Objectives: The objective of this study was to assess the reliability of measured sound waves amplitude using the 3M Littmann Sound Analysis Software as a diagnostic tool in suspected femoral neck fractures.

Methodology: Sound waves generated by 125 Hz tuning fork was placed on both patella and then stored on the 3M Electronic Stethoscope Model 4000 placed at both anterior superior iliac spines. Data was then transferred by an infrared transmitter to a computer with the 3M Littmann sound analysis software to convert the sound to a universally recognised format * (wav) for audio feedback and visual display (phonocardiogram) as amplitude height. The amplitude ratio was defined as the proportion of the amplitude height between the fracture side and the normal side for femoral neck fractures, between the right and left side for controls, and between the painful hip and normal side for suspected hip fractures. MRI and clinical progression were used as gold standard test to confirm diagnosis.

Results: A total of 65 patients were studied which consisted of 25 patients with femoral neck fractures, 20 patients with suspected femoral neck fractures, and 20 patients served as controls without hip pathology. There were 48 females and 17 male patients and the mean age of the study population was 82 years (s.d:8.2 yrs) which was similar in all groups. The mean amplitude ratio of sound waves in the control group was 0.91(s.d:0.1), and in patients with femoral neck fractures 0.21(s.d:0.12), this differences were statistically significant (p< 0.001). In patients with extracapsular femoral neck fractures, the mean amplitude ratio of 0.16 (s.d:0.1) was significantly lower when compared with intracapsular fractures (0.26 s.d:0.13, p=0.03). Using an amplitude ratio of less than 0.45 as indication of fracture, tuning fork test had a sensitivity of 85.7% and specificity of 87.5% in diagnosis of suspected femoral neck fractures when compared with MRI and clinical monitoring. The Positive Predictive Value (PPV) was 85.7% and the Negative Predictive Value (NPV) was 87.5& .

Conclusions: We conclude that sound wave amplitude measured objectively by a 125Hz tuning fork is a reliable and cost-effective tool as an initial screening test for patient with suspected hip fractures

The aim of our study was to determine if the canal flare index of the proximal femur is a dependent factor in prosthetic failure after Austin Moore hemiarthroplasty.

We measured the canal flare index on A-P hip X-rays of 100 and 100 patients with failed and successful Austin Moore hemiarthroplasty respectively. We also measured the canal flare index of a control group of 100 patients without hip fractures. The canal flare index (CFI) is defined as the ratio of the width of the femoral canal at two levels: 20mm proximal to the centre of the lesser trochanter and the canal isthmus. Overall we reviewed 300 radiographs. The study group consisted of 68 males and 232 females. In the failed Austin Moore group there were 62 patients (62%) with loosening, 28 patients (28%) with dislocations and 10 patients (10%) with periprosthetic fractures. The canal flare index of the proximal femur was significantly higher in patients who had persistent thigh pain with radiological loosening in comparison the successful and control groups. (3.3 vs 2.6; 3.2 vs 2.7 respectively: p< 0.001). On the other hand patients with periprosthetic fractures had a lower canal flare index in comparison with the successful and control groups (2.1 vs 2.6; 2.1 vs 2.7 respectively: p< 0.001). However there was no differences in the CFI of patients with dislocations compared with successful (2.4 vs 2.6;p=0.1) and control groups (2.4 vs 2.7;p=0.2). This remained the same when controlled for age and sex in a logistic regression analysis.

Conclusion: The CFI can identify patients prone to persistent thigh pain who present as radiological loosening and to periprosthetic fractures and an alternative cemented prosthesis should be considered in this group of patients

Objective: The main objective of our study was to compare the outcome and complications between open and percutaneous tennis elbow release using the Total Elbow Scoring System (TESS). Our null hypothesis is that there is no difference in patient based outcome measures and morbidity between both groups.

Methods: We evaluated a cohort of 40 patients (41 elbows) with clinical evidence of tennis elbow that had surgery after failed conservative treatment. All patients were followed up for a minimum of 12 months and information entered into a structured questionnaire. Other outcomes measures assessed include; Visual Analogue Score (VAS), length of time to return to work, and wound complications.

Results: Seventeen (17) and Twenty-four (24) elbows were managed by percutaneous release and open surgery respectively. There were twenty-one female patients (22 elbows) and nineteen male patients (19 elbows). The mean age of the study population was 45years (s.d.: 8.4yrs). The mean duration of symptoms before surgery was 20 months (s.d.: 9.1mths). All 17 elbows that had percutaneous release procedures had a TESS score greater than 80, in comparison to 19 out of 24 elbows with open procedures, although this was not quite significant. (p=0.06). A score of between 80 and 100 is considered good or excellent. Patients that had open surgery had a significantly higher pain (Visual analogue score) VAS in comparison to closed procedures (p=0.01).

A significantly higher proportion of patients that had percutaneous procedures were able to return to work within 2 weeks in comparison to open procedures (p-=0.03). There were 4 cases of wound complication that occurred only in patients with open surgery.

Conclusion: We conclude that percutaneous release for tennis elbow can produce satisfactory outcomes, with lower morbidity and earlier return to work compared with open procedures.