Introduction and Aim: The metacarpal fractures constitute 10% of skeletal fractures in general affecting mainly children and young adults. There is a lot of discrepancy and lack of evidence with regards to correctly managing the little finger metacarpal fractures. Our study was aimed at investigating the current practice of management little finger metacarpal fractures among upper limb surgeons in United Kingdom.

Methods: We conducted an online survey between June 2006 and June 2007 consisting of 10 multiple-choice questions that was e-mailed to 278 upper limb orthopaedic specialist surgeons. The response rate was 58% (n = 158) from the upper limb surgeons. Four questionnaires had to be excluded due to multiple responses to each question or incomplete forms.

Results: 43% upper limb surgeons prefer neighbour strapping alone for non-operative management of little finger metacarpal fractures. Ulnar gutter cast or splint was the next choice among 19% upper limb surgeons while 13% respondents apply neighbour strapping to ring finger along with a splint. There was mixed response regarding period of immobilisation. 40% of surgeons were in favour of 3 weeks of immobilisation, 23% for 2 weeks while 28% do not immobilise these fractures at all.

With regard to considering the most important indication(s) for surgical intervention, rotational deformity was the most common indication (84%), followed by open fracture (70%), intra-articular fracture (44%), associated 4th metacarpal fracture (26%), shortening > 5mm (21%) and volar angulation – (15%). If treated non-operatively, the most preferred period of fracture clinic follow up was one visit at 3 weeks by 40% while 36% thought that no follow up is required once decision is made to treat them conservatively.

Conclusion: Isolated undisplaced fractures of little metacarpal are usually managed conservatively using a plethora of methods of immobilisation. The indications for operative intervention are open fracture, rotational deformity, intra-articular fractures and shortening. Many clinical studies have demonstrated that in the conservative care of boxer’s fractures (casting, with or without reduction), between 20 degrees and 70 degrees of dorsal angulation is acceptable. We conclude that contemporary literature provides no evidence as to whether conservative or operative methods of the treatment of these fractures is superior, but rather suggests that they are equally effective. We conclude from our survey that there is no consensus even among the upper limb surgeons with regards to management of little finger metacarpal fractures in United Kingdom.

Aims of study: The aim of this study was to analyze the results of oxford unicompartmental knee replacement in a distrct general hospital in UK.

Methods of study: A prospective study of 50 patients undergoing minimally invasive oxford unicompartmental knee replacement for osteoarthritis was conducted between 2001 and 2005. All patients were operated by the senior author of the study. Oxford Phase III medial unicompartmental (meniscal bearing) instrumentation and implants used in all cases.

Pre-op oxford knee score was recorded in all the patients. Post-op scores were recorded annually and at final follow up. X-rays were analyzed for implant positioning and loosening. Data were analyzed using SPSS version 12.

Results: Mean age of patients in our group was 65 years (range 44–78 years). There were 32 females and 18 males in the study. There were no intra-operative complications in any of the patients. Average duration of follow up was 16 months (range 6 months–4 years). Significant improvement in Oxford Knee score was noted after the surgery (43.7 vs. 20.8) (p< 0.05). Average duration of hospital stay was 4 days (range 3–6 days).

Conclusion: Oxford unicompartmental knee replacement gives excellent results, given careful patient selection, meticulous surgical technique and post-operative rehabilitation.

Previous studies of adult acquired flatfoot have reported the results of treatment. No study has described the clinical characteristics of a consecutive series.

In a ten-year period we managed 166 patients with adult acquired flatfoot. Forty were male and 126 female The median age of the men was 56 years and of the women 60 years (p=0.149). Twenty-eight had bilateral problems and 78% had gastrocnemius/soleus tightness.

We used the Truro classification. There were 26 stage 1 patients, with a median age of 45 years. Eight were male and 18 female. Eight had features of enthesopathy but rheumatological investigations were negative. There were 84 stage 2 patients, with a median age of 61 years; 23 were male and 61 female. Twenty-five patients were stage 3, with a median age of 59 years; 5 were male and 20 female. 23 patients were in stage 4, with a median age of 67 years; 4 were male and 19 female. Six patients were stage 5, with a median age of 67.5 years; all were female. There were two patients in stage 6, aged 81 and 85 years, both female. The stage 1 patients were significantly younger than the others (p< 0.001); there were no other significant differences in ages or sex ratios.

Most patients had predominantly soft-tissue problems. However, we identified 33 whose problems related mainly to osteoarthritis. These patients had a higher median age (62.5 years versus 58 years, p=0.0138) and stiffer deformities (p< 0.0001).

Most patients (131, 78.9%) were managed solely with orthotics, shoe adaptations and physiotherapy. Thirty-five patients were offered surgery. Twenty-eight procedures were performed on 23 patients. Surgery was commoner in the arthritic group (15/33 offered surgery versus 20/133, p=0.001).

Introduction: It is commonly believed that there is deterioration of one grade of mobility with fracture neck of femur in elderly population. Several studies have been published in literature regarding outcome after operative management of fractures of proximal femur, but none of these focus on deterioration of mobility or its grades after the surgery.

Methods: A prospective pilot study of 50 consecutive patients with fracture neck of femur, who presented to the department were included in the study. Mobility and mortality was assessed at 6weeks and I year post operatively. We used a grading system of mobility with grades from I – VI, where grade I means fully independently mobile and grade VI stands for a bed ridden patient.

Results: Results showed that deterioration of mobility grade was much worse then conventionally thought. Out of 20 patients who were independently mobile without any aid preoperatively, only 5 patients were capable of walking with a stick. The overall mortality at 1 year post-op. was 40%. Patient’s age, residential status, MMS, ASA grade, preoperative mobility and mobility at 6weeks showed good prediction of post operative mortality in these patients.

Conclusion: Contrary to common belief much severe mobility deterioration was seen in patients following fracture neck of femur in elderly patients. Thus, deterioration of mobility becomes a very important factor to be considered in planning the management of these patients.

Plantar fibromatosis is a relatively rare disease compared to its counterpart in the hand. Though it is considered to be a part of Dupuytrens diathesis it has been less exhaustively studied to enable evidence based management strategies.

We followed up all patients presenting with plantar fibromatosis to our institute between 1980 and 2006, identifying 41 patients. 6 patients were lost to followup. Thirty-five patients with 60 involved feet were included in the study. There were 22 males and 13 females, all white Caucasians. The median age at presentation was 45 (19–63 years), and the median follow up was 10 years (2–25 years)

Twenty-one of our patients had palmar Dupuytren’s disease, six had knuckle pads, four had Peyronie’s disease, four had other superficial fibomatoses and two keloids. Six were diabetic, four had epilepsy of whom two took valproate and one phenobarbitone. Eight patients had a family history of fibromatoses.

The most common presentation was a painful lump (20); 13 patients had a painless lump (13) and two had only pain. All patients reported a proliferative phase of enlarging nodule size, often with pain, which lasted 1–4 years (median 2 years). Thereafter most patients reported improvement in symptoms (size of lump and pain) as well as function. As we came to recognise this, we treated most patients with symptomatic measures and observation only. At review, 17 patients considered their symptoms were improving, 14 were stable and only four had noticed deterioration. Seven patients, mostly early in the series, were treated by wide excision; six had recurrence at review although only one was symptomatic.

Plantar fibromatosis is a benign condition which stabilises and may improve after an initial proliferative phase lasting about two years Most patients require no intervention.