The aim of this study was to evaluate prospectively the outcome following arthroscopic Bankart repair using two types of suture anchors, absorbable and non-absorbable. Patients with a diagnosis of recurrent traumatic anterior instability of the shoulder, seen between April 2000 and June 2003 in a single unit, were considered for inclusion in the study. Patients were assessed pre-operatively and post-operatively using a subjective patient related outcome measurement tool (Oxford instability score), a visual analogue scale for pain and instability (VAS Pain and VAS instability) and a quality of life questionnaire (SF-12). The incidence of recurrent instability and the level of sporting ability were recorded. Patients were randomised to undergo surgical repair with either non-absorbable or absorbable anchors.

130 patients were included in the study. 6 patients were lost to follow-up and 124 patients (95%) completed the study. Both types of anchors were highly effective. There were no differences in the rate of recurrence or any of the scores between the two. Four patients in the non-absorbable group and 3 in the absorbable group experienced further episodes of dislocation after a traumatic event. The rate of redislocation in the whole series was therefore, 5.6%. In addition, 4 patients, all of them in the absorbable group (4%) described ongoing symptoms of instability but no true dislocations. 85% of the patients have returned to their previous level of sporting activity.

There are no differences in the outcome of Arthroscopic Bankart repair using either absorbable or non-absorbable anchors. Both are highly effective, showing a redislocation rate of 5.6%.

Introduction: Large numbers of studies have been conducted to help the decision making of appropriate management of an ankle fracture.

Aim: To assess intra-observer and inter-observer agreement of treatment for ankle fracture based on plain radiographs.

Materials and Methods: Fifty patients with ankle fracture were randomly selected. Antero-posterior and lateral view ankle radiographs were blinded by the first author and then reviewed by five orthopaedic surgeons with varying clinical experience. The observers were asked for their opinion about how they would like to treat the fracture? They were provided with additional basic information of patient age, sex, mechanism of injury and associated comorbidities. This exercise was repeated again after four weeks. The kappa coefficient and observed agreement values were used for statistical analysis.

Results: The kappa values on both occasions were 0.41(SE: 0.084, 95% Confidence interval: 0.248–0.576, P< 0.00001) and 0.29(SE: 0.099, 95% confidence interval: 0.098 TO 0.487, P< 0.00001). These results show only fair inter-observer agreement.

The kappa values for intra-observer agreement were from 0.34 to 0.69 (P< 0.001) for different observers. The observed agreement for these observers was from 70% to 94%. Only two most senior observers had good agreement.

Conclusion: These results show that there is only fair inter-observer agreement of the treatment for ankle fracture based on plain radiographs and only senior clinicians were consistent about their preferred mode of treatment on both occasions. There is a need of clear guidelines and better understanding of biomechanics of Ankle Fractures to minimize the ‘grey’ zone of when to intervene.

Purpose: The diagnosis and treatment of superior labral antero posterior (SLAP) lesions is a controversial subject in shoulder pathology. The aim of this retrospective study was to evaluate the strength of association between clinical assessment (O’Brien test), standard MRI, and arthroscopic identification of a SLAP lesion.

Method: Patients who underwent isolated arthroscopic treatment of a SLAP lesion by two senior orthopaedic surgeons between 2004 and 2007 were included in this study. Pre-operatively, all had a standard MRI and the outcome of O’Brien test had been documented. Sensitivity of these measures in detecting a SLAP lesion confirmed through arthroscopy were calculated independently and combined. The relationship between O’Brien test and standard MRI are also presented.

Results: Forty-five patients were included in this study. The O’Brien test demonstrated a sensitivity of 42% (true positive) in detecting a SLAP lesion while sensitivity of the standard MRI was only 13%. The sensitivity of the O’Brien test and standard MRI when considered together was 47%, only slightly higher than the O’Brien test alone. The association between the O’Brien test and standard MRI in identifying a SLAP lesion as measured by the phi correlation coefficient was −0.19 which suggests little to no relationship (p = 0.095).

Conclusion: The current study illustrates the difficulties in accurately diagnosing a SLAP lesion pre-operatively. Previously documented sensitivity of the O’Brien test in identifying a SLAP lesion was not replicated herein. Furthermore, this study draws into question the practice of patient’s undergoing a standard MRI for SLAP lesion identification because the added value from this investigation was nominal. A standard MRI is often requested when the diagnosis is not certain or to exclude other shoulder pathology. If, however, a SLAP lesion is suspected clinically in absence of other shoulder pathology, then a diagnostic tool other than standard MRI may be more meaningful. Some literature suggests MRI arthrogram may be useful in diagnosing a SLAP lesion but access to this tool can be limited.

Purpose: The aim of this study was to evaluate prospectively the outcome following arthroscopic Bankart repair using two types of suture anchors, absorbable and non-absorbable.

