Introduction: We studied the possible causes of intraoperative metaphyseal fractures in elderly patients with displaced intracapsular fracture neck of femur treated with an HAC coated bipolar hemiarthroplasty and their effect on patient morbidity.

Methods: 326 patients with 337 displaced intracapsular fractures admitted from November, 2001, to November, 2005 were included. They underwent Furlong bipolar hemiarthroplasty marketed by Joint Replacement Instrumentation Ltd (JRI). The operations were performed by employing a similar technique and anterolateral approach. Postoperative management was same.

Results: Thirty five (10.25%) patients sustained an intraoperative metaphyseal fracture. We found a strong correlation between the incidences of metaphyseal fracture and stem size. Size 9 stem was used in 80 patients without any fracture. Stem size 10 was used in 159 patients and was associated with metaphyseal fractures in 14 patients (8.80%); size 12 stem was used in 98 patients with 21 metaphyseal fractures (21.42%). Vancouver type AL fractures were 26 and 9 type AG. The fracture was found to be unstable and fixation was undertaken in 7 patients. The mean hospital stay for the patients without metaphyseal fracture was 24 days (range 2–83) in comparison to 30 days (range 17–96) for patients with fractures.

Thirty one patients presented from 3–18 months after operation with hip related problems, 17 had thigh pain, 10 periprosthetic fractures but 8 of these 27 had history of intra-operative metaphyseal fractures. Four patients had revision surgery, one each for acetabular erosion and sinking of prosthesis due to old metaphyseal fracture, two had Girdlestone arthroplasty due to deep wound infection.

Conclusion: We conclude that a size 12 stem was associated with high complications rate because there is a big jump for the elderly patients from size 10 to 12 due to the non-availability of size 11 stem in this system. We observed the effect on patient morbidity due to metaphyseal fractures.

Introduction:- We reviewed 69 patients with subcapital fracture neck of femur treated with two hole plate DHS and parallel de-rotation screw into the cranial part of the femoral head between January 2000 to January 2005.

Methods:- Patients were selected for fixation by having Garden 1 to 4 fractures, being younger, more active and mobile. Reduction was classified as “good” when residual angulation in the lateral projection was less than 15 degrees, no varus angulation and good alignment in the calcar area. Screw position was considered “good” when there was less than 10 degrees deviation in the direction of screws, screw threads not bridging the fracture site, screw tips less than 5mm from subchondral bone and no signs of intra-articular penetration. The fracture was considered healed when bridging of trabecular bone was present. Patients were reviewed until they were pain free at rest or on walking and had radiological healing of fracture.

Results:- 13 had Garden 3 & 4, 46 had Garden 1 & 2 and 10 had impacted fractures. Sixty eight patients had operation within 24 hours in the next available trauma list. Average age at operation was 70 years (range 21– 89) and hospitals stay 13 days (range 2–52). Good reduction was achieved in 61 patients, 54 of these had good screw position, 8 patients (11%) had combination of poor reduction and poor screw position; five of them had loss of fixation within 6 to 12 weeks postoperatively, one each had segmental collapse and avascular necrosis between 12 to 24 months of operation.

Conclusion:- Their was no re-displacement, non-union, avascular necrosis or segmental collapse when fractures were well reduced and had good screw position. Two hole plate DHS and a parallel de-rotation screw has high rate of fracture union. We recommend its use for treatment of subcapital femoral neck fractures.

The purpose of this study was to review the midterm results of HAC coated bipolar hemiarthroplasty in patients with displaced intracapsular fracture neck of femur in elderly patients.

There were 264 patients with 274 fractures from November, 2001, to June, 2004. The operations were performed by employing a similar technique and anterolateral approach. Postoperative treatment was same. The mobility was assessed by ambulation. Pain was evaluated using a visual analogue scale and clinical evaluations were performed using the Harris Hip Scoring System.

The mean age of 142 survived patients reviewed in the study was 77.5 years (range 61-89 years) at the time of operation and mean follow-up was 25 months (range 18-48 months). Hundred and twenty six patients had no or mild occasional pain but no restriction of activity. Ninety of the ninety eight able to walk independently or with one stick before fracture were doing the same. The surviving implants were radiographically stable and demonstrated evidence of osseointegration and no acetabular wear. Harris hip score averaged 84 points. Fourteen patients (10%) scored 90-100, 80 patients (56%) scored 80-89, 42 patients (30%) scored 70-79, and 6 patients (4%) scored less than 70.

We conclude that patients who score grade 1-3 of American Society of Anaesthesiologist and are mobile preoperatively outside their own home either independently or with one stick are better treated with HAC coated bipolar hemiarthroplasty with extra benefit of easy and quick conversion to total hip replacement if required in future.

Introduction: To access efficacy of our protocol for treatment of displaced Gartland type 3 supracondylar fracture humerus in children by giving a small incision medially to identify correct entry point of medial wire and to save the ulnar nerve. This incision is extendable for open reduction if required and have no effect on morbidity.

Methods: All Patients with displaced Gartland type 3 supracondylar fractures of humerus admitted from October 1997 to October 2003 were included into this study. They were all treated by closed or open reduction through medial approach and fixed with medial and lateral cross K-wires within 12 hours of admission.

Results: There were 43 children with a mean age of 7.2 years at presentation. Follow up time averaged 48 months (range 12–84 months). No patient had iatrogenic ulnar nerve injury. The postoperative mean value of Bauman’s angle in affected elbow was 76.7° with +/− 1.0° and 74.8° with +/− 0.6° on the unaffected elbow. All patients showed satisfactory results according to Flynn’s criteria.

Discussion: Cross K-wires give reliable results; a small medial incision is cosmetically more acceptable, provides an excellent view for correct entry point of the wire after visualising ulnar nerve with added advantage of extension if fracture required open reduction.

Introduction: Total Knee Replacement is a commonly done planned operative procedure frequently requiring blood transfusion. Fear of adverse reactions, transmission of viral illnesses like AIDS, Hepatitis B, C and Non A Non B has led to interest in alternatives to allogenic blood transfusion.

Predonation of autologous blood, administration of erythropoeitin alpha, postoperative blood recovery using cell saver or suction devices for reinfusion of whole blood have all been suggested to overcome this problem.

Aim: Our study was aimed to assess the efficacy of reinfusion of autologous blood transfusion from the blood collected after completion of the surgical procedure using Constavac reinfusion drain system.

Method: A prospective analysis of 54 patients undergoing primary total knee replacement was done. All patients with preoperative Hb of 12.5gm/dl or more were included. Postoperative drop in Hb below 9 gm/dl was an indication of supplemental transfusion. Probability of sepsis or malignancy were criterion for exclusion.

Results: In all patients undergoing Total knee replacement , average amount of blood reinfused was 480 mls. 50 of the 54 (92.6%) patients did not need any homologous blood transfusion. Average drop in Hb was 2.3 gm/dl. In nine patients (16.7%) there was drop in Hb of more than 3 gm% but only three of them needed blood transfusion. Patients with valgus deformity and needing lateral release were more at risk of needing homologous blood transfusion. No complications or adverse effects were noticed.

Discussion: Our study shows that reinfusion alone may be sufficient in most cases needing Total knee replacement. It is a reliable, safe, simple and cost effective way to overcome the need of allogenic blood transfusion in patients undergoing Total Knee Replacement. This may reduce the load on blood banks for cross matching all patients undergoing knee replacement except in valgus knees .