophic non union (p< .025) and were less likely to be using a walking aid (p< .05). No difference was seen between the groups with regards to segment involved, smoking, NSAID use, associated injuries, previous fixation, length of bone defect, free flap coverage, presence of infection, radiological and functional score.

Discussion: Our results suggest that return to work following Ilizarov treatment of a complex non-union does not correlate with either the biology of the fracture, the time course of treatment or the final result. We hypothesise that it is likely to be related to personality traits of the patients.

Background: The measurement facility on PACS is used to aid decision making. This facility is inaccurate and does not reflect clinical parameters, rendering its use ineffectual. Previous works utilised only a single prostheses type, were under-powered and not statistically robust.

Aim: To establish and statistically analyse the reliability of PACS software for the measurement of orthopaedic parameters at a university teaching hospital.

Methods: Retrospective analysis of radiographs of 100 patients (50 hip hemi-arthroplasty, 50 intra-medullary nailing) was performed to provide a wide base and allow a comparison of the spherical implant and a nail.

Implant sizing from theatre records was compared with the post-operative films. The size of the implant on radiograph, the magnification of the exposure and the effect of further magnification was noted. Analysis of the results was by paired student’s t testing incorporating inter-observer error into the test statistic.

Results: The hip prostheses were found to be oversized (range: 7–16mm; mean: 10.9mm). This is highly significant (p=< 0.01). The nails were similarly oversized (range: 0–6mm; mean: 1.87mm). This result was significant (p=< 0.05) although the error was less than for the spherical prosthesis. This is presumed due to the nature of the implant size and the distance of the implant from the cassette during exposure.

Discussion: This study demonstrates with statistical significance the unreliability of PACS measurement software. The manufacturer was contacted and has confirmed that accurate imaging can only be obtained on a named case, calibrated image. This has implications for all orthopaedic surgeons.

Introduction: Electrolyte imbalance in the elderly is a clinical problem faced by both elderly care physicians and orthopaedic surgeons alike. The abnormalities in homeostatic mechanisms that manifest with age can have dramatic consequences for the unwary clinician. This study aims to establish the incidence of hyponatraemia within an orthopaedic population and to determine whether this is different to a control group of elderly care patients.

Methods: Retrospective, consecutive analysis of serum sodium levels of 200 patients (100 hip fracture patients and a control group of 100 elderly care patients). Serum sodium levels on admission and during the inpatient stay were recorded and analysed using student’s t-tests to establish the incidence of hyponatraemia, changes in serum sodium level during admission and differences between the two groups.

Results: Hyponatraemia was evident in a third of all admissions (Orthopaedic: 29%; Elderly Care: 33%). The admission sodium level for both groups was not statistically different (t (198) =0.70, p=0.49). There was no significant difference in the observed hyponatraemia between the two populations throughout their care in hospital (t (198) =0.64, p=0.52).

Discussion: While there is a high incidence of hyponatraemia within the elderly population, there is no difference in its incidence between the aged orthopaedic population and the general elderly population. This is seen on admission and is also shown to be independent of operative procedures and fluid management as in-patients. Clinicians must be aware of the innocuous symptoms that may herald the catastrophic and avoidable consequences of this condition.