Developments in plate technology have increased interest in the operative fixation of Colles' fracture. The vast majority of patients are treated non-operatively, yet there are few medium or long-term outcome studies.

The aim of this study was to evaluate medium-term outcome of a cohort of patients who previously received treatment in a plaster cast. 236 patients entered two previous prospective, randomised control studies comparing closed reduction techniques or plaster cast type. Both studies showed no difference in clinical or radiological outcome between groups. 43% of this cohort had a final dorsal tilt of > 10° and 44% had final radial shortening of >2mm. All patients now have a minimum follow-up of five years and 60 have died. The remaining 176 patients were contacted by post and asked to complete two validated patient-based questionnaires: a modified Patient Evaluation Measure and a quickDASH. 112 replies were received. The mean age of patients is 67 years (range 23 – 91 years). 31 patients are employed and 57 retired. 77% of patients had a quickDASH score of less than 20. 59% of patients never experience wrist pain whilst 8% of patients have daily pain.

All Patient Evaluation Measures have shown a median score of 12 or less (0=excellent, 100= terrible). The best score was for pain (median 4; IQR 2-12) and the worst for grip strength (median 12; IQR 4 – 41). No radiological outcome 5 weeks after injury correlated with any outcome score, except for dorsal tilt, which correlated with difficulty with fiddly tasks (p=0.04) and carpal malalignment which correlated with interference with work (p=0.04).

In conclusion, our results show a good functional outcome five years after non-operative management of Colles' fracture. A degree of malunion is acceptable and in the light of our results the economic impact of surgery must be evaluated.

The aim of this study was to assess patient-based outcome two years following non-operative management of displaced Colles fractures.

100 patients were evaluated at a minimum of two years after displaced Colles fracture. Fractures were reduced under regional anaesthesia and immobilised in a Colles-type cast for five weeks. The fractures were assessed radiographically by measurement of radial angle, dorsal tilt, radial shortening and carpal malalignment at the time of injury, post-manipulation, and after one and five weeks. The fractures were classified according to Frykman classification. A validated patient-based outcome questionnaire, using a visual analogue score, was used to assess outcome at the end of two years.

7 patients had died, 8 patients were unable to complete the questionnaire because of confusion and 5 were lost to follow-up. Complete outcome data were available on 80 patients.

The median age was 61 years. The median pain score was 5 (25%-2 and 75%-12, range 0–100). There was loss of reduction, with more than 5° dorsal angulation and/or 5mm radial shortening in 70% cases. We found that age had no effect on patient outcome except that patients over 50 years complained of more finger stiffness The Frykman classification was an important prognostic factor and a higher grade resulted in worse outcome in a number of areas. Dorsal angulation had no significant effect and carpal malalignment correlated with poor visual appearance. Radial angle and radial shortening were both associated with increased complaints of wrist pain and stiffness

This prospective patient based outcome study has demonstrated that patients make a good functional recovery following nonoperative management of Colles fracture. 70% of our patients had a poor radiological outcome but few reported problems with pain and function at 2 years. Extra-articular malunion due to radial angulation and shortening was common and correlated with wrist pain and stiffness at two years. Frykman classification correlated with pain and functional outcome.

Purpose: Massive rotator cuff defects are often associated with incapacitating pain and severe functional impairment and pose a difficult management problem.

Introduction: Tears of the rotator cuff are a common orthopaedic condition. The surgical treatment for such defects is varied and include simple debridement, “balanced” repair, local musculotendinous transfers, and autograft or allograft tendon grafts. This study was designed to evaluate the mid-term results of porcine dermal xenograft tendon grafts in the treatment of chronic, massive rotator cuff defects.

Method: Ten patients with a mean age of 64.9 years (46 – 80), 5 male, 5 female, with mean cuff defects of 4.5 cm, were selected from the waiting list to undergo an open subacromial decompression and grafting of the rotator cuff defect with a PDX patch. The patients were then subjected to the standard post-operative rehabilitation regime. All patients were assessed pre-operatively and at six weeks, three months, six months, and one year using the Constant score and Mini-DASH questionnaire. The study had the approval of the regional ethics committee.

Results: All ten patients were followed up and demonstrated excellent pain relief from the procedure. Pain scores improved from 6.7 pre-operatively to 13.9 at 12 months. At the same time intervals function score improved from 12.1 to 15.7, range of movement from 13.6 to 21.4, power from 5.1 to 10.9, Constant score from 39.6 to 56.9 and finally the DASH score from 26 to 17.9. There were no major post-op complications and the graft did not cause any adverse reaction. Subjective and functional results improved to six months from pre-op values, but at one year, with the exception of pain, the results were slightly less good but still improved.

Conclusion: This procedure offers an alternative method of managing massive rotator cuff tears. It simplifies the surgery with no tension on the repair and may reduce the requirement for prolonged splintage. Pain relief is excellent and there have been no reported adverse effects to the graft.

Most infections in arthroplasty are caused by staphylococci, about half being due to S. aureus. One of the most worrying aspects of this organism, and particularly of MRSA, is increasing multiple drug resistance, so that antimicrobial prophylaxis is probably already compromised. Vaccination offers a novel approach to overcome this. Detailed consideration of the pathogenesis of prosthesis–related infection indicates that a) prosthetic material rapidly becomes coated after implantation with plasma–derived conditioning film, and b) attachment of the bacteria to the conditioning film, by means of specific bacterial surface binding proteins, is an essential primary event. We hypothesise that antibodies to these binding proteins will block bacterial adhesion to the prosthesis, so reducing the incidence of infection. The aim of this research was to determine the effect of specific antibodies to two binding proteins (fibronectin - and fibrinogen–binding proteins, Fnbp and Fgbp respectively) on bacterial adherence to orthopaedic biomaterials coated with plasma conditioning film.

Antibodies to recombinant sequences of Fnbp and Fgbp were raised in rabbits. A strain of S. aureus bearing a genetically inserted fluorescent reporter (GFP) was used. Orthopaedic biomaterials (steel, titanium and PMMA) were coated with FFP–derived conditioning film, placed in a specially–designed flow cell and exposed to a flow of S. aureus for 3h. Images were captured every 15min and analysed for adherent bacteria using image analysis software. The experiment was repeated in the presence of the antibodies and the results compared.

Each antibody reduced the number of bacteria binding to all three materials by greater than 50%. Combining the two antibodies gave similar results to those when they were used individually.

These preliminary results suggest that while further research is required, vaccination aimed at blocking bacterial attachment to conditioning film on implanted prostheses might reduce the incidence of S. aureus infection in arthroplasty. If so, this would apply even to MRSA. Questions remaining to be addressed include the clinical relevance of a 50% reduction in attachment, and future research will attempt to link this to a reduction in infection.