The use of percutaneous Kirschner wires [K-wires] and plaster is a popular method of treatment for displaced distal radius fracture. However, multi-database electronic literature review reveals unsurprisingly different views regarding their use.

From August 2002 till June 2004, 280 distal radial fractures were admitted to our orthopaedic department. They were recorded prospectively in the departmental trauma admissions database. We studied the 87 cases treated with the K-wires and plaster technique. They were classified according to the AO classification system. The mean patient age was 53 [5-88] years. The mean delay before surgery was 7 [0-24] days. We studied the complications reported by the attending orthopaedic surgical team. 48 out of 87 patients [55.1%] were reported to have complications.

We analysed the displacement and the pin tract infection, as they were the main reported complications. 28 out of 87 patients [32%] had displacement [9 had further surgery to correct the displacement, 19 did not have any further surgery as the displacement was accepted]. 11 out of 87 patients [12.6%] had pin tract infection [7 needed early removals of the K-wires and systematic treatment]. Further analysis showed no statistically significant relation between the complications rate and the age of the patients, the delay before surgery or the type of the fractures.

We demonstrate a considerable high displacement and infection rate with the use of K-wires and plaster technique for fixation of distal fracture irrespective of the age of the patients, the delay before surgery or the fracture classification. There are other methods for fixation of the distal radial fracture with proven less morbidity which should be considered.

Introduction: Hip resurfacing has become re-established in recent years as a viable option in younger, active individuals. The results of a multi-centre evaluation of the Cormet resurfacing device are presented.

Materials and Methods: Data has been entered from 1997 onwards from 5 centres, patients being selected as suitable by 8 individual surgeons. Pre and intraoperative details recorded including indications, patient details, implant used, Harris Hip Score (HHS) and surgical approach.

Results: A total of 781 procedures in 676 patients have been recorded (54% posterior approach, 40% antero-lateral, 6% Ganz approach). The mean follow-up is 2.5 years (0.1–9.7 yrs) and the mean postoperative HHS is 85.9 (range 25–100). The mean age at surgery was 54.2 years. 60% of implantations were on male patients. The principal diagnosis was; OA 87%, RA 5%, AVN, post-traumatic OA and DDH 2% each, Perthes 1% and the remainder 1%. It is thought likely that many cases of OA had many of the above-named pathologies as a precursor. The mean maximum flexion postoperatively was 98.6 degrees. Uncemented heads (a recent innovation) were used in 7%. Kaplan-Meier survivorship is 93% at 9 years. In the OA subgroup 3.3% have been revised, approximately equal numbers for femoral head collapse, dislocation and cup loosening, but the vast majority due to femoral neck fracture, which in turn was generally associated with the posterior approach.

Conclusions: The results of this cohort (which includes the learning period of the contributing surgeons) indicate highly satisfactory outcomes in terms of HHS and implant longevity. Sub-classification of cases into those presenting abnormal anatomy and those with ‘ordinary’ OA indicates better survivorship still in the latter group. The surgical challenge varies more with hip resurfacing than with standard hip arthroplasty and this should be considered when results of surgery are reviewed. The revision options are generally much simpler than after standard THR.

Introduction: Hip resurfacing has become re-established in recent years as a viable option in younger, active individuals. The results of a multi-centre evaluation of the Cormet resurfacing device are presented.

Methods: Data has been entered from 1997 onwards from 5 centres, patients being selected as suitable by 8 individual surgeons. Pre and intraoperative details recorded including indications, patient details, implant used, Harris Hip Score (HHS) and surgical approach.

Results: A total of 905 procedures in 782 patients have been recorded (52% posterior approach, 39% anterolateral 9% Ganz approach). The mean follow-up is 2.8 years (0.1–9.5 yrs) and the mean postoperative HHS is 86.1 (range 25–100). The mean age at surgery was 54.4 years. 61% of patients were male. The principal diagnosis was; OA 88.3%, RA 4.3%, AVN 2.1%, posttraumatic OA 1.1%, DDH 2.1%, Perthes 0.7% and the remainder 1.4%. It is thought likely that many cases of OA had many of the above-named pathologies as a precursor. The mean maximum flexion postoperatively was 98.7 degrees. Uncemented heads (a recent innovation) were used in 10%. Kaplan-Meier survivorship is 93% at 9 to 10 years. Survivorship in the OA subgroup was 96.7% with approximately equal numbers for femoral head collapse, dislocation and cup loosening, but the vast majority due to femoral neck fracture, which in turn was generally associated with the posterior approach.

