The aim of our study was to assess the use of the Clavicular Hook Plate in treating acromio–clavicular joint dislocations and fractures of the distal clavicle. The prospective study was carried out at two hospitals- a teaching hospital and a district general hospital.

Between 2001 and 2004 a total of 37 patients with AC joint injuries and distal clavicle fractures were treated surgically with this device. Four of the patients had sustained a Neers Type 2 fracture of the distal clavicle, while 33 patients had acromio-clavicular joint dislocation (Rockwood Type 3 or higher). Mean age of the study group was 35.2 years. Post operatively, shoulder pendulum exercises were commenced on the second day and all patients discharged within 48 hours. During the first few weeks, we restricted shoulder abduction to 90 degrees. At the first postoperative follow up appointment at 2 weeks, average shoulder abduction was 30 degrees and forward elevation −40 degrees. This improved at 6 weeks to 85 degrees and 105 degrees respectively. The plates were removed at an average time interval of 11 weeks for the ACJ dislocations (range 8–12 weeks) and 15 weeks for the clavicle fractures (range 12–16 weeks). At three months after plate removal, we evaluated patients to measure the Visual Analogue Score(VAS) and Constant Score. The mean VAS was 1.4 (range 0–6) and the mean Constant score was 92 (range 72 to 98). Wound healing problems occurred in two patients, while two had a stress riser clavicle fracture. These had to be subsequently fixed with a Dynamic Compression Plate. One patient developed a superficial wound infection. Seven patients had problems due to impingement between the hook and the under surface of the acromion. A 45 year old female patient developed ACJ instability after plate removal. Radiographs revealed widening of the AC joint and some osteophyte formation. She went on to develop frozen shoulder which was treated with intensive physiotherapy.

The AO hook plate represents an improvement over previous implants in treating injuries around the AC Joint. However, the need for a second operation to remove the plate remains a significant problem. Complications resulting from impingement were common in our patients and represent a major drawback of this implant.

Purpose: In this prospective study we present the intermediate results of our experience using the Prodisc disc replacement for lumbar degenerative disc disease.

Methods and Results: A total of 29 patients underwent Prodisc disc replacement by the senior author(AAH). There were 9 males and 20 females with a mean age of 39 years(Range 28–60 years). 18 patients had a single level disc replacement (L5/S1-- 14 patients, L4/5-- 4 patients). 11 patients had double level disc replacement (L4/5& L5/S1--7 patients, L3/4& L4/5--3 patients, L2/3& L3/4--1 patient). All patients were assessed pre-operatively with clinical examination, plain films, MRI scans and discography. The indication for surgery was discogenic pain at one or two adjacent segments confirmed with discography, minimum six months of conservative treatment, 20–60 years of age and an Oswestry score > 40%. All patients also agreed to a prearranged follow up protocol. Follow up included clinical examination, plain films and subjective evaluation using the Oswestry scale, Visual Analogue Scale and SF 36 scoring system at 6 weeks, 3 months, 6 months and annually.

Results- The follow up range was from 3 months to 2 years. 26 patients had excellent to very good results and 2 patients had good results. There was one complication at 3 months post operatively. This patient sustained a fractured pedicle and underwent revision surgery involving removal of the prosthesis and Anterior Lumbar Fusion. At 6 months post revision a CT scan confirmed fusion. Rapid recovery was the most noticeable aspect of this study as well as rapid return to normal activities.

Conclusion: The Prodisc disc replacement is a good treatment option for lumbar degenerative disc disease provided the operative indications are strictly adhered to. The early and mid term results presented are encouraging, however close follow up of these patients is essential to ascertain the long term results.

