Hip fracture is associated with highest mortality following trauma in the elderly. The objective of this study is to evaluate the association between duration of anaesthesia and duration of surgery with 30 days mortality following hip fracture surgery.

This retrospective cohort study reviewed patients underwent surgery following hip fracture in a district general hospital. Patients less than 65 years, periprosthetic and pathological fractures were excluded. Totally 254 patients were included in the study, who had surgery between February 2005 and September 2008 (20 months period). Mortality details retrieved through National Statistics database. Chi Square tests and Logistic regression analyses were performed to check the relationship between 30 days mortality and all independent variables including duration of anaesthesia and duration of surgery.

The incidence of 30 days mortality following hip fracture surgery was 9.4%. The commonest reason of death was cardiac failure and chest infection. Patients who had General anesthesia (GA) had more complications and mortality in comparison with those who had regional anaesthesia. GA increases the odds of 30 days mortality to 2.5 times. Patients under American Society of Anesthesiologists (ASA) II had decreased odds of 30 days mortality than ASA III & IV (odds Ratio 0.16). However duration of anesthesia up to 120 minutes and duration of surgery up to 90 minutes were not associated with 30 days mortality (P>0.05). The 30 days mortality following dynamic hip screw fixation surgery was 14.6% and intra medullary nail was 12.5%. The 30 days mortality in cemented hemi-arthroplasty was 6.9% and uncemented hemi-arthroplasty was 6%. The 30 days mortality was nil in the group of patients who had undergone cannulated hip screw fixation.

In elderly people following hip fracture surgery 30 days mortality was not affected by duration of anaesthesia and duration of surgery. However 30 days mortality was related with GA, ASA III & IV and post-operative complications mainly cardiac failure and chest infection. These patients need specialist medical care

The St Leger total knee replacement is a bicondylar prosthesis developed as a cheaper alternative to other similar implants of its time. Between October 1993 and June 1999, 144 St Leger total knee replacements were implanted in 114 patients. The aim of this study was to clinically and radiologically assess these patients after a mean follow up of 10.22 years.

Between February and July 2007 ninety-one patients recalled for clinical evaluation (using functional and objective Knee Society Scores) and radiological assessment (using the Knee Society Scoring System). 11 patients had died and 12 were lost to follow up or were medically unfit to attend evaluation. Of the ninety-one patients recalled, 18 had had their prostheses revised (19 knees). 63% of prostheses had survived 10 years or more.

Of the patients with St Leger knees in situ (99 knees) the American Knee Scores showed 78% poor, 10% fair, 6% good and 6% excellent results. Radiological assessment identified 12 arthroplasties that had failed (5 femoral components, 5 tibial components and 4 patellae,) 58 that needed close follow up (18 femoral components, 31 tibial components and 38 patellae) and 29 that were well fixed. A best-case Kaplan-Meier cumulative survivorship was 87% at 10 years. (Worst-case was 71% at 10 years)

These 10 year results showed that the St Leger total knee prosthesis did not perform as well as other bicondylar prostheses of the same generation and had a higher revision rate. Despite favourable published mid-term results, the long-term results for the St Leger total knee replacement have shown it to be unreliable and not worth the initial financial saving.

In our region, we found six different radiological configurations of cannulated hip screws fixation in patients with intracapsular fracture of the femoral neck (AO type 3,1,B). These configurations, produced at the time of the screws insertion were I: Triangular, consisted of two parallel screws with a third screw placed either superiorly, inferiorly, anteriorly or posteriorly. II: Two or three screws in a vertical line. Current literature suggests that parallel lag screws and subchondral fixation are important for stable fixation, but there are no current guidelines about the optimum configuration to achieve the best fixation.

In a laboratory setting, using standard synthetic bones and ordinary AO cannulated hip screws, six different configurations were fashioned similar to clinical practice. Each specimen was subjected to a single progressive vertical load until failure. Displacement curves, in relation to the load (peak and ultimate), were recorded on the computer based data acquisition system.

The most significant result of the study was that there is a significant difference between the superior ‘single screw triangle’ [mean difference 627 (Newton), 95% CI (66.72, 1187.28)] and ‘two screws vertical’ configurations [mean difference 744 (Newton), 95%CI (183.72, 1304.28)]. No other significant differences were detected.

If cannulated hip screws are chosen for internal fixation of femoral neck fractures we would, based on our study, recommend the use of triangular configurations with two parallel screws and a third screw placed either anteriorly, posteriorly, superiorly or inferiorly as they afford better strength and stability of fixation. The configuration of two or three vertical screws should be avoided as they provide lower grade of stability and a high incidence of failure. This suggests surgical technique can influence mechanical stability and thus outcome. This needs to be emphasized, particularly during training, in the hope of improving overall results in the future.

The purpose of the study was to compare three shoulder scoring systems with the aim of assessing their ability to identify disability over a spectrum of disease within a routine shoulder practice.

Considering our aims three systems were chosen for investigation; General Oxford Shoulder Questionnaire (GOSQ), Simple Shoulder Test Questionnaire (SST) and Hospital for Special Surgery System for Assessing Shoulder Function (HSS). Each was completed by 108 consecutive patients referred to our shoulder clinic, representing a spectrum of disease. These were compared with a pain and function score derived from the UK SF-36 Health Score. A subset of 27 patients repeated the questionnaires twenty four hours later to test repeatability of the scores. Agreement was calculated using Bland and Altman’s statistical method for assessing agreement between two methods of clinical measurement. This analysis was done both on the group as a whole and divided into five subgroups by diagnosis: instability (subgoup1), cuff tears and impingement (2), adhesive capsulitis (3), arthritis (4) and miscellaneous (5).

Reproducibility as a standard deviation (SD) of the difference between the scores after 24 hours: HSS 9.9, GOSQ 8.8, SST, 15.5 and SF-36 11.1.

Using the Bland and Altman method for assessing agreement, the scores both for repeatability and in comparison with the SF-36 are disappointing. It would appear that out of the three scores tested the HSS gives the most consistent results over a range of shoulder problems.