Introduction: The long term results of a previously published (J Shoulder Elbow Surg. 2002 Sep–Oct; 11(5):486–492) series of 44 primary Souter-Strathcyde total elbow arthroplasties performed on 36 patients with rheumatoid arthritis by a single surgeon in a district general hospital are presented.

Methods: Of the 36 patients 14 patients had died leaving 22 patients or 28 elbows that could be followed up with a mean follow up of 11 years (range 9.7–17.8 years). Patients were followed up in research clinics. They underwent plain radiographs and clinical examination. The notes of the deceased patients were reviewed.

Results: In the surviving patients 60% reported complete freedom of pain, 28% mild intermittent pain and 11% moderate pain. The mean range of motion at follow up was 91 degrees (range 30–130 degrees). This represented a mean gain of 15 degrees of flexion, but only a 1 degree gain in extension. Fourteen elbows had a range of motion of 100 degrees or greater compared with 9 before surgery.

In the deceased patients 2 patients had undergone revision and the remaining patients had died of causes unrelated to the surgery with the prosthesis intact. There was 1 permanent ulnar nerve palsy and two deep infections one requiring debridement. Eight of the original 44 primaries required revision, 3 for fractures and 5 for loosening.

Discussion: In patients with rheumatoid arthritis and low functional demand, the Souter-Strathclyde total elbow arthroplasty performs well in abolishing pain and increasing independence in carrying out the activities of daily living.

One-hundred and seventy patients with 252 club feet treated by early posterior release were reviewed after a follow-up averaging 15 years 10 months. The feet were assessed both functionally and clinically and the results related to any bony deformity found radiographically; a satisfactory result was obtained in 81%. Lateral tibial torsion was examined and found to be less than in a normal population. The relationship between primary bone deformity and eventual functional result was examined, and a classification of talar dome deformity introduced. The range of ankle movement was a major factor in determining the functional result, and this in turn was influenced by the degree of talar dome flattening. It is suggested that the primary bone deformity present at birth dictates the eventual result of treatment.

Twenty young men with displaced fractures of one or more long bones in the lower limb, but with no evidence of cranial, thoracic or abdominal injury, were studied prospectively. Although all the patients became hypoxaemic, the six who developed signs of respiratory distress (Group 1) were found to have a significantly lower arterial oxygen tension and a significantly higher rate of urinary urea excretion than the remaining 14 patients whose pulmonary function appeared to be clinically normal (Group 2). Circulating fat macroglobules were identified in three cases, only one of whom was in Group 1, and hence the tests for fat embolism were not of prognostic value. Although an immunodeficient state is considered to contribute to the pulmonary insufficiency which occurs after major trauma, convincing evidence of a lymphocyte-suppressive agent was found in only one patient.