Aims: To validate the use Ottawa Ankles Rules (OAR) protocol in the accidents department, to evaluate its sensitivity in excluding a fracture and to examine the practical benefits. Methods: From August 2000 to January 2001 we examined 124 patients with foot and ankle injuries in the A& E department by three of our junior doctors. They were judged according to OAR protocol which requests an x-ray according to certain criteria. We have estimated the time spent in A& E. 72 of them were in accordance of the OAR protocol and they had typical x-ray examination & subsequent treatment. Results: The remaining 52 (41.9%) patients consist the target population. They were reexamined in 48–72 h, in one week and in one month and there was no need for an x-ray to any of them. None of them had a second opinion & they followed the given orders. The target group stayed for an average of 8.8 min (SD=4.4), while the other group for 24.6 min (SD=10.8), which was statistical significant (p< 0.001). From the above is obvious a 100% sensitivity of the method & so decrease in the amount of x-rays by 41.9%.

Conclusions: It is apparent that this protocol can be safely introduced in the A& E department. It has to be used by orthopaedic surgeons (trainees) with appropriate behavior & respect to the patient. It can diminish the number of x-rays, the amount of radiation, the cost and the waiting time in the A& E department.

Aim: The purpose of the study is to determine the opioid Ð sparing effect of Rofecoxibe and Lornoxicam in comparison to placebo in total knee arthoplasty. Method: This was a prospective, randomized, double-blind study. 82 patients with mean age of 70 years old (±3.5) and weight 82 (±4) were included. The operation was done under spinal anaesthesia. All patients after the operation were transferred to the Orthopaedic High Dependency unit where PCA morphine with a bolus of 1 mgr and lock-out interval of 8 min was started. There were randomized to receive 50 mgr of Rofecoxibe orally the morning of the operation or 8 mg of Lornoxicam I.V. twice a day. The third group did not receive any additional analgesic. After 24 hours the consumption of morphine and the evaluation of pain according to VAS scale were recorded. The evaluation of pain was done by the same doctor.

Results: There was no statistically signiþcant differences between the three groups either in the consumption of morphine or the pain intensity (Wilcoxon test)Conclusions: Our study showed that the administration of Rofecoxibe 50 mg per os, Lornoxicam 8 mg I.V/b.d. or placebo makes no difference either in the consumption of morphine or the pain intensity during the þrst 24 hours.

Aims: To elicit the predisposing factors responsible for early death in the aged population with hip fracture.

Methods: In this perspective study we dealed with 65 patients over 65 years old (51 women) with mean age 80.1 years old (65 – 104) who suffered a hip fracture (34 trochanteric and 31 subcapital). We studied age, sex, ASA score, delay for surgery and mobility preoperatively, blood loss and operative time interoperatively and postoperative delirium and fixation failure. Haemoglobin, WBC, serum albumin and Mini Mental Test were recorded both pre and postoperatively. The place of the accident was also recorded. The above parameters were compared for survivors and non-survivors patients.

Results: 11 patients died during the first 6 months with a mortality rate 16.9%. In all other parameters we detected no significant differences between groups.

Conclusions: The failure pattern (deaths) after a hip fracture during the first 6 months postoperatively included female of advanced age, with dementia and medical problems (ASA), who developed delirium postoperatively and had diminished preoperatively mobility.