Aims

The number of females within the speciality of trauma and orthopaedics (T&O) is increasing. The aim of this study was to identify: 1) current attitudes and behaviours of UK female T&O surgeons towards pregnancy; 2) any barriers faced towards pregnancy with a career in T&O surgery; and 3) areas for improvement.

We compared cancellation rates with two different systems for operating booking. During 9 months of ‘Full Booking’ we gave each patient in the Outpatient Clinic an operating date. After a transition period, we then tried ‘Partial Booking’ (putting each patient on the waiting list and only giving dates after a Consultant-delivered Pre-Assessment Clinic (PAC) review at least 6 weeks before their target operating date.)

This was one Consultant's firm, with Day Cases and urgent cases excluded, and a waiting time of nine months. Cancellations were defined as an operating date given that was not honoured. Cancellations due to bed crises were excluded.

During the Full Booking phase there was a cancellation rate of 55%, with 64 cancellations out of a potential 116 operating slots. Of these: 29% condition improved, 22% date inconvenient, 19% unwell, 5% gone elsewhere/Private, 9% were moved due to Consultant leave dates, 3% Did Not Attend, and 12.5% date brought forward to fill a cancellation slot.

During the Partial Booking phase, 23% of patients attending the PAC were removed from the waiting list without ever being given operating dates. (17 of 132 did not want the operation, 7 Did Not Attend, 6 were unfit). Of the 94 patients given dates, only 8 cancelled (8%). Four subsequently decided against surgery, and four had tests that suggested surgery would not be helpful.

The improved efficiency could be due to PAC changes: Consultant presence, having six weeks to act on test results, and dates being agreed only after ‘passing’ PAC. Partial Booking had other benefits, with fewer queries, better informed consent and the optimum time to plan teaching lists, order kit and improve patients' fitness. The Government is still committed to Full Booking. Our cancellation rate improved from 55% to 8% when changing from Full Booking to Partial Booking.

Aim: To assess the long-term treatment outcome following conservative treatment of wrist ganglions by aspiration and steroid injections.

Materials and Methods: Between December 2001 and November 2003, 49 patients with wrist ganglions were seen and treated by one surgeon*. There were 20 males and 29 females with an average age of 37 years (range 13 to 70 years). Anatomically we had 41 dorsal wrist, 5 volar wrist and 3 digital ganglions. Diagnosis was made on clinical examination, explained to patients about the condition and given three options of treatment.

Reassurance,

39% (14) were satisfied with reassurance alone, 69%(34) had aspiration and steroid injection and one opted for surgery.

Those who opted for aspiration and steroid injection are included in the study.

The aspiration was carried out under sterile technique, area infiltrated with 1% lignocaine, followed by aspiration of ganglion content using 16 G needle and injection of Methyl-prednisolone Acetate BP 40 mg/ml. The patients were advised to carry out their normal activities and followed up at 6 weeks, 3 months and 6 months.

Follow up period range between 6 weeks to 6 months (average of 3.8 months).

Results: 34 ganglia treated with aspiration and steroid injection had a cure rate of 47%(16), 31%(10) and 12%(4) respectively after 1,2 and 3 treatments with a cumulative success rate of 88%(30 of 34). We had recurrence rate of 12% (4 of 34) after 3 injections and two patients with skin discoloration.

Conclusion: Treatment options should be given to patients with wrist and digital ganglions. Conservative treatment is quite successful, which will avoid surgery and associated complications. Even though our sample size is too small to make any statistical significance, cumulative success rate of 88% following multiple treatments of aspiration and steroid injections are in comparable with other studies.

Introduction: Reports of the results of screw-cup arthroplasties have been disappointing with high revision rates.

Aim: To review our experience of 173 HA-coated screw- cups that have been implanted in 150 patients.

Methods: The patients were followed up at six weeks, three months, six months, again at one year and annually thereafter. The patients were assessed using the Merle D’ Aubigne (MDP) clinical scoring scale and by radiographic review.

Results: The average follow-up was 6.5 years (range 5–9 years). The follow-up rate was 93%. Two patients had revision surgery for recurrent dislocations (1.2%). Two patients were revised for aseptic loosening (1.2%). One patient underwent revision surgery for to deep prosthetic infection (0.6%) and two patients were revised for polyethylene wear without loosening (1.2%). This gave a total revision rate of 4.0%. The average post operative MDP scores were 5.7 for pain, 5.5 for range of movement and 5.4 for function. A radiological review revealed one patient with extensive granuloma formation and two patients with evidence of migration although no cups were revised for migration alone.

Discussion: We believe that the lower revision rate in this series is due to the double advantage of an HA coated cup (which leads to low revision rates for aseptic loosening), and the use of a ceramic head (which produces low polyethylene wear rates). We believe our results convey strong evidence for the advantage offered by HA coating for use with a screw-cup or other prosthesis.