The management of pathological fractures due to Metastatic Bone Disease (MBD) and Primary Bone Tumours (PBTs) has implications for the Trauma service due to the extra pressures on staff, service delivery and budgets.

We undertook an analysis of a cohort of patients presenting with MBD and PBTs. A retrospective chart review of all cases with MBD and PBTs admitted to a 40-bed Trauma Unit between 2005 and 2009 was conducted. The study looked at frequency, primary pathology, and site of pathology/fracture, time from primary diagnosis to referral, subsequent interventions and others.

The results identified 34 patients, 21 females (62%) and 13 males (38%) (mean age: 64.6 years) with MBD or PBTs. Metastases secondary to breast cancer (n=13, 38%) and Myeloma (n=5, 15%) were the most common with the majority being found in the femur (n=22, 65%) and the Humerus (n=6, 18%). The mean time from primary tumour diagnosis to fracture referral was 29.6 months with 27 (79%) patients undergoing definitive surgical management within the unit.

The conclusions of the study demonstrate that a wide variety of pathology presented to the unit over a 5 year period. Considerable variation was noted in the time from primary tumour diagnosis to presentation with a fracture. This could be due to improvements in treatments of specific cancers or a lack of understanding of what an Orthopaedic surgeon can offer the cancer patient. No definitive increase in pathological fractures was seen.

The consensus opinion is that prompt and appropriate management of pathological fractures in cancer patients is cost effective. Management of these injuries, in a Trauma Unit, represents a small, but significant part of the annual work-load. While no significant trend has been seen, with respect to an increased incidence, it is noted that a proportion of these patients were a number of years from their initial diagnosis. With improvements in the survivorship of cancer patients, close scrutiny will be required to determine whether this ultimately translates into an increased fracture burden.

Introduction: Revision Hip Surgery presents an increasing Orthopaedic Burden. Indications for revision include recurrent hip dislocation, infection, peri-prosthetic fracture, failure of implants, including aseptic loosening, osteolysis, wear or mechanical failure of components.

Within the region of Northern Ireland, we have investigated the indications for revision hip procedures, carried out from April 2006 to March 2007. We wanted to establish if the indications of revision surgery are comparable to other national registers.

Methods: An audit of all hospitals, which carry out hip revision surgery, was carried out, to identify patients who have undergone revision total hip surgery. The indications for revision procedures were identified, from hospital databases, patient records and examination of pre-operative X-rays. Revision procedures included replacement of one or both components, application of Posterior Lip Augmentation Devices and cable plating or component revision for peri-prosthetic fractures.

Results: 180 patients, who had undergone revision, were identified in six hospitals. 56 were female and 124 were male. Revisions were performed for a peri-prosthetic fracture in 38 (21%), infection in 12 (7%), recurrent dislocation in 23(13%) and failure of implants in 105 (58%). In 2 patients (1%) revision was performed after the development of avascular necrosis following resurfacing hip replacement.

Discussion: The largest body of information on revision hip surgery is the Swedish registry. Their incidence for revision hip surgery is 7%. Their indications were: aseptic loosening 71%, Infection 7.5%, Fracture as 5.6% and dislocation as 4.8%. Our data indicate a greater prevalence of revision for recurrent dislocation and peri-prosthetic fractures than the Swedish data. Further work should aim to identify any remediable surgical factors which account for these differences.