Objective: To assess functional outcome and complications in patients with Weber C fracture following syndysmotic screw removed.

Patients & Methods: Forty three consecutive patients with closed Weber C type ankle fractures between 2002–20003 were studied. The syndysmotic screw was removed at 6–12 weeks time post operatively. Postoperative complications and functional outcome were studied.

Results: Following removal of the syndysmotic screw 6 patients had superficial wound infection, 4 patients had pain due to instability, one patient had DVT and one patient had broken screw. The functional outcome using ankle scores compared to the other studies in the literature did not show any significant difference.

Conclusion: Syndysmotic screw removal has significant morbidity. Guidelines with randomised control studies are recommended.

Stem dissociation in modular revision knee replacement due to failure of the frictional lock of the Morse taper has been reported in the literature. However, the medium and long-term implications of stem dissociation are unknown, as clinical outcomes have not been reported. We report a series of 10 cases in which there was intra-operative dissociation of the tibial stem.

Between 1994 and 1999, 98 patients underwent revision total knee replacement for aseptic loosening at our institution. Ten of these patients were noted to have tibial stem dissociation, apparent on the immediate post-operative radiographs. The senior author (RWP) performed all procedures and used a standardized operative technique. The Co-ordinate modular knee revision system was used in all cases. The quality of the bone was noted in all the cases intra-operatively; and was graded as 1) sound bone, 2) soft but intact, 3) soft and fractured cortex.

Our study demonstrates that the tibial stem dissociation did not cause any significant detriment to the clinical outcome on minimum follow-up of six years in nine cases where the tibial metaphyseal cortical rim was intact. In one case, where the medial tibial plateau had a cortical defect, the prosthesis drifted into varus mal-alignment and the patient required a further revision for aseptic loosening. We therefore question whether long canal filling tibial stems are necessary in all revision total knee replacements particularly when the cortical rim is intact and a non-constrained poly-ethylene insert is used.

Introduction: We found some unusually long delays and repeated canellations in patients on warfarin and associated proximal femur fractures. Aim of our study was to find the safe INR levels at which the patients can be subjected to surgery and if possible determine the approximate time when patients would reach the safe levels based on INR results at admission. Generally an INR level of less than 2.0 is considered safe and there is no set policy within hospitals on advance booking of these patients.

Methods: We identified all proximal femur fractures in a one year period in our hospital who were on warfarin, determined the reason for which they were on warfarin. Checked INR, LFTS and Renal function on admission. Patients had daily INR levels done at 6’oclock in morning to determine the suitability for theatre.

Results: There were 23 patients of total 437 patients with proximal femur fractures on warfarin. Single most important reason for treatment on warfarin was atrial fibrillation(in 18 patients),other reasons were thromboembolic disease, recurrent pulmonary embolism and heart valve replacement. The INR on admission ranged 1.6–4.0 with a mean of 2.6.We found that most patients with an INR less than 3.0 on admission had acceptable levels within three days of admission whilst those with an INR greater than 3.1 had an acceptable levels within four days. In patients with raised LFTS or renal function impairment took longer time to settle.

Conclusion: We recommend that patients with an INR less than 3.0 can be provisionally booked for theatre 3 days from admission while those with an INR 3.1–4.0 can be listed for theatre 4 days from admission except where there is a grossly altered renal or liver function. By listing patients in above method, unexpected cancellations and the practice of keeping the patients fasted on a daily basis can be avoided.

Introduction Hallux valgus (HV) is a common foot deformity with a prevalence of up to 48%. It usually affects females and its radiographic severity is expressed by various angles, such as the HV Angle, the Inter Metatarsal Angle (IMA) and the Distal Metatarsal Articular Angle (DMAA).

The aim of our study was to assess the impact that HV has on patients’ quality of life and to correlate each of the above angles to SF-36 sub-scales.

Method Twenty-three female patients with a mean age of 48.5 years were included in the study. Diagnosis was established by clinical and standardised radiological examination. Patients were medically fit and the only pathology that could affect their SF-36 score was HV. They all completed in the SF-36 form on their first visit at the clinic. Statistical analysis was performed via SPSS 12.0.

Results Mean radiographic angular deformities measured 35, 13, and 17 degrees for HVA, IMA, and DMAA respectively. The HVA and IMA demonstrated significant association (p=0.018) as regarding their severity, indicating that they probably interact during the progression of the deformity. The Physical Component Summary score was significantly lower in our patients than the recommended norms for the same age (p=0.015). HVA significantly affected the General Health (p=0.023), IMA, the Role Physical (0.039), Role Emotional (p=0.056) and Mental Health (p=0.043). The coefficients were all negative indicating a worse health scenario as the deformity increases.

Conclusion These results suggest that HV deformity seriously affects peoples’ quality of life. In addition, according to our data, surgical treatment is absolutely indicated and operative correction of the angular deformities would be expected to normalise those patients’ SF-36 score. However, this remains to be proved.