The safe and effective management of orthopaedic patients out of hours requires the communication of radiographs between junior residents and their non-resident seniors. Despite stringent guidelines issued by the Caldecott Guardian on the transmission of patient sensitive data, there is no data describing actual exchanges in the literature. The objective was t describe current trends in the transmission of patient sensitive data between resident Orthopaedic juniors and their non-resident seniors out of hours.

The method was a Questionnaire survey polling Orthopaedic registrars in North London. Seventy-six (76) trainees participated in the survey. Fifty Three (53) trainees received radiographs for review off site. Forty-eight (48) reported receiving patient radiographs for review to their personal email account. 48% of these trainees reported that the images contained patient sensitive information. 40% of the trainees who received images to their personal email had a NHS mail account which was not used.

Remote access to patient radiographs improves patient management out of hours. Although there is some awareness of Caldecott guidelines for the handling of patient sensitive electronic data, compliance is extremely poor. We recommend that all trainees who routinely handle patient sensitive data remotely acquire a free NHS mail account for receiving patient radiographs

Introduction: Preoperative planning plays an important role in any surgical procedure and total hip replacement (THR) is no exception. Templating of radiographs allows preoperative assessment of the correct size of implant to be used, lowers the risk of periprosthetic fracture, helps restore femoral offset and leg length, facilitates the optimisation of alignment and ensures the correct implants sizes are available.

With the wide scale use of Picture Archiving and Communication Systems (PACS) in the National Health Service (NHS), the potential exists for faster and more accurate templating of THRs.

Aim: In performing this study, we assessed whether there is adequate provision of the current NHS PACS to allow optimal digital templating for THRs. We also made comparison between the availability and overall ease of conventional versus digital templating.

Methods: Data was collected using a telephone questionnaire requesting information from the on-call orthopaedic Specialist Registrar (SpR) in 28 Greater London and surrounding area NHS Hospitals. Data on the availability of PACS and the ability to template using hard-copy or digital templating was collected and analysed.

Results: PACS were used in all 28 (100%) hospitals that were contacted. None performed conventional templating regularly and only 8 (28.6%) admitted to occasional templating. The predominant reason for this was difficulty in obtaining hard copies of x-rays in 12 (42.9%) hospitals, as well as lack of availability acetate templates, with 13 (46.4%) claiming that this was the case.

Digital templating software was available in 14 (50%) hospitals. Despite this, none of them performed digital templating regularly. In the 50% that did have digital templating, this was not routinely done for the following reasons:

only 3 (10.7%) allowed easy access to the software to the SpRs

Discussion: Digital PACS systems have made great improvement in the access of radiographs in the NHS. With regards to orthopaedic practice, however, we have shown that the benefit of digital templating is being overlooked within the NHS.

Purpose of study: The aim of this study was to evaluate patient-orientated outcome of spinal dynesys fixation used for low back pain and also the re-operation rate in a retrospective review of 25 cases with an average follow-up period of four years.

Materials and Methods: A total of 25 patients who had undergone semi-rigid fixation of the lumbar spine with the Dynesys system in the Chase Farm Spinal Unit between November 2001 and March 2003 were reviewed.

Results: Two patients required removal of implant and revision to solid fusion. Both were one year post Dynesys instrumentation. All other patients had their original Dynesys implant in situ at latest follow-up. Two patients were referred to a pain specialist for further management. The mean Oswestry score pre-operatively and 4.4 year post operatively were 57.2 and 37.52 respectively. The mean VAS pre op was 9.32 and post op it was 5.04.

Conclusion: Dynamic stabilisation certainly continues to remain an attractive alternative to rigid stabilisation and the few retrospective and laboratory studies that exist in the current literature reveal results which are comparable with rigid fixation.

Discussion: Though te results were promising we think a large multicentre prospective studies are required to truly enable us to evaluate the efficacy of dynamic stabilisation. This study contributes towards furthering our understanding of this complex subject.

