Introduction: The return of haemoglobin (Hb) to preoperative levels at 1–6 months following elective lower limb joint arthroplasty is well documented. Previous reports have suggested in healthy, elective patients there is no significant improvement in Hb levels following iron supplementation compared with placebo. There may also be unpleasant side effects. However, there is little published on this topic in the elderly population who suffer a femoral neck fracture and undergo emergency surgery, and often have poorer iron reserves.

Methods: We examined the blood results and discharge prescriptions of consecutive patients who underwent femoral neck fracture surgery at our institute in a 12 month period. Patients who had received a blood transfusion were excluded. 82 patients remained. Normal Hb levels at the time of surgery and 1–6 months post-operatively (late Hb) were collected.

Results: Thirteen patients (16%) were prescribed iron supplementation on discharge. No patients who went on to receive iron had a normal Hb (11.5 – 15.5g/dL in females, 13– 8g/dL in males) immediately following surgery (mean Hb 9.17g/dL) compared with 26% (mean Hb 10.41g/dL) in those who received no iron. At 115.2 days (range 28–284) following surgery 88.9% of patients prescribed iron had a normal Hb compared with only 48.1% of those who received no treatment (P=0.0167).

Discussion: The low level of iron prescribing was surprising, and may be the result of published evidence in elective patients. Our numbers are small, but we show a statistically significant difference which warrants further investigation. We suggest that, unlike the younger, healthier elective arthroplasty patients, femoral neck fracture patients may benefit from dietary iron supplement.

Background: One stop shoulder clinic was established in the North Tees University Hospital as part of conjoint effort between the department of trauma and orthopaedics and radiology in the year 2005. A consultant shoulder surgeon, consultant radiologist, extended scope shoulder physiotherapist and shoulder nurse practitioners run the clinic on weekly basis.

The aims are:

Immediate and more accurate diagnosis and plan accordingly.

Methods and materials: A retrospective study of 150 patients who had been seen in the one stop shoulder clinic and conventional clinic. We studied the number of hospital visits, the waiting time for final intervention and or discharge, the accuracy of initial diagnosis and treatment and the cost-benefit analysis.

Results and discussions: One-stop clinics have been successfully established in a few fields of medicine. One stop breast lump clinic has been running for almost 10 years with a very good reputation of rapid, accurate and cost-effective diagnosis of breast lumps. Similar successful examples have been emerged in gynaecology such as fertility clinic and uterine bleeding clinic; and in urology such as haematuria clinic. To our best knowledge, this is the first study that investigated the one-stop clinic in shoulder problems. Our results showed similar trend of success in term of reduction of patients’ hospital visits, waiting time to treatment and accuracy of the diagnosis. We also conducted a cost-benefit analysis of the one stop shoulder clinic in comparison with the conventional shoulder clinic and we concluded that it is cost effectiveness.