Introduction: We report the early results of the hydroxyapatite coated, distally locking Cannulok revision hip prosthesis. The component was used to treat difficult periprosthestic and pathological fractures, often in the presence of aseptic loosening or infection in a group of elderly patients.

Methods: 16 patients with a mean age of 78 years underwent surgery by a single surgeon over a period of 3 years. No patients have been lost to follow-up and they have been followed up clinically and radiologically for an average of 24 months.

Results: The mean modified Merle D’Aubigne and Oxford Hip Scores were 14 and 23.6 respectively. These results are comparable to the published results for the previous uncoated version of the Cannulok hip, and other revision hip series.

Discussion: We believe the HA coated distally locked Cannulok revision hip implant provides a relatively simple and effective reconstructive option that can be used as an alternative to more extensive surgical options in elderly patients with periprosthetic fractures.

Introduction: The term dorsal bunion describes a condition characterised by a swelling in the region of the 1st MTPJ with an elevated first metatarsal and a flexed toe. The literature available concentrates on the forefoot aetiology- no author has yet documented the role of the hindfoot in its pathogenesis.

Methods: We have conducted a review of 28 consecutive patients, excluding those with hallux rigidus collected prospectively in the course of a full-time foot and ankle practice between 1996 and 2005. All of the patients have been examined with respect to their primary pathology leading to the dorsal bunion and had the mobility and position of the hindfoot assessed.

Results: In the series of 28 patients, the average age was 31.6 and there were 18 male and 10 females. Every patient examined had either a rigid hindfoot or stiffness contributing to a failure to correct for abnormal forefoot position.

Conclusion: The causes of dorsal bunion may be considered to be Primary (Hallux Rigidus) or Secondary (CTEV, neurogenic, iatrogenic, global forefoot supination).

It is the authors’ view that hindfoot stiffness in secondary cases of dorsal bunion causes an inability of the footto compensate for an abnormal position of the forefoot- the 1st ray must compensate by flexion of the hallux to allow the foot to adopt a plantigrade position.

The authors felt that it would be an interesting and worthwhile exercise to examine the process and management of open long-bone fractures referred to East Grinstead as we felt that we were not achieving the timeframe, as advised by the BOA/BAPS guidelines.

Methods The notes of patients who were referred East Grinstead for soft tissue management of long-bone fractures were examined over a 1 year period and analysed. After the results were seen to be poor in terms of management, practices were changed and the following year’s patients’ management underwent the same analysis prospectively.

Results The first years audit revealed average day of referral of 6.1, day of transfer was 13.2 days and time to soft tissue coverage was 18.3 days. 8% of patients achieved the BOA/BAPS guidelines of coverage by day 5. The second cohort of patients showed little improvement in their process of care.