Aim: A prospective randomised clinical trial was performed to evaluate two forms of immobilisation in the treatment of colles fractures not requiring manipulation.

Methods: Patients were randomised to either plaster cast (PC) or a removable splint: wrist splint (FWS) according to date of presentation. Patients who had associated injuries to the same upper limb, previous wrist fracture, and open fractures, below 20 years or impaired cognitive function were excluded. The hospital ethical committee approved the study and informed consent was obtained from patients. Patients were reviewed at one week, two weeks, six weeks and twelve weeks following enrolment into the trial. Radiographs were performed on the first four visits. Subjective data was obtained using a patient questionnaire. Levels of pain, comfort in cast, swelling and any modifications to the cast were documented. Was used at six and twelve weeks to assess Clinical assessment was performed by a qualified physiotherapist using the demerit score of Sarmiento which combines range of motion, grip strength and functional assessment.

Results: There were thirty-seven patients in the PC group and thirty-four in the FWS group. They were well matched in terms of age and sex distribution One patient in the PC group required manipulation under anaesthesia due to loss of position at one week. There was no statistical difference between either treatment method in radiological position. Nine patients in the PC group required change of cast due to loosening or discomfort. A further eight patients in the PC group required cast trimming. Visual analogue scores for pain and cast discomfort were lower in the FS group (p< 0.05). Grip strength compared to the opposite side was higher in the FS group (55.9% Vs 47.8% at week six, 71.8% Vs 65% at week twelve). Functional assessment demonstrated a higher score in the FS group at six weeks. However the difference did not reach statistical significance at repeat examination at twelve weeks.

Conclusion: In this study there was no difference in either method in maintaining fracture position. However there was greater patient satisfaction and earlier rehabilitation in those patients treated in a futura wrist splint. Patients treated in plaster cast required a greater use of plaster room resources. We feel that the use of a removable wrist splint in suitable patients with either undisplaced or minimally displaced distal radial fractures is validated by this study.

Introduction: Cement removal in revision total hip arthroplast;y can be technically challenging. Traditional methods can be associated with femoral fracture or uncontrolled cortical perforation and bone loss. A new technique has been developed tha.t permits segmental extraction of bone cement from the femoral canal. Fresh cement is introduced into the old cement mantle and a threaded rod is placed into the wet cement and held in place while the cement hardens. The thread-forming rod is then removed leaving a threaded channel in the cement. Extraction rods are then screwed 1.5 to 2.5 cm into the threaded channel. A slap hammer, which attaches to the opposite end of the extraction rod, is used to remove 1.5- to 2.5-cm segments of cement. The old cement – cancellous bone interface fails before the new-old cement interface and the old/new cement is removed in segments. This allows minimal removal of cancellous bone.

Patients and Methods: Patients who had contra-indications to segmental cement removal such a discontinuous cement mantle were excluded. Twenty-five consecutive cases of revision arthroplasty were entered into the study. The indications were for aseptic loosening in twenty-three cases and deep infection in two cases.

Results: In twenty-two cases the cement was removed completely. In five cases the cement was removed en-bloc in one single extraction rather then in segments. In two cases there was failure of the new cement to bond to the original cement and alternative methods were used. In a further case the cement was removed using a combination of segmental and conventional techniques. There were no cases of cortical perforations or perforaltions in this series. We have found it to be a reliable and safe method of cement removal. The cost of the system is offset by reduced operative time and blood loss.

