Introduction

Government figures show a trend of increasing incidence in motorcycle trauma in the UK over the last decade. These patients often have multiple injuries and place a significant burden on the admitting units. In the face of changes to health service funding, with the introduction of Payment by Results, we wanted to determine the true cost of treating these patients in the setting of a District General Hospital.

Introduction: Nerve conduction study (NCS) examination of the ulnar nerve is a diagnostic tool when investigating patients presenting with cubital tunnel syndomre (CTS). However, NCS are associated with a false negative rate. Decompressive surgery of the ulnar nerve remains the primary treatment of cubital tunnel syndrome. The aim of our study was to look at:

The correlation between the results of NCS and the subsequent outcome from surgery

Method: A retrospective study of 75 cases of CTS was undertaken. All patients had clinical examination with documentation of features, followed by NCS if indicated. If NCS were carried out, the results of the study was graded (negative, mild, moderate or severe). All patients had decompressive surgery of the ulnar nerve at the elbow. Operative functional outcomes was evaluated pre and post operatively using standard DASH score. A successful outcome was defined as resolution of symptoms.

Results: There were 53 men and 22 women. Patient age showed a normal distribution (range 26–84, mean 49 years). Overall, 65 patients (87%) had resolution of symptoms postoperatively and 10 patients (13%) had unresolved symptoms (5 sensory, 1 pain, 2 sensory & pain, 2 sensory & motor). Outcomes of patients that did not undergo NCS showed a resolution rate of 89% (24/27). Those that had a negative NCS, showed a resolution rate of 100% (12/12), whilst those that had a positive NCS showed a resolution rate of 81% (29/36).

Discussion: Our study highlighted that patients with electro-negative CTS can be effectively and safely treated by simple decompression. Surgical outcome can be correlated to the severity of the pre-operative NCS. There would seem no reason to refer patients for NCS prior to offering operative treatment.

We have investigated those factors which influence the range of movement after total knee arthroplasty, including sex, age, preoperative diagnosis and preoperative flexion deformity and flexion range. We also compared cemented and cementless tibial fixation, the influence of collateral ligament and lateral parapatellar releases and of replacement of the patella, and of the period of postoperative immobilisation. We reviewed 516 Johnson-Elloy (Accord) knee arthroplasties performed between 1982 and 1989, with a minimum follow-up of 12 months. The most important factors in the range of flexion achieved after arthroplasty are the diagnosis and the preoperative range of flexion. In patients with osteoarthritis there was a mean loss of flexion; in rheumatoid arthritis there was a mean gain. In both groups, the stiffer knees gained motion and the more mobile knees lost it. Post-operative range of motion was not influenced significantly by cement fixation, collateral ligament or patellar retinacular releases, prolonged immobilisation or patellar replacement.