Hallux Valgus (HV) surgery is the most common surgery performed in the foot. The Cochrane review done in 2004 showed that no osteotomy is superior to another, however, surgery was shown to be superior to conservative or no treatment for Hallux Valgus deformity. We performed a postal survey in August 2005, to determine the most common procedures performed for HV deformity, type of anaesthesia used, and the length of stay for Hallux Valgus surgery across the United Kingdom. A list of foot and ankle surgeons was obtained from the BOFAS register and a questionnaire was sent. We received 122 (61%) responses from 200 questionnaires sent. Out of which 4 had retired and 118 were available for analysis. The table below demonstrates the common procedures performed by those who replied. Eight-eight percent of the surgeons used foot block along with GA, 9% used GA only and 3% performed the surgery under regional anaesthesia only. Forty percent of surgeons performed the surgery on an overnight stay basis and 30% performed the surgery as a day case. Twenty-five percent of surgeons mentioned that they performed unilateral surgery as a day case and bilateral surgery on an overnight stay basis. Less than 5% kept the patients for more than 2 days. From the responses, most surgeons in the United Kingdom perform Scarf osteotomy with or without Akin osteotomy for Hallux Valgus correction. The majority performed it on an overnight stay basis or as a day case. Most commonly, foot block along with NSAID’s were used for post-operative pain relief

Introduction: The Foundation Programme was implemented across the United Kingdom in 2005 and aims to “bridge the gap between medical school and specialty/general practice training.” Musculoskeletal complaints are the single most common reason for patients seeking medical attention and it is imperative that all clinicians should have at least a basic competency in musculoskeletal medicine. Aim: To determine if Foundation Programmes give junior doctors sufficient training to deal competently with musculoskeletal complaints. Methods: We prospectively enrolled junior doctors at the completion of their Foundation Programme. They were assessed using the Freedman and Bernstein musculoskeletal examination tool- the only validated method of assessing musculoskeletal medicine knowledge currently available. Passing this test only implies a basic level of competence in musculoskeletal medicine. Results: We recruited 112 junior doctors from across the United Kingdom. Only 8.9% of those recruited passed the assessment. Significantly higher mean scores were obtained by those with Foundation Programme exposure to Orthopaedics- 62% vs. 51.6% (p=0.005), an interest in Orthopaedics as a career- 64.8% vs. 52.8% (p=0.026) and those who felt that they had gained adequate Foundation Programme exposure to musculoskeletal medicine- 64% vs. 51.6% (p=0.0014). Those who were interested in General Practice obtained significantly lower scores than the rest of the group- 48.4% vs. 55.6% (p=0.009). Orthopaedics, internal medicine and general practice were the future specialty interest of 6%, 29% and 36% respectively. Only 15% had any Foundation Programme exposure to Orthopaedics and only 13% felt they had been given adequate exposure to musculoskeletal medicine. Conclusions: Foundation Programmes are currently failing to ensure junior doctors entering specialty training have a basic competence in musculoskeletal medicine. Given the high prevalence of musculoskeletal conditions encountered by most clinicians this is unacceptable and steps must be taken to improve the quality of Foundation Programme training in musculoskeletal medicine