Ethics approval: None

Interest Statement: None

The aetiology and pathophysiology of non-union is still unclear, but in this condition there is an abnormal bone metabolism. The paracrine matrix RAS has been implicated in the regulation of bone remodeling and injury responses, possibly via its effects on kinins. The influence of the local RAS or the genetic influence of the ACE/ BK2R genes to bone remodelling may thus be central to the disorder, or augmented in these conditions. We thus compared the distribution of the ACE I/D and BK2R “+9/-9” functional polymorphisms in patients with non-union and compared them to appropriate control.

Gene analysis was performed on buccal cells collected from all subjects and the data was analysed for 59 patients (46 males, 13 females; mean age 40.1±15.7 years) with non-union and 81 control subjects (49 males, 32 females; mean age 51.4±22.81 years. The overall genotype distribution was consistent with Hardy-Wein-berg equilibrium for the overall and individual groups for ACE (p0.16), B1BKR (p0.68) and B2BKR genotypes (p0.12)

As the -9 allele is associated with greater gene transcription and higher mRNA expression of the receptor we combined the -9/-9 homozygous and -9/+9 heterozygous groups and compared them with the homozygous +9/+9 groups. This showed a significant difference between the non-union and control groups, with the +9/+9 homozygous being less prominent in the former (p=0.03)

The B2BKR -9 allele is associated with the incidence of non-union in fracture healing, in this first study to address this question. We found no association with either the ACE I/D or B1BKR genotypes.

In conclusion, with previous findings that the absence of the -9 allele of the B2BKR +9/-9 polymorphism is associated with greater gene transcription and higher mRNA expression of the receptor our findings are suggestive that increased BK activity via the B2BKR may predispose to the development of non-union.

Aims: The purpose the study was to evaluate the radiographic progression of distal radial fractures treated with casting with or without percutaneous wires over a one-year period. Methods: One hundred consecutive patients with unilateral Collesñ fractures were enrolled (78 females, 22 males; mean age 72). These were treated with either a below elbow cast with or without manipulation, or by percutaneous wire þxation and a cast after adequate reduction. Two independent observers evaluated all the patients with serial X-rays at 1, 2, 6 weeks and 1 year. Radial length, shift and inclination and volar tilt were compared to the position immediately after injury. Results: Sixty seven patients showed loss of position beyond that seen at 6 weeks after injury. Only 15% of the 21 patients who did not require a manipulative reduction showed any progression of deformity. Only 19% of the 79 patients that had manipulation (± wire þxation) maintained this throughout. The rest showed either early (6 weeks) or late loss of position with a signiþcant proportion of these showing more than 2mm loss of radial length. Loss of position was more frequent in fractures that were only manipulated compared those manipulated and wired; the latter also tended to lose position late rather than early. Twelve of the 30 cases with early loss of position were re-manipulated but þnal position was almost uniformly equivalent to slip position. Conclusions: Radiological parameters are of prognostic importance. Our standard protocols do not hold fracture reduction at 1 year, with þnal deformity greater than appreciated. No beneþt of remanipulation was observed. There may be a need to modify traditional treatment to hold fractures for longer and be able to resist deforming forces.

Aims: The purpose of the study was to analyse the early experience of the technique of transitory percutaneous pinning to manage three and four part proximal humeral fractures. Methods: An independent review of 66 consecutive patients with proximal humeral fractures treated in our unit over a three-year period was carried out. The patients underwent closed reduction under image intensiþer guidance with percutaneous pinning using an average of 3.5 wires (range 3–4). A standard three dose prophylactic antibiotic regime was used. A protective collar and cuff was the used for 4 weeks, and a physiotherapy program of pendular movements going on to assisted active exercises started after this. The wires were typically removed in an outpatient setting at 4 to 6 weeks. Results: The postoperative radiographs were deemed satisfactory with good overall alignment by two external observers in all cases. Our þndings were however remarkable for a very high early complication rate. This included pin migration (50%), stiffness (41%), pain (33%), infection (25%), nonunion (8%) and radial nerve palsy (8%). The complication rate increased dramatically in those over the age of 50 or those with osteopenia. Conclusions: The technique of transitory percutaneous humeral pinning is technically demanding. Our early experience would suggest high rates of early complications and readmissions. This technique should be applied with caution in older patients with osteopenia.