Method: Patients with a diagnosis of recurrent traumatic anterior instability of the shoulder, seen between April 2000 and June 2003, in a single unit were considered for inclusion in the study. Patients were assessed preoperatively and postoperatively using a subjective patient related outcome measurement tool (Oxford instability score), a visual analogue scale for pain and instability (VAS Pain and VAS instability) and a quality of life questionnaire (SF-12). Length of follow up was 1.5 to 5 years, mean 2.6 years. The incidence of recurrent instability and the level of sporting ability were recorded. Patients were randomised to undergo surgical repair with either non-absorbable or absorbable anchors.

Results: 130 patients were included in the study. 6 patients were lost to follow up; therefore 124 patients (95%) completed the study. Both types of anchors were highly effective. There were no differences in the rate of recurrence or any of the scores between the two groups. 4 patients in the non-absorbable group and 3 in the absorbable group experienced further episodes of dislocation after a traumatic event: the rate of redislocation in the whole series was therefore 6%. In addition 4 patients, all of them in the absorbable group (4%,) described ongoing symptoms of instability but no true dislocations. 85% of the patients have returned to their previous level of sporting activity.

Conclusions: There are no differences in the outcome of Arthroscopic Bankart repair using either absorbable or non-absorbable anchors. Both are highly effective, showing a redislocation rate of 5.6%.

Our aim was to assess the reproducibility and the reliability of the Weber classification system for fractures of the ankle based on anteroposterior and lateral radiographs. Five observers with varying clinical experience reviewed 50 sets of blinded radiographs. The same observers reviewed the same radiographs again after an interval of four weeks. Inter- and intra-observer agreement was assessed based on the proportion of agreement and the values of the kappa coefficient.

For inter-observer agreement, the mean kappa value was 0.61 (0.59 to 0.63) and the proportion of agreement was 78% (76% to 79%) and for intra-observer agreement the mean kappa value was 0.74 (0.39 to 0.86) with an 85% (60% to 93%) observed agreement. These results show that the Weber classification of fractures of the ankle based on two radiological views has substantial inter-observer reliability and intra-observer reproducibility.

Introduction and Aims: To evaluate the clinical outcome of Titanium hemiarthroplasty in the management of hallux metatarsophalangeal joint arthritis.

Method: Fifty-five joints in 46 patients were treated surgically with Titanium implant for arthritic hallux meta-tarsophaelangeal joints. There were 35 women and 11 men. The pathological indications were hallux rigidus (74%), rheumatoid arthritis (10%) and degenerative changes associated with hallux valgus (16%). Six cases were done as a revision of sialastic to titanium prosthesis due to severe silicone synovitis.

Results: The mean age was 60 (range 43–76) years, and the mean follow-up was 56 (range 28–86) months. The mean time taken to get back to normal activities is 36.6 (range 21–90) days. The mean range of motion achieved was 32 (range 20–64) degrees and the relief of pain was excellent or good in 86% of the patients. There were no surgical complications in the form of infection, osteolysis or instability. The synovitis in the revision group has subsided.

Conclusions: The clinical results of Titanium hemiarthroplasty were good. The advantages of this procedure were preservation of joint movement and good pain relief.

Aim: To evaluate the clinical outcome of Titaneum hemi-arthroplasty in the management of hallux metatarsopha-langeal joint arthritis. Methods: 55 joints in 46 patients were treated surgically with Titaneum implant for arthritic hallux metatarsophaelangeal joints. There were 35 women and 11 men. The pathological indications were hallux rigidus (74%), rheumatoid arthritis (10%) and degenerative changes associated with hallux valgus (16%). 6 cases were done as a revision of sialastic to titanium prosthesis due to severe silicone synovitis. Results: The mean age was 60 (range 43–76) years, and the mean follow up was 56 (range 28–86) months. The mean time taken to get back to normal activities is 36.6 (range 21–90) days. The mean range of motion achieved was 32 (range 20–64) degrees and the relief of pain was excellent or good in 86% of the patients. There were no surgical complications in the form of infection, osteolysis or instability. The synovitis in the revision group has subsided. Conclusions: The clinical results of Titaneum hemiarthroplasty were good. The advantages of this procedure were preservation of joint movement and good pain relief.

In five years 55 joints in 46 patients were treated surgically with a titanium implant for arthritic hallux meta-tarsophalangeal joints. There were 35 women and 11 men. The pathological indications were hallux rigidus (74%), rheumatoid arthritis (10%) and degenerative changes associated with hallux valgus (16%). Six cases were done as a revision of silastic to titanium prosthesis due to severe silicone synovitis.

The mean age was 60 (range 43–76) years, and the mean follow up was 56 (range 28–86) months. The mean time taken to get back to normal activities is 36 (range 21–90) days. The mean range of motion achieved was 32 degrees (range 20–64) and the relief of pain was excellent or good in 86% of the patients. There were no surgical complications in the form of infection, osteolysis or instability. The synovitis in the revision group has subsided.

The clinical results of titanium hemiarthroplasty were good. The advantages of this procedure were preservation of joint movement and good pain relief.