Knee warmth is a common clinical observation following total knee arthroplasty (TKA). This can cause concern that infection is present. The purpose of our study was to establish the pattern of knee skin temperature following uncomplicated TKA. It was a prospective study carried out between 2001 and 2004. A pocket digital surface thermometer was used.

A preliminary study established that the best site to measure knee skin temperature was superomedial to the patella and the best time was 12 noon. Patients with an increased risk of infection and those with a contralateral knee pathology or a previous surgery were excluded. Forty-eight patients fulfilled the inclusion criteria and consented to participate; the skin temperature of operated and contralateral knees was measured pre-operatively and daily during the first six weeks post-operatively. Measurements were also taken at 3, 6, 12 and 24 months following surgery. During the course of the study, patients developing complications of the operated knee or any pathology of the contralateral knee were excluded.

Thirty-two patients completed the main study. Following surgery, systemic and both knees temperatures increased. Whereas systemic and contralateral knee temperatures settled within one week, the operated knee temperature took a longer time. The difference in temperature between the two knees had a mean value of +2.9°C at 7 days. This mean value decreased to +1.6°C at 6 weeks, +1.3°C at 3 months, +0.9°C at 6 months +0.3°C at 12 months and +0.04°C at 24 months. Following uncomplicated TKA, the operated knee skin temperature increases compared to the contralateral knee. This increase peaks at day 3 and diminishes slowly over several months; however, it remains statistically significant up to 6 months.

These results correlate with the findings of previous studies that showed a prolonged elevation of inflammatory markers.

Introduction: Muscle strength has been incorporated in the outcome assessment tools of many joints such as the shoulder and the hand. The purpose of this study was to examine the reliability and therefore the suitability of muscle strength around the ankle joint to be incorporated in foot and ankle assessment tools.

Participants: Sixty-nine healthy volunteers participated in this study (35 females and 34 males); the average age was 35 years (range: 21 to 71 years).

Methods: Three measurements of plantar flexion strength and of dorsiflexion strength of each ankle were performed using the Nottingham Mecmesin Myometer. Measurements were repeated at 2 weeks interval. The averages from first and second occasions were statistically compared.

Results: The average plantar flexion strength was 20.2 kg (range 11 to 41 kg). The average dorsiflexion strength was 14.7 kg (range 7 to 26 kg). The ninety five percent limits of agreement were −5.9 (29%) to +5.2 (26%) kg for the planter flexion and −4.9 (33%) to +5.2 (35%) kg for dorsiflexion.

Discussion/Conclusion: Both plantar flexion and dorsiflexion strengths showed repeatability. Nevertheless, the reliability of planter flexion is higher. Furthermore, this reliability is similar to those of grip strength and shoulder abduction strength. Hence, we advise to incorporate ankle planter flexion strength in foot and ankle outcome assessment tools.

The purpose of this study was to investigate the effect of the degree of abduction on shoulder abduction strength.

Thirty healthy volunteers with no history of shoulder complaint participated in this study. A modified Nottingham Mecmesin Myometer was used. The modification allowed the Myometer to be attached to a clinic table at different angles in order to be at 90°to the arm in varying degrees of abduction. Abduction strength of both shoulders was measured on four occasions at two-week intervals. On each occasion, a different abduction position was adopted at 90°, 60°, 30°and 0°.

The results showed that shoulder abduction strength varies according to the degree of abduction. In comparison with that at 90° of abduction, shoulder abduction strength showed an increase by 12.5% and of 31.3% at 60° and 30° of abduction respectively. However, it was decreased by 18.8% at 0° of abduction. The Student’s T-test showed significant difference between shoulder abduction strength at 90° abduction and all other three abduction positions.

Abduction strength forms an important component of shoulder function assessment tools such as the Constant-Murley score. However, there is no consistency in literature with regards to the method used for its assessment. An extensive review of the literature failed to reveal any evidence to support any particular method. The purpose of this study was to compare the reliability of a single measurement with that of the maximum and average of three consecutive measurements. Sixty healthy volunteers participated in this study. Three measurements of shoulder abduction strength were taken on two occasions separated by 2 weeks. For each shoulder, two single (first) measurement values, two average values and two maximum values were obtained. For each method, 95 % limits of agreement were calculated. Both methods average and maximum have higher reliability than a single measurement. Furthermore, the reliability of the maximum is slightly higher than that of the average.

