Our aim was to compare displayed pressure with actual intra-articular pressure using three fluid delivery systems. The pumps used were the Arthrex, FMS and Dyonics.

We investigated thirty patients undergoing shoulder arthroscopy. Patients with a previous disruption to the joint capsule were excluded.

A standard set-up was used with the patient in a lateral position and arm in traction. The arthroscope was introduced from the posterior portal. The rotator interval was identified and the needle introduced from this point. The needle was attached to a arterial pressure transducer. The pressure transducer was coupled to the anaesthetic machine. Pressures of 30, 50 and 80 mmHg were dialled on the fluid management systems. Once the pressures stabilised on the pumps the intra-articular pressure was measured independently using the pressure transducer.

Median pressures for the FMS and Arthrex pumps were approximately twice set pressures. Median pressures for the Dyonics pump were closer to set pressures but the range of values was wider.

The three pumps were inaccurate and behaved differently to each other. They are not interchangeable. Each pump performed inconsistently.

The image intensifier is an essential part of orthopaedic trauma surgery. The Image Intensifier can move in a number of planes and has to be positioned accurately. Frustration arises in the surgeon, the radiographer and the rest of the theatre staff when the image intensifier is moved in the wrong direction and there are also increased radiation hazards to all involved if unnecessary x-rays are taken due to incorrect positioning. Communication between the surgeon and the radiographer lies at the heart of safe practice. A questionnaire was designed and circulated to all the radiographers using the image intensifier and to orthopaedic surgeons including consultants, SpRs in London southwest deanery and SHOs of St George’s Hospital, London. They were then asked to write descriptors on a diagram illustrating the major movements of the image intensifier (Vertically up/down, to the patients left/right and head/feet). The questionnaires were completed by 32 radiographers and 48 surgeons (8 consultants, 33 registrars and 7 SHOs). There was very little consensus either within or between the groups as to what command should be used for which direction. A set of directions was agreed upon and put on image intensifier machine. When used these produced a significant reduction in misunderstood commands Confusion abounds when directing the Image Intensifier. When a set of directions can be agreed upon stress reduces and satisfaction improves although it is difficult to measure the reduction in radiation exposure.

The purpose of the study was to perform an independent assessment of the results of open reduction and internal fixation (ORIF) on a selected group of displaced intra-articular calcaneal fractures from two centres.

It still remains controversial whether to manage intraarticular calcaneal fractures conservatively or operatively with few long-term results. The identification of patients who may benefit from the procedure is still undecided.

Fifty fractures in 46 patients with a defined significant displacement of an intra-articular fracture of the calcaneum underwent ORIF by one of the two senior authors. Mean age at operation was 46 years and mean follow-up was 44 months. 88% of the injuries were due to a fall from a height. 30% of the patients had contralateral foot/ankle injuries, and 20% of the patients developed a superficial wound infection. The infection rate was significantly higher in patients whose surgery was delayed more than 14 days.

All patients were independently reviewed after a minimum two-year follow-up. A clinical, radiographic and subjective assessment of the outcome was made. The results were correlated to the original fracture type. The mean Atkins score was 88 (out of 100). Bilateral injuries fared worse. Heel pain at follow-up correlated with a poor score. Atkins scores over 90 occurred in 77% of Saunders Type II, 50% in Type III, and 43% in Type IV fractures. 94% returned to work at a mean of 10 months post-injury. Three patients have undergone a subtalar arthrodesis – two for persistent pain and one for a significant malunion. One patient required a flap but there have been no cases of chronic osteomyelitis.

In patients with significantly displaced fractures, ORIF is a worthwhile procedure with 90% of patients satisfied and 94% returning to work. Gross articular comminution does not preclude a good/excellent result if hindfoot alignment is restored. ORIF after fourteen days should be avoided due to the high risk of infection.

The purpose of the study was to perform an independent assessment of the results of open reduction and internal fixation (ORIF) on a selected group of displaced intra-articular calcaneal fractures from two centres.

It still remains controversial whether to manage intraarticular calcaneal fractures conservatively or operatively with few long-term results. The identification of patients who may benefit from the procedure is still undecided.

Fifty fractures in 46 patients with a defined significant displacement of an intra-articular fracture of the calcaneum underwent ORIF by one of the two senior authors. Mean age at operation was 46 years and mean follow-up was 44 months. 88% of the injuries were due to a fall from a height. 30% of the patients had contralateral foot/ankle injuries, and 20% of the patients developed a superficial wound infection. The infection rate was significantly higher in patients whose surgery was delayed more than 14 days.

All patients were independently reviewed after a minimum two-year follow-up. A clinical, radiographic and subjective assessment of the outcome was made. The results were correlated to the original fracture type. The mean Atkins score was 88 (out of 100). Bilateral injuries fared worse. Heel pain at follow-up correlated with a poor score. Atkins scores over 90 occurred in 77% of Saunders Type II, 50% in Type III, and 43% in Type IV fractures. 94% returned to work at a mean of 10 months post-injury. Three patients have undergone a subtalar arthrodesis – two for persistent pain and one for a significant malunion. One patient required a flap but there have been no cases of chronic osteomyelitis.

In patients with significantly displaced fractures, ORIF is a worthwhile procedure with 90% of patients satisfied and 94% returning to work. Gross articular comminution does not preclude a good/excellent result if hindfoot alignment is restored. ORIF after fourteen days should be avoided due to the high risk of infection.