Introduction. The placement of a large interbody implant allows for a larger surface area for fusion, vis a vis, via retroperitoneal direct anterior, antero-lateral and lateral approaches. At the same time, spinal navigation facilitates a minimally invasive fixation for inserting posterior pedicle screws. We report on the first procedures in the United Kingdom performed by a single-surgeon at a single- centre using navigated robot-assisted spine surgery without the need for guide-wires. Materials and Methods. Whilst positioned in the supine or lateral position, a routine supine anterior lumbar interbody fusion (ALIF), and/or antero-lateral ALIF (AL-ALIF) and/or lateral lateral interbody fusion (LLIF) is performed. The patient is then turned prone or kept in the single lateral position (SPL) for insertion of the posterior screws performed under robotic guidance. Intraoperative CT scan 3D images captured then are sent to the Robotic software platform for planning of the screw trajectories and finally use again at the end of the procedure to confirm screw accuracy. We identified 34 consecutive patients from October 2019 to January 2020 who underwent robotic assisted spine surgery. The demographic, intraoperative, and perioperative data of all these patients were reviewed and presented. Results. Of the 34 patients, 65 levels were treated in total using 204 screws. Of the 21 patients (60%) who underwent single-level fixation, 14 of them (67%) were treated at the L5/S1 level, 3 at L3/L4, 3 at L4/L5 and 1 at L2/L3 level. The remaining 13 patients (40%) underwent multi-level fixation, of which 4 were adult scoliosis. 15 underwent a supine ALIF approach, 1 underwent AL-ALIF, 8 patients underwent combined LLIF and AL-ALIF approach in a lateral decubitus, whilst 9 underwent pure LLIF approach (of which 3 patients were in the single position lateral) and one patient had previous TLIF surgery. The average estimated blood loss was 60 cc. The average planning time was 10 min and the average duration of surgery was 50 min. The average patient age was 54 years and 64% (22/34) were male. The average BMI was 28.1 kg/m. 2. There were no re-interventions due to complications or mal positioned screws. Conclusion. Minimally invasive spine surgery using robot-assisted navigation yields an improved level of accuracy, decreased radiation exposure, minimal muscle disruption, decreased blood loss, shorter operating theatre time, length of stay, and lower complication rates. Further follow-up of the patients treated will help compare the clinical outcomes with other techniques

Introduction: The aim of this study was to assess the practice of obtaining informed consent for Total Hip Replacement Surgery in the United Kingdom. Methods and results: 1571 consultant members of the BOA were surveyed by postal questionnaire regarding their practice towards obtaining informed consent for total hip replacement surgery. 524 (33.3%) replies were received. 368 (23.4%) of the 524 consultants who replied still performed total hip replacement surgery. In obtaining informed consent for hip replacement surgery consultants warned of the following complications: Infection 99.7%, Dislocation 98.9%, Leg length discrepancy 75.2%, Aseptic loosening 85.8%, neurovascular damage 61.9%, Wear 63.2%, DVT 96.0%, PE 89.0% and Mortality 71.6%. Consent was routinely obtained by Senior House Officers in 38.7%, by Pre-Registration House Officer in 3.8% and by specialist nurses in 5.4% of cases. Patient information leaflets were provided by 72.0% of consultants for Hip Replacement. Discussion: We recommend national guidelines relating to obtaining consent for hip replacement should be published by the British Hip Society. This should be incorporated into their best practice documents regarding Hip replacement Surgery. Consent should also be obtained by a suitably experienced practitioner

Purpose: The purpose of this study was to determine how patients with soft tissue sarcoma are followed up in the United Kingdom to inform the development of a prospective clinical trial. Methods: A list of clinicians (surgeons and oncologists) treating patients with soft tissue sarcomas in the United Kingdom was compiled and a postal survey performed. Reminders were sent to non-responders. The survey included questions about the specialty of the clinician, the grade, membership of specialist societies, perceptions about risk factors for recurrence and the value of follow up and asked specifically about three clinical scenarios. Results: Of 192 clinicians who were sent the questionnaire, responses were obtained from 155 (81%). 128 of these met the criteria for analysis. In the given clinical scenarios, length of follow up varied from 1 year to lifelong. The total number of clinic visits in 5 years varied from 5 to 30, of chest radiographs from 0 to 24, of chest CT scans from 0 to 10, and of local site imaging from 0 to 13. 88 (84%) agreed that follow up is of benefit. 57 (59%) agreed that it would be reasonable to follow up selected patients in the community. 96 (93%) agreed that a study of follow up protocols would be of value. Discussion: There is significant variation in follow-up protocols amongst clinicians in the United Kingdom. A prospective study of follow-up protocols is likely to be supported

