This multicentre audit assessed the total Tip Apex Distance (TAD) of sliding hip screws for intertrochanteric hip fractures in the 3 fracture hospitals in Northern Ireland (Ulster Hospital, Royal Victoria Hospital & Altnagelvin Hospital). Patient demographics and anaesthetic information was also reviewed. A sample of 140 patients with adequate screening films (39 UHD, 50 RVH & 51 Altnagelvin) were selected. The TAD was measured on AP & lateral screening films and compared to the standard of 25mm or less (total in 2 views) as recommended by Baumgaertner et al (JBJS (Am) 1995).

All 3 hospitals had an average of under 25mm (22.1, 19.9 & 19.6mm respectively) with overall average of 20.4mm, and a TAD of 25mm or less was achieved in 66.7%, 82% & 80.4% in respective hospitals (77.1% of patients overall). No patients were readmitted due to cut-out, despite 22.9% of patients having a TAD greater than 25mm. Among patients with TAD over 25mm the average TAD was 30.1mm

Demographics showed a 77.8% of patients to be female, with a slight predominance of left sided injuries. Most patients were of ASA grading 2–3. Anaesthetic method preferences varied between hospitals. Patients with TAD over 25mm were not significantly different from those with TAD of 25mm or less in age, gender, ASA or operated side.

Introduction: Several small leucine-rich proteoglycans (SLRPs) are involved in the regulation of collagen fibril size(s) in a variety of different soft and hard musculosk-eletal tissues. In the intervertebral disc (IvD) the major SLRPs involved in regulation of types I & II collagen fibril size are believed to be decorin, fibromodulin and lumican. Research into IvD degeneration and backpain is hampered by a lack of specific biomarkers to detect and monitor the disease process. We have discovered that two keratan sulphate (KS) substituted members of the SLRP family, Keratocan and Lumican (that are major KS-pro-teoglycans found in cornea) were unusually expressed in extracts from degenerative disc tissues.

Methods: Non-degenerate disc tissue (n=10) was obtained from 2 scoliosis patients and degenerate disc tissue from 11 patients undergoing surgery. The degenerate discs were graded using criteria described by Pfir-rman et al (Spine26: 1873; 2001). Tissue samples were extracted with 4M guanidine HCl and after dialysis subjected to SDS-PAGE and Western blot analyses using monoclonal antibodies that recognise epitopes on kera-tocan and lumican.

Results & Discussion: Keratocan was not found in the non-degenerate disc tissue but was present in all degenerate IvD tissues tested. Lumican showed and increased expression in extracts of degenative IvD tissues. Our working hypothesis is that the increased expression of these two SLRPs in degenerative disc tissue results from a reparative depostion of a type I collagen fibrillar ‘scar’. This unusual expression suggests their potential as biomarkers for detecting the onset of degenrative disc disease.

Introduction: Several small leucine-rich proteoglycans (SLRPs) are involved in the regulation of collagen fibril size(s) in a variety of different musculoskeletal tissues. In hyaline articular cartilage the major SLRPs involved in regulation of type II collagen fibrils are believed to be decorin and fibromodulin. These two SLRPs along with another family member, lumican, have also been identified in intervertebral disc tissues. In recent studies, we serendipitously discovered that, keratocan and lumican [two keratan sulphate (KS) substituted members of the SLRP family] were unusually expressed in extracts from degenerative joint and degenerative disc tissues. The object of this study has been to further investigate this finding with a view to examining the increased expression of keratocan and lumican using qualitative Western blot analysis and quantitative ELISA methods. Our working hypothesis is that the increased expression of these two SLRPs in degenerative joint and disc tissue results from a reparative deposition of a type I collagen fibrillar ¡®scar¡^-.

Methods: Monoclonal antibodies were produced to core protein epitopes in lumican and keratocan. Degenerate cartilage was obtained from patients undergoing routine joint replacement for either hip or knee joints, whilst normal articular cartilage tissue was obtained from surgical knee procedures. In addition, disc samples were obtained from patients undergoing a variety of spinal procedures and were Graded I-IV using a modified Thompson score. The tissue was diced and extracted in a 4M guanidine HCl buffer, pH6.8 containing an inhibitor cocktail for 48 h at 4¢ªC. Samples were then dialysed exhaustively against Milli Q water and assayed for glycosaminoglycan (GAG) content using the DMMB assay. Cartilage extracts containing equal amounts of GAG were then separated by SDS-PAGE and transferred to nitrocellulose for Western blotting using mMAbs to either keratocan or lumican. In addition, a competitive ELISA has been developed for quantifying keratocan and lumican.

Results: Western blot analysis of normal and degenerative articular cartilage revealed the presence of both keratocan and lumican. However, the presence of these SLRPs was substantially increased in the degenerate articular cartilge extracts. In addition, these proteins were also present in extracts of intervertabral disc with an increase being apparent in those disc samples with increased pathology. Preliminary data for the development of a quantitative ELISA for these two SLRPs shows promise.

Discussion: The unexpected increase in the detection of keratocan and lumican in degenerative articular cartilage and disc suggests their potential as biomarkers for the onset of degenerative joint and disc disease. However, this will involve the development of a quantitative assay and the investigation of the presence of these molecules in synovial fluid and serum.

Proximal femoral replacement gives reliable relief of pain and return to function in proximal femoral metastases. However, there can be technical problems with reattachment of muscles and tendons to the prosthesis, inadequate reattachment can lead to loss of function and joint stability.

We were keen to establish how effective our current method of abductor reattachment was. All the post operative x-rays of patients who had undergone Stanmore Mets Proximal Femoral Replacement, over the last 2 years at the Royal Shrewsbury and Robert Jones and Agnes Hunt Orthopaedic Hospitals, were reviewed. Particular note was made of the position of the trochanteric osteotomy, whether it remained attached or not to the prosthesis.

The Stanmore Mets Proximal Femoral Replacement has a plate which secures the trochanteric osteotomy to the prosthesis. Two screws go through the plate, osteotomy and into the prosthesis..

There were six patients, 4 male and 2 female with a mean age of 67 years. The primary carcinomas included 2 breast, 2 prostate and 1 lung and 1 renal. In five of the six patients the trochanters became detached. In 3 of the 5 patients the trochanter became detached in the first post operative week and by 2 months all 5 trochanters were detached.

We have since changed our method of attachment of the trochanteric osteotomy to the prosthesis to a hooked trochanteric plate. The plate is attached to the prosthesis by wires. Short term follow up of five patients have shown that all the trochanters have remained all attached.