Introduction

Despite costing up to 5X more than a one-third tubular plate (TTP) and no absolute indications, distal fibula locking plates (DFLP) are becoming increasingly popular in the fixation of ankle fractures, particularly in the elderly. We reviewed all our distal fibula fracture fixations, over the course of one year, in order to rationalise DFLP use.

Patient reported outcomes and satisfaction as a measure of service quality is becoming an increasingly important tool in local service assessment as well as a quality indicator within commissioning frameworks. We analyse the introduction of SCP led MDT facilitated patient group meetings addressing the education and preparation of patients listed for ankle and hindfoot surgery at WSH HYPOTHESIS- To identify the outcome benefits to patients from this type of quality initiative. This has been previously demonstrated in other specialities in the trust such as hip and knee replacement resulting in mandatory attendance as part of the care pathway.

Feedback was gathered via a patient questionnaire from 60 patients invited to meetings over an 18 month period. Two groups of patients who have undergone hindfoot/ankle surgery at WSH were compared. Group 1 attended a 1 hour MDT meeting preoperatively designed to educate the patient on all aspects of their surgery from pre assessment through to post operative management. Group 2 did not attend any such meeting whether invited or not.

Aims: To determine the clinical, radiological and sur-vivorship results of a series of 200 cementless STAR total ankle replacements. Methods: 200 consecutive total ankle replacements were prospectively entered into the study. There were 119 with inßammatory joint disease and 81 with osteoarthritis. Mean follow up was 46 months (24 to 101). No ankles were lost to follow up for reasons other than patient death. All ankles were clinically assessed with AAOFAS scores and radiologically assessed within a year of the results being analysed. Results: Fouteen ankles were revised or fused. Eight ankles required further surgery to resolve a complication. The cumulative survival rate at 5 years was 92.7% using time to decision to revise or fuse the joint as the endpoint. The most frequent complications were wound healing problems and malleolar fracture. This became less common as experience was gained. Conclusions: These midterm results are promising but the authors do not advocate ankle replacement in all those with degenerative disease of the ankle

Between 1993 and 2000 we implanted 200 cementless, mobile-bearing STAR total ankle replacements. None was lost to follow-up for reasons other than the death of a patient. The mean follow-up was for 46 months (24 to 101).

A complication requiring further surgery developed in eight ankles and 14 were revised or fused. The cumulative survival rate at five years was 92.7% (95% CI 86.6 to 98.8) with time to decision to revision or fusion as an endpoint.

The most frequent complications were delayed wound healing and fracture of a malleolus. These became less common with experience of the operation. The radiological appearance of the interface of the tibial implant was significantly related to its operative fit and to the type of bioactive coating.

To determine whether reducing the splintage rate in DDH patients had any effect on the rate of surgical procedures for the treatment of DDH. .

Since 1991, in the Blackburn region, there has been a limited target ultrasound screening programme for developmental dysplasia of the hip.

The detailed records of the demographics, clinical and ultrasound findings, treatment and outcomes of all children screened by the senior author were reviewed.

In 1996 and 1997 only those with persistent major dysplasia at 8 weeks and those with dislocatable hips were placed into Pavlik harnesses.

In 1998 only those babies with persistent major dysplasia at 8 weeks of age, or persistent hip instability at 1–2 weeks were placed into Pavlik harnesses.

The splintage rates, late dislocation rates (diagnosed after 6 mnths of age) and surgery rates were determined.

During the study period 11164 babies were born in the region. 797 (7.1%) babies were seen by the senior author.

Surgery in early irreducible hips is unavoidable. Surgery in late dislocators is only avoidable by changing from a selective ultrasound screening policy to performing ultrasound screening on every baby born.

With a limited hip screening programme and clinical and ultrasound monitoring of patients, splintage rates can be minimised without increasing the rate of surgery for developmental dysplasia.

No child who would have been splinted by the criteria used by other centres, and who wasn’t splinted in this series, required surgery.