Purpose: Management of unstable or comminuted displaced fractures of the distal radius is difficult. We report our experience treating these fractures with AO volar plate fixation applying the principle of a volarulnar tension band platting. An attempt to introduce a new radiological classification for the accuracy of reduction is made. The classification includes 10 criteria.

Materials and Method: We reviewed clinically and radiologically 99 patients (101 fractures); 60 were type C and 41 were type A. The average follow up was 37 months (24 – 57). The average age was 46 years (19 – 81). Sarmiento’s modification of Gartland and Werley and Cooney’s modification of Green and O’Brien were used for clinical assessment. Lidstorm and Frykman used for radiological assessment.

Results: At final follow up the means of distal radius parameters were: volar tilt of 9°, radial inclination of 22°, radial height of 11mm and palmer cortical angle of 32°. The mean dorsiflexion was 61°, palmer flexion was 59°, pronation was 80° and supination was 76°. Grip strength was 86% of the opposite side. The average DASH score was 13.6. There was 13 poor results, 6 of them had a significant loss the initial reduction. There was significant correlation between our classification outcome and the clinical outcome.

Conclusion: AO volar plate fixation of unstable distal radius fractures provides a strong fixation that maintains reduction and allows early mobilisation.

Purpose: This study was to assess shoulder function after breast reconstruction surgery using latissimus dorsi flap.

Materials and Method: Sixty-eight patients (72 breasts) had this operation between September 1999 and June 2002. fifty-four patients (58 breasts) were assessed. The average age was 50 year (range 30 – 66 year). Average follow up was 38 month (range 24 – 54 month). DASH and Constant-Murley were used for clinical assessment.

Results: Twenty-nine (50%) shoulders found to have a normal function; whereas, 11 (19%) shoulders had mild disability, 10 (17%) shoulders had moderate disability and 8 (14%) shoulders had severe disability. Only 6 (10%) patients reported being unsatisfied with their outcome; these were, from a shoulder function point view, 4 patients with sever disability, 1 patient with moderate disability and 1 patient with normal shoulder function. However, all these 6 patients were not satisfied with their breast reconstruction outcome.

Conclusion: This study confirms that following breast reconstruction surgery using latissimus dorsi flap, there is a considerable deterioration of shoulder function of varying degrees. Nevertheless, shoulder function is not the main concern of this group of patients.

The purpose of this study was to assess shoulder function after breast reconstruction surgery using latissimus dorsi flap.

Sixty-eight patients (72 breasts) had this operation. Average follow up was 38 months (range 24 to 54 months). DASH and Constant-Murley were used for clinical assessment. Twenty-nine shoulders found to have a normal function; whereas, 11 shoulders had mild disability, 10 shoulders had moderate disability and 8 shoulders had severe disability. However, only 6 patients reported being unsatisfied with their outcome. Furthermore, all these 6 patients were not satisfied with their breast reconstruction outcome.

This study confirms that following breast reconstruction surgery using latissimus dorsi flap, there is a considerable deterioration of shoulder function of varying degrees. Nevertheless, shoulder function is not the main concern of this group of patients.

Purpose: Management of the unstable or comminuted displaced fractures of the distal radius is difficult. We report our experience treating these fractures with AO volar plate fixation. An attempt to introduce a new radiological classification for the accuracy of surgical reduction is made. The classification includes 10 criteria and 100 points.

Methods: 124 patients had volar plate fixation performed between June 2000 and May 2003 using AO volar plate. We reviewed clinically and radiologically 101 patients; 60 were type C and 41 were type A (after failed conservative treatment). The average follow up is 37 months (24 – 57). The average age is 46 years (19 – 81). Postoperative regimen consisted of immediate physiotherapy and a wrist splint for three weeks. Cooney’s modification of Green and O’Brien and Sarmiento’s modification of Gartland and Werley were used for clinical assessment. Lidstorm and Frykman used for radiological assessment.

Results: At final follow up the means of distal radius parameters were: volar tilt of 9 degrees, radial inclination of 22 degrees, radial height is 11mm and palmer cortical angle of 32 degrees. The mean dorsiflexion was 61 degrees, palmer flexion was 59 degrees, pronation was 80 degrees and supination was 76 degrees. Grip strength was 86 percent of the opposite side. The average DASH score was 13.6. There was 14 poor results, 6 of them had significant loss the initial reduction. There was significant correlation between our classification and the clinical outcome.

Conclusion: AO volar plate fixation of unstable distal radius fractures provides strong fixation that maintains reduction and allows early mobilisation.