Purpose: The aim of this survey was to assess the practice of obtaining informed consent for Total Knee Replacement Surgery in the United Kingdom. Method: A postal questionnaire was distributed to consultant members of the British Orthopaedic Association. They were questioned regarding their practice for obtaining informed consent for Total Knee Replacement Surgery. Results: Of the 1571 consultant members contacted 34% (526) replied. From these 76% (400) performed total knee replacements. Informed consent was obtained in a pre-operative assessment clinic in 64%, on admission in 32.5% and during the first clinic visit in 3.5% of cases. Consent was routinely obtained by Consultants in 76%, Senior House Officers in 38%, Pre-Registration House Officers in 4% and Specialist Nurses in 5% of cases. Consultants warned of the following complications: Infection 99.2%, Stiffness 70.5%, Aseptic loosening 81.6%, neurovascular damage 56.9%, DVT 96.5%, PE 88.5%, Wear 61.2% and Mortality 67.4%. Patient information leaflets were provided by 71.5% of consultants for Total Knee Replacement. Conclusions: This survey has identified inconsistencies in the complications described to patients. Junior practitioners are continuing to obtain informed consent. Informed consent should be obtained by a suitably experienced practitioner. Patient information leaflets should be provided to patients at the time of listing. We recommend national guidelines relating to obtaining consent for Total Knee Replacement should be published by the BASK. These could be incorporated into their best practice document regarding Total Knee Replacement Surgery

Introduction: Cephalosporins have traditionally been the preferred antimicrobial prophylaxis for 90% of orthopaedic surgeons. With a recent increase in Clos-tridium difficile and MRSA infections, antimicrobial prophylaxis is changing. The aim of this study was to conduct a national survey of current orthopaedic antimicrobial prophylaxis regimes. We wanted to ascertain whether there were any recent changes in these regimes and the reasons for these changes. We also aimed to show any relationship between antimicrobial usage and Clostridium difficile rates. Methods: Information on prophylaxis regimes and Clostridium difficile rates was requested through a five item questionnaire which was sent to all hospitals in the United Kingdom. Results: The response rate was 83 %. The top three antimicrobial regimes in trauma and elective orthopaedic surgery were cefuroxime alone (52 %), flucloxacillin plus gentamicin (18 %) and co-amoxiclav alone (8 %). Half of all hospitals had changed antimicrobial regimes and half of these changes were due to Clostridium difficile. The incidence of Clostridium difficile was 70% higher in hospitals using Cefuroxime than hospitals using other antibiotics (0.19% vs. 0.32%)(p < 0.001). Clostridium difficile infection was more common in trauma than elective surgery. Conclusion: Cefuroxime is still the most commonly used antimicrobial agent but its use has declined mainly due to a surge in Clostridium difficile rates. Reduction in cephalosporin use along with other infection control measures has resulted in a fall in Clostridium difficile infection rates

Tropical pyomyosistis is an uncommon condition in the United Kingdom. Early diagnosis and appropriate treatment are crucial for a good outcome. We had seen 13 cases in our previously published series from 1998 to 2009. This is an update showing a significantly increased incidence from 2010 to 2016. A retrospective review of all cases of pelvic pyomyositis in our centre from January 2010 to April 2016 was undertaken from case notes and radiology reports. All children with clinical and radiographic evidence of pyomyositis were included. Since our previous publication we had changed our practice to get an MRI scan in all children who presented with a limp, fever and raised inflammatory markers, and had no effusion in the hip ultrasound scan. We identified 24 children with a mean age of 7 years (range, 1 week to 14 years). MSSA (Methicillin-Sensitive Staphylococcus aureus) was the most common cultured organism (n=8). Median hospital stay was 9 days (3 to 12). Obturator internus was the most common muscle affected. All patients had appropriate antibiotics with 2 patients requiring surgical drainage of abscesses. The majority of children (n=22) showed a complete recovery with antibiotics only. Incidence of pyomyositis has increased dramatically in our population and early diagnosis can result in a good outcome. We recommend MRI scan in all patients who present with a clinical picture of septic arthritis of the hip but with no effusion