Discussion: The results of this cohort (including all contributors’ learning curves) indicate highly satisfactory outcomes in terms of HHS and implant longevity. Subclassification of cases into those presenting abnormal anatomy and those with ‘ordinary’ OA indicates better survivorship still in the latter group. The surgical challenge varies more with hip resurfacing than with standard hip arthroplasty and this should be considered when results of surgery are reviewed. The revision options are generally much simpler than after standard THR.

We present an independent multi-centre follow-up of metal-metal resurfacing from district regional hospitals (DGHs) in a series of ‘young’ patients with implants from a single manufacturer.

Between November 1995 and November 2002, two hundred and thirteen primary total hip resurfacings were performed in six centres. Two hundred and ten patients were followed up with none lost to follow-up. The average age of the patient group was 52.9 years range (21.9–71.3 years). Of these 210 patients 119 were male and 91 were female. There were three bilaterals and five revisions recorded with a revision rate of 2.3% at seven years. The maximum duration of follow-up was 84 months, the minimum was 3 months and the mean follow-up was 43.5 months.

The average Harris Hip score at the latest follow-up review was 78.15 (range 23–100). The Kaplan-Meier Survivorship of Cormet was 95% at 7 years and a survivorship of 97.38% at three years. These results indicate that metal-metal resurfacing meets the NICE guidelines for suvivorship at the three year benchmark in DGHs with local patients and is on course to meet the 10 year benchmark despite the extremely demanding patient group.

As there is little information on the factors that influence fracture union following intramedullary nailing of the tibia we retrospectively investigated patient-, injury- and treatment-related factors in 161 patients with closed or grade I open fractures of the tibial diaphysis. The patients were reviewed until clinical and radiological evidence of union at a mean of 13.3 months (4 to 60). Multivariate statistical analysis using a Cox proportional hazards model showed that the risk of failure of union increased by 2.38 times for highly comminuted fractures, by 3.14 times when nail dynamisation was applied, and by 1.65 times when the locking screws failed. In fractures with no or only minimal comminution the risk of nonunion increased if the post-reduction gap was ≥ 3 mm.

Aims: To establish whether the Ôidealñ concentric positioning of acetabular components within the acetabular cement mantle is achieved during routine cemented total hip arthroplasty.

In vitro studies recommend concentric placement of the acetabular component. There are however no in vitro studies on acetabular component positioning.

Methods: Radiographs of 100 primary cemented total hip replacements were studied. Acetabular component positioning and cement mantles were assessed with respect to implant type, grade of surgeon and operated side.

Results: 78% of the components were eccentrically placed, with increasing cement mantle thickness from zones 1 to 3. Concentricity occurred in only 13% of the Charnley Ogee, and 28% of the IP Lubinus components. The Charnley Ogee was more superiorly eccentric than the IP Lubinus (p< 0.001). The IP Lubinus was generally more open than the Charnley Ogee and Stanmore (p=0.053). Surgical grade affected neither cement mantle nor opening angle.

Conclusions: This study indicates that the ideal component position in the acetabulum is very difþcult to achieve consistently in most patients, using the two commonly used cemented prostheses in this study. The practical difþculty of concentric component positioning while obtaining simultaneous pressurisation is illustrated.

Between January 1987 and December 1988 there were 7575 births in the Swansea maternity unit. Of these 823 (10.9%) were considered to be at ‘high risk’ for developmental dysplasia of the hip (DDH). Static ultrasound examination was performed in each case and the results classified on the basis of the method of Graf. A total of 117 type III–IV hips in 83 infants was splinted using the Aberdeen splint.

Radiographs of these hips were taken at six and 12 months. Hilgenreiner’s measurements of the acetabular angle were made in all cases and the development of the femoral capital epiphysis was assessed by measuring the epiphyseal area. The effect of splintage on the acetabular angle and the epiphyseal area between the normal and abnormal splinted hips was compared. Radiographs of 16 normal infants (32 normal unsplinted hips) were used as a control group.

This cohort has now been followed up for a minimum of nine years. There have been no complications as a result of splintage. The failure rate was 1.7% or 0.25 per 1000 live births. No statistical difference was found when comparing the effect of splintage on the acetabular angle and epiphyseal area between normal and abnormal splinted hips and normal unsplinted hips.

Our study has shown that while the Aberdeen splint had a definite but small failure rate, it was safe in that it did not produce avascular necrosis. The current conventional view that a low rate of splintage is always best is therefore brought into question if the Aberdeen splint is chosen for the management of neonatal DDH.

Transverse fractures of the sacrum with neurological complications have been studied in four patients illustrating the following features: diagnosis is often delayed, there are radiological difficulties in making the diagnosis, and the indications for surgery are not well defined. Specific radiographic views are recommended. All the cases presented in this report responded well to conservative management.