Purpose: A single blind prospective randomised controlled trial comparing the Metal-on-polyethylene articulation with the metal-on-metal articulation in THA.

Method: The clinical and radiological findings of the consecutive patients who were enrolled in the RCT at the participating centres were recorded prospectively. The clinical evaluation was performed with the Harris scoring system as well as the Oxford Hip Scoring Sheet. The computer randomised option was revealed to the operative surgeon only after the patient was anaesthetised, during the recruitment period (June 1998 to July 2004). Of the total of 378 patients, 2 died prior to the final review and 63 were lost to follow-up. The final study group contained 315 patients, with 159 patients in the metal-on-polyethylene group and 156 patients in the metal-on-metal group.

Results: The indication for the hip arthroplasty for majority (309 patients) was primary osteoarthritis. The average age at the time of the surgery was 68.2 years and the average duration of follow-up was 85 months (42–115). There was an improvement of the Oxford hip scores from an average of 37 per-operatively to 16 postoperatively. The Harris hip scores also improved from an average of 47.0 pre-operatively to 87.3 post-operatively. The patient groups were statistically similar with respect to age, sex and duration of follow-up, and the final outcome scores revealed no statistical difference between the two groups.

Conclusion: The clinical results obtained with the use of the articulation are comparable to those obtained by the metal-on-polyethylene articulation encouraging the use of this alternative bearing surface.

Introduction: Trauma constitutes a substantial portion of the workload of any Trauma and Orthopaedic department and any attempt for improvement in service is warranted. Aim of this study was to compare a New with an Old Trauma Service Protocol, by means of quality of Clinical service, junior doctors training and financial impact.

Methods: Search was performed through the HISS archives and the theatre registry. Quantitative and qualitative parameters were assessed.

Wait till surgery, length of patient hospitalisation, out of hours surgery, case cancellations, complications and number of procedures performed by junior doctors were all compared. Medical and nursing staff members were interviewed regarding their subjective opinion for the two protocols.

Results: Length of wait to surgery was substantially decreased for most of the fracture groups. Out of hours surgery were almost eliminated and there were hardly any cancellations for reasons other than medical. The number of trauma cases performed by junior doctors was increased and there was always performed under supervision. The total length of stay for all the trauma patients was substantially decreased in the second year. All health professionals quoted improvement of their working-lives with less stress and better organization. The financial impact was less than we thought.

Discussion: Within a patient focused NHS all patients deserve the best of care that could be provided; implementing proper resources for Trauma service should be one of our first priorities in the Bone and Joint Decade.

Aim: To test the hypothesis that the number of admissions in an orthopaedic trauma ward are related to weather conditions.

Materials and Methods: Details of all admissions to the orthopaedic trauma ward over one complete year were retrieved from a computerised data base. Fractures were classified according to the AO classification.

Meteorological data correlated with trauma admissions and data analysis using SPSS version 10.1

Results: Total number of admissions = 1390 [mean age: male=44.2, female=67.6 years]. Commonest fractures in descending order: neck of femur, distal tibia and distal humerus. Overall correlation: significantly +ve (p=0.013) with sunshine (more sunshine = more fractures) and significantly –ve (p=0.001) with rain (less rain = more fractures). 34.5% of admissions were non trauma related.

Conclusion: Females were significantly older than men probably reflecting hazardous activities by younger males and the presence of osteopaenia in females. No significant monthly (seasonal) variations were seen. Influence of weather conditions:

Proximal femoral fracture incidence increase with fall in temperature (freezing conditions does NOT further increase the risk) and rain (but NOT dependent on the amount of rain).

A long term prospective study is required to further support the above findings if clinical trauma resources are to be planned based on predicted weather forecast.

A prospective randomised study was undertaken of patients with displaced Colles’ type distal radial fractures. Group 1 underwent bridging external fixation with a Pennig device; group 2 underwent manipulation and plaster immobilisation. All patients were initially treated for 6 weeks and reviewed regularly for 12 months.

At a mean of 7.8 years 86 fractures were available for review (36 treated by fixator and 50 treated in plaster). They were assessed to determine the anatomical and functional outcome of their wrist and also the incidence of post-traumatic degenerative change.

The patients had standard anteroposterior and lateral radiographs taken, to allow standard measurements to be made. The degree of arthritic change was also documented. An independent physiotherapist carried out a functional assessment, consisting of range of movement and grip strength in both wrists.

A Gartland and Werley demerit score was calculated, 94% of patients in each group had an excellent or good outcome. Patient satisfaction was comparable, 94% in the fixator and 92% in the plaster group were entirely satisfied.

Although a significant difference was found in terms of radial shortening between the groups, favouring the fixator group (p< 0.05), shortening of > 2mm did not adversely effect the functional outcome. However bridging external fixation did not improve the dorsal angulation in this study. No other radiological or functional parameter showed a statistical difference between the groups.

One patient in this series developed symptomatic post-traumatic arthritis. Grade 1 radiological signs (Knirk & Jupiter) occurred in 25% of patients but only half of these had sustained intra-articular fractures.

In conclusion: no overall long term benefit has been found to treating Colles’ type distal radial fractures with bridging external fixator as compared to plaster immobilisation.