The results of the DRAFFT (distal radius acute fracture fixation trial) study, which compared volar plating with Kirschner (K-) wire fixation for dorsally displaced fractures of the distal radius, were published in August 2014. The use of K-wires to treat these fractures is now increasing, with a concomitant decline in the use of volar locking plates.

We provide a critical appraisal of the DRAFFT study and question whether surgeons have been unduly influenced by its headline conclusions.

Cite this article: Bone Joint J 2016;98-B:298–300.

In December 2012 the orthopaedic Hand and wrist unit at Derriford hospital introduced the use of collagenase injections for the treatment of Dupuytrens' contracture, and currently remains the only centre to use it in the southwest peninsula.

We present the short term results of our first year of use of the therapy. There was a statistically significant improvement in PEM scores by 1 and 3 months post-treatment (P: 0.0001 and 0.0016 with 95% confidence).

Full correction was obtained in 81% of all MCPJ contractures included in the analysis. Success with PIPJ contractures was more limited, however there was still an average correction of 30 degrees achieved.

Complications were limited to skin tears, all of which healed at subsequent follow-up, and 2 failures of therapy. We will continue to use this therapy and as experience and expertise build we hope we can improve our outcomes further.

Aims: To review the results from a series of GSB III total elbow arthroplasties performed at an independent centre. Between 1996 and 2004 the senior author performed 58 total elbow arthroplasties in 44 patients (10 males, 34 females) using the GSB III implant. These were reviewed and the outcome assessed through the use of a patient-answered questionnaire and clinical and radiological review. Mean age was 65 (49 to 84 years). Indications for surgery included rheumatoid arthritis (46 elbows) and post-traumatic osteoarthritis (11 elbows). Mean F/up was 4.1 years (0.8 to 8.5 years). 4 patients had died (6 elbows) and 4 patients (4 elbows) were unavailable for review. 2 of the implants had been revised (1x aseptic loosening, 1x deep infection), leaving a total of 46 elbows available for review. The survival rate at a mean of 4 years was 98% with aseptic loosening as the endpoint. Complications included 1 case of intraoperative fracture and 1 persistent ulnar neuritis. Overall patient satisfaction was high. The mean Mayo Elbow Performance Score was 83 out of 100 (range, 34 to 100) and mean Liverpool Elbow Score was 8 out of 10 (range, 1 to 10).

Conclusion: Previous studies of outcome following total elbow arthroplasty using the GSB III elbow prosthesis at independent centres have shown satisfactory results, but have looked at small groups of patients. Our results offer more robust data to show that the medium term outcome following total elbow arthroplasty using the GSB III prosthesis is satisfactory.

Aims: To review the results from a series of GSB III total elbow arthroplasties performed at an independent centre.

Between 1996 and 2004, the senior author performed 58 total elbow arthroplasties in 44 patients (10 males, 34 females) using the GSB III implant. These were reviewed and the outcome assessed through the use of a patient-answered questionnaire and clinical and radiological review. Mean age was 65 (49 to 84 years). Indications for surgery included rheumatoid arthritis (46 elbows) and post-traumatic osteoarthritis (11 elbows). Mean F/up was 4.1 years (0.8 to 8.5 years). Four patients had died (six elbows) and four patients (four elbows) were unavailable for review. Two of the implants had been revised (1x aseptic loosening, 1x deep infection), leaving a total of 46 elbows available for review. The survival rate at a mean of four years was 98% with aseptic loosening as the endpoint.

Complications included one case of intraoperative fracture and one persistent ulnar neuritis. Overall patient satisfaction was high. The mean Mayo Elbow Performance Score was 83 out of 100 (range, 34 to 100) and mean Liverpool Elbow Score was 8 out of 10 (range, 1 to 10).

Conclusion: Previous studies of outcome following total elbow arthroplasty using the GSB III elbow prosthesis at independent centres have shown satisfactory results, but have looked at small groups of patients. Our results offer more robust data to show that the medium term outcome following total elbow arthroplasty using the GSB III prosthesis is satisfactory.

Of 586 employed patients with a whiplash injury 40 (7%) did not return to work. The risk was increased by three times in heavy manual workers, two and a half times in patients with prior psychological symptoms and doubled for each increase of grade of disability. The length of time off work doubled in patients with a psychological history and trebled for each increase in grade of disability. The self-employed were half as likely to take time off work, but recovered significantly more slowly than employees.