Introduction: Stiffness is a disabling problem following TKR surgery. The overall incidence is 1–3%. Though multiple factors have been implicated in development of stiffness, it still remains an incompletely understood condition. Furthermore, opinion is divided about the efficacy, timing and the number of MUA’s post TKR surgery, as there are no definitive guidelines.

Aims & Objectives: The aim of this study was to assess the predisposing factors for stiffness following TKR surgery, to determine the efficacy of single and multiple manipulations and to investigate the most appropriate timing for manipulation.

Material & Methods: We retrospectively reviewed 86 patients who underwent manipulation for stiffness post-primary TKR surgery with at least one-year follow up. The number of manipulations, predisposing factors, the flexion gain at different intervals, final gain in flexion and range of movement was noted till the end of 1 year.

Results: Results were assessed by timing and number of MUA’s performed. Sixty five patients underwent single MUA and 21 had multiple MUA. At the end of one year the single MUA group showed 310 of sustained gain in flexion and in the multiple MUA group only 90 flexion gain was noted (p=0.003). MUA within 20 weeks of primary surgery showed 300 of flexion gain, whereas only 70 of flexion gain was seen when MUA was undertaken after 20 weeks (p=0.004). Patients on warfarin (9.5%) and with previous major surgeries to the knee prior to TKR (11.5%) had increase incidence of stiffness and poor flexion gain.

Conclusion: The timing of the 1st MUA is crucial, with better results achieved in MUA performed less than 20 weeks (particularly between 12–14 weeks) from primary surgery. Age, sex and type of disease do not influence the severity of stiffness in this study. There appears to be no added benefit in re-manipulation.

Aims & Objectives: To assess whether the incidence of infection in Primary Total knee Arthroplasty is increased as a result of previous steroid infiltration into the knee joint.

Introduction: Steroid injection into the arthritic joint is a well-known modality of treatment of the arthritic joints. Its efficacy is well documented. Increased incidence of Infection secondary to steroid injection as compared to uninjected joints is reported in recent literature.

Material & Methods: 440 patients underwent Total Knee replacement (PFC SIGMA-Depuy) by senior author during 1997–2005 at Wrightington hospital. 90 patients had intraarticular steroid injection prior to surgery of which 45 patients had injection with in 1 year prior to surgery. All patients had at least one year follow up. Infection rate was assessed by case note, x-rays and microbiology review till last follow up.180 patients of a matched cohort who had total knee replacement without steroid injection were compared for infection rate.

Results: 2 cases of superficial infection were noted in Injection group and 5 cases of superficial infection in Non Injection group. No cases of Deep infection noted in either group. Stastical analysis showed no significant difference in incidence of infection in either group.

Conclusion: Steroids are useful adjuncts in the management of patients with arthritic joints. This study shows no increased incidence of infection in patients given steroid injection prior to arthroplasty.

Materials & Methods: A retrospective study. 25 cases of fracture Calcaneum during April 2001–2004 were reviewed for their clinical outcome.

Aim of the study: To assess the clinical and functional outcome of the Management of Intra and Extra articular Calcaneal fractures in district general hospital.

Results: 22 male and 3 female. Intraarticular fractures 15 (60%)of which 10 were displaced and 5 undisplaced.

Extraarticular were 10 (40%) of which displaced and undisplaced were 5 each. Fall from height was seen in 20 (80%)patients. Associated injuries was seen in 10(40%) patients of which 8(32%) of them had fracture spine. All the cases of intaarticular fractures had C.T. scan.

The final outcome all the fractures treated conservatively were good. Fractures underwent ORIF had better outcome and more complication rate as compared to conservative treatment.

Conclusion: Commonest mode of injury is fall from height and associated injury incidence is usually high.

Even the undisplaced intraarticular fractures of calcaneum do develop residual stiffness and difficulty in walking on uneven ground.

Displaced fractures needs fixation for better results and facilitation for secondary operations.

Wound infection, stiffness and deformity are known complications.

In this small audit all three group did develop stiffness and we recommend a bigger, independent audit.

Aim of the study: to assess the early complication rate following k-wiring of distal radius fractures and their clinical outcome. A retrospective treatment.

METHOD: 48 patients with 50 Distal Radial fractures, number? High velocity (26 Males, 22 Females; Mean age 34 years; Range 4 to 88 years) treated by Closed K-Wiring during the period between January 2005 to June 2005 were assessed in terms of early complications following MUA and K-Wiring and their final outcome. All cases were performed by staff grade or above.

12 patients (24%) had discharge, pin tract granulation, loosening, out of which 4 required antibiotic. Out of 12 only 2 (4%) has positive swab culture requiring Intravenous antibiotics.

3 patients (6%) had symptoms suggesting superficial radial nerve damage of which 2 recovered completely after pin removal. One had residual symptom, put on waiting list but symptoms got better and she refused further treatment.

9 patients (18%) had stiffness out of which only 3 (6%) had residual stiffness at the end of 6 months. However this stiffness can not be attributable to k-wiring alone (?fracture intra articular).

CRPS was noted in 1 patient (2%) and recovered after prompt physiotherapy. There were no cases of deep infection, osteomyelitis, tendon rupture, pin migration or significant loss of position in our study.

CONCLUSION: Our data suggests that though early complication rate of K-wiring is alarming, it does not affect the final outcome of fracture management; and this complication can be avoided by proper technique and care.