In hallux valgus (HV), toe pronation is frequently seen, although there may be some with no pronation.

Hip fractures are common in the elderly. These people often had a history of multiple falls, and previous fractures. Fear of falling (FOF) have being reported in the follow-up of hip fractures.

Introduction: Perioperative blood losses in TKR (total knee replacement) are significant and it has been determined that hidden blood loss is frequently more significant than visible blood loss. The aim of this study is to determine if there were any differences in blood loss due to the timing of ischemia cuff release during TKR.

Materials and methods: We studied 103 patients divided into 2 groups; in group A, of 41 patients, the cuff was released when all the bon cuts had been carried out, hemostasis of bleeding blood vessels was carried out and pressure was elevated until the end of surgery and placement of the compressive bandage. In group B, of 62 patients, once the prosthesis was cemented the cuff was released, hemostasis was applied, the wound was sutured and the compressive bandage was put in place without elevating the cuff pressure. In both groups we recorded intraoperative blood loss, both external blood loss and through the drainage, which was removed at 36–48 hours. Hidden blood loss was determined using the formula of Naddler et al that considers sex, weight, height and preoperative hemoglobin and hemoglobin 4 days after surgery.

Results: In group A the mean volume drained was 502 ml, hidden blood 928 ml, with a total loss of 1429 ml. In group B the mean volume drained was 567 ml, hidden blood 764 ml and total loss of blood 1331. There were no significant differences between both groups.

Conclusions: The significance of blood loss in TKR is therefore confirmed, especially hidden blood loss. There were no statistically significant differences according to the moment at which the ischemia cuff was released.

Total knee arthroplasty had been reported to present similar amount of blood loss in external and hidden form. We studied whether lateral patellar release made any differences on both forms of blood loss.

Material and methods: We studied 91 patients (83 women an 8 men) undergoing primary unilateral total knee arthroplasty cemented posterior stabilised with patellar substitution, in 40 lateral patellar release were performed. Surgery is performed under tourniquet. The blood drain was recorded. We assumed that blood volume on the fourth postoperative day was the same as before surgery. Blood volume was estimated taking sex, body mass and height into account. Haemoglobin was recorded on preoperative and four days postoperative.

Results: We found more external blood loss in patients without lateral patellar release (p< 0,05) but no statistical differences in total and hidden blood loss. The amount of hidden blood in both groups were more than twice (975 mL) the external blood loss (443 mL). No relationship was found between body mass and any type of blood loss.

Conclusions: Lateral patellar release made no difference in the amount of total blood loss. In total knee arthroplasty hidden blood loss doubled external blood loss.

Hip fractures are frequent due to osteoporosis and old age. The incidence of the second hip fracture had been reported as 5–9%. Subcapital displaced fractures in the elderly are treated sometimes with hip hemiarthroplasty. Our aims was to evaluate patients with bilateral no simultaneous hip fracture treated with hemiarthroplasty at our institution.

Material and methods.- Twenty-two patients, 19 women and 3 men, were evaluated with a mean age of 79 at the initial fracture and 82 at the subsequent fracture. In 13 the first fracture was on the left and 9 on the right. All were of Garden grade IV. One of the fractures occurred from 1994 to 2003. The mean hospital stay was 18 days for the first fracture and 14 for the second. The second fracture happened a mean of 4 years after the first one (1 month to 9 years). This report is based on 14 of these patients, with more than one-year follow-up. The others 8, 6 had died and 2 were missing.

Results.- Walking capacity: previous to the first fracture 11 walked more than 1000 meters, 3 between 100 and 500 meters. Outdoors: after the first fracture 6 walked without help, 3 used one cane and 3 used a walker or two canes, and 2 were unable. After the second fracture 1 walked without help, 2 used one cane, 5 used two canes or walker and 6 were unable. Indoors: after the first fracture 12 walked without help, 2 were able with the help of one cane, 2 with two canes. After the second fracture 2 walked without help, 3 used one cane, 7 used two canes or walker and 2 were unable to walk. Dressing: all were independent before; after the first 12 and after the second 7. Bathing: 13 were independent before, after the first 9 and after the second 5. Feeding: all were independent before, after the first 11 and after the second 6. Toilet: 13 were independent before, after the first 9 and after the second 4. Shopping: 11 were independent before, after the first 5 and after the second 0. Housekeeping: 11 independent before, 1 with help and 2 unable, after the first 4 were independent, 5 need help and 5 unable, and after the second 1 was able, 3 with help and 11 unable after the second. Public transport: 3 were able and 11 unable before the fracture, after the first fracture 3 were able and 11 unable, after the second fracture none was able, 2 with help and 12 unable. Finances: 2 were able and 12 unable before the fracture, after the first fracture 2 were able and 12 unable, and after the second 2 with help and 12 unable. Eight were limping and 6 had groin pain.

Conclusion.- Previous to the first fracture walking capacity was good in this age group. Following the first hemiarthroplasty patients deteriorate in their walking capacity and others activities of daily life and much so after the second one. Limping or groin pain was present in all after the second fracture with more than one year follow-up.

Aims: In order to reduce the waiting list, the Spanish National Institute of Health sent a large number of patients from Badajoz to other private hospitals, from October 1996 to December 2000, to undergo knee replacement. No medium or long-term follow-up was arranged. Our aims were to compare revision operations in those patients with the ones performed locally.

Material and methods: In that period of time 791 knee arthroplasties were sent to distant centres and 620 were performed in our institution. All revision surgery was performed in our hospital after two months of the index operation in the distant hospitals. We stopped entry of patients in this study in December 2003.

Results: 82 (10.3%) knees have so far required revision surgery in the distant centres group. Of these, 45 have been for deep infection, 26 for aseptic loosening, 5 failed unicompartmental, 3 stiffness, 2 painful non-replaced patellas, 1 non-union of the tibial tuberosity

In the local group 17 (2.6%) knees have so far been revised in the same period of time. Of these 10 have been for deep infection, 3 for aseptic loosening, 3 for instability, and 1 for soft tissue impingement.

Conclusion: The causes for such a difference in revision rates were analysed and include implant selection, surgical technique and absence of follow-up. A constant and angry complaint of all patients sent to other hospitals and subsequently revised was the lack of follow-up.

Aims: To develop a system of digital analysis of Magnetic Resonance Imaging images which allows a comparative measure of symmetric muscular areas. Material and methods: Images DICOM from de lumbar region of patient with low back pain and sciatica were used to study the multifidus muscles. The images were processed with Osiris and NIH image programs. The data obtained was analysed by program routines in Visual Basic, and with MS Excel. The image analysis was made with a region of interest, and its histogram. By this method we can distinguished muscle and fat, fixing a grey density level which can separate them and be able to measure areas of each one, proportions of both densities and to stablish the average value of the histogram. Conclusions: This method is useful for determination of differences in symmetric muscular masses, such as cross sectional areas, and quality of muscles