The transosseous equivalent/Suture Bridge or TOE/SB repair has received much attention in recent years as more shoulder surgeons transition to all arthroscopic rotator cuff repairs. The purpose of this study was to compare the biomechanical behaviour of several variants of the Suture Bridge repair performed by the authors.

Four different Suture Bridge constructs were performed six times on 24 sheep infraspinatus tendon humerus constructs. The first group was a standard Suture Bridge with two medial mattress stitches with knots (KSSB4). The second group had four medial mattress stitches with knots and was called KDSB8. The third group had two medial mattress stitches without knots and was called USBFT4. These first three repairs used two medial 5.5 mm Bio-Corkscrew FT Anchors and two lateral 3.5 mm PushLock Anchors (Arthrex). The fourth repair had two medial mattress stitches without knots and used all Pushlocks and was called USBP4.

The repairs were then analysed for failure force, cyclic creep and stiffnessafter. Cycling was performed from 10 to 100 N at 1 Hz for 500 cycles. Following cyclic testing a single cycle pull to failure at 33 mm/sec was performed. The constructs were also observed for failure mechanism and gap formation using digital video recording.

The KDSB8 repair with a mean failure force of 456.9N was significantly stronger than the USBP4 repair at 299.7N (P=0.023), the KSSB4 repair at 295.4N (P=0.019) and lastly the USBFT4 repair at 284.0N (P=0.011). There was no statistical difference between the measured failure force for the two mattress stitch KSSB4 repair with knots and the knotless two mattress stitch repairs USBFT4 and USBP4. There was not a statistical difference between any of the repairs for measured stiffness and cyclic creep. However, the KDSB8 repair showed no discernable gap formation or movement at the footprint during cyclic testing. The KSSB4, USBFT4 and USBP4 repairs demonstrated bursal sided gap formation in the range of 1 to 3 mm.

Based on the results of this study the transosseous equivalent/Suture Bridge repair with four stitches tied in the medial row and maximal lateral suture strand utilization (KDSB8 TOE/SB) is the strongest. The KDSB8 also appeared to show less bursal sided gap formation and greater footprint stability than the other Suture Bridge constructs tested.

The AO, Frykman, Mayo and Fernandez classification system for distal radius fractures were evaluated for interobserver reliability and intraobserver reproducibility using plain radiographs. Five orthopaedic consultants, five orthopaedic registras and five orthopaedic senior house officers classified 20 sets of distal radius fractures on two seperate occasions. There were 2400 induvidual observations. Kappa statistics were used to establish a relative level of agreement between observers for the two readings and between seperate readings by the same observer. Our results for intraobserver reproducibility showed Fernandez Kappa value of 0.49, Frykman 0.47, Mayo 0.45 and AO 0.33. A 0.4 result shows good consistecy accorcing to well reconised staistical boundries and is significant. That is reproducibility happened at a level greater than by chance. Interobserver Kappa values were poor in all classification systems. We also sought to look at varibles within grade of surgeon and developed Kappa values for these also.

Purpose: To evaluate the objective outcomes in patients who had undergone hardware removal after ORIF of calcaneus fractures.

Materials and Methods: Between 1994 and 2002, 31 cases of hardware removal was performed in 30 patients (25 male, 5 female) with an average age at operation of 47 years (31 to 65 years) were reviewed. Patients’ demographic details were recorded including smoking habit. Fracture patterns were graded according to the Sanders’ classification with preoperative CT scans. The clinical result was assessed using Bristol hind foot scoring system. Serial radiographs assessments were also recorded.

Results: Average follow-up was 4.5 years. Average delay from time of injury to surgery was 12.4 days (range 5 to 24 days). 7 (23%)fractures were Sanders’ type 2A, 8 (26%)fractures were type 2B, 6 (19%)fractures were type 2C, 2 (6%) fractures were type 3AB and 8 (26%) fractures were type 3AC. Average time from surgery to hardware removal was 27 months (range 11 to 45 months). There were 16 smokers and 14 non-smokers. There were 5 deep infections and 3 superficial wound infections after ORIF of calcaneus fractures. 84% of the patients shown objective improvement following hardware removal at the latest follow-up. 2 patients had unsuccessful hardware removal due to dense scarring. No wound infections were recorded. Smoking habit had no significant bearing on the objective outcome improvement following hardware removal (p= 0.891), time from surgery to hardware removal (p=0.53) and wound morbidity (p= 0.4882). Objective improvement showed a statistically significant improvement in the Sanders’ type 2 compared with Sanders’ type 3 (p=0.015).

Conclusion: Removal of hardware is justified in symptomatic patients following ORIF calcaneus fractures. It results in an improved objective outcome and has a low complication rate. Hardware removal may be considered in cases of Sanders’ type 2 calcaneus fractures which are refractory to improvement.

Introduction: We describe a new technique of using acetabular suction to improve cementing conditions in acetabular arthroplasty.

Aim: To analyse the effectiveness of a technique of applying suction to the acetabular cavity during cementing as a method of maximising the quality of the bone-cement interface.

Methods: In this study, a series of 100 cemented primary Exeter hip replacements performed by the senior author, using contemporary cementing techniques together with an acetabular suction technique were evaluated for the degree of cement penetration and the quality of the cement-bone interface so created. Radiographs were digitally scanned with high resolution and a CAD program was used to assess quantitatively the cement penetration in each of the Charnley-DeLee zones. The quality of the cement-bone interface was assessed using the grading system as described by Ranawat.

Results: An analysis showed significant cement penetration in each of the Charnley-Delee zones especially in zones 1b, 2a and 2b. The quality of the cement-bone penetration was excellent with most showing a Type I interface (perfect cement-bone interlock with gradual merging of cement into the cancellous bone with no radiolucency or rounding off of the cement front) in all zones.

Conclusions: These results indicated that application of acetabular suction significantly improved the cement penetration on the acetabular side in cemented total hip arthroplasty. We recommend this as a satisfactory method to ensure the best possible conditions for creation of an enduring cement- bone interface.