The best surgical treatment of lateral epicondylitis remains uncertain. Recently radiofrequency microtenotomy (RFMT) has been proposed as a suitable surgical treatment. We aim to compare open release with RFMT and present the results of our randomised controlled trial.

Patients with symptoms of tennis elbow for at least 6 months who had failed to respond to conservative management were included in the trial. They were randomised to open release or RFMT. Outcome measures included grip strength, pain and DASH scores.

41 patients were randomised, 23 to RFMT and 18 to open release, 2 patients withdrew from the study. Our results show that both treatments give a significant benefit at all time points for DASH and pain scores, but only open release gives a significant improvement in grip strength. Comparing the two treatments the only significant difference is the open group have better pain scores at 6 weeks, but this is not seen at later follow up.

In conclusion both groups have shown benefit from the treatments, but one is not shown to be clearly superior.

Introduction:

Although dislocation of the peroneal tendons (PT's) in association with calcaneal fractures has been described over 25 years ago, it frequently passes unrecognised by radiologists and orthopaedic surgeons. This retrospective study aims to determine the prevalence of PT dislocation in association with calcaneal fractures at a single institution and describe systematic steps to avoid missed diagnosis at each stage of management.

The 2011 National Hip Fracture Database (NHFD) Report has shown our institute has the fewest number of patients meeting the 36-hour target to theatre in the UK (9%) but well above the national average for review by geriatrician (42.5%) at 76%. We believe our timely medical input means patients' are more physiologically normalised prior to surgery. We aimed to review our postoperative results to see if our patients had significantly different morbidity and mortality compared to the rest of the UK.

We reviewed 152 patients between the period September 2009 and September 2010. All of the patients were prospectively identified and their information was added to our hip fracture database. Using the auditing software we reviewed the patients' outcomes and compared them to national averages using figures from the NHFD.

Of the 152 patients identified 13% met the 36-hour target. The average time to theatre for the study group was 89 hours. 83% of the group had a pre-operative assessment by a geriatrician. The primary reason for surgical delay was a lack of space on a theatre list (61.2%) followed by being medical unfit (16.4%). The average length of acute hospital stay was 16.4 days matching the national average while 30 Day mortality at 7.9% was (0.5%) lower than NHFD figures.

We continue to try and improve our time to surgery for hip fracture patients and accept this is mostly related to limited theatre access. Deficient resources due to Northern Ireland's exclusion from the best practice tariff means we are unable to compete with the top performing units in the NHFD. While it makes humanitarian sense to expedite surgery, evidence used to determine the 36-hour target is quoted as “low quality” or “very low quality”. Our data shows no significant difference in outcomes compared to national figures.

Current evidence suggests that we should be moving away from Thompson's hemiarthroplasties for patients with intracapsular hip fractures. Furthermore, the use of cement when inserting these prostheses is controversial. This study aims to show the Inverness experience.

We performed a retrospective review of all NHS Highland patients who underwent a hemiarthroplasty for an intracapsular neck of femur fracture over the last 15 years. Demographics and the use of cement were documented. Further analysis of this group was performed to identify any of these patients who required revision of their prosthesis. Patients requiring revision had their case-notes reviewed to identify the cause for further surgery.

From 1996 until present 2221 patients from the Highland area had a hemiarthroplasty for an intracapsular neck of femur fracture. 1708 where female (77%) and 513 male (23%). The ages ranged from 28 years to 104 years (mean 80 years, median 81). 2180 of this group had their operations in Raigmore Hospital with the remaining 41 at various centres throughout Scotland. 623 (28%)had a cemented hemiarthroplasty, with the remaining 1578 (72%) having an uncemented Thompson's hemiarthroplasty. The revision rate for the cemented group was 2% (13 of 623 patients). In the uncemented group it was 0.4% (6 of 1578). Reasons from revision included dislocation, periprosthetic fracture, infection and pain.

Current evidence from some joint registers regarding the use of Thompson's hemiarthroplasty in the elderly is discouraging. The use of bone cement in this group with multiple co-morbidities is not without it's risks. Our data suggests that uncemented Thompson's hemiarthroplasties in low demand elderly patients with multiple co-morbidities can yield excellent results with less risk to the patients.

Adverse weather conditions during the winter months put increased pressure on orthopaedic trauma departments across the country. The increased incidence of injuries has resulted in a strain on resources at a local level and a situation can arise whereby cases need to be prioritised according to clinical need and fitness of the patient. Ankle fractures, frequently caused by slipping in adverse weather conditions, tend to be an injury where a high proportion of patients are young and active and can therefore cope better physiologically waiting several days for their operation. It is well documented that there is a window of opportunity when operating on ankle fractures, during which the swelling will permit fixation. We aimed to establish whether a link exists between delay to surgery for ankle fractures, the length of post-op hospital stay and the rate of complications.

We included all patients who underwent surgical fixation of an ankle fracture over a three month period between 1.1.10 and 31.01.11. Data was obtained through theatre records, discharge and clinic letters and from the local PACS X-ray system. Basic patient data, admission, theatre and discharge dates were collected along with details regarding mechanism of injury, type of fracture, fixation and documented complications. Patients were subdivided into two groups: those who underwent surgery within 48 hours of injury and those who waited longer than 48 hours. Many of the patients in the delayed surgery group remained inpatient until after their surgery whilst those more capable of mobilising with crutches were allowed home to elevate.