The use of routine sampling for histological analysis during revision hip replacement has been standard practice in our unit for many years. It is used to identify the presence of inflammatory processes that may represent peri-prosthetic infection. This study follows up on a smaller study in the same unit in 2019 where an initial 152 cases were scrutinised. In this follow up study we examined 1,361 consecutive patients over a 16-year period whom had undergone revision hip replacement in a tertiary orthopaedic centre for any reason excluding primary bone tumour or malignant metastasis. All patients had tissue sampling for histopathological analysis performed by consultant histopathologists with a specialist interest in musculoskeletal pathology. The presence of bacteria in greater than 50% of samples sent for microbiological analysis in each patient was used as the gold standard diagnostic comparator for infection. This was then compared with the histology report for each patient. After excluding 219 patients with incomplete data and 1 sample rejection, 1,141 cases were examined. Microbiology confirmed infection in 132 cases (prevalence of infection 11.04%) and histopathology analysis suggested infection in 171 cases. Only 64 cases with confirmed infection in more than 50% of microbiology samples had concurrent diagnosis of infection on histological analysis (5.60% of total; PPV 51.20%). Furthermore, microbiology analysis confirmed infection in 62 cases where histological analysis failed to identify infection (5.43% of total; False negative rate 49.21%). Overall, histopathology analysis was seen to have a good specificity of 93.99% but poor sensitivity of 50.79%. We believe that this is the largest series in the literature and is somewhat unique in that all histology analysis was performed by consultant histopathologists with specialist interest in musculoskeletal pathology. Based on the costs incurred by this additional investigation our experience does not support routine sampling for histological analysis in revision hip arthroplasty. This is a substantial paradigm shift from current practice among revision arthroplasty surgeons in the United Kingdom but would equate to a substantial cost saving

Purposes of the study and background. Cognitive Functional Therapy (CFT) is a psychologically informed, physiotherapist-led intervention that targets the biopsychosocial complexity of persistent low back pain (LBP). CFT has demonstrated positive outcomes in two randomised controlled trials (RCT) but has not previously been evaluated in the United Kingdom National Health Service (NHS). This study aimed to determine the feasibility of completing a definitive RCT, that will evaluate the clinical and cost-effectiveness of CFT in comparison to usual physiotherapy care (UPC) for people with persistent LBP in the NHS. Methods and results. A two-arm parallel feasibility RCT compared CFT with UPC in participants with persistent LBP. Data concerning study processes, resources, management and patient reported outcome measures (disability, pain intensity, quality of life and psychosocial function) were collected at baseline, three and six-month follow-up, analysed and evaluated in order to establish feasibility. Sixty participants (n=30 CFT and n=30 UPC) were recruited with 71.6% (n=43) retained at six-month follow-up. CFT was delivered to fidelity, relevant and clinically important outcome data were rigorously collected and CFT was tolerated by participants with no safety concerns. The Roland-Morris disability questionnaire was the most suitable primary outcome measure and sample size calculations were completed for a definitive RCT. Intention to treat analysis indicated a signal of effect in favour of CFT with moderate and large between group effect sizes observed across outcome measures at six-month follow-up. Conclusion. It is feasible to conduct a randomised study of CFT in comparison to UPC for NHS patients. A future fully powered clinical and cost effectiveness RCT could be completed. Conflicts of interest: No conflicts of interest. Sources of funding: Chartered Society of Physiotherapy, Physiotherapy Research Foundation

