Background: Ankle fractures in adults are an increasing part of the workload of orthopaedic surgeons today. Stable ankle fractures are usually managed conservatively and followed up in the fracture clinic to identify any later displacement which may lead to the need for surgical treatment. the guidelines for follow up varies from place to place with equally varying outcomes. the aim of this study was to look at the pattern and outcome of follow up of these fractures and also the influence, if any, of serial radiological imaging during this period.

Methods: We retrospectively reviewed the follow up of patients who were refered to the clinic as stable ankle fractures and who were treated conservatively following their first clinic attendance. the period covered was April 2002 to march 2003 and we also assessed the documentation of medial side tenderness from the casenotes.

Results: 66 patients were identified consisting of 44 Weber A, 20 Weber B and 2 Weber C fractures with an average follow up of 10weeks. 82% of cases had documented medial side tenderness. None of the Weber A fractures displaced, irrespective of weight bearing instructions and medial side tenderness. Only 2(10%) of the Weber B and 1 (50%) of the Weber C fractures required surgical intervention due to displacement detected after clinic review at week one.

Conclusion: Weber A fractures are inherently stable injuries, do not displace over time and hence do not require further clinic attendances and xrays after the first consultation. Beyond the first week, regular clinic reviews and serial xrays are not necessary in the treatment of Weber B ankle fractures. The presence of medial side tenderness was a poor indicator for joint instability in this series. with proper protocols in place, these can lead to a significant decrease in the workload of orthopaedics surgeons.

Purpose: We carried out a questionnaire survey amongst all the members of the British Association for surgery of the Knee (BASK) to provide us with a guide to the current practice and opinions on cementing techniques in Knee replacement.

Materials & Methods: Between January and February 2003, all the three hundred members of the BASk were mailed a thirteen-question survey regarding the current practice of TKR with specific emphasis on the cementing techniques.

Conclusion: Our study shows the wide variation in current practice and attitudes towards cementing in Total Knee replacement amongst the specialist Knee surgeons of Britain, but the practice of the majority is in accordance with the guidelines issued by the BOA & BASK.

Aims: This study aims to identify whether there is seasonal variation in proximal femoral fractures in ageing population. Methods: We carried out a study to find out whether there is a definite variation in the incidence of these fractures. The number of operated proximal femoral fractures across 31 hospitals of Northwest England and Scotland were collected on a monthly basis from 1994 to 1999. This database of 27,000 operated proximal femoral fractures was assessed statistically. Results: Our analysis reveals that the incidence of these fractures during December is about 17% higher than rest of the annual mean with a 2% standard error of the mean (SEM) and in January this increase is about 22% with a SEM of 1%. These trend and pattern were observed for both intra and extra capsular fractures of neck of femur and was consistent over the five years. There was no other significant change in the incidence pattern during other months of the year. Conclusions: This study, one of the largest of its kind ever carried out, proves that there is an increase in the incidence of hip fractures in the months of December and January. There should be appropriate allocation of manpower and rehabilitation facilities during the months of December and January to tackle this seasonal variation.

Aims: We wanted to study the outcome of bone transport by Ilizarovñs method in simple and complicated gap non-unions where other conventional methods have little role to play. Methods: Sixty-six consecutive patients with an age range of 23–64 years (58 males and 8 females) were included in this study. Forty-four patients (67%) had associated problems like infection, deformity and shortening along with gap non unions of varying length. All the patients were treated with ring þxators and the principles of Ilizarovñs treatment were adopted. Corticotomy was carried out in all the cases. Appropriate arrangement of apparatus assembly was done according to the requirement of individual gap non-unions. Follow up ranged from 6 to 46 months. Results: In all but three cases, union was achieved along with satisfactory correction of other associated problems. In one case the patient had previously undiagnosed hypothyroidism and showed signs of callus at corticotomy site after treatment with thyroxine. This patient lost to follow-up. Two other cases needed further surgery (Ilizarovñs ring þxator). In one case, cancellous bone grafting had to be carried out. In six tibial gap non-unions, residual equinus deformity persisted. Conclusions: Ilizarovñs method of bone transport is quite effective in treatment of gap non-unions associated with complex problems, where other methods have proven to be less successful.

Proximal femoral fractures have always been in the centre of attention in terms of their demand on the manpower and resources of the NHS. With an ageing population, the number of these fractures will continue to be a big part of the workload of all the Orthopaedic and rehabilitation units. Hence it is important to be aware of any definite variation in the incidence of proximal femoral fractures for appropriate planning of the available resources.

We carried out a study to find out whether there is a definite variation in the incidence of these fractures. The number of operated proximal femoral fractures across 31 hospitals of North-west England and Scotland were collected on a monthly basis from 1994 to 1999. This database of 27, 000 operated proximal femoral fractures was assessed statistically.

Our analysis reveals that the incidence of these fractures during December is about 17% higher than the rest of the annual mean with a 2% standard error of the mean (SEM) and in January this increase is about 22% with an SEM of 1%. These trend and pattern were observed for both intra and extra capsular fractures of neck of femur and was consistent over the five years. There was no other significant change in the incidence pattern during other months of the year.

This study, one of the largest of its kind ever carried out in Britain, proves that there is an increase in the incidence of hip fractures in the months of December and January. There should be appropriate allocation of manpower and rehabilitation facilities along with a matching reduction in the elective Orthopaedic admissions during the months of December and January to tackle this seasonal variation.