Introduction

Surgical experience has been shown to improve the clinical outcomes in Total hip arthroplasty. The objective of this study was to compare clinical and radiological outcomes between Consultants and NCHDs grade surgeons for the Exeter total hip replacement taken from the Cappagh National Orthopaedic Hospital Joint Register.

Introduction

Trauma is the leading cause of death and disability in children. Pelvic fractures although rare, with a reported incidence of one per 100,000 children per year are 2^nd only to skull fractures with respect to morbidity. The objectives of this study were to improve understanding of paediatric pelvic fractures through a concise review of all aspects of these fractures and associated injuries. Understanding the patterns in which paediatric pelvic fractures and their associated injuries occur and the outcome of treatment is vital to the establishment of effective preventative, diagnostic and therapeutic interventions.

Introduction: In September 2007, the Health Service Executive implemented a new employment control policy, due to budgetary constraints. The health ministry and the HSE state that there are no adverse effects on patient care as a result of implementing this policy. In our regional orthopaedic unit, these cutbacks resulted in closure of 12 orthopaedic beds and consequently, a loss of a minimum of 40 joint replacements per month. Most of these patients are having their replacements carried out under the NTPF scheme at a rate, which is three times the local cost.

Aim: The aim of this study was to evaluate the impact of bed closure and consequent reduction in elective orthopaedic workload on a regional orthopaedic unit.

Materials and Methods: A comparative review of elective joint arthroplasty was undertaken with regard to theatre workload, length of time on waiting lists and referrals to the national purchase treatment fund from September 2007 to December 2007. This data was compared with same timeframe in 2006.

Results: Since the implementation of the HSE policy, the elective bed capacity was reduced by 66%. Elective joint replacements performed from September–December 2007 have reduced by 72 patients (109 to 37) compared with the same timeframe in 2006, a reduction in workload of 66%. 107 patients added to waiting list since bed closures, which constitutes a 6-fold increase in time on waiting list.

Conclusion: Following the recent implementation of the HSE policy in September 2007 we have objectively quantified a significant negative impact on elective orthopaedic services in our unit. This false economy also has a negative impact on training opportunities as only more urgent and complex cases are performed in the public sector, while routine cases are carried out in the private sector. Should this trend continue, the impact on surgical and hence future patient care may be detrimental to the public health care system in Ireland.

Introduction: Distal radius metaphyseal fractures in children are not uncommon, but when they occur proximal to the insertion of the pronator quadratus muscle, reduction and maintenance of reduction can be challenging. The deforming forces at the fracture site result in pronation and shortening of the distal fragment. Manual manipulation of this fracture often results in tearing of the dorsal periosteum and hence renders this fracture highly unstable.

Aim: We present a novel easily reproducible mini-open surgical technique and functionally and radiologically evaluate a series of eleven patients who have undergone this technique.

Materials and Methods: The surgical technique consists of a mini-open intrafocal image intensifier guided reduction technique with percutaneous k-wiring fixation. Five males and six females with an average age of 8.8 years (range 5 to 13 years), who sustained a pronator quadratus distal radius fracture and subsequently underwent this surgical technique from 2005 to 2007, were evaluated both radiologically in terms of radial length, radial tilt and volar tilt compared with the contralateral limb and functionally using the Mayo Modified wrist score and the patient related wrist evaluation questionnaire.

Results: Patients were followed up for an average of 18 months (range 2–31 months). All patients achieved clinical and radiological union. No patient required remanipulation for loss of reduction. Radiological outcome measures similar to contralateral limb with good functional scores. No complications were noted. All patients returned to preoperative level of function

Conclusion: This minimally invasive technique has been shown to be technically easy, reliable and reproducible with excellent results and low risk of displacement compared to other techniques used to treat this potentially challenging fracture.

Slipped upper femoral epiphysis (SUFE) is a condition, which affects the immature hip joint. Many theories have been postulated as to its underlying aetiology however; its exact cause is, as yet unknown. The final common pathway appears to be failure of the of the growth plate to resist shearing forces, giving rise to displacement of the femoral head. We hypothesized that the lubricating ability of the synovial fluid in hip joints of children with SUFE was defective, thereby allowing increasing shear forces on the physis to occur, so that when the joint is loaded it will fail at its weakest point, namely the capital epiphysis.