Introduction. Catastrophic neck injury is rare in rugby, however the consequences are invariably devastating. Schoolboys have previously been identified as a group at risk. This study came about as a result of a recent increase in admissions of schoolboy rugby players to the National spinal injuries unit in Glasgow. Aim. To audit schoolboy rugby admissions to spinal injury units throughout the United Kingdom and Ireland, in doing so to appraise the current state of data collection. To obtain estimates of playing numbers from the Home unions. Method. Retrospective review of all 12 spinal injury units for records of cases subsequent to 1996. Representatives of each of the four home unions were contacted to confirm cases and establish playing numbers. Results. Records were available from 1996 in Scotland and Ireland and from 2000 in England and Wales. Two units collect prospective data, two had easily retrievable data. In the absence of any register data retrieval was challenging elsewhere. Of the 36 cases 24 would be classified as catastrophic 12 as near misses. The median age for injury was 17. 51% of injuries occurred in the tackle, 35% in the scrum. 92% of scrum injuries involved neurological damage, 61% with complete neurological loss at presentation, 8% with no neurological injury. Tackle injuries were associated with neurological damage in 42%, 26% with complete lesions and no neurological injury in 57%. Estimates for playing numbers (U18 inclusive) approximate to Scotland 19,000, Wales 30,000, Ireland 40,000 and England 1,200,00. Conclusion. •. A persistent number of schoolboys were injured through the study period. •. Recording of serious neck injuries is inconsistent through the United Kingdom and Ireland. •. The numbers injured in Scotland were disproportionate in view of the relative playing populations. •. Whilst less frequent, scrum injuries were more often associated with spinal cord injury

Introduction: Although knee athroplasty is a very successful operation, British knee surgeons have a wide variation in their methods of patient management. Aims: To determine current knee practice within the United Kingdom. Material and Methods: A postal survey was conducted of all members of the British Association of Knee Surgery. They were asked about pre-operative assessment, type of prosthesis used, antibiotic prophylaxis, DVT prophylaxis, bilateral arthroplasty, preferred anaesthetic, urinary catheter, patella replacement, autologous blood transfusion, mobilisation, duration of hospital stay and patient follow up. Results: 71% (221) members replied. The results and implications will be presented in full at the presentation. Some of the more interesting findings included: 18% did not have a pre-admission clinic, 18% use thromboprophylaxis for medicolegal reasons only (do not believe it works), 19% never replace the patella, 48% perform unicondlyar arthroplasty, 41% follow up patients indefinitely, one discharges patients at 6 weeks, 77% perform bilateral arthroplasty. Discussion and Conclusion: Comparison with a 1996 study of UK knee practice shows that most techniques are unchanged although slightly more surgeons routinely use an uncemented implant. (4.8% 1996, 12% 2001). There remains a wide variation in UK practice. The authors would be grateful if colleagues from other countries would contact them so that comparable studies of practice could be performed in their countries. This data may be used to compare international attitudes to knee arthroplasty

Knee dislocations are a rare but serious cause of trauma. The aim of this study was to establish current demographics and injury patterns/associations in multi-ligament (MLI) knee injuries in the United Kingdom. A National survey was sent out to trauma & orthopaedic trainees using the British Orthopaedic Trainees Association sources in 2018. Contributors were asked to retrospectively collect a data for a minimum of 5 cases of knee dislocation, or multi-ligament knee injury, between January 2014 and December 2016. Data was collected regarding injury patterns and surgical reconstructions. 73 cases were available for analysis across 11 acute care NHS Trusts. 77% were male. Mean age was 31.9 (SD 12.4; range 16–69). Mean Body Mass Index (BMI) was 28.3 (SD 7.0; range 19–52). Early (<3 weeks) reconstruction was performed in 53% with 9 (23%) patients under-going procedures for arthrofibrosis. Late (>12 weeks) reconstruction took place in 37% with one (3.7%) patient under-going arthroscopic arthrolysis. 4% had delayed surgery (3–12 weeks) and 5% had early intervention with delayed ACL reconstruction. For injuries involving 3 or more ligament injuries graft choices were ipsilateral hamstring (38%), bone-patella tendon-bone (20%), allograft (20%), contralateral hamstring (17%) and synthetic grafts in 18%. Multi-ligament knee injuries are increasingly being managed early with definitive reconstructions. This is despite significant risk of arthrofibrosis with early surgery. Ipsilateral and contralateral hamstring grafts make up the bulk of graft choice however allograft (20%) and synthetic grafts (18%) remain popular

