Introduction: The volume of medical waste has increased in line with increasing medical, diagnostic and therapeutic procedures, and large joint arthroplasty is a major contributor. Demand for landfill sites due to increasing household, industrial and hospital waste loads, have made the current situation untenable.

Methods: A prospective observational study of the waste from non contaminated packaging in consecutive joint replacements was undertaken. The total weight and volume of waste, the cost of disposal, and percentage and constituents of recyclable items were recorded for each case.

Current costs and methods of local waste disposal were also investigated.

Results: The average non-contaminated waste from a primary joint replacement is 5.2 kg and less than 1% is non-recyclable. Paper waste constitutes 57%, plastic waste 36%, cardboard waste 16% and metallic waste < 1%. Landfill costs are between £60–70 per tonne with recent and projected increases in landfill taxes.

Revenue generated from recycling paper is between £50–80 per tone and plastic waste between £150–180 per tonne.

Conclusions: Currently all potentially recyclable waste from common orthopaedic procedures is going to landfill. Reduce, Reuse and Recycle are the cornerstones of waste management. Medical organisations and staff need to understand how best to segregate waste and take advantage of opportunities for reuse and recycling.

The introduction of a local or national recycling policy would make a definite impact on the environment, as well as potentially saving money.

Introduction Open calcaneal fractures are high-energy compression injuries that commonly result in dismal outcomes, despite appropriate care. Fracture pattern associated with these compound injuries have never been documented in detail. Plain radiographic studies and CT are imaging modalities commonly utilized to assess the fracture patterns.

Methods The roentgenographic studies of thirty-nine consectutive compound fractures treated at our University Hospital were retrospectively reviewed to evaluate fracture subtypes and incidence. Hindfoot roentgenograms were performed in all individuals; more than three-fourths of the fractures were also assessed with CT.

Results A vast array of fracture patterns was noted with variable incidence. Over 90% were intra-articular fractures. Eighty-seven percent resulted from blunt trauma - the remaining followed penetrating trauma. Six distinct fracture patterns were delineated. The fracture subtypes were stratified into low, intermediate and high levels of energy. Low energy (Type I) included minimally-displaced fractures. These comprised only eight percent of our series. Intermediate energy fractures (Type II) included tongue-type, thalamic fractures and reconstructible posterior facet fractures. These three subtypes comprised 69% of the series. Finally, the Type III, or high-energy fractures was made up of “pulverized fractures” and fracture-dislocations. These comprised 23% of our series.

Conclusions Stratification of injury severity based on fracture subtypes and wound characteristics should assist orthopedists treating these compound hindfoot injuries. An injury classification is proposed combining a three part “energy of injury” scheme with a two-part “soft tissue” classification. A fuller understanding of the injury subtypes should help establish future management standards.

We report a prospective study of the feasibility of employing specially trained physiotherapists to screen neonates for congenital dislocation of the hip. During ten years 42,241 babies were screened, using clinical tests; 255 were diagnosed and treated by a Pavlik harness. In the same period 13 children presented late with congenital dislocation of the hip which had not been detected by the screening programme.