AIM

To evaluate patient outcomes in surgically managed ankle fractures with respect to fracture pattern, timing of surgery and length of stay.

Aim: To assess satisfaction of patients seen in the fracture clinic in our DGH. The results from the audit were compared with the National Average to assess the efficiency and patient satisfaction.

Methods: We did a questionnaire survey of patient satisfaction attending the fracture clinic in our DGH. The above audit was done for a period of 4 weeks on patients attending one orthopaedic surgeon fracture clinic during the month of March 2006. 130 patients completed the questionnaire, 20 of which were incomplete. This left us with 110 questionnaires for assessment.

Results: The M:F was 11:7. 88% of them felt access to the clinic was easy. 12% of the patients were disabled of which only 15% felt the access was easy. 28% were seen on time and 65% were seen within 15 minutes of the stated appointment time. 82% of them felt that were not informed of the waiting time. 87% of them felt that were able to discuss their problem with the doctor. 95% of them felt the doctor explained the diagnosis and the reasons for their action in an understandable way. 94% felt the staffs were courteous. 91% were satisfied with the fracture clinic service, 60% felt the clinic was organised well, 88% felt their dignity was respected and 88% rated the care they received to be excellent to good.

Conclusion: The above audit showed that majority of the patients seen in the fracture clinic were satisfied and level of service was comparable to the national average.

Abstract: resurfacing hip arthroplasty has shown promising early results in the treatment of hip arthrosis in younger patients as published from specialist centres in the United Kingdom. We are reporting early results and complications of Birmingham hip resurfacing arthroplasty (BHR) from a district general hospital.

This is a retrospective study of 216 hips in 186 patients during January 1999 to December 2004. The study included review of notes and X rays and a questionnaire based assessment of hip function and activities using Oxford Hip Score (OHS) and Duke’s activity score (DAS). This study has got national ethical committee approval.

The response rate for questionnaire was 76%. Average age was 53.3 years (range 20–72). Male: female ratio was 3:1. There were 152 unilateral and 32 bilateral cases. Majority of the cases had osteoarthritis in the hip. Average follow-up was 30.3 months (range 12–72). Average length of stay was 6 days (range 3–17). Average OHS and DAS were 15.8 and 51 respectively. 163 patients had OHS of less than 24. 113 patients had DAS of 58.2.

Radiological assessment showed six cases of hetero-topic calcification. Lysis was noted at prosthesis-neck junction in two cases but patients were asymptomatic.

The complications included superficial wound infection in 2, DVT in 6, neuroparaxia of sciatic and brachial plexus in one case each. There were six dislocations. There were nine revisions – seven following fracture neck of femur and two for aseptic loosening. The incidence of fracture neck of the femur was high in early part of the study suggesting technical improvement with experience.

Overall failure was 4.1%, slightly higher than other published literature. The OHS and DAS were comparable to other published results.

In conclusion the results of the BHR are encouraging and long-term prospective study is needed to find out the longevity of the implants and long-term results.

Introduction: The incidence of younger people requiring arthroplasty is on the rise. Metal on metal Hybrid hip resurfacing arthroplasty is an exciting alternative to conventional arthroplasty, to Orthopaedic surgeons, in young active patients where preserving bone stock is important.

Materials and Methods: All patients with a hybrid Birmingham hip resurfacing arthroplasty (cemented femoral component and a hydroxyappitie coated press fit acetabulum) from 1997–2001, operated by the senior surgeon were followed up. They had annual AP and lateral x-rays, the pre and post op Harris hip scores were recorded and a patient satisfaction survey was done. Results: There were 36 patients, aver follow up 17.2 months, the aver age was 52.Except for 2 patients with femoral neck fractures which required revision there were no other significant complications. Both these patients had a notched femoral neck intraoperatively. There were no revisions for aseptic loosening .The average preop and post op Harris hip scores were 45.5 and 92.1 respectively. There were no radiological signs of loosening. 93% said they would recommend it to others, 93 % rated the surgery as being excellent to good and 96 % returned to normal or near normal level of activity as

Conclusions: We feel that Conservative Hip arthroplasty with resurfacing of the femoral head is an attractive concept particularly in younger patients.

The advantages are preservation of bone stock, non violation of the proximal femur, reduction of stress shielding in the proximal femur and it is quite physiological.

The one important thing is to avoid notching the neck to prevent disastrous fractures. The implant is less forgiving and the learning curve is steep. The ultimate usefulness can only be gauged once longer follow-ups are available.