Introduction: A recent JBJS(Br) article examined skin markers after contamination with a standard MRSA inoculum and cultured on MRSA-indicator nutrient agar. The Penflex™ marker showed no survival after 15 minutes, whereas the Viomedex™ marker produced MRSA cultures for up to three weeks.

Research undertaken at Wrightington has shown that in primary joint replacement coagulase-negative staphylococci account for 67.2% – 76% of contaminants isolated from the ultra clean zone. It is the most prevalent and persistent species on human skin and mucous membranes and accounts for 58% of failures due to deep infection of primary THR.

Further studies of nosocomial infection transmission show bacterial contamination of healthcare workers’ scissors, ballpoint pens, stethoscopes and lab coats with MRSA, VRE and gram-negative bacilli.

Multiuse skin markers may become colonised, possibly with MRSA, MRSE and gram-negative bacilli. This may contaminate patients and cause premature failure of arthroplasty, leading some units to adopt a single use policy.

Our aim was to ascertain bacterial colonisation of multiuse skin markers.

Method: Multiuse indelible skin markers were collected from Orthopaedic staff, wards and Day Surgery Units within the Mid-Yorkshire Hospitals.

Pens identified by a number, brand, location and approximate pen age.

Pen tips were neutralised with 10ml sterile Peptone water and this was used as the inoculum.

Cap interior swabbed with sterile swab (pre-dipped in sterile water).

Both were inoculated into enrichment broth and plated onto Blood and McConkey media.

Incubation at 37°c for 18 hours with plates read at 7 days for colony forming units.

Results: 31 pens. 15 different brands. Age 1 month– 3yrs

No growth on all plates after incubation for 7 days.

Conclusion: These results indicate that multiuse indelible skin markers are safe. There is no evidence to support subsequent cross contamination or the need for sterile single use pens for preoperative marking.

Introduction: The level of femoral neck resection is important during THR. Intraoperative landmarks include the greater trochanteric tip, lesser trochanter and femoral head height. However, intraoperative identification can be difficult. It is possible to use callipers from the apex of the femoral head in the long axis of the femur but this produces geometrical error resulting in under resection.

We describe a simple method that resects the posterior femoral head to allow uniplanar measurement with a ruler.

Inclusion Criteria: Uncemented THR performed by the senior authors (MSB & LV).

Methods: Neck resection level was calculated from templated preoperative AP radiographs as the distance from the femoral head apex.

After head dislocation via a posterior approach, the head is resected with an oscillating saw parallel to posterior neck in the coronal plane

A ruler is placed on the cut surface with a clip attached at the templated resection level and the level marked.

Standard operative technique to insert prosthesis ensuring stability and leg length equalisation.

Pre and postoperative AP radiography were compared to calculate accuracy.

Results: 22 Uncemented THR’s, M:F = 10:12, Mean age = 54.5yrs (range 43–83yrs), Range of variation in resection level = −3 to +8mm, Mean (95%CI) of variation in resection level = +3.61mm (±0.26mm)

Assuming 20% radiographic magnification = +2.95mm (±0.20mm)

Discussion: Our results are comparable to other methods described in the literature and illustrate that this simple technique can accurately translate the templated neck resection level using standard Arthoplasty tray equipment.

Litigation for leg length discrepancy is becoming more prevalent in UK practice and with differing radiograph magnification levels careful planning and sound surgical technique is essential.

Digitised calibrated radiographs and templates are becoming standard practice and this simple technique will continue to ensure accurate leg length equalisation

To investigate the fears of female patients of child bearing age, who required surgical stabilisation for pelvic fractures, and to assess the outcomes of subsequent pregnancy. Between 1990 & 2002 from a prospectively kept database in our institution, patients sustaining pelvic fractures requiring surgery who were women under 35 years of age at the time of injury were identified and included in this study. Patient’s medical records and radiographs (birth canal status) were reviewed and data collected.

All the patients were attempted to be contacted by telephone and a questionnaire completed recording the type of pelvic injury, previous obstetric history, fears regarding future pregnancy, pregnancy outcomes, Euroqol pain scores pre & post fracture and painkiller usage. Those who were unable to be contacted by telephone, were followed up by a postal questionnaire. The mean time of follow up from injury was 4.2 years (range 1 to 12 years). Out of 554 patients, 197 (36%) were women and of these, 54 (27%) patients were less than 35 years old at the time of injury. A telephone questionnaire was completed on 31 patients [57 % (study group)], results from the postal questionnaire are being collated. The mean age of the study group at injury was 23.3 years (range 6 to 34 years). There were 14 (45 %) isolated ace-tabular fractures and 17 (55 %) pelvic ring fractures. 11 (36 %) had previously had children prior to the injury, and 22 (71 %) had planned to have children in the future, prior to fracture. 23 (74 %) had expressed fears related to their future ability to have children.

Out of 8 (26 %) patients who had subsequent pregnancies, only 1 (12.5%) had a normal vaginal delivery. Out of the rest, 3 (37.5%) patients had investigations for pelvic disproportion; 2 (20%) went on to elective caesarean section for disproportion; 1 patient requested an elective section after concerns regarding delivery; 1 patient had a ventouse assisted delivery for delayed second stage; 1 patient had an ectopic pregnancy; 1 patient had a miscarriage at 18 weeks gestation and 1 patient had infertility problems. 4 out of 31 (13%) patients were advised against future pregnancy and one patient underwent a tubal ligation following this advice. Pelvic fractures represent a serious group of injuries; after initial recovery, many female patients have serious concerns regarding future pregnancy. A number will go on to have further pregnancies, and many will suffer the risk of complications following their pelvic injury.