Aims: To present our experience from the diagnosis and treatment of axillary vein thrombosis in seven cases. Methods: We reviewed the medical records and x-rays of all the patients who were admitted and treated for axillary vein thrombosis (AVT) in the Orthopaedic and Vascular Surgery Departments of our hospital between 1995 and 2001. Results: We reviewed seven patients (þve males and two females, mean age 52.3 years old) presented in our hospital with AVT. Two of these cases occurred following musculoskeletal injuries (extrinsic trauma), three after central line insertion for oncological treatment (intrinsic trauma), one was related to the oral contraceptive pill (thrombophilic tendency) and one case was effort related (Paget-Schroetter syndrome). Clinically there was plethoria, arm swelling and persistent superþcial veins which were aggravated with activity and dependency. Venography or Duplex scan was used to establish the diagnosis. Causing factors and associated morbidity were assessed and treated. All of the cases of vein thrombosis responded well to conservative treatment (heparin/low molecular weight heparin for three months). None of the cases developed pulmonary embolism and we had no mortality. Conclusions: This study demonstrates that the innocent appearance of upper limb swelling should raise the index of suspicion of a potential underlying vascular lesion. Although quite rare, missed AVT may cause associated morbidity but very rarely mortality.

Introduction: Osteoid osteomas (OO) are benign skeletal tumours with a predilection for the long bones of young patients. Many different methods are used for their treatment, conservative or operative, less or more radical with variable technology applications to destruct the “nidus”.

Material & Method: We present thirty eight patients with OO who were treated in our hospital between 1995–2001. Their medical records and radiographs are retrospectively reviewed and the patients were contacted and interviewed with a telephone discussion.

Results: In thirty two cases OO were located in the lower limb, two in upper limb and four in spine. Thirty seven of those were treated operatively using open wide excision of nidus in twenty two of which with additional bone grafting.In three of the cases after excision of OO, precautious internal fixation was applied to the bone. Two patients developed deep vein thrombosis, another two had increased pain in anterior superior iliac spine from the bone graft harvesting area. We had one recurrence, which was treated with a second operation.

Conclusion: We conclude that although the traditional method of treatment is the wide surgical excision, this technique has increased morbidity and higher risk for complications comparing to more minimally invasive procedures. We suggest that it should be the first choice of treatment for either spinal or recurrent OO.

Data is collected prospectively on all patients undergoing total knee replacement at the Princess Alexandra Hospital in Harlow, as part of an on-going research programme. The database commenced in April 1994 and we will be presenting the details of 1114 patients who underwent total knee replacement between April 1994 and December 2000. The early outcomes will be discussed, as well as a particular emphasis on some groups, like simultaneous bilateral total knee replacements& total knee replacements in the elderly population. We will also present the details of the radiological component positioning in total knee replacements and comparison between the radiological alignment achieved between consultant grade and trainee grade surgeons. The effect of surgeon grade on component positioning was tested using factorial analysis of variance. The statistical analysis was performed using StatView4.0 software The main coronal alignment angle was 6.02 degrees and the mean sagittal tibial angle was 87.11 degrees. Our revision rates will also be discussed.

Introduction: Enchondromas are benign cartilaginous tumors, which are most often localized, in the small bones of the hand. Treatment methods fall into a broad spectrum ranging from conservative, medical therapies, to a variety of surgical procedures, which may or may not employ the use of local adjuvant treatment or bone grafting.

Material & Method: We present thirty four patients with hand enchondromas treated surgically in our department during the last eleven years. Their medical records and radiographs were reviewed retrospectively and the patients were contacted and interviewed by telephone.

Results: The patients were treated operatively with an intralesional approach, with meticulous curettage of the bone lesion, use of phenol 5% and grafting using coralline hydroxyapatite. X-rays taken over the first postoperative year revealed adequate bone synthesis at the site of enchondroma excavation, and there was no evidence of recurrence, fracture, infection or other complication related to the procedure.

Conclusion: We conclude that the combination of curettage of the lesion with the use of phenol as local adjuvant and grafting using coralline hydroxyapatite during the surgical treatment of enchondromas, is a safe technique to reduce or prevent recurrence and allow adequate and uncomplicated local new bone formation.