We prospectively reviewed 24 patients (35 feet) who had been treated by a Scarf osteotomy and Akin closing-wedge osteotomy for hallux valgus between June 2000 and June 2002. There were three men and 21 women with a mean age of 46 years at the time of surgery. The mean follow-up time was 20 months.

Our results showed that 50% of the patients were very satisfied, 42% were satisfied, and 8% were not satisfied. The mean American Orthopaedic Foot and Ankle Society score improved significantly from 52 points pre-operatively to 89 at follow-up (p < 0.001).

The intermetatarsal and hallux valgus angles improved from the mean pre-operative values of 15° and 33° to 9° and 14°, respectively. These improvements were significant (p < 0.0001). The change in the distal metatarsal articular angle was not significant (p = 0.18).

There was no significant change in the mean pedobarographic measurements of the first and second metatarsals after surgery (p = 0.2). The mean pedobarographic measurements of the first and second metatarsals at more than one year after surgery were within the normal range.

Two patients had wound infections which settled after the administration of antibiotics. One patient had an intra-operative fracture of the first metatarsal and one required further surgery to remove a long distal screw which was irritating the medial sesamoids.

We conclude that the Scarf osteotomy combined with the Akin closing-wedge osteotomy is safe and effective for the treatment of hallux valgus.

Aim: The purpose of this prospective study was to assess the outcome of scarfe osteotomy for hallux valgus. Method: 26 patients were reviewed but only the results of 24 patients (33 osteotomies) were available for analysis. The assessment involved the American Academy Foot and Ankle Society Score, pedobarographic & radiographic examination.

There were 3 male and 21 female patients with a mean age of 46 years. The mean follow up was 17 months. Statistical analysis was carried out. Results: The AAFAS score improved from a mean preoperative value of 52 to 89 postoperatively. The mean improvement was 34 (range 12–46). The inter-metatarsal and hallux valgus angles improved from a mean preoperative value of 15 and 31 degrees respectively to a mean postoperative value of 8 and 14 degrees. 22 patients (91.6%) were satisþed with the outcome of surgery. The pedobarographic results will be illustrated. In one patient a fracture occurred intra-operatively and two patients had wound infection which settled with antibiotics. Conclusion: The early results of the scarfe osteotomy for hallux valgus in our hands are encouraging.

To ascertain the effect of the site and number of loose bodies on the functional outcome of Outerbridge-Kashiwagi (O-K) procedure in management of osteoarthritis of the elbow.

12 patients were reviewed after having O-K procedure, and assessed using Mayo Elbow Performance score, and radiographs assessed using Derby Elbow Osteoarthritis Radiography score.

There were 10 male and 2 female patients with mean age of 47 years. The mean follow up was 24 months. In 8 (66%) patients the diagnosis was primary osteoarthritis, and 4 (34%) had post-traumatic arthritis. Nine (75%) patients had osteoarthritis of the dominant elbow, and three were non-dominant. Nine patients had locking and catching symptoms. 7 patients had < 2 loose bodies, and 5 had > 2 loose bodies. 7 had anterior loose bodies alone and 5 had both anterior and posterior loose bodies.

The Mayo Elbow Performance score improved from a mean preoperative value of 51 to 85 points postoperatively (p< 0.0001). There were 3 excellent, 7 good, 2 fair, and no poor results. Visual analogue pain score improved from a mean of 7.4 to 2.6 postoperatively (p< 0.001). The Derby Elbow Osteoarthritis Radiography score improved from preoperative mean of 6.5 to 5.3 postoperatively (p< 0.013). There was no significant difference between functional outcome of primary osteoarthritis and post-traumatic arthritis (p> 0.42). Number of loose bodies had no significance on the functional outcome (p> 0.39), neither did the site of the loose bodies (p> 0.44). There was no significant difference of the number of loose bodies on the overall total score of Derby Osteoarthritis Elbow Score (p> 0.2). In two patients revision had to be undertaken due to persistent locking that improved postoperatively.

The number and site of loose bodies, the type of osteoarthritis and the duration of symptoms have no significant prognostic value in predicting functional outcome

This study examines the value of a proforma in improving the standards of orthopaedic operation notes.

The standard of operation notes in orthopaedic surgery is notoriously poor. This has clinical, medicolegal and research implications. There is no published study on the influence of a proforma on the quality of orthopaedic operation notes.

An audit of the quality of operation notes in the orthopaedic department of Chesterfield and North Derbyshire Royal Hospital was undertaken. 1, 928 cases were identified from theatre log books and 88 randomly selected casenotes were scrutinised by a single observer for the legible inclusion of parameters based on Royal College of Surgeons guidelines. An operation note proforma was devised and used routinely over a period of six weeks. The effectiveness of the proforma was assessed by examining operation notes randomly selected from the procedures performed during that period. Identical parameters were assessed. Results from the two groups were compared and statistically analysed using the Wilcoxon signed ranks test. To investigate the longer term impact of proformas an identical audit was undertaken in a neighbouring unit in which a proforma had been in use for five years.

Following introduction of the proforma in Chesterfield there was a statistically significant increase in the inclusion of the assessed parameters (p=0. 001). Criteria such as the patient ID number, pre-op diagnosis, tourniquet use and time, prophylactic antibiotic administration, prosthesis details and post-op instructions showed a marked improvement. No parameter showed a significant reduction in its documentation rate. The results from Rotherham were comparable to those achieved following the introduction of the proforma in Chesterfield.

This study clearly demonstrates the effectiveness of a proforma in improving the standard of operation notes. The results from Rotherham suggest that high standards can be maintained long after the introduction of the proforma. We recommend the routine use of operation note proformas in orthopaedic surgery.