3D cell culture studies more accurately represent the complex in vivo mechanical environment of human bone and are, thus, superior to 2D studies when testing the efficacy of osteoporosis therapies. As such, the objective of this study was to use a 3D model to investigate the effect of sclerostin antibodies. Sclerostin is a protein, which inhibits osteoblasts and is downregulated under mechanical stimulation. It is not yet known how expression of sclerostin mediates the site-specific and temporal changes in mineralisation. To address this, we developed a 3D cellular niche of MC3T3 osteoblasts encapsulated within gelatin and applied mechanical loading to the constructs using a custom-designed compression bioreactor system (0.5% strain at 0.5 Hz, 1 hr/day) (VizStim) under continuous perfusion of cell culture media. Osteoblasts were pretreated with estrogen for 14 days, followed by estrogen withdrawal (EW) to simulate postmenopausal conditions. 3D constructs were successfully fabricated and actin staining revealed the formation of dendritic cells under both static and stimulated conditions indicative of osteocyte-like cells. Under static conditions, estrogen treatment enhanced production of calcium by osteoblasts when compared to the same cells cultured under estrogen deficient conditions. Overall, preliminary results propose a link between mechanical stimulation, estrogen deficiency and mineral production by osteoblasts. Ongoing studies are comparing the static and stimulated groups after a longer culture period of 21 days using sclerostin antibodies. This research aims to deliver further understanding of the mechanical regulation of bone formation, and will inform novel approaches for regeneration of bone tissue and treatment of osteoporosis.

We completed a retrospective case study of 66 consecutive isolated closed 5^th metacarpal neck fractures that presented to our Hospital between September 2009 and March 2010. Their management was established by referring to outpatient letters and A&E notes. The aim of the study was to establish if it would be more efficient and cost effective for these patients to be managed in A&E review clinic without compromising patient care.

Of these 66 patients, 56 were males and the mean age was 26 years (12–88 years). Four fractures were not followed up at our Trust, six did not attend their outpatient appointment, one did not require follow up.

Of the remaining 55, reviewed at a fracture clinic, all but two were managed conservatively, with 47% requiring one outpatient appointment only. The cost of a new patient Orthopaedic outpatient appointment is £180 with subsequent follow up appointments costing £80 per visit, in contrast to an A&E review clinic appointment at a cost of £60.

In view of the small percentage in need of surgical intervention: we highlight the possibility for these patients to be managed solely in the A&E department with a management plan made at the A&E review clinic with an option to refer patients if necessary, and the provision of management guidelines and care quality assurance measures.

This, we believe, would maintain care quality for these patients, improve efficiency of fracture clinics and decrease cost. We calculate that even if only all the patients that required one follow up appointment could have been managed by A&E alone then the saving to the local health commissioning body over a six month period from within our trust alone, would have been £3000, which across all trusts providing acute trauma services within the NHS would amount to a substantial saving nationwide.

Introduction: Arthrodesis of the shoulder joint is appropriate for several conditions, including paralysis, degenerative disease, infection, and salvage of failed arthroplasty. Two common complications of shoulder fusion, non-union and unacceptable arm position, may reflect failure to achieve rigid fixation during the surgical procedure. Numerous fixation techniques have been described, including plate fixation, external fixation, and screw fixation.

Aim: To compare the biomechanics of five fixation techniques of shoulder fusion in a human cadaveric model.

Methods: Twenty-five shoulder fusions were carried out in fresh-frozen human cadaveric specimens with the following five techniques: screw fixation alone (n=5), external fixation alone (n=5), external fixation supplemented with screw fixation (n=5), single plate fixation (n=5), and double plate fixation (n=5). Each specimen was tested on a servo-hydraulic machine under repeated physiologic loads to determine the bending and torsional stiffness.

Results: There was a statistically significant difference in bending and torsional stiffness between all five fixation techniques (ANOVA, p< 0.05). Normalised bending (B) and torsional (T) stiffness, in descending order, were: double plate (B=1.0, T=1.0), single plate (B=0.77, T=0.89), external-fixation with screws (B=0.68, T=0.74), external-fixation alone (B=0.40, T=0.53), and screws alone (B=0.13, T=0.26).

Discussion & Conclusion: Statistically significant differences in bending and torsional stiffness have been identified using five different techniques of shoulder fusion. The risk of the most common complications of this surgical procedure, non-union and unacceptable arm position, may be minimised if these biomechanical findings are applied to surgical decision-making.