Introduction Comminuted intra-articular fractures of the distal radius are severe injuries where the outcome depends on accurate anatomical reduction and reconstitution of the articular surface, and early mobilisation. This prospective outcome study aims to assess the anatomical and functional outcome of internal fixation of these complex fractures using a fragment specific fixation system.

Methods Fifty consecutive comminuted intra-articular distal radius fractures presenting at our hospital were treated by the one surgeon (MP). Inclusion criteria were age under 80 and AO classification C-3. Various combinations of wires, buttress pins/clips and plates were utilized according to each fracture configuration. No post-op splintage was used. All patients commenced hand therapy from day one post-op. Patients were reviewed at two weekly intervals till fracture union and monthly thereafter. All patients were independently assessed by a hand therapist for range of motion and grip strength. Patient function was assessed using the DASH (Disabilities of the Arm, Shoulder and Hand) and the PRWE scores. Thirteen males and 37 female with an average age of 53.8 (29 to 72) were treated with the TriMed between February 2002 and February 2003. Average follow-up was seven months (3 to 14).

Results All fractures had healed at the six week review, with mean palmar tilt of 12°, radial tilt of 19° and radioulnar variance of 5 mm, with articular step less than 1 mm. The mean DASH score was 19 (SD 9) and mean PRWE score was 19 (SD 11). Average range-of-motion was 65 (SD 17) dorsi-flexion, 55 (SD 19) palmar-flexion, 73 pronation and 67 supination. Grip strength recovered to 85% on average when compared to the opposite hand. There were no deep or superficial wound infections. Three patients had difficulty regaining early hand function, with difficulty complying with physiotherapy. One had borderline mental retardation. Two displayed symptoms of RDS, one responding to medication, and one requiring guanethidine arm block.

Conclusions Intra-articular distal radius fractures can be reliably and anatomically reduced and stabilized using fragment-specific fixation. Fixation of markedly comminuted fractures is secure enough to allow immediate motion. Clinical and radiographic results are excellent, and patient satisfaction is high. Patient compliance with hand therapy is critical for a good functional result.

Introduction The accuracy of UCA implantation is an important prognostic factor in survivorship. Previously, conventional instrumentation was adapted for UCA, possibly contributing to a lower long-term survivorship. This study aims to assess UCA position on x-rays, performed through a minimally invasive approach, in comparison to UCAs utilising an open approach.

Methods Patients were selected for UCA according to strict criteria. In particular, a varus knee < 15 and correct-able,< 15 fixed flexion deformity, intact cruciate ligaments and weight bearing knee x-rays indicating osteoarthritis in the antero-medial region and relative lateral compartment sparing. Patello-femoral joint disease was not an exclusion criterion. Ultimately, the decision to proceed with UCA was made at the time of surgery where the cruciates and lateral compartment could be inspected directly. Data was retrieved retrospectively for a continuous cohort of patients. Radiographs of component alignment were measured by an independent observer not involved in the surgery. Radiographs were measured for 56 UCAs, performed by one of the authors. Twelve patients had bilateral UCAs at the same surgery and one patient had a combined UCA/TKR. Short knee x-rays (anterior-posterior and lateral views) were used to estimate the axes of the femur and tibia as the reference points for component measurements.

Results The femoral component varus/valgus angle was 5.6° (range: 2 to 10) and flexion/extension angle was 4.9° (range: 0 to 11). The tibial component varus/valgus angle was 86.4° (range: 80 to 89°) and the postero-inferior tilt angle was 83° (range: 80 to 85). There was no radiolucency at the tibial plateau interface greater than one millimetre. One patient was treated for deep vain thrombosis and two patients underwent manipulations due to reduced range of motion. There were no deep or superficial infections and no UCA revisions.

Conclusions Radiological analysis of Oxford UCAs using a minimally invasive technique demonstrates similar implant positioning compared to the open approach. Patients gain the advantage of earlier recovery due to less synovial and quadriceps disturbance and no patella dislocation. Ongoing follow-up is required to determine whether these benefits extend to improved prosthesis survivorship.

Aim: To determine the effectiveness of arthroscopic surgery, without excision of the radial head, in elbows with end stage arthritis of the radiocapitellar joint.

Methods: Twenty-three elbows with bone-on-bone degeneration of the radio-capitellar joint, but with only minor degeneration of the humeroulnar joint, had arthroscopic surgery, with synovectomy, removal of loose bodies and excision of impinging tissues and bone. The average age was 51 years (range: 16 years to 59 years). Evaluation was by a questionnaire and the follow-up was after a minimum of one year.

Results: The average follow up was 41 months (range 12 months to 83 months). Twenty-one of 22 patients reported improvements. Six patients were pain free, 12 had mild residual pain and six had significant, continuing pain. Only three patients reported residual lateral elbow pain. The average visual analogue pain score was 3.4. According to the Mayo elbow function score, there were eight excellent, seven good, six fair, and three poor outcomes.

Conclusions: Satisfactory improvements in symptoms and function were obtained in arthritic elbows with arthroscopic surgery, even in the presence of severe radiocapitellar arthritis.

Aim: To evaluate the results of arthroscopic resection of the superomedial corner of the scapula, using a new superior portal, in patients with painful snapping scapulæ.

Methods: An analysis was made of 10 patients who had each undergone arthroscopic resection of the superomedial corner of the scapula. The patients were evaluated by questionnaire and clinical examination, and the results assessed by the UCLA rating score.

Results: There were four women and six men with a mean age 26.9 years (range: 16 to 40 years). The average duration of symptoms was 53.2 months (range: 12 to 154 months). Their x-rays and CT scans were normal. The average follow-up period was 11.3 months (range: three to 23 months). There were no post-operative complications. The scapulothoracic crepitus disappeared in two patients, decreased in seven patients, and remained the same in one patient. The mean postoperative visual analog pain scale was 2.7. All felt the procedure to be worthwhile. On the UCLA score there were four excellent, four good and two fair results.

Conclusions: Scapulothoracic arthroscopy using medial and superior portals is a safe procedure. Resection of the superomedial corner of the scapula reliably improved symptoms from the painful snapping scapula.

Aim: To determine the long-term outcome of surgery for rotator cuff disorders.

Methods: Ninety-two patients were followed up, after a minimum of nine years following rotator cuff surgery, including arthroscopic and open subacromial decompression, and repair of a rotator cuff tear. The results were assessed with the UCLA rating score. These results were compared with another group with a two-year follow-up.

Results: The follow-up periods for the 92 patients were from nine to 14 years. There were 58% of patients in the good or excellent group, 23% in the fair, and 19% in the poor. The results in cases with rotator cuff repairs were similar to those with only subacromial decompressions. The long-term results were a little worse than the results in the two-year follow-up group.

Conclusions: In some cases there was a gradual deterioration over time in shoulder symptoms following rotator cuff surgery. After 10 years, 19% had a poor result.