For hallux valgus correction, distal first metatarsal osteotomy is generally used for minor to moderate deformities, diaphyseal osteotomy for moderate deformities and basal osteotomy or fusion for severe deformities. With the advent of locking plates, there has been renewed interest in opening wedge basal osteotomy. As little has been written about its geometry, we undertook this study in order to understand its power and limitations.

Proximal opening wedge osteotomies were performed on saw bone models in four orientations, with three different wedge sizes: 1. Perpendicular to the ground (PG); 2. Perpendicular to the shaft (PS); 3. Perpendicular to shaft with 30° declination (DEC); 4. 30° oblique (OB). Pre- and post-osteotomy measurements were made of axial and plantar translation and intermetatarsal angle.

Plantar translation and intermetatarsal angle correction increased with increasing wedge size. The DEC osteotomy produced the greatest increase in length of metatarsal shaft, while the PS osteotomy gave the least. The most plantar translation was achieved with the DEC osteotomy. Overall, the PS osteotomy gave the largest correction of the intermetatarsal angle.

Although there are several published clinical case series of the proximal opening wedge osteotomy, this is the first study to fully evaluate its geometry.

Purpose: After surgeons at a regional centre for orthopaedics began to use a simplified version of multimodal analgesia protocol in total knee arthroplasty (TKA), using intra-operative periarticular infiltration of bupivacaine and epinephrine, it was decided to review which methods of anaesthesia and analgesia were being used in the unit and how effective these were in terms of postoperative analgesic requirements and patient mobility.

Methods: A retrospective casenote review was conducted of 67 consecutive patients undergoing primary TKA. Data were collected in the areas of demographics, anaesthetic analgesia, mobility and length of stay.

Results: Of 67 patients, 31 received periarticular local anaesthetic, 23 underwent femoral nerve block and 13 had neither. Patients who had the periarticular injection required significantly less morphine. In addition, length of stay was shorter and mobility was achieved sooner in these patients.

Discussion: Our technique of periarticular injection is the simplest to be described to date, using injection of bupivacaine and epinephrine alone. Unlike most previous studies, we have shown a significant improvement in postoperative mobility and a reduction in length of hospital stay, as well as confirming previous findings of a reduction in the use of opioids. This study also confirms the efficacy of bupivacaine in periarticular injections, as most previous trials have used ropivacaine, and shows that the technique is practical for use in an NHS orthopaedic unit.

Conclusion: This study has described the use of a simple technique of analgesia by periarticular injection, which has reduced the amount of opiate analgesia required postoperatively, as well as showing benefits in mobility and length of hospital stay.

Introduction: Increasing medicolegal pressures, as well as problems with continuity of care and trauma patients outlying on non-orthopaedic wards, led to a concern regarding the quality of operation notes, especially with regard to postoperative instructions. A computerised system was introduced to address these issues.

Method: The quality of trauma operation notes was surveyed over a period of four weeks, before and after the introduction of the computerised system. Royal College of Surgeons guidelines, as well as additional orthopaedic criteria, were used as the expected standards.

Results: Most criteria were met significantly more of the time after the introduction of the computer generated notes, including antibiotic prophylaxis, weightbearing status and outpatient appointment.

Discussion: A computerised system is an effective and acceptable way of improving the standard of trauma operating notes. Users should be reminded to sign the resulting printed note until a full paperless record is in place.

Aim: To determine the time at which callus is visible on plain radiographs of tibial fractures and hence the appropriate time to order x-rays to assess union.

Method: The radiographs of patients with tibial diaphyseal fractures were graded for amount of callus on a scale of 1 (no callus) to 5 (no visible fracture line) and the time from injury recorded.

Results: 68 patients were identified, with 45 managed non-operatively by cast, 16 with intramedullary nails and 7 with other methods of fixation. Mean time to grade 3 callus (at least 2 cortices) in adults with non-operatively treated fractures was 8.4 weeks and 4.6 weeks for children. Mean time to union (four cortex bridging callus) was 17.6 weeks for adults and 8.1 weeks for children. In the nailed fractures, mean time to radiographic union was 20 weeks.

Conclusions: To assess union in adult tibial diaphyseal fractures, we recommend an x-ray at eight weeks and 16 weeks after injury, providing there are no clinical concerns. For children, the times should be reduced to 4 and 8 weeks after injury, respectively. Nailed tibial shaft fractures should have radiographs at 12 weeks and 18 weeks to assess union.

The current incidence of periprosthetic supracondylar femoral fractures around total knee arthroplasties (TKAs) is 0.3% to 2.5%, but may well be increasing. An acceptable treatment is to insert a supracondylar nail, but not all TKAs will permit the passage of a supracondylar nail.

Method: We ascertained the ten most common TKA prostheses currently used in the United Kingdom from the National Joint Registry (NJR) Report published in September 2005. We used samples of each prosthesis with a saw bone model and checked their compatibility for accepting a supracondylar nail.

Results: We present the dimensions of the intercondylar notches of the top ten TKA prostheses, which account for over 90% of TKAs performed over the last year nationally. Our reference chart demonstrates which of these are suitable for use with supracondylar nails.

Discussion: Most of the TKAs commonly used in the UK will allow supracondylar nailing for fixation of peri-prosthetic fractures. There are, however, notable exceptions and our chart provides a quick and easy reference for knee surgeons involved in these cases.