Introduction: We performed a clinical and radiological study to determine the functional outcome in terms of union and shoulder function and other related complications associated with treatment of humeral diaphyseal fractures with Intramedullary nailing.

Methods and Patients: A review of 100 consecutive humeral nailing over a period of four years performed solely for diaphyseal fractures using Russell Taylor nails.

51 male and 49 female.

Out of 100 nails, 90 were statically locked while 9 were locked proximally and 1 was locked only distally.

The outcomes were assessed clinically, radiologically and using the Disability of Arm Shoulder and Hand (DASH) function scoring system.

Statistically Cronbach’s alphas were calculated for the three scales of the DASH instrument. These scales were the function/symptom scale consisting of 30 items, sports/music module containing 4 items, and work module comprising 4 items.

Medians (interquartile ranges) and ranges are presented for numerical variables.

Mann-Whitney U tests (two-tailed) and Univariate and multivariate regression analysis were used.

Results: 90% fractures united initially and 4% had delayed union, giving cumulative union rate of 94%. Six non unions required a second procedure.

The DASH function scale scores was categorised into good 71 patients 85.5% (Score 0-< 25),

Medium 4 patients 4.8% (Score 25-< 40) and Poor 8 patients 9.6% (Score 40+).

Univariate and multivariate regression analysis showed, Increasing age (adjusted OR=0.96,95%CI 0.93–0.99,P< 0.01) and communited compared to simple fractures (adjusted OR=0.12,95%CI 0.03–0.45,P< 0.01) were associated with reduced likelihood of attaining full range of motion.

Male patients (unadjusted OR=2.37,95%CI 0.90–6.25,P=0.08) and patients involved in RTA compared to falls (unadjusted OR=4.5,95%CI 0.96–21.07,P=0.06) were associated with higher likelihood of attaining full range of motion.

85 % had no complication, while 15 % had complications.

One nerve palsy and one case of infection.

Seven patients required nail removal and 3 required removal of proximal locking screw.

Conclusion: To date, we have the largest series in the literature of antegrade nailing for diaphyseal fractures. In our series the vast majority of patients achieved desired functional outcome and union, hence we recommend the use of intramedullary nailing for humeral diaphyseal fractures. By eliminating surgical technique errors, complications can be reduced further and even higher union rates can be achieved.

Purpose: Trapezium excision and arthroplasty combined with ligament reconstruction as a treatment for first carpometacarpal joint arthritis is known to be associated with synovitis, prosthesis subluxation /dislocation and proximal migration of the metacarpal. To determine the effectiveness of our technique we used the objective and subjective outcome scores to assess the long term results

Methods: Ten patients (11 thumbs) underwent trapezium arthroplasty and ligament reconstruction procedure for grade III/ IV Eaton and Glickel arthritis. The FCR tendon was harvested split into half from proximal to its insertion site. The insertion site was left intact, the split tendon was passed through the first metacarpal base, passed along the radial side of the implant, through scaphoid and back to the 1st metacarpal as an entrapment technique. 7 female and 3 male patients with mean age of 53.9 comprised our series. Off the 10 patients 60% had surgery on their dominant hands.

Results: All the patients had excellent results at a mean follow up of 33.5 months. The mean score (Buck-Gramco) for the tip pinch, grip strength and subjective score for pain, function and dexterity was comparable to the contra-lateral side. The mean tarpezial space ratio calculated from plain x-rays at the follow up was 0.37cm (p< 0.01)|There was evidence of synovitis, prosthesis subluxation or shortening of the thumb.

Conclusions: This new method of securing the prosthesis does offer excellent results with good patient satisfaction

Material and Methods: In our study the results of a consecutive series of symptomatic non unions of scaphoid fractures treated with Herbert screw and bone graft during period between July 1996 and June 2000 are studied. Out of a total of 66 patients (one bilateral), 61(91.04%) cases who had symptomatic non unions (type D) were treated with Herbert Screw plus iliac crest bone graft while 6(8.95%) cases were treated for acute unstable fractures (type B)with Herbert screw only (these are excluded from the study). The time interval between injury and surgery was 12.2 months (range 2–72 months) Patients were followed up for radiological evidence of union and clinically for range of movement of wrist, grip strength and outcome score. Results:Total No 61, Union 47 (77.1%), Persistent non-union 14 (22.9%). The site of fracture (p=.044), type (p=.028), screw placement (p=.019) were found to be significant factors infl uencing outcome. No statistically significant influence on outcome was found with patient’s age (p=0.983) and also with time interval to non union surgery (p=0.749). Using the scaphoid outcome score, an assessment scale based on pain, occupation, wrist motion, strength and patient satisfaction, functional results were graded as excellent in 19 cases, good in 12 cases, fair in 10 cases and poor in 5 cases. Conclusion: We recommend axial placement of Herbert screw with bone grafting via Russe approach and for difficult proximal pole non unions dorsal approach is recommended.

