Magnetic resonance imaging (MRI) continues to become more widely accessible as an investigation, with an increasing number of scans being performed in the outpatient setting for suspected shoulder pathology.

We performed a retrospective review of all shoulder MRI scans performed in an orthopaedic outpatient setting in a district general hospital between October 2010 and October 2011. We also reviewed the medical notes for these patients. 75 MRI Shoulder scans were performed on 74 patients. In 5 cases (7%), no other form of imaging was performed prior to MRI scan. 11 patients (15%) had no provisional diagnosis included in the referral. The nature of referral, indication for MRI and subsequent management of these patients was also examined.

Our findings may support the use of guidelines for requesting MRI scans of the shoulder in outpatients.

The study looked at early outcomes of 55 patients who underwent open reduction and internal fixation of distal radius fracture with a single variable angle volar locking plate (Variax, Stryker), by a single surgeon (GS), between May 2007 and December 2008.

A retrospective review of notes and radiographs was performed. Twenty-nine women and 26 men were included. The mean age was 52 years. Mean follow up time was 3 months. The dominant wrist was involved in 38 patients. The mechanism of injury was of low energy in 38 patients and of high energy in 17 patients. All patients had comminuted fractures and 52 patients had intraarticular fractures. Seven patients underwent intraoperative carpal tunnel decompression.

At latest follow up, active wrist motion averaged 37° extension, 40° flexion, 70° pronation, and 56° supination. Grip strength averaged 64% and pinch grip 77% of the contralateral wrist. Postoperative complications included one flexor pollicis longus rupture, one malunion and three patients with loosening of screws. There was a higher rate of complications seen in patients with high energy injuries.

These early results suggest that volar plating with a variable angle plate is an effective treatment option, especially for complex intraarticular distal radius fractures. A medium term outcomes study of a larger number of patients is planned.

Lumbar Spinal Canal Stenosis is a common condition in the ageing population. In Spinal decompression surgery a balance needs to be struck between the need to decompress the neural elements in the spinal canal and the risk of worsening the segmental instability that often coexists in this condition. Traditionally decompression has been supplemented with rigid stabilization e.g. fusion, which is irreversible. Recently semi-rigid or ‘soft’ stabilization philosophies have evolved. The Wallis Device is a second generation interspinous distraction/stabilization implant designed to achieve ‘soft’ segmental stabilization. In addition to stabilising the decompressed segment, it also provides a ‘block’ to full segmental extension, helping to maintain spinal canal dimensions even in the erect position.

We followed up and assessed outcomes in 50 patients (25 spinal decompression + Wallis implant and 25 spinal decompression alone). The two arms of the study were matched for gender, age and level of lumbar decompression. A single surgeon was involved in each case and carried out a standard procedure of fenestration and medial facetectomy. Outcomes were assessed during clinical follow-up as well as by telephone, and included the VAS, the Oswestry Disability Index (ODI) and the EQ5D Health Domain.

Early results suggest decreased incidence of recurrent symptoms and global improvement in all parameters measured, in those subjects that underwent Spinal decompression with Wallis stabilisation.