The effects of infection following implantation of an orthopaedic prosthesis are devastating. The prevention of perioperative contamination is therfore of the utmost importance in arthroplasty. We undertook a prospective study to assess bacterial contamination in elective arthroplasty surgery. Splash bowls containing sterile saline are used to store and clean instruments used during the course of a procedure. The incidence of bacterial proliferation in splash bowls was examined as a marker of intra-operative contamination. A 100mL aliquot of fluid was removed from the splash basin at the end of the procedure and passed through a grid membrane using a vacuum pump. The membrane filter was then plated on chocolate agar and colony counts recorded at 24 and 48 hours. Organisms were identified by standard techniques. Demographic data, and perioperative data including the duration and type of procedure, the number of scrubbed and other personnel in theatre and the type of skin preparation and gowns used were also noted. A total of 43 cases were examined. 14 samples yielded positive cultures. Staphylcoccus was the most commonly cultured organism (9 cases). Four patients grew Pseudomonas species. Five patients grew other Gram-negative organisms including Neisseria and bacillus subspecies. Five patients grew multiple organisms. Mean duration of follow up was 8.4 months (range 6 – 18 months). None of the patients with contaminated samples developed any clinical signs of infection in the perioperative period; nor was there clinical or radiological evidence of infection or loosening on subsequent follow up. Despite the use of a laminar airflow system in all cases, in excess of 30% of cases were contaminated. This study underlines the importance of adhering to rigorous protocol in theatre including minimising theatre traffic and the use of antibiotic prophylaxis.

Introduction: Occipito-cervical fusion has evolved from the used of simple onlay bone grafts to the use of sophisticated modular implants. Initial stiffness prevents micromotion and allows a higher fusion rate.

Methods: A composite occipito-cervical model (OCM) was developed and validated using data obtained from cadaveric specimens. A jig was designed to pot the OCM, which allowed the application of independent moment forces to simulate flexion, extension, lateral flexion and rotation. The following implants were used 1 ) Grob plate with C1/C2 transarticular screw fixation.2) Grob Plate without C1/C2 transarticular screw fixation.3) Cervifix rod system 4) A Ransford loop system 5.) Olerud plate fixation. A three dimensional ultrasonic motion analysis system (Zebris Inc.) was used to record motion at three positions: 1)C0 2) C2 3) C4.A separate OCM was used for each instrumentation system.

Results: The Grob plate with C1/C2 transarticular fixation was found to confer the greatest initial stiffness. The Ransford loop construct was found to confer the least initial stiffness. Plate fixation offered greater stability then rod or loop constructs. We found the three dimensional motion analysis system to be ideal for displacement analysis in complex spinal instrumentation constructs.

Introduction: Compartment syndrome is a well recognised complication of tibial diaphyseal fractures. The sequelae of late treatment can be devastating to both patient and surgeon. The aim of this study was to identify the incident, outcome and possible risk factors of compartment syndrome treated in a regional trauma unit.

Patients and Methods: A total of six hundred and twenty three tibial diaphyseal fractures were managed over a four year period (1995–1999). Two hundred and forty three of these were treated using a reamed intramedullary nail. One hundred and ninety four of these were closed and forty nine were open. AO radiological classification and Tscherne soft tissue classification were used to grade severity of injury. The mechanism of injury was recorded for all tibial fractures. Patients who were diagnosed with compartment syndrome were clinically and radiologically evaluated.

Results: Compartment syndrome was diagnosed in seventeen cases with an average follow up of twenty eight months (range 8–48 months). This represented a rate of compartment syndrome of 2.7% of all tibial fractures but 6.9% of cases treated with a reamed tibial nail. The average age of patients was twenty four years (range 18–42 years). Fractures were closed in twelve cases and open in 5. Results in this group were good in ten cases, fair in four cases and poor in three cases (Edwards Classification). Six patients developed complications following fasciotomy including drop foot, equinus contracture, muscle weakness and MRSA infection. In patients with complications, the interval between onset of symptoms and decompression was greater than ten hours. All patients who developed compartment syndrome had been treated using a reamed intramedullary nail.

Discussion: There was a statistically significant association between the use of intramedullary reaming and development of compartment syndrome (p< .05). We recognised a hitherto undescribed trend of compartment syndrome following reamed intramedullary nailing of tibial fractures sustained during sport activity. This may relate to higher initial compartment pressure in this group at the time of fracture. Increased awareness may avoid the consequences of late treatment of compartment syndrome.