The Fixion expandable nailing system provides an intramedullary fracture fixation solution without the need for locking screws. Proponents of this system have demonstrated shorter surgery times with rapid fracture healing, but several centres have reported suboptimal results with loss of fixation. This is the largest comparative series to be reported to date.

We compared outcomes between 50 consecutive diaphyseal tibial fractures treated with a Fixion device at our institution to an age, sex and fracture configuration matched series of 57 fractures at a neighbouring hospital treated with a conventional interlocked intramedullary nail. Minimum follow up time was 2 years.

Operating time was significantly reduced in the Fixion group (mean 61 minutes, range 20–99) compared to the interlocked group (88 minutes, 52–93), p< 0.00001. The union rate was no different between the Fixion group (93.9%) and the interlocked group (96.5%), p=0.527. Time to clinical and radiological union was significantly faster in the Fixion group (median 85 days, range 42–243) compared to the interlocked group (119, 70–362), p< 0.0001. The overall reoperation rate was lower in the Fixion series (24.5% vs 38.6%, p=0.121), although the majority of reoperations in the interlocked group were more minor, for screw removal. 3 Fixion nails were revised for fixation failure and 2 manipulations were required for rotational deformities after falls; all of these patients were non-compliant with post-operative instructions. There were no fixation failures in the interlocked group. 3 fractures were noted to propagate during inflation of Fixion nails.

The Fixion nail is faster to implant and allows more physiological loading of the fracture, with a faster union time. However, these advantages are offset by a reduction in construct stability. Our results have demonstrated a learning curve with a reduction in complications as our indications were narrowed, avoiding osteoporotic, multifragmentary, unstable fractures and non-compliant patients

It is established good practice that hip and knee replacements should have regular follow-up and for the past seven years at the North Hampshire Hospital a local joint register has been used for this purpose and we compare this with results of the Swedish and UK national and the Trent Regional registries.

Since March 1999, all primary and revision hip and knee arthroplasties performed at North Hampshire Hospital, Basingstoke have been prospectively recorded onto a database set up by one of the senior authors (JMB). Data from patients entered in the first five years of the register were analysed. All patients have at least one year clinical and radiological review then a minimum of yearly postal follow-up. 3266 operations (1524 hips and 1742 knees) were performed under the care of 13 consultants. Osteoarthritis was the most common primary diagnosis in over 75% of hips and knees. Our revision burden was 7.5% (10.2% hips and 3.5% knees). As of 31/12/2006 6.2% of patients had died and 5.5% were lost to follow-up.

Revision rates were 1.5% and 1.4% for primary total hip and knee replacements respectively.

Our data analysis of revisions and patello-femoral replacements has allowed us to change our practice following local audit which is ongoing. Oxford scores at 2 years had improved from a mean of 19 and 21 pre-operatively to 40 and 39 for primary hips and knees respectively. Our costs are estimated at approximately £35 per patient for their lifetime on the register.

Compared to other registries:

Our dataset is more complete and comprehensive

Purpose We describe a simple method of dressing pin sites, based on the principles developed in the Ilizarov Institute, that can be easily used in British operating theatres.

Method There are a wide variety of protocols for pin site care but infection rates of up to 80% are reported. The Russian Ilizarov Institute claim low infection rates which may be influenced by their dressing technique. Pin sites are dressed with gauze sponges held against the skin with specifically manufactured rubber stoppers passed over the wires. These provide pressure at the pin site. Plastic syringes consist of a barrel and a plunger with a rubber bung. The rubber bung from a 5ml syringe plunger can be easily removed and slid over the end of a half-pin or both ends of a fine wire. This must be done before the frame is attached and we recommend applying the bungs each time a pin is inserted. At the end of the procedure a cut piece of gauze is applied around the pin site and held in place by the rubber bung, providing a secure non-bulky dressing. A dressing protocol developed by the senior author, based on “The Russian Protocol”, was audited and found to have made a significant impact on the incidence on pin track infection. The bungs can be slid back up the pin when the dressings are changed and left up if the pin site is to remain uncovered. Should the pin site begin to discharge the bung can again be used to hold the dressings securely.

Conclusion We have found this to be a simple, quick, inexpensive and reliable method of pin site dressing that can be readily used in everyday practice, and, reduces the pin track infection incidence.

Many techniques exist for reduction of anterior dislocation of the shoulder. The two commonest methods are the Hippocratic and Kocher. Iatrogenic complications have been linked to both techniques; though reports of brachial plexus traction-injury from the Hippocratic method are rare compared to the more common complication of surgical neck of humerus fracture secondary to the Kocher technique.

Method Questionnaires were sent to 125 Orthopaedic and 125 A& E departments in the UK, asking staff to independently comment on their preferential reduction technique in anterior dislocation of the shoulder.

Results Overall 62% performed the Kocher method and 29% performed a Hippocratic reduction. However, 64% of Orthopaedic consultants performed a Hippocratic reduction (34% performing Kocher) compared to only 14% of A& E consultants, (70% of whom performed a Kocher reduction).

Conclusion The significant risk of humeral neck fracture in performing a Kocher reduction, especially in an inadequately anaesthetised patient in the A& E setting, and the overwhelming preference of Orthopaedic consultants to perform a Hippocratic reduction, indicate that the Kocher method should not be employed.