Introduction and Aim: The metacarpal fractures constitute 10% of skeletal fractures in general affecting mainly children and young adults. There is a lot of discrepancy and lack of evidence with regards to correctly managing the little finger metacarpal fractures. Our study was aimed at investigating the current practice of management little finger metacarpal fractures among upper limb surgeons in United Kingdom. Methods: We conducted an online survey between June 2006 and June 2007 consisting of 10 multiple-choice questions that was e-mailed to 278 upper limb orthopaedic specialist surgeons. The response rate was 58% (n = 158) from the upper limb surgeons. Four questionnaires had to be excluded due to multiple responses to each question or incomplete forms. Results: 43% upper limb surgeons prefer neighbour strapping alone for non-operative management of little finger metacarpal fractures. Ulnar gutter cast or splint was the next choice among 19% upper limb surgeons while 13% respondents apply neighbour strapping to ring finger along with a splint. There was mixed response regarding period of immobilisation. 40% of surgeons were in favour of 3 weeks of immobilisation, 23% for 2 weeks while 28% do not immobilise these fractures at all. With regard to considering the most important indication(s) for surgical intervention, rotational deformity was the most common indication (84%), followed by open fracture (70%), intra-articular fracture (44%), associated 4th metacarpal fracture (26%), shortening > 5mm (21%) and volar angulation – (15%). If treated non-operatively, the most preferred period of fracture clinic follow up was one visit at 3 weeks by 40% while 36% thought that no follow up is required once decision is made to treat them conservatively. Conclusion: Isolated undisplaced fractures of little metacarpal are usually managed conservatively using a plethora of methods of immobilisation. The indications for operative intervention are open fracture, rotational deformity, intra-articular fractures and shortening. Many clinical studies have demonstrated that in the conservative care of boxer’s fractures (casting, with or without reduction), between 20 degrees and 70 degrees of dorsal angulation is acceptable. We conclude that contemporary literature provides no evidence as to whether conservative or operative methods of the treatment of these fractures is superior, but rather suggests that they are equally effective. We conclude from our survey that there is no consensus even among the upper limb surgeons with regards to management of little finger metacarpal fractures in United Kingdom

The use of routine sampling for histological analysis during revision hip replacement has been standard practice in our unit for many years. It is used to assess for the presence of inflammatory processes that may represent peri-prosthetic infection. Our study examines 152 consecutive patients who underwent revision hip replacement in our centre for all reasons, excluding malignant neoplasm or metastasis. We reviewed the cases from a prospectively collated database, comparing microbiology results with histology results. Both microscopic and macroscopic analysis by specialist musculoskeletal histopathologist was included in our study. We found 17 (11.2%) patients had cultured bacteria from intra-operative samples. Eight patients (5.3%) had histological findings interpreted as infection. Only one patient who had macroscopic and microscopic histology findings suggestive of infection also had culture results that identified a pathogen. Furthermore, the macroscopic analyses by the histopathologist suggested infection in nine patients. Only one patient with positive culture in greater than 2 samples had histological features of infection. Of the 4 patients who were found to have 3 or more samples where an organism was identified only one had histological features of infection. This represents 25% sensitivity when using histology to analyse samples for infection. Of the 8 patients who had both macroscopic and microscopic features of infection only 1 patients cultured bacteria in more than 3 samples (PPV 12.5%). Our experience does not support the routine sampling for histology in revision hip replacement. We suggest it is only beneficial in cases where infection is suspected or where a multi-procedure, staged revision is performed and the surgeon is planning return to theatre for the final stage. This is a substantial paradigm shift from the current practice among revision arthroplasty surgeons in the United Kingdom but will equate to a substantial cost saving

