The use of tourniquet in lower limb orthopaedic surgery is well established, however, it does have associated risks and complications and its use has been previously questioned. The purpose of this study was to compare postoperative pain scores, analgesic requirements and time to discharge in patients undergoing tourniquet assisted and non-tourniquet assisted routine knee arthroscopy.

A total of 40 patients were randomised to tourniquet assisted and non-tourniquet assisted groups. Arthroscopy was performed using a standardised local anaesthetic infiltration in the non-tourniquet assisted group. All patients completed a postoperative pain score.

Findings demonstrated that the incidence and mean scores for postoperative pain were significantly lower in the non-tourniquet group. Additionally postoperative analgesic requirements of patients in the non-tourniquet group were also found to be significantly lower and time spent in recovery and on the ward postoperatively was also lower in the non-tourniquet group compared to the tourniquet group.

On the basis of the results in our study we recommend abolishing the use of tourniquet in routine knee arthroscopies in the virgin knee.

Trigger finger is one of the most common problems presenting to hand clinics in the UK. Traumatic and compressive forces created through digital movement leads to thickening of the flexor tendon sheath. The most successful methods used to treat trigger finger are corticosteroid injection and surgical release. The ring, thumb and middle finger are the most frequently affected digits. The incidence of multiple digits being affected is between 20% and 24%, with a higher incidence in Diabetes Mellitus sufferers. We report a case of failed injection therapy in a patient with multiple trigger digits, review the literature and advocate the use of surgical release as a first line treatment option in those patients with multiply involved digits.

The Department of Health and the Public Health Laboratory Service established the Nosocomial Infection National Surveillance Scheme in order to standardise the collection of information about infections acquired in hospital in the United Kingdom and provide national data with which hospitals could measure their own performance. The definition of superficial incisional infection (skin and subcutaneous tissue), set by the Center for Disease Control (CDC), should meet at least one of the defined criteria which would confirm the diagnosis and determine the need for specific treatment.

We have assessed the interobserver reliability of the criteria for superficial incisional infection set by the CDC in our current practice. The incisional site of 50 patients who had an elective primary arthroplasty of the hip or knee was evaluated independently by two orthopaedic clinical research fellows and two orthopaedic ward sisters for the presence or absence of surgical-site infection. Interobserver reliability was assessed by comparison of the criteria for wound infection used by the four observers using kappa reliability coefficients. Our study demonstrated that some of the components of the current CDC criteria were unreliable and we recommend their revision.