Purpose: The aim of our study was to establish the pattern of knee skin temperature following uncomplicated TKA.

Methods and Materials: It was a prospective study that was carried out between 2001 and 2004. A pocket digital surface thermometer was used. A preliminary study established the site and time of temperature measurement.. Patients with an increased risk of infection and those with a contralateral knee pathology or a previous surgery were excluded. Forty-eight patients fulfilled the inclusion criteria and consented to participate; the skin temperature of operated and contralateral knees was measured preoperatively and daily during the first six weeks postoperatively. Measurements were also taken at 3, 6, 12 and 24 months following surgery. During the course of the study, patients developing complications of the operated knee or any pathology of the contralateral knee were excluded.

Results: Thirty-two patients completed the main study. Following surgery, systemic and both knees temperatures increased. Whereas systemic and contralateral knee temperature settled within one week, the operated knee temperature took a longer time. The difference in temperature between the two knees had a mean value of +2.9^oC at 7 days. This mean value decreased to +1.6^oC at 6 weeks, +1.3^oC at 3 months, +0.9^oC at 6 months +0.3°C at 12 months and +0.04°C at 24 months.

Conclusion: Following uncomplicated TKA, the operated knee skin temperature increases compared to the contra-lateral knee. This increase diminishes slowly over several months; however, it remains statistically significant up to 6 months.

Displaced comminuted intra-and extra-articular fractures of distal radius require anatomical reduction for optimum results.

To assess clinical, functional and radiological results of volar-ulnar tension band plating of dorsally displaced comminuted fractures of distal radius, we used volar-ulnar tension band plating technique (without bone grafting) and early mobilisation to treat dorsally displaced and comminuted fractures of distal radius in 47 patients with an average age of 48 years (range, 19–76 years).

Volar tilt, radial height, ulnar inclination and volar cortical angles were measured on the unaffected side. AO volar plate was pre-contoured to match the volar cortical angle of the unaffected side. The horizontal arm of the plate was fixed to the distal fragment first. When the longitudinal arm of the plate was brought onto the radial shaft, the displaced distal fragment was levered out anteriorly to restore the normal volar tilt. Adjustment in ulnar inclination and radial height can be made by medio-lateral and cephalo-caudal movement of the longitudinal arm of the plate.

The average follow-up was 26 months (range 12–41 months). According to Gartland and Werley’s system 25 patients had excellent, 15 had good, 7 had fair functional results. The median Disability of Arm, Shoulder and Hand (DASH) score was 10 (range 0–60). Average grip strength as percentage of the unaffected side was 80 %. Average Palmarflexion was 61 degrees, Dorsiflexion 66 degrees, Ulnar deviation 34 degrees, Radial deviation 19 degrees, Supination 74 degrees and Pronation 80 degrees. According to Lidstrom and Frykman’s radiological scoring system 39 patients had excellent and 8 had good anatomical results.

Conclusion: This relatively new technique has given good results in majority of patients. We recommend its use in displaced and comminuted fractures of distal radius in physiologically young patients with high need and demand.

Introduction: Displaced intra and extra-articular fractures of distal radius require anatomical reduction in physiologically young patients.

Material and methods: We used volarulnar tension band plating technique (without bone grafting) and early mobilisation to treat dorsally displaced and comminuted fractures of distal radius in 47 physiologically young patients with an average age of 48 years (range, 19–76 years).

Volar tilt, radial height, ulnar inclination and volar cortical angles were measured on the unaffected side. AO volar plate was pre-contoured to match the volar cortical angle of the unaffected side. Horizontal arm of the plate was þxed to distal fragment þrst. When the longitudinal arm of the plate was brought onto the radial shaft, the displaced distal fragment was levered out anteriorly to restore the normal volar tilt, ulnar inclination and radial height.

Results: The average follow-up was 26 months. According to Gartland and Worleyñs system 26 patients had excellent, 14 had good, 6 had fair and 1 had poor results. The median Disability of arm, shoulder and hand (DASH) score was 10 (range, 0–60). According to Lidstrom and Frykmanñs radiological scoring system 39 patients had excellent and 8 had good anatomical results.

Conclusion:We believe this technique is technically demanding and requires good understanding of anatomy and force transmission in an intact and fractured distal radius. This relatively new technique of volarulnar tension band plating of distal radius has given good results in majority of patients. We recommend its use in displaced and comminuted fractures in physiologically young patients with high need and demand.