There is ongoing debate regarding the optimal management of displaced distal radius fractures in the elderly. The aim of this review was to compare outcomes of operatively versus non-operatively managed displaced extra-articular or undisplaced intra-articular distal radius fractures in patients 65 years and older.

All patients over the age of 65 years with displaced extra-articular or undisplaced intra-articular fractures seen in Tauranga Hospital between 1^st January 2009 and 31st December 2009 were included in the study. Patients from out of town, with incomplete radiographs or who had since passed away were excluded as were patients with comminuted intra-articular or undisplaced/minimally displaced extra-articular fractures. Patients attended follow-up where clinical assessment was carried out by a single Hand Therapist who was blinded to the side of injury and previous management, completed the Patient Rated Wrist Evaluation (PRWE) and DASH questionnaires and a visual analogue satisfaction score.

There were 91 distal radius fractures in patients 65 years and older seen in Tauranga Hospital over this 1 year period. 44 were excluded leaving 47 patients. 6 declined follow-up and 5 failed to attend. 36 patients (3 males, 33 females, average age 74.7 years) were included in the study – 23 had been treated non-operatively with casting +/− manipulation while the remaining 13 patients had undergone open reduction and internal fixation.

Comparing the injured with the uninjured wrist in the operatively managed group there was an average loss of 5.8 degrees flexion, 1.2 degrees extension, 1.7 degrees ulnar deviation and 3.8 degrees supination with a gain of 0.7 degrees radial deviation, no change in pronation and a loss of 1.2kg in grip strength. These operatively managed patients had an average PRWE score of 6.5, DASH score of 31.5 and satisfaction score of 8.8. Conversely, in the non-operatively managed group there was an average loss of 17.5 degrees flexion, 9.4 degrees extension, 11.3 degrees ulnar deviation and 10.9 degrees supination with a gain of 0.1 degrees radial deviation, no change in pronation and a loss of 4.7kg in grip strength. These non-operatively managed patients had higher PRWE (42.5) and DASH (56) scores and were in general less pleased with their outcomes (mean satisfaction score – 5.6).

Patients in the operatively managed group at 12–24 months post-injury had less significant loss of function as well as lower PRWE and DASH scores and higher satisfaction outcome scores.

The use of modular components for hip and knee arthroplasty, available since the late 1970’s, has become increasingly popular. Modularity increases the inventory of components required for arthroplasty with the increased possibility of implantation of mismatched components.

All members of the New Zealand Orthopaedic Association were sent a confidential questionnaire asking whether they had selected mismatched components for arthroplasty within the last five years and if so, how often. Information was requested on which components were involved, how and when the mismatch was discovered and what action was taken once mismatch identified. Surgeons were asked to comment on factors contributing to the mismatch occurring and their standard practise to avoid this possibility occurring.

One hundred and forty eight questionnaires were sent out and 120 replies received giving a response rate of 81%. Twenty-eight surgeons (23%) had implanted mismatched components within the last five years, occurring during total hip arthroplasty in 20 cases, knee arthroplasty in six and others in four. The mismatch was discovered prior to wound closure in 39%, during the admission in 51% and after discharge in a further 10%. The mismatch led to a further surgical procedure in 13 patients (46%). The elements contributing to the mismatch will be discussed.

Modular arthroplasty is popular and enables the surgeon to modify the components to the individual patient. This is valued by surgeons accordingly and is unlikely to diminish in frequency. The mismatch rate may be higher than recognised as some mismatches may not have been noted if there was no clinical problem. Strategies to avoid this complication occurring will be discussed.

Aspetic loosening is a major problem of total hip arthroplasty, especially in young and/or active patients. This study was performed to assess the clinical performance of non-cemented, metal-on-metal implant and complications including loosening and osteolysis at medium-term follow-up.

Between 1994 and 1998, 38 patients (45 hips) had a THA with a Metasul articulation. Thirty-two patients (39 hips) were available for follow up an average of 5.3 years following the operation. Patients were independently assessed by clinical examination, with use of the Harris Hip Score, patient self-assessment forms and radiographs.

The average age was 53.5 years (range 29 to 68) with a diagnosis of primary OA accounting for 34 hips and other diagnoses for 5 hips. The average Harris Hip Score for those patients without a revision was 94.7 points (range 71 to 100). One patient had a revision of a loose femoral component at 16 months, at last review he had a Harris Hip Score of 99.7 points. No patient had a loose or revised acetabular component. Two patients had an early dislocation without sequelae. Thirty-six hips were rated as very good or excellent. There was no radiological evidence of progressive radiosclerotic lines and no other evidence of loosening.

This group of young and/or active patients with Metasul articulations has clinical results equivalent to metal-on-polyethylene articulations. There is no evidence to suggest that the rate of loosening is higher as was documented by previous metal-on-metal designs. At medium term follow up there is no evidence that the metal-on-metal articulation gave rise to any new problems or complications.