Aims: To validate the use Ottawa Ankles Rules (OAR) protocol in the accidents department, to evaluate its sensitivity in excluding a fracture and to examine the practical benefits. Methods: From August 2000 to January 2001 we examined 124 patients with foot and ankle injuries in the A& E department by three of our junior doctors. They were judged according to OAR protocol which requests an x-ray according to certain criteria. We have estimated the time spent in A& E. 72 of them were in accordance of the OAR protocol and they had typical x-ray examination & subsequent treatment. Results: The remaining 52 (41.9%) patients consist the target population. They were reexamined in 48–72 h, in one week and in one month and there was no need for an x-ray to any of them. None of them had a second opinion & they followed the given orders. The target group stayed for an average of 8.8 min (SD=4.4), while the other group for 24.6 min (SD=10.8), which was statistical significant (p< 0.001). From the above is obvious a 100% sensitivity of the method & so decrease in the amount of x-rays by 41.9%.

Conclusions: It is apparent that this protocol can be safely introduced in the A& E department. It has to be used by orthopaedic surgeons (trainees) with appropriate behavior & respect to the patient. It can diminish the number of x-rays, the amount of radiation, the cost and the waiting time in the A& E department.

Aim: The purpose of the study is to determine the opioid Ð sparing effect of Rofecoxibe and Lornoxicam in comparison to placebo in total knee arthoplasty. Method: This was a prospective, randomized, double-blind study. 82 patients with mean age of 70 years old (±3.5) and weight 82 (±4) were included. The operation was done under spinal anaesthesia. All patients after the operation were transferred to the Orthopaedic High Dependency unit where PCA morphine with a bolus of 1 mgr and lock-out interval of 8 min was started. There were randomized to receive 50 mgr of Rofecoxibe orally the morning of the operation or 8 mg of Lornoxicam I.V. twice a day. The third group did not receive any additional analgesic. After 24 hours the consumption of morphine and the evaluation of pain according to VAS scale were recorded. The evaluation of pain was done by the same doctor.

Results: There was no statistically signiþcant differences between the three groups either in the consumption of morphine or the pain intensity (Wilcoxon test)Conclusions: Our study showed that the administration of Rofecoxibe 50 mg per os, Lornoxicam 8 mg I.V/b.d. or placebo makes no difference either in the consumption of morphine or the pain intensity during the þrst 24 hours.

Aims: To elicit the predisposing factors responsible for early death in the aged population with hip fracture.

Methods: In this perspective study we dealed with 65 patients over 65 years old (51 women) with mean age 80.1 years old (65 – 104) who suffered a hip fracture (34 trochanteric and 31 subcapital). We studied age, sex, ASA score, delay for surgery and mobility preoperatively, blood loss and operative time interoperatively and postoperative delirium and fixation failure. Haemoglobin, WBC, serum albumin and Mini Mental Test were recorded both pre and postoperatively. The place of the accident was also recorded. The above parameters were compared for survivors and non-survivors patients.

Results: 11 patients died during the first 6 months with a mortality rate 16.9%. In all other parameters we detected no significant differences between groups.

Conclusions: The failure pattern (deaths) after a hip fracture during the first 6 months postoperatively included female of advanced age, with dementia and medical problems (ASA), who developed delirium postoperatively and had diminished preoperatively mobility.

The purpose of this study was to present long-term results of elbow dislocation in children. Eleven patients (10 male) with elbow dislocation (mean age 10.4 years old) were re-evaluated with mean follow up 85 months (24 – 186). Active range of motion and instability were clinically evaluated. Osteoarthritic changes, position and shape of medial epicondyle were radiographically recorded. Functional evaluation was made with Hospital for Special Surgery Elbow Assessment protocol (up to 100).

All cases were treated with closed reduction under general anaesthesia. Three patients were treated surgically with KW for fractures of medial epicondyle. Lack of extension (5° – 15°) was detected in 3 patients two of which had fractures (1 osteochondral and 1 of medial epicondyle). 4 patients were presented with flexion deficit (5° – 10°) while 1 patient had reduction both for supination and pronation (fx of medial epicondyle). Decreased pronation was recorded in two more patients (5° — 10°). Radiologically we found a patient with medial and lateral epicondyle alteration, a patient with osteochondral fracture and another one with ossification of LCL. Functionally the overall result was excellent (subjectively) while mean HSS Elbow Assessment score was 99.1 (96–100).

