Introduction: Trauma constitutes a substantial portion of the workload of any Trauma and Orthopaedic department and any attempt for improvement in service is warranted. Aim of this study was to compare a New with an Old Trauma Service Protocol, by means of quality of Clinical service, junior doctors training and financial impact.

Methods: Search was performed through the HISS archives and the theatre registry. Quantitative and qualitative parameters were assessed.

Wait till surgery, length of patient hospitalisation, out of hours surgery, case cancellations, complications and number of procedures performed by junior doctors were all compared. Medical and nursing staff members were interviewed regarding their subjective opinion for the two protocols.

Results: Length of wait to surgery was substantially decreased for most of the fracture groups. Out of hours surgery were almost eliminated and there were hardly any cancellations for reasons other than medical. The number of trauma cases performed by junior doctors was increased and there was always performed under supervision. The total length of stay for all the trauma patients was substantially decreased in the second year. All health professionals quoted improvement of their working-lives with less stress and better organization. The financial impact was less than we thought.

Discussion: Within a patient focused NHS all patients deserve the best of care that could be provided; implementing proper resources for Trauma service should be one of our first priorities in the Bone and Joint Decade.

Introduction Hallux valgus (HV) is a common foot deformity with a prevalence of up to 48%. It usually affects females and its radiographic severity is expressed by various angles, such as the HV Angle, the Inter Metatarsal Angle (IMA) and the Distal Metatarsal Articular Angle (DMAA).

The aim of our study was to assess the impact that HV has on patients’ quality of life and to correlate each of the above angles to SF-36 sub-scales.

Method Twenty-three female patients with a mean age of 48.5 years were included in the study. Diagnosis was established by clinical and standardised radiological examination. Patients were medically fit and the only pathology that could affect their SF-36 score was HV. They all completed in the SF-36 form on their first visit at the clinic. Statistical analysis was performed via SPSS 12.0.

Results Mean radiographic angular deformities measured 35, 13, and 17 degrees for HVA, IMA, and DMAA respectively. The HVA and IMA demonstrated significant association (p=0.018) as regarding their severity, indicating that they probably interact during the progression of the deformity. The Physical Component Summary score was significantly lower in our patients than the recommended norms for the same age (p=0.015). HVA significantly affected the General Health (p=0.023), IMA, the Role Physical (0.039), Role Emotional (p=0.056) and Mental Health (p=0.043). The coefficients were all negative indicating a worse health scenario as the deformity increases.

Conclusion These results suggest that HV deformity seriously affects peoples’ quality of life. In addition, according to our data, surgical treatment is absolutely indicated and operative correction of the angular deformities would be expected to normalise those patients’ SF-36 score. However, this remains to be proved.

Introduction and Aims: The clavicle has several important functions each of which may be affected after fracture and malunion of the bone. The aim is to establish any association between shortening of the clavicle, following successful conservative management and clinical outcome.

Method: 132 patients with history of an acute fracture of the clavicle were reviewed. None of them had previous pathology affecting shoulder function, prior to injury. Men accounted 93 with average age 25.4 years, and women 39 with average age 34.2 years. All underwent conservative management with standard protocols and the fracture was united. The length and relative shortening of the united clavicle were assessed on a standardised posteroanterior chest x-ray. Intra- and Inter-observer reliability of measurements were assessed. Clinical outcome was evaluated with the Constant score. Mean follow-up was 30 months.

Results: Clavicular shortening following fracture union was 11.4 mm on average (range 3–25 mm), and was encountered in 120 patients. Intra- and inter-observer variability of measurements were not significant. Fracture healing time averaged 10 weeks (range 6–20 weeks) and 5.3% of patients presented delayed union. Thirty-four patients (25.8%) were unsatisfied with the result. The mean Constant score was 84 (range 62–100). Forty patients were having pain, and 21 had shoulder function impairment. Shortening > 14mm was statistically associated with unsatisfactory results.

Conclusion: Clavicle is an important element in the integral functional mobility of the shoulder and malunion after fracture could lead to unsatisfactory results. We describe a simple, reliable method of Clavicular length-shortening evaluation and we report the results following successful conservative management. Identification of those patients likely to have poor results after conservative treatment, would give the opportunity for alternative treatment modalities. Further prospective randomised trials are necessary.

