The Orthopaedic Competence Assessment Project (OCAP) is a validated system for assessment of competence in orthopaedics. OCAP materials are increasingly used in the NHS. Defence Orthopaedic trainees now deploy for 6 weeks on Operation Herrick.

The senior author used OCAP induction and assessment materials with the 3 three trainees assigned to him at the United Kingdom Medical Facility at Camp Bastion, Afghanistan. Mini-CV and ‘Military Trauma’ Knowledge and Procedure Profiles were provided and learning agreements signed at an initial meeting. Interim and final meetings took place to review progress and update Knowledge and Procedure Profiles. Procedure Based assessments (PBAs) were also attempted during the attachments.

Afghanistan was ideal for training due to a significant trauma caseload, close one-on-one supervision and no working time directives. The use of induction and assessment materials with which trainer and trainees were already familiar gave structure and focus to training on deployment and allows the benefit of the deployment to be demonstrated.

The treatment of complex intra-articular fractures involving the knee has always proved challenging. The goals are to achieve satisfactory reduction, bony union and good functional outcome. Studies have investigated the outcome of various forms of treatment, including internal fixation and primary knee arthroplasty. In recent years there have been advances in technology bringing about more sophisticated implants such as pre-contoured peri-articular locking plates. Similar advances have been made in the production of constrained knee arthroplasty prostheses with the introduction of the Rotating Hinge Knee (RHK).

The initial non-rotating hinged prostheses for total knee arthroplasty did not enjoy a good reputation. The cumulative survival rate has been quoted as 65% at 6 years, significantly lower than that of conventional stabilised prostheses. Therefore the use of such implants was restricted to complex primary or revision arthroplasty, and tumour surgery. Studies have been published advocating the use of hinged prostheses for distal femoral fractures in elderly patients. The average age in the most recent study was 82, of whom 42% had died within the first post-operative year.

This study is a case series of 16 patients with fractures who were treated with hinged knee replacements, a subgroup of whom were treated with RHK. Demographic and outcome data has been retrospectively collected. We discuss the indications, experiences and outcomes in the management of these patients. This study also stimulates debate about the use of RHK to treat fractures in a younger population.