Introduction: Obesity is detrimental to the health of an individual, however does a high body mass index (BMI) actually determine post operative morbidity following hip replacement surgery?

Methods: 550 consecutive primary hip replacement patients were included in this study. Patients were followed up at four weeks, six weeks and one year following surgery. Any complication that the patient had was recorded and listed either as local or general. The complications were further sub divided into minor and major depending on the risk they posed to the patient or the joint.

Results: The average BMI of our patients was 28.3 (4.3). 56 (10%) patients had a complication following hip replacement surgery. The group who did not have any complications had an average BMI of 28.13 (SD=4.6) while the group who sustained complications had an average BMI of 29.46 (SD=5.8) with a p value of 0.104 (Student t-test). When BMI was grouped in values of 5 starting from < 25 and ending with > 35 the p value was 0.029 (chi square test). Odds ratios for grouped BMI varied from 0.086–1.61(95% CI 1.01–1.08) (p=0.086). Odds ratios for individual surgeons ranged from 0.96–2.41 (p=0.024)

Discussion: When we looked at the overall BMI there was no significant difference between the group who had a complication and the group who did not have a complication, however when the BMI was split into groups those patients in group 30–34 and 35+ experienced a higher rate of complications. The final odds of BMI was 1.05 (1.01,1.09). There was a higher complication rate in the groups other than the ideal BMI of 25–29, and even a fall in BMI caused an increase in the complication rates.

Conclusions: Obese individuals are at a higher risk of developing a complication following surgery, however the operating surgeon also has an influence on the complication rate following hip replacements.

The authors would like to present a retrospective study conducted on 178 patients having undergone a hip replacement. The aim of this study was to look at the immediate and short-term complications of hip replacement in relation to the body mass index (BMI).

Patients ranging from age 49 to 90 were included in this study with an average age of 67.5. BMI ranged from 18 to 41. Length of stay ranged from 3 days to 76 days with an average of 11.5 days. Follow up of each patient included any wound complications, time to mobilisation and time to discharge. Operative blood loss and need to transfusion were also looked at. Blood loss was found to be from 150 mls to 2400 mls.

A large number of orthopaedic surgeons use a BMI value of 35 as the upper cut off point to refuse elective surgery. Using the Null hypothesis the authors wanted to prove that a higher BMI resulted in higher complication rates. Statistical analysis of the data however did not show a significant relationship between BMI and early complications in hip replacement surgery. Parameters measured had a higher relationship to individual surgeons rather than the BMI.

The authors would like to conclude that using the BMI as a predictor of a higher rate of short-term complications and refusing surgery to patients with a higher BMI is not justified.

Introduction and Aims: To evaluate the results of humeral nailing with the new Fixion inflatable humeral nail.

Method: We retrospectively studied 42 patients with acute humeral fractures (20), delayed and non-union (12) and pathological fractures (10), who where treated with an inflatable humeral nail and had a minimum follow-up of six months. Our primary outcome measures were clinical and radiological union. Secondary outcome measures were revision of the nail, screening time and operative time. We made a clinical assessment of the patients using the Constant score of the shoulder and a measure of health-related quality of life, using the EuroQol EQ-5D questionnaire.

Results: In patients with acute fractures 16/19 (84%) went on to clinical and radiological union (1/20 patients died four weeks post-operatively from bronchopneumonia). All of the patients with delayed and non-union of humeral fractures went on to clinical and radiological union. In the patients with pathological fractures, the nail provided good palliative symptom relief. Average screening time was 40.5 seconds (21–107). Average operative time was 71 minutes (26–142). Constant score of the shoulder had a median of 67 (SIQ 46.5–77.5) in the affected arm and 87 (SIQ 74–89) in the normal arm.

Conclusion: The treatment of humeral fractures using the inflatable intramedullary nail is a simple and safe technique, avoiding the time and complications associated with distal locking. Its seems to be an appropriate technique with excellent results in those patients with delayed and non-union of humeral fractures, and provides effective palliation in patients with pathological fractures. Its efficacy in patients with acute fractures is comparable to other intramedullary nails. In our experience, it is particularly effective in the multiply injured and the infirm because of the speed and ease of insertion.

Aims: The aim of this study was to þnd out if undisplaced displaced distal radial fractures require plaster immobilisation. Methods: In this prospective study, undisplaced distal radial fractures were divided into two groups; plaster immobilisation was used for one group while removable volar splint was used for the other group. Follow up was at six weeks, three months and six months. Patients were assessed by clinical examination, grip strength, radiological assessment, EQ-5D and a Short Form 12 questionnaire. Results: At 3 months, no difference was found between the two groups in clinical evaluation, radiological assessment, the functional outcome, grip strength, and visual analogue score for pain. Conclusions: We conclude that undisplaced distal radius fractures can probably be treated with out a plaster cast and put straight into wrist orthosis.

Objective: To compare the presentation, diagnosis and treatment of spinal tuberculosis in two cities, one in the UK, and one in Malaysia

Design: Retrospective comparison over a five-year period from June 1995. The Centres studied were the Royal Orthopaedic and Queen Elizabeth Hospitals, Birmingham (UK), and the Kuala Lumpur General Hospital (KL), Malaysia.

Subjects: There were 80 patients (29 females, mean age 42) in the KL group, and 19 patients (8 females, mean age 45) in the UK group.

Outcome measures: Frankel grading before and after treatment were measured for both groups.

Results: KL patients had higher rates of immunocompromise, and had fewer spinal levels involved, 2.1 compared with 2.6 (p-−0.04). There were 65 procedures, 58 positive ZN stains, and 65 positive cultures as compared with 24, 2 and 9 in Birmingham respectively. Improvement in Frankel grading was seen in four patients in UK (5 grades), and in 17 patients in KL (29 grades).

Conclusions: Although the two groups exhibited similar demographics, the rate of immunocompromise-related tuberculosis, severity of neurological deficit, and type of surgery undertaken differed significantly. Reasons for the difficulty in identifying the tubercle bacillus in Birmingham are discussed.

We have prospectively compared the fixation of 100 intertrochanteric fractures of the proximal femur in elderly patients with random use of either a Dynamic Hip Screw (DHS) or a new intramedullary device, the Gamma nail. We found no difference in operating time, blood loss, wound complications, stay in hospital, place of eventual discharge, or the patients' mobility at final review. There was no difference in failure of proximal fixation: cut-out occurred in three cases with the DHS, and twice with the Gamma nail. However, in four cases fracture of the femur occurred close to the Gamma nail, requiring further major surgery. In the absence of these complications, union was seen by six months in both groups.

We report three patients in whom a fractured odontoid process was associated with a fracture of the superior articular process of the second cervical vertebra. Although there were no signs of neurological disorder, damage to the C1-C2 joint in all three patients made fusion necessary. Forced lateral flexion is suggested as the possible mechanism of injury.