The treatment of massive chronic tears is problematic. The re-tear rate following surgery for extensive cuff tears remains high, and there is little consensus regarding optimum treatment. To investigate the outcome of a cohort of patients who had open repair of an extensive cuff tear using the Leeds Kuff patch as an augment. A retrospective cohort study of consecutive patients with a massive cuff tear who had surgery in our regional elective orthopaedic centre over a two year period from January 2015 to Dec 2016. All patients followed identical rehabilitation protocols, supervised by physiotherapists with an interest in the shoulder. Outcomes assessment was undertaken at a minimum of 12 months by a registrar or physiotherapist who was not part of the treating team. Pre-op data collection included; range of motion, pain score, Oxford shoulder score (OSS), assessment of muscle atrophy on MRI. Data collection was completed in 15 patients. The mean age was 62 yrs (56 – 75). The mean pre-op OSS was 22, improving to a mean of 43. The range of motion and pain score improved. There were no intra-operative complications. One patient required a second surgery for evacuation of a haematoma at 10 days post op. One patient had an obvious re-tear at 4 months. Open rotator cuff repair with synthetic Kuff patch augmentation for chronic degenerative tears appears worthwhile when assessed at 12 months and they continuous to improve even at 18 months. This treatment method may be a useful option for patients > 70 years old.

The management of scapho-lunate (SL) instability remains controversial. Since 2001, the senior author has used a modified Brunelli tenodesis to achieve soft tissue stabilization in patients presenting with dynamic or static SL instability.

From 2001 to 2009, 13 patients were prospectively studied. All patients complained of painful clicking in the wrist, inability to use the wrist for loading activities, and all had a positive scaphoid shift test (Kirk Watson). Wrist arthroscopy was performed to confirm the diagnosis and to confirm the absence of degenerative change in all cases. Data collection pre-operatively included, range of motion, grip strength, DASH score and pain score.

All patients had wrist immobilisation in a forearm cast for six weeks post operatively. Physiotherapy commenced at that stage and clinical assessment was performed at 3 months, six months and 12 months post surgery. Patients were discharged from follow-up after 12 months.

A significant improvement in grip strength and DASH score was documented at the 12 month post operative assessment. The range of wrist flexion was decreased in all patients. The majority returned to their original employment. All patients reported that their wrist instability symptoms were improved.

Blood transfusion requirement in shoulder surgery has been reported from 8.1% to up to 15%. Our observation was that blood transfusion rarely required after open shoulder surgery. We therefore decided to conduct a retrospective case notes study to look at the crossmatch-transfusion ratio for shoulder surgery.

A total of 211 patients were included in the study. Results were analysed using paired T-test from SPSS (15.0). There were 63 elective procedures and 148 trauma procedures during that period. Ten patients (4.8%) required intra-operative or post operative transfusion. Crossmatch-transfuison ratio was 21.

There should be a clear equation between crossmatch and its use, intra-operatively and post operatively. This study highlighted unnecessary cross-matching for shoulder operations which puts extra pressure on the laboratory staff, the blood bank and also has financial implications.

At present patients who require shoulder hemiarthroplasty in our unit routinely have two units of blood cross matched pre-operatively. Our observation was that blood transfusion rarely required after open shoulder surgery. We therefore decided to look at the crossmatch-transfusion ratio for the following procedures in our department; elective shoulder hemiarthroplasty, reverse total shoulder replacement, open rotator cuff repair, shoulder hemi-arthroplasty for trauma, open reduction and internal fixation of proximal humeral fractures.

We undertook a retrospective review of all such patients during the period of 2002 to 2005. All trauma and elective surgery included. Hospital notes were analysed to include age, sex, pre operative haemoglobin level, blood transfusion intra-operatively and post-operatively.

A total of 211 patients were included in the study. There were 63 elective procedures and 148 trauma procedures during that period. No patient required intra-operative or post operative transfusion. Three patients who required transfusions post operatively, due to other associated injury (liver laceration x1, spleen injuries x 2) were excluded from the study. Crossmatch-transfuison ratio was > 2.

There should be a clear equation between cross-match and its use, intra-operatively and post operatively. This study highlighted unnecessary cross-matching for shoulder operations in our unit which puts extra pressure on the laboratory staff, the blood bank and also has financial implications. We recommend, Standardised approach for pre-operative cross match practise, pre-operative group and screen to detect atypical antibodies and efficient hospital pathology services, to provide blood for transfusion within specified time, for atypical antibody negative blood, should it require.

We report the case of an 80-year-old woman treated by palliative knee arthrodesis for metastases of the proximal left tibia secondary to bladder carcinoma, using percutaneous femortibial intramedullary arthrodesis nailing.

The technique provided a simple alternative to massive allografting, total joint prosthesis or amputation, with advantages of low morbidity, short operating time, minimal blood loss, immediate ambulation and weight bearing, relief of pain, restoration of independence, and ease of nursing care.

We are satisfied with the procedure of percutaneous femorotibial intramedullary nailing as a palliative treatment of proximal tibial metastases in an elderly patient.