64 patients underwent fixation of an acute ankle fracture during the three month study period. 28 patients (44%) had a documented fall on ice or snow. 29 patients were operated upon within 48 hours. 35 patients surgery was delayed by a mean of 9 days (3-28). The mean length of post op hospital stay for the early surgery group was 3.00 days. In the delayed surgery group the mean length of stay was 4.28 days (p=0147). There were 4 complications in the early group (14%) compared with 7 in the delayed group (20%).

Delaying surgery for ankle fractures more than 48 hours suggests a trend towards an increased length of post-operative hospital stay and a slightly increased rate of complications but not to significant levels. A larger sample size may have provided a significant difference. Given this trend, we recommend early fixation of ankle fractures wherever possible providing soft tissue swelling allows tension free wound closure.

Current evidence suggests that we should be moving away from Thompson's hemiarthroplasties for patients with intracapsular hip fractures. Furthermore, the use of cement when inserting these prostheses is controversial. We aim to show the Inverness experience.

We performed a retrospective review of all NHS Highland patients who underwent a hemiarthroplasty for an intracapsular neck of femur fracture over the last 15 years. Demographics and the use of cement were documented. Further analysis of this group was performed to identify any of these patients who required revision. Patients requiring revision had their case-notes reviewed to identify the cause for further surgery.

2221 patients from the Highland area had a hemiarthroplasty for an intracapsular neck of femur fracture since 1996. 1708 female (77%) and 513 male (23%). Ages ranged from 28 years to 104 years (mean 80). 2180 of this group had their operations in Raigmore with the remaining 41 at various centres throughout Scotland. 623 (28%)had a cemented hemiarthroplasty, with the remaining 1578 (72%) having an uncemented Thompson's hemiarthroplasty. The revision rate for the cemented group was 2% (13 of 623 patients). In the uncemented group it was 0.4% (6 of 1578). Reasons from revision included dislocation, periprosthetic fracture, infection and pain.

Current evidence from some joint registers regarding the use of Thompson's hemiarthroplasty in the elderly is discouraging. The use of bone cement in this group with multiple co-morbidities is not without it's risks. Our data suggests that uncemented Thompson's hemiarthroplasties in low demand elderly patients with multiple co-morbidities can yield excellent results with less risk to the patients.

Although it has long been appreciated that a healthy balanced diet improves health, there is a growing understanding of the way in which certain nutrients can actually improve immune function. Boosting immune function by the use of “immunonutrition” has been shown to improve outcomes, in particular rates of infective complications, in certain groups of surgical patients.

In this study we examine the immune status of elderly patients who have suffered a hip fracture and are known to be vulnerable to infection and poor post-operative outcomes to identify specific immune defects associated with this particular cohort. This may allow us to explore the potential benefits of immunonutrition in this group of patients in the future.

This was a cohort observational study, in which a series of 16 patients who underwent surgery for hip fractures were followed. The patients were female patients with an age of 60 to 85 years and a mental status questionnaire score of at least 8 out of 10.

Immune function was evaluated prior to surgery, on the day following surgery and then at between days 4 and 7 post-operatively. Samples were tested directly ex-vivo using a variety of flow cytometric assays.

We report profound loss of innate immune function related specifically to monocyte and granulocyte ability to generate a respiratory burst in response to E.coli uptake persisting up to day 7 post-operatively. In addition, serum cytokine levels indicated very poor T cell function, in identifying these patients as particularly vulnerable to infections.

Background

Angular stable volar locking plates have become increasingly popular for more comminuted fractures of the distal radius. Newer designs of plates have been thicker in profile and incorporate more options for distal fragment fixation. Although they have been shown to be successful at maintaining reduction to allow early mobilisation the main drawback is from screw cut-out. In our practice we have noticed that the newer style of plates that offer more rigid fixation has lead to more instances of screw cut-out. We aimed to quantify the minimum number of locking pegs and or screws need to maintain the operative reduction.

The present study investigates the repeatability of two new methods of measuring acetabular wear with differing levels of automation. Experimental evaluation showed that the more automated method was more repeatable. Both methods segmented the femoral head and acetabular rim with ellipses. The displacement of the ellipse centres was measured and the difference at year 1 and 5 taken as a measure of wear. Measurements were obtained twice for each case. The less automated of the two methods involved the annotation of 9 points on the femoral head and 18 on the acetabular rim to which two least squares ellipse fits[1] were performed. The second and more automated method was active ellipses[2][3]. This method uses iterative robust ellipse fitting and a model of appearance learned from a training set to cause two ellipses to converge on the contours of the femoral head and acetabular rim from a single starting point. Fifty cases with radiographs taken at year 1 and year 5 were measured by both methods. The radiographs contained CPTs with 28mm heads and were digitized at 150 dpi. Fifty postoperative radiographs containing 22.225mm Zimmer CPT heads trained the more automated method. None of the radiographs had metal backed cups or highly eccentric rims. The repeatability coefficient (2 standard deviations) of the active ellipses was 0.23mm and that of the best annotator was 0.40mm while the worst was 2.69mm due to an outlying measurement. Limits of agreement were calculated between the two methods as −0.61mm to 0.91mm and show the active ellipses could replace annotation. Given that the active ellipses are nearly twice as repeatable this is desirable. The range of difference in measurements for the active ellipses is less than that of the annotator.