Aim: To assess the blood loss in patients undergoing total knee arthroplasty and to determine the effects of surgical technique, duration of surgery and use of tourniquet. To look at the value of patient factors including gender, age, weight, pre-operative haemoglobin as predictive factors for future transfusion. We assessed the complications of wound healing, regaining the range of motion and thromboembolic effects.

Patients and Methods: A prospective review of 150 patients undergoing knee arthroplasty, with a minimum follow-up of 2 years (2–8 years). We divided the patients into three groups (n=50). Group A had no tourniquet applied and haemostasis secured before skin closure, Group B had tourniquet released after cementation to secure haemostasis before skin closure and Group C had tourniquet applied until after the skin closure.

Patients were matched for age, gender, pathology, weight, implant type, pre operative haemoglobin and senior operator in all three groups. We assessed intra-operative and total blood loss, transfusions requirements, postoperative wound complication, regaining of the range of motion, incidence of systemic effects of tourniquet and duration of hospital stay. We also looked at the effects of NSAIDS on blood loss and compared the validity of various factors reported in the literature to be predictive of future transfusion after the surgery. Statistical analysis used were, student’s t-test, univariate and multivariate analysis and regression statistical analysis.

Results: Group A had maximum blood loss (mean 1374 mls.) followed by Group B (mean 774 mls.) The mean blood loss of Group C was 550 mls (p< 0.001, 95% confidence interval range of 527843 mls). Statistically the duration of operation was the most important factor in minimising the blood loss (p< . 0001 R₂ =0.68). The association of pre operative haemoglobin and weight as predictors of future transfusions statistically did not show a strong relationship (R2 = 0.17, R₂ = 0.13 respectively). Statistically no significant difference was found in wound complications, hospital stay, post operative pain and regaining the range of motion in three groups (R₂ 0.58). Patients on NSAIDS did not loose more bloods than patients not on NSAIDS.

Conclusions: The use of tourniquet until after the skin closure is statistically the best method for reducing blood loss in total knee arthroplasty. It does not cause significant wound problems and does not significantly affect the regaining of range of motion. Furthermore the usage of NSAIDS does not cause excessive postoperative bleeding.

Treatment of scaphoid fractures continues to be a difficult problem for both acute unstable fractures and non-unions. In our study, the results of a consecutive series of symptomatic non-unions of scaphoid fractures treated with Herbert screw and bone graft during period between July 1996 and June 2000 are studied. Out of a total of 66 patients (one bilateral), 61 (91.04%) cases who had symptomatic non-unions (type D) were treated with Herbert screw plus iliac crest bone graft while 6 (8.95%) cases were treated for acute unstable fractures (type B) with Herbert screw only (these are excluded from the study). All fractures were classified according to Herbert classification. Russe approach was used in 50 patients while dorsal approach was used in 11 cases with proximal pole fracture non-union. The time interval between injury and surgery was 12.2 months (range 2–72 months). Patients were followed up for radiological evidence of union and clinically for range of movement of wrist, grip strength and outcome score. The site of fracture, type, screw placement, the time interval between the original injury and non-union surgery, and age of the patient, were investigated to assess whether they influenced outcome.

Results: Total No. 61 – union 47 (77.1%), persistent non-union 14 (22.9%). We found site of fracture (p=0.044), type of fracture (p=0.028) and screw placement (p=0.019) as statistically significant factors influencing outcome. No statistically significant influence on outcome was found with patient’s age (p=0.983) and also with time interval to non-union surgery (p=0.749). Forty-six (75%) patients were available for clinical follow-up. Seven (15.2%) had persistent non-unions of which four had proximal pole fracture non-unions. Using the scaphoid outcome score, an assessment scale based on pain, occupation, wrist motion, strength and patient satisfaction, functional results were graded as excellent in 19 cases, good in 12 cases, fair in 10 cases and poor in 5 cases. We recommend axial placement of Herbert screw with bone grafting via Russe approach and for difficult proximal pole non-unions dorsal approach is recommended.