Shockwave treatment in our unit is provided in conjunction with our Urological colleagues. Shock Wave Therapy has been used as a last option in patients with difficult and chronic Orthopaedic conditions with an informed consent for all patients.

Material and Methods: 28 patients from Ealing Hospital and West Middlesex Hospital were referred to The Lithotripsy unit at Charing Cross Hospital for Shock wave therapy.

Patients were consented by the Orthopaedic surgeon and the treatment was administered by urologist

The cases included:

4 Humeral fractures: 1 Case in HIV +ve 19 years old

Results: There was complete resolution of symptoms in the 4 cases of soft tissues.

– Clinical and radiological union in 3 of the 4 Humeral Fracture including HIV+ve and in 2 of 3 tibial fracture and 1 of 2 scaphoid.

Discussion: Shock wave therapy is a new consevative treatment modality used in orthopaedic as the last option before surgery but there is a need for RCT.

Introduction: The purpose of the study was to evaluate the outcome of multiple spinal operations by an expert spinal surgeon HV Crock.

Materials and Methods: A retrospective review of 169 patients who had multiple spinal surgery including spinal Fusion and spinal decompression was undertaken. A special Questionnaire form was designed and sent to each patient to answer with an appointment for the patient to be seen and assessed in the spinal assessment clinic where data from the questionnaire, clinical notes and thorough clinical examinations were recorded in a spinal data base which covered the following sections:

Patients Symptoms

Results:

– 76 patients 66% of the patients who replied “were satisfied” with the surgery.

There were no significant post-operative neurogenic complications, such as cauada equina syndrome or severe leg weakness interfering with standing and walking retirement. There was always a temporary relief followed by deterioration of symptoms after a period ranging between 1–2 years.

Conclusions: Overall, patients with failed back syndrome need to be evaluated and treated in a multidisciplinary setting, where a group of Health Care Professionals from various fields, such as Physiotherapy, Pain Management and Clinical Psychologist work together, towards the common goal for the benefit of the patient

Aim To assess the outcome of ankle fractures in diabetic patients.

Method The case notes and X-rays of 39 patients with diabetes, who had sustained ankle fractures between 1994–2003, were retrospectively analysed.

Results There were 23 females and 16 males with mean age of 66 years in females and 51 years in males. The fracture was the result of a twisting injury in 37 of 39 patients. The average duration of diabetes prior to the fracture was 9.6 years. Thirty per cent of patients had systemic complications. Twenty patients had insulin dependent and 19 had non-insulin dependent diabetes. Fractures were on the left side in 21 patients. One patient had a Gustilo grade 2 fracture. Two had a single malleolar fracture, 28 had bi-malleolar fractures and the remaining nine had tri-malleolar fractures. Talus shift was present in 26 cases. The average time to surgery is 3.8 days. The mean ASA grade is 2.3. Twenty-one patients were managed operatively, of which seven had an infection. One patient underwent amputation. One had post-operative myocardial infarction. Nineteen were managed conservatively and in this group, four patients had infected pressure sores from the plaster, of which two needed plastic surgery care. One was managed with external fixator and developed osteomyelitis, and persistent talus shift and non-union.

Three patients died within 2 years of fracture due to diabetes-related complications. Union was achieved in 36 cases and 30 of the patients walked independently after union.

Conclusion There is a high complication rate following surgery for fractures of the ankle in diabetic patients, but conservative treatment also carries a significant risk because poor skin condition can lead to pressure sores while in plaster and these may need major plastic interventions.