The pattern of injury to the carpal ligaments following wrist trauma is unclear. Different imaging techniques often prove inconclusive rendering the diagnosis difficult and hence the treatment controversial. This study aimed to observe and evaluate the differences in scapholunate kinematics before and after sectioning the scapholunate interosseous ligament (SLIL) and radioscaphocapitate ligament (RSC).

Twenty two embalmed cadaveric wrists were used. There were four males and seven females with an average age of 84 years. Their medical records confirmed the absence of previous history of wrist diseases or injuries. The extensor and flexors tendons of the wrist were removed leaving the capsule intact. Two drill bits (1.5 mm) were used to make a hole each in scaphoid and lunate, one centimeter apart. The drill bits were left in the bones to act as metal wires for calibration. Each wrist was moved through a set of motions and each movement was performed thrice; first one with the ligaments intact, second with SLIL sectioned and the last one with RSC excised. Digital photographs were taken and angles measured with MB Ruler software. Analysis of variance was done using SPSS 12.

There was no angle between the metal pointers when the ligaments were intact. There was movement and change in angle detected when SLIL and RSC were sectioned. The sectioning of the SLIL lead to a significant increase in the angle between the pointers in all the movements recorded (p value < 0.001). Subsequent sectioning of the RSC further increased this angle but this increase was much smaller compared to that after sectioning SLIL. On completion of the measurements the wrist capsule was opened to reveal that both the ligaments had been successfully sectioned and there were no degenerative changes in the bones or ligaments in any wrist.

This first cadaveric evaluation of alterations in scapholunate motion with sectioning of SLIL and RSC revealed that SLIL has a significant influence on the scapholunate kinematics, where as sectioning of the RSC has little additional effect. This in-vivo finding might have implications of importance of preserving SLIL during wrist surgeries and its role in management of carpal instabilities.

We have evaluated the effect of vacuum aspiration of the iliac wing on the osseointegration of cement into the acetabulum. We entered a total of 40 patients undergoing primary total hip arthroplasty into two consecutive study groups. Group 1 underwent acetabular cement pressurisation for 60 seconds before insertion of the acetabular component. Group 2 had the same pressurisation with simultaneous vacuum suction of the ilium using an iliac-wing aspirator. Standard post-operative radiographs were reviewed blindly to assess the penetration of cement into the iliac wing. Penetration was significantly greater in the group with aspiration of the iliac wing.

Aseptic loosening of the acetabular component is the major long-term complication of cemented total hip arthroplasty (THA). Failure of the acetabular cup occurs two to three times more frequently than failure of the femoral component. Third generation cementing techniques have improved the longevity of cemented components in THA. Although suction venting of the femoral shaft is a well-recognised practice, venting of the acetabulum during the cementing process has been little studied. This prospective study sets out to evaluate the effect of iliac wing vacuum aspiration on cement penetration of the acetabulum. Forty patients (Male 18, Female 22) aged 19–82 years (average 67+12 years) undergoing primary THA were entered consecutively into two study groups (20 hips per group). Reasons for THA included osteoarthritis (35) acetabular Dysplasia (2), rheumatoid arthritis (1), perthes (1) and conversion THA post dynamic screw (1)> A single consultant surgeon performed all procedures in a standard operating room with laminar flow. A posterior approach was used in all hips. Third generation cementing techniques were used for acetabular component insertion. Twenty-six millimetres internal diameter Charnley ogee LPW polyethylene cups (Depuy) with varying external diameters [43 mm (9), 47 mm (24), 50 mm (5) and 53 mm (3)] were used and implanted with “Simplex” polymethylmethacrylate cement (Howmedica). Group 1 underwent acetabular cement pressurisation for sixty seconds prior to insertion of cup. Group 2 underwent pressurisation with simultaneous vacuum suction of the ipsilateral ilium using an Exeter iliac wing aspirator. Pre-and post-operative haemoglobin values were recorded for all patients. Standard post-operative radiographs were reviewed blindly to assess penetration of cement. A custom-made template facilitated measurement of depth (mm) of cement penetration in three areas corresponding with Delee-Charnley acetabular zones. Cement penetration was enhanced in all zones following iliac wing vacuum aspiration. The effect of venting was statistically significant (zone I 21.1+6.4mm v 12.8+2.8mm. zone II 7.0+2.4mm v 5.5+2.0mm, zone III 5.3+2.4mm v 4.2+1.4mm). The bone cement mantle interface was also completely obliterated following iliac wing aspiration.