Aim: We present our experience with 20 periprosthetic femoral fractures which were treated with a Biomet plate. Aim of the current study is to clarify the indications of the method and emphasize on the importance of fracture classification in the preoperative planning.

Material-methods: Retrospective study of 20 patients treated between 1999 and 2001. Ten of the patients sustained a periprosthetic fracture around a total hip replacement, 8 around a hemiarthroplasty and 2 around a revised total hip replacement.

Fractures were classified according to the Vancouver classification system. The mechanism of injury, the ambulatory status prior to the fracture and the loosening zones (according to Gruen) were studied.

Results: In 14 patients the results were satisfactory and in 3 poor. Three patients died during follow up. There were marked differences in the outcome depending on the fracture type. In B1 and C fractures the results were satisfactory. Patients with a B3 fracture had a worse outcome.

Patients with a periprosthetic fracture around a hemiarthroplasty had better results compared to those with a fracture around a total hip replacement. Poorer outcomes were noticed in patients with a periprosthetic fracture around a revised total hip replacement.

Conclusion: A careful patient selection is important for the success of the method. The accurate classification of the periprosthetic fractures helps in the preoperative planning.

Patients with mechanical back pain have been treated in a nurse-led spinal clinic. They attend two one-on-one sessions with a nurse, the second session usually between three and 12 months after the first. Between these visits, they also attended two sets of classes in the spinal assessment clinic to help them improve and manage their back pain. A questionnaire is completed at presentation and at review.

The questionnaires include three scores: The low back outcome Score, MSPQ and the Zung Depression Scale. Since 1995, approximately 2250 patients have been treated. The influence of smoking, gender, age, occupation and marital status on recovery has been studied.

Smoking: Patients who had given up smoking between the first and second questionnaires showed a significant improvement in their outcome score and MSPQ score. Out of 827 who said they smoked on presentation, 280 said they did not on review. From an average outcome score on presentation of 25, those who gave up improved more than those who did not (average score at review 37 vs. 31). A similar trend was seen in the MSPQ averages (from 9 to 7.4 vs. 9 to 8.7). Non-smokers had better results than smokers with an increased outcome score from 30 to 38, MSPQ from 8 to 7.1 and Zung from 20.6 to 19.6. Thus people who gave up smoking showed a larger improvement in their outcome and MSPQ scores than those who continued smoking and those who did not smoke at all.

Gender: Women showed greater improvement in each of the areas than men – 14.5% greater in the outcome score, a 21.2% greater increase in the MSPQ score, and 3.7% in the Zung score.

Age: Patients were divided into 10-year groups. The age group of 50–60 showed the lowest average response for each score, ( 28 to 34 on outcome (average difference = 8), 8.3 to 7.8 on MSPQ (average difference = −0.8), and 21.1 to 21 on Zung (average difference = −0.7). The 30–40 group showed the highest average change on each score (29 to 39 on outcome, 7.9 to 6.9 on MSPQ, 21.8 to 20.1 on Zung). The adjacent age groups showed similar trends but the numbers were not significant.

Occupation: Occupation was divided into eight categories from high-grade professionals to the unemployed. The least improvement was shown by the low-grade occupations (semi-skilled manual workers and the unemployed). The greatest improvements were shown by the middle grade groups. The highest grade occupation showed poor improvement but this was not significant.

Marital Status: For the outcome score, patients who were divorced/separated showed the least improvement, while the married group showed the greatest. On the MSPQ and Zung score, divorced/separated showed the greatest and second greatest improvement (61 % greater than the average on Zung score). The single group showed the worst overall response, scoring the second lowest improvement for the outcome score, the lowest on the MSPQ score (difference −0.47) and their average response actually worsened for the Zung score (from 21 to 21.6).

Conclusion: This study demonstrates that demographic and socio-economic factors significantly influence the level of improvement which patients make in their recovery from mechanical back pain after a treatment program.

The aim of this study was to compare implementation of RCGP guidelines in patients in Primary Care with acute low back pain between GP and Nurse Practitioner. This report presents preliminary results.

The intention was to recruit 200 patients presenting to GP with new episode of back pain. 50% randomised to NP care, 50% to GP care. Outcome measured by documentation audit and patient feedback. Individuals complete a questionnaire which includes a Low Back Outcome Score (LBOS) at 14 weeks, 6,12 and 24 months. All patients in NP arm given back book and advised against bed rest.

Initial Findings: (n = 145): The LBOS score was identical (30) for the 73 patients randomised to nurse practitioner care and the 72 with routine GP care. There were no significant differences between the scores at 14 weeks and 6 months, with an increase in LBOS to 45–49, but numbers dropping to 28 in the NP group and 26 in the GP group.

Process audit at 14 weeks: Only 10 of NP patients were not given the back book compared with 74% for GP care. 13% of NP patients were prescribed bed rest against 18 for GP care.

Initial results suggest no significant difference in outcome between GP and Nurse Practitioner patients. Of interest is that 10% and 13% of patients failed to recall important features of management. This implies that audit of healthcare processes by patient questionnaire may be unsatisfactory.

The aim of this study was to test the effectiveness of a nurse practitioner-led clinic for managing the pre and postoperative care of patients undergoing lumbar spine surgery, against traditional clinic treatment.

Ninety patients were randomised- 46 (Group 1) attended a nurse practitioner run pre-operative class and post-operative follow-up clinic and 44 (Group 2) were seen by the surgeon before and after the operation. All patients completed the Low Back Outcome Score, MSPQ and Zung score, pre-operatively and at six months post-op.

There were 46 male and 44 female patients, and mean age was 45.4 years (range 20–77). The two groups were demographically similar (p = 0.418). The mean pre-op outcome score was 23.49 in group 1 and 17.41 in group 2 (p = 0.038) and the mean post-op scores were 44.67 and 35.38 for group 1 and 2 respectively (p = 0.021). Intra-group comparison showed an improvement in post-op outcome score for all patients (p = 0.001), but those in group 1 were significantly more satisfied (p = 0.008). Four theatre slots were lost in group 2 but none in group 1.

A nurse practitioner-led pre-op counselling and post-op follow-up is more effective than the traditional clinic attendance for patients undergoing lumbar spine surgery and prevented waste of theatre time.

The off-loading characteristics of the cast-braces of 30 patients with fractures of the shaft of the femur have been investigated, during axial loading, using strain-gauge transducers. These were applied at the level of the fracture, where the cast was circumferentially split, and to the hinges of the brace at the knee. They measured the load transferred between the two portions of the thigh cast, and between the thigh cast as a whole and the below-knee cast; by subtraction from the total load on the limb, the skeletal force at the fracture level and at the knee could be calculated. In all patients there was an increase in the fracture load as union progressed which was thought to be due to physiological feedback mechanism from the fracture site. The load carried by the two portions of the thigh cast and by the thigh cast as a whole was proportionately high at first and stabilised at an average of 35 per cent of body weight.