Aim: The purpose of this study was to report the long-term follow-up (mean of 15 years) of patients with displaced intra-articular calcaneal fractures from a randomised controlled trial published in 1993.

Patients and Methods: 46 patients (82% of patients in the initial study group) were alive at a mean of 15 years post injury. The patients had been randomly allocated to either conservative or operative (Soeur and Remy technique) treatment in the original study. Clinical (AOFAS, FFI and calcaneal fracture score) and radiological (Böhler’s angle and calcaneum height) outcome measures were used. The grade of osteoarthritis was also assessed at long-term follow-up.

Results: 26 patients (57%) were reviewed and these patients served as the focus of the study (11 conservative and 15 operative). The clinical outcomes after conservative treatment were not found to be different from those after operative treatment, scores of the AOFAS were 78.5 and 70 respectively (p = 0.11); scores of the FFI were 24.4 and 26.9 respectively (p = 0.66) and calcaneal fracture scores were 70.1 and 63.5 respectively (p = 0.41). The radiological outcomes after conservative treatment were not found to be different from those after operative treatment, Böhler’s angles were 10° and 16° respectively (p = 0.07) and the height of the calcaneum were 37mm and 36mm respectively (p = 0.57). There was no difference in the grade of osteoarthritis between the groups.

Conclusion: The functional and radiological long-term outcomes after conservative treatment of displaced intra-articular calcaneal fractures were equivalent to those after operative treatment. The operative technique showed no benefit compared to conservative treatment at long-term follow-up. There was a trend for higher scores on clinical outcomes with conservative treatment

Three radiological methods are commonly used to assess the outcome of total hip replacement (THR). They aim to record the appearance of lucent areas and migration of the prosthesis in a reproducible manner. Two of them were designed to monitor the implant through time and one to grade the quality of cementing. We have measured the level of inter- and intraobserver agreement in all three systems.

We randomised 30 patients to receive either finger packing or retrograde gun cementing during Charnley hip replacements. The postoperative departmental radiographs were evaluated in a blinded study by two orthopaedic trainees, two consultants and two experts in THR. The trainees and consultants repeated the exercise at least two weeks later. We used the unweighted kappa statistic to establish the levels of agreement.

In general, intraobserver agreement was moderate but interobserver agreement was poor, with levels similar to or less than those expected by chance. Our results indicate that such systems cannot provide reliable data from centres in different parts of the world, with various levels of surgeon evaluating radiographs at differing time intervals. We discuss the problem and suggest some methods of improvement.

Despite the use of ultraclean air, there are still cases of infection in total joint arthroplasty. One possible route by which bacteria may enter the wound is indirectly by contamination of instruments during skin preparation and draping.

We found that bacterial air counts were 4.4 times higher during preparation and draping for hip or knee arthroplasty using an unscrubbed, ungowned leg holder than during the operation itself. With the leg holder scrubbed and gowned during preparation and draping, the air counts were reduced but were still 2.4 fold greater than intraoperatively. On some occasions, the air counts during preparation and draping exceeded the standards for ultraclean air irrespective of the attire of the leg holder.

We recommend that the leg is held by a scrubbed and gowned member of the team. More importantly, we consider that instrument packs should be opened only after skin preparation and draping have been completed.