Aim: The aim of this study was to establish a biomechanical porcine cadaveric model to study SUFE and use this model to determine how defective joint lubrication may increase the probability of SUFE.

Methods: Using immature porcine femurs and a custom-made rig, a torsional load was applied about an axis perpendicular to the growth plate in order to cause the femur to fail along the growth plate. The Hounsefield testing machine applied a tensile load and recorded the associated elongation. From these figures the torque applied to the femoral head and the associated angular rotation could be computed. Using Weibel analysis we were able to determine the probability of SUFE occurring for a range of synovial fluid coefficients of friction, a range of joint reaction forces and neck-shaft angles.

Results: We found that it is possible to induce a SUFE in an immature porcine loaded hip joint and that there was an increased probability of slip with increased coefficient of friction of synovial fluid, increased percentage body weight and increased neck-shaft angle.

Conclusion: Defective lubrication may be a key underlying aetiological factor responsible for SUFE.

Introduction: The Sheehan total knee endoprosthesis has been widely used since 1971. It incorporates a semi-constrained hinge with intramedullary stems cemented into the femur and tibia for fixation. This gives a stable polycentric knee mechanism that allows axial rotation as well as simulating other knee movements. This design has certain disadvantages including the large amount of bone resected for implantation and its constrained nature which predisposes to loosening. Revision rate of up to 30% have been reported. We discuss the difficulties encountered during revision and the techniques that need to be used to overcome these.

Patients and methods: We reviewed the records of 21 patients who required revision of Sheehan TKRs between 1987 and 2001. Reason for revision was recorded and all patients were scored using the Knee Society Index of Severity Instrument (Saleh et al CORR 2001). The operative details were examined and technical difficulties at the time of surgery recorded. Per-operative and early post-operative complications related to the revision procedure were also noted.

Results: The average age of patients requiring revision was 65 years old (range 39–79). The average time from primary surgery to revision was 16.2 years (range 8–20 years). The reasons for primary surgery were rheumatoid arthritis in 9 and osteoarthritis in 12. Revision surgery was required for pain associated with tibial subsidence and painful bone on bone contact in 14.Two patients had dislocation of their tibial on femoral component. One patient had a one-stage revision for infection and one had revision for a fractures tibial intramedullary stem. Three patients had revision to anterior flanged femoral components to facilitate patellar resurfacing for patello-femoral pain. The overall complication rate approached 80%!

Discussion: While the Sheehan TKR was of great benefit to a large number of patients it is not without its problems. These results show that prostheses coming to revision did not necessarily fail early and so with time we can expect more to present for revision. The high complication rate and the need for complex reconstructive techniques attest to the difficulty of revising these prostheses. Some of these problems are the legacy of the prosthetic design and should be borne in mind when taking on these cases.

The Mater Hospital is Ireland’s primary referral centre for spinal injuries receiving 80–90% of all spinal cases annually. In today’s society the number of people competing at more competitive and professional levels is also increasing. Over the years, a lot of work has gone into safety precautions in sport. However despite those improvements our impression was that the incidence of both minor and serious sporting injuries is increasing.

The purpose of this study was to determine the incidence, pattern and mechanism of sports-related spinal injuries in Ireland over the last decade.

Data was collected by performing an audit of the National Spinal Injuries Database from 1994–2001. This database is a prospective computerized database. Data entered relates to the initial presentation, mechanism, level of injury and their acute in-hospital management.

On average 200–220 patients are admitted annually to the National Injuries Spinal Unit. 173 of these were related to sport, which represented 13% of total spinal injuries. 80% are male under 40 years. 29% sustained neurological deficit. The sports responsible for most spinal injuries in Ireland were equestrian (43.8%), followed by rugby (16.4%), diving (15%), GAA (13.6%) and skiing (3%). Rugby injuries were most likely to cause neurological damage. Equestrian accidents commonly caused thoracolumbar fractures while injuries sustained in diving, rugby and GAA were mostly to the cervical spine.

Sport is an important cause of spinal injuries in Ire-land. Coaches and team doctors must be educated about safe practices and emergency management of these terrible injuries and for those unfortunately affected in the prime of their lives adequate rehabilitation resources need to be implemented so as to lessen their economic burden.