Patients due to have a major orthopaedic operation should be assessed in advance, in order to be fully prepared for the operation the scheduled day the without cancellations and be cost-effective. We studied 208 patients the last 2 years scheduled for hip and knee replacement. Mean Age 68.7. F=150, M=58. The patients were formally admitted in the assessment stay unit where a fully orthopaedic and anaesthetic examination was done and appropriate lab tests were carried out. The whole procedure lasted 4 hours and was charged 88 Euros.

Only 37 patients have no medical problems. 98 suffered from hypertension and 10 of them needed further adjustment of their treatment. Out of 27 patients who had coronary artery disease, 12 referred to a cardiologist. All of the 12 patients with various heart problems needed further assessment. Readjustment of their treatment needed 3 out 15 diabetic patients. 1 out of the 8 patients with rheumatoid arthritis 1 needed reevaluation and 1 out 19 who suffered from various diseases 1 needed reassessment (Renal failure). Statistically 39 out of 208 had problems p< 0.001.

The anaesthetic assessment contributes to 1.Reduction of cancellations due to medical reasons. 2. Effective use of the theatre time. 3. Reduction of cost.

The purpose of this study was to present the long team functional results after conservative treatment of intraarticular calcaneal fractures. Nine patients with 11 fractures (mean age at accident 52 years old) were reevaluated. Mean follow-up was 8 years (6–15). 5 fractures were tongue type, 5 were compression fractures and 1 with comminution according to Essex Lopresti classification. These patients were clinically and functionally evaluated with the Ankle-Hind foot scale (Kitaoka, 1994). They were submitted to radiographic testing (foot AP, ankle lateral, axial and medial axial views). Osteoarthritic (OA) changes, calcaneal dimensions (height, width) and Bohler’s – Gissane’s angles were recorded.

According to Ankle Hind foot score (highest 100) our patients scored a mean 77 points (48–90). OA changes were recorded in 7 cases in the ankle joint and in all cases in taloscaphoid, calcanocuboid (severe in 8) and subtalar joints (severe in 5). We found width reduction in 6 patients and height reduction in 2, compared to the healthy side. Bohler’s angle was abnormal in 6 cases (−21°to 52°) while Gissane’s angle was abnormal in 9 (84° to 115°).

Treatment of intraarticular calcaneal fractures is still controversial. Recent studies show a tendency for surgical treatment. In the present study a distinction between clinical and radiographic findings was made. Patients had satisfactory functional results although severe osteoarthritic changes were recorded.

Aim: There are more than 50 methods for the treatment of Reflex Sympathetic Dystrophy Our aim is to test how effective is the treatment of patients with Reflex Sympathetic Dystrophy with guanethidine

Method: 15 patients (F=12, M=3, Mean age 59.9) were seen in the chronic pain clinic with Reflex Sympathetic Dystrophy. 13 patients had sustained a Colles fracture and 11 of them had a closed reduction and application of POP and 2 had an external fixation. 1 had an operation for release of median nerve and 1 amputation of 3 fingers due to trauma. There were first seen in the Pain Clinic 12–16 weeks after the initial injury. Main symptoms were pain and stiffness. On examination all of them had oedema of the hand, stiffness and discoloration. Allodynia was present in 8. Patsy osteoporosis was evident on the x-rays. Palmar elytritis with atrophy in 6. The treatment was intravenous sympathetic block with 20 mg guanethidine plus 2ml 2% lignocaine and N/Saline up to 20 ml. The second block was repeated after 3 days and the following depending on the response to pain. Physiotherapy session followed each block.

Results: 2 patients needed 5 blocks, 7 patients 4 blocks, 5 patients 3 blocks and 1 patient 2 blocks. In the end there was complete regression of the pain, oedema and restoration of the movement.

Conclusion: The sympathetic block with I.V. administration of guanethidine in combination with physiotherapy seems to be a safe and simple treatment of choice, well tolerated and with good results.

We investigated the spines of 15 patients who had significant leg-length inequality as a result of femoral shaft fractures sustained after skeletal maturity but below the age of 21 years. The patients were examined at least 10 years after fracture. The spines were studied clinically and radiographically before and after correction of leg-length inequality with a shoe-raise. Lateral spinal flexion was measured from radiographs. The lumbar scoliosis associated with the leg-length inequality was compensatory: after equalisation of leg-length the overall curve and the axial rotation were corrected completely. There was also an equal range of lateral flexion to either side after correction. Minor malalignments of the whole spine remained despite correction of the compensatory scoliosis, and within the lumbar spine correction of the scoliosis had not occurred equally at all levels. No patients complained of significant discomfort and neither structural abnormalities nor degenerative changes were seen on the radiographs.