Introduction: Ewing’s sarcoma is the second commonest primary tumor in childhood and its 5-year survival is currently just over 70%. The aim of the current study was to identify the prognostic significance of p53 and hsp70 overexpression into the nuclei of tumor cells.

Method: 30 patients treated for Ewing’s in a 15-year period, in a Children’s hospital, were included in the study. Treatment protocols included always Neo-adjuvant Chemo and did not considerably change in time. The male to female ratio was 1.8: 1. The average age was 10.5 years (range 2–18y). Central axis and extremities were equally affected, with pelvis being the commonest site. Expression of P53 and HSP70 in > 20% and > 15% of the tumor nuclei respectively, was considered compatible with mutation. The mean follow up was 7.2 years.

Results: Seventeen patients eventually died. HSP70 trace was negative, meaning that at the time of biopsy the tumor nuclei were not expressing the protein. Mutated p53 was traced in 13% of the tumor nuclei and had significant negative prognostic value in 5-year survival (p=0.039) and in Event Free Survival (p=0.006).

Discussion: The search of factors that could independently affect the prognosis in Ewing’s sarcoma continues. Identification of these factors would lead to application of more intense therapeutic means only to those patients with a poorer prognosis without getting everyone in the risk of adverse effects.

Introduction and aim: The resemblance of acute osteomyelitis and primary bone tumor is well established. However, pubic osteomyelitis presents particular diagnostic dilemmas and acute osteomyelitis of the distal femur resembling soft tissue sarcoma has not previously reported in the English literature.

Patients and methods: We report two cases of acute osteomyelitis in 6-year and 7-year old children, affecting the pelvis and the distal femur respectively. Both patients reported previous trauma and presented with a painful limp. Clinical examination revealed a painful mass in both. Laboratory screening and imaging modalities were inadequate to establish the correct diagnosis.

Results: ESR and CRP were raised in both patients, however blood cultures were negative. Plain x-rays showed a lytic lesion at the pelvic site and were unremarkable for the femur. Bone scan was not specific. MRI Scan suggested primary bone tumor in both cases, i.e. Ewing’s sarcoma and liposarcoma/rabdomyosarcoma respectively. Open biopsy established the correct diagnosis and S. Aureous was isolated in both cases. Treatment was conservative

Conclusion: Acute osteomyelitis may cause diagnostic confusion especially if its location and/or presentation are particularly unusual. Blood investigations are frequently inconclusive. Even the most sophisticated imaging modalities may fail to establish the diagnosis and biopsy is then necessary. This should be always performed in specialized centers, in order to minimize complications. Treatment is fairly straightforward.

From 1998–2000 inclusive, we treated 155 acute, non-pathological fractures of the clavicle in adults. We reviewed 134, of which 95 were involving the middle third. The average time of follow-up was 24 months (range 9–33). Aim of this retrospective study was to review the results of operative versus conservative treatment in a view to create a standard protocol for these fractures management. Men accounted 67 the average age being 26.8 (range 15–83) and 28 were women with average age 36.8 (range 23–91). We operated on 23 patients: 3 due to neurological symptoms of C6 nerve root irritation, 4 due to a symptomatic non-union, 10 due to severe displacement and comminution with pressure on the overlying skin and 6 due to their request in a view to earlier return to activity as they were skilled athletes. All fractures healed within 6–14 weeks, and return to normal activity level was 8 weeks on average ( range 2–12). A 3.5mm DCP plate was used in all cases. We treated conservatively 76 patients. Non-union was encountered in 4 (4.2%) and was symptomatic in all of them so they were fixed with a 3.5mm DCP plate and bone grafted. The healing rate was 8–20 weeks, and return to pre injury activity level was 16 weeks on average (14–24). Unsatisfactory results reported from 23 patients, 21 of who were treated conservatively (27.6%) and only 2 operatively (8.7%). In the group of patients treated conservatively initial shortening was similar to the final and when 14mm or more was strongly associated with poor results. In the group treated operatively no significant shortening was found. We recommend young, active patients should be given the option of operative treatment in a view to earlier return to activities with a possible better clinical outcome.