Introduction

Classical fixation using a circular frame involves two rings per segment and in many units this remains the norm whether using ilizarov or hexapod type frames. We present the results of two ring circular frame at King's College Hospital.

Introduction: There is concern that cobalt and chromium ions released from metal on metal (MOM) bearing surfaces may have an adverse effect on renal function over time.

Aim: The aim of this study was to assess renal function in patients who have had MOM hip resurfacing at between two and seven years follow up.

Methods and Materials: Seventy seven patients had MOM hip resurfacing performed in our unit between 1st March 2001 and 28th February 2006. All patients were invited to present for an up to date renal profile. Of these, 59 patients volunteered a sample (76%). Forty-eight were male and eleven were female. Ages ranged from 33 to 63 years (mean 59 years). Nine patients had hypertension pre-operatively. No other risk factors for renal dysfunction were present in our patient population.

Results: Pre-operative urea and creatinine levels ranged from 2.9 to 10.6mmol/L (mean 6.4mmol/L) and 50 umol/L to 121umol/L (mean 77.2umol/L) respectively. Post-operative urea and creatinine levels ranged from 5.3mmol/L to 6.3mmol/L (mean 5.3mmol/L) and 62umol/L to 75umol/L (mean 67umol/L) respectively. Two patients who had normal serum creatinine profiles pre-operatively showed mildly elevated serum creatinine levels at most recent follow up.

Conclusion: Medium term follow up of patients following MOM hip resurfacing does not suggest evidence for the development of renal impairment in this patient population.

Introduction: Carpal tunnel decompression is the most commonly performed procedure in hand surgery. This study was done to assess the effectiveness and acceptability by patients of open carpal tunnel release under local anaesthetic and compare our results with previous published work from our department following alterations to our operative techniques.

Methods: 92 carpal tunnel releases were performed on 80 patients over a four year period, 2001 to 2004. 55 were females and 25 were males. A patient satisfaction survey was done by a postal questionnaire which addressed opinion regarding preference for LA over GA, pain due to LA infiltration, effectiveness of LA, patient comfort during surgery, outcome of surgery and overall satisfaction with the procedure. In this cohort of patients we did not use a tourniquet which caused severe pain in 29% of cases in the previous study. We also administered LA with adrenaline using a dental syringe to reduce pain which was previously reported as severe in 20% of cases.

Results: 62 patients replied to the questionnaire, a response rate of 77.5%. Preference for LA over GA was 90% as compared to 70% in the previous study. Pain due to tourniquet use was previously reported as severe in 29% of cases but this did not apply in this subset of patients. Pain due to infiltration of LA with a dental syringe was severe in 9% of cases compared to 20% with a 25G needle. Effectiveness of LA, outcome of surgery and overall satisfaction with the procedure remained unchanged.

Conclusion: Carpal tunnel decompression is a quick, convenient, inexpensive and safe method of treatment. We have demonstrated that injecting LA with adrenaline using a dental syringe obviates the need for tourniquet and improves patients’ acceptability and tolerance of this procedure.

Abstract: The impact of FOI and the rising tide of litigation have focused clinicians on their vulnerability. As the British Orthopaedic News states, the Bristol Enquiry made 198 recommendations of which only a few were specific to paediatric cardiac surgery. With this climate in mind, a Research Project on a system of Risk Management has been established in Trauma & Orthopaedics and A& E in Sligo General Hospital.

A “Clinical Incident Data Collection Form” has been developed to collect and analyse different classifications such as potential risks, near misses, clinical incident, equipment failure and drug error. Trauma, Orthopaedic and Emergency speciality trigger lists will be set up. A Research Officer is in post and a Multidisciplinary Steering Group has been developed, and speciality links have been established. An education programme has commenced for multidisciplinary staff.

The aim is to design and test the Clinical Risk Management in action in order to control and reduce risk in clinical care in the Trauma & Orthopaedic and A& E Department in Sligo General Hospital.