Surgery for spinal deformity was previously carried out only in teaching hospitals in the United Kingdom. With increasing numbers of patients especially adults, seeking treatment for spinal deformity, the number of centres offering treatment for spinal deformity is going to have to increase. The deformity part of the Spinal Surgical Service in the District General Hospital in Taunton started in 2005. This paper is an audit of this deformity service. It looks at two key areas – that of patient satisfaction and patient reported outcomes of surgery. Patient satisfaction was assessed by a validated questionnaire that evaluated a patient's perception of consultations, consent, preoperative assessment, operative and post operative experience and follows up visits. Patient reported outcomes were evaluated using the SRS 30 questionnaire. 104 patients were contacted and 95 patients (91%) responded. The overall patient satisfaction rate was 96%, with 87% very pleased with the result of surgery, 80% felt that their body shape had improved considerably, 62% had an increased ability to carry out day to day activities to a much higher level and 78% had significantly decreased pain after surgery. The results of the different domains of the SRS questionnaire also supported this. The authors believe that this audit proves that it is possible to provide a spinal deformity service in a District General Hospital in the United Kingdom safely and effectively with a high degree of patient satisfaction. Audits of this kind are required to compare results of treatment between different centres and establish standards

Null Hypothesis: All spinal surgeons in the United Kingdom will routinely use X-ray screening in their practice when performing lumbar spinal surgery. Background: Surgery at the wrong level fortunately occurs uncommonly in spinal surgical practice. When it occurs it is a potential source of morbidity for the patient and may result in litigation for the surgeon. The authors analysed the intra-operative x-ray practice of UK spinal surgeons at the time of discectomy, decompression and instrumented fusion. They also assessed their views on surgery at the incorrect level and x-ray facilities available in their centres. Method: 130 members of BASS (British Association of Spinal Surgeons) were sent an anonymous postal questionnaire concerning their practice and views on x-ray use at the time of surgery. Results: 91(70%) questionnaires were returned. There was a large variation in practice between surgeons. 54 percent of surgeons always used x-ray screening for decompression/discectomy procedures whilst 12 percent only used imaging intermittently. The timing of x-ray screening in relation to opening of the ligamentum flavum was also subject to considerable variation. A small number of surgeons never used x-ray screening for pedicle screw insertion and some only used it occasionally. There was a spectrum of opinion on whether wrong level surgery was substandard practice. Conclusion: The Null Hypothesis has been disproved. There is a wide spectrum of practice and opinion on intra-operative x-ray practice among UK spinal surgeons. Some comments, suggestions and recommendations are made by the authors

Aim: To establish the surgical treatment of displaced intracapsular femoral neck fractures in hospitals across the United Kingdom. Methods: The on-call registrars in all 223 hospitals receiving acute orthopaedic admissions in the UK, were interviewed by telephone. Their usual practices were recorded for two groups of patients, active and frail. The proportions of hospitals using the different surgical options were determined. Results: Despite stereotyped clinical features, management varied between specialists within some hospitals: two or more different methods of treatment were in routine use for active patients in 22% of hospitals, and for frail patients in 27%. The management also varied between hospitals. Overall, for active patients, bipolar hemiarthroplasty was in use in 41%, internal fixation in 37%, unipolar hemiarthroplasty in 32% and total hip replacement in 16% of hospitals. For frail patients either Austin-Moore or Thompson prostheses or both were in use in 94% of hospitals. Where used, Austin-Moore prostheses were uncemented in 93% of hospitals, and Thompson prostheses cemented in 79%. Bipolar prostheses were in use in 8%, and the alternative of internal fixation undertaken for frail patients in 1% of hospitals. Conclusions: The findings demonstrated a lack of consensus in several aspects of the treatment of displaced intracapsular fractures of the femoral neck, with implications for consideration of best practice, in the UK, and worldwide

Universal neonatal screening of developmental dysplasia of the hip (DDH) remains controversial and a few centres have adapted this practice in the United Kingdom. Our institute has established a DDH screening programme for many years. The following shows our result after a recent hospital relocation and changes to the screening programme. All infants born in Coventry are screened for DDH by a clinical examination and ultrasound scan (USS). 5,084 babies were born over a 12-months period. Normal examination and USS were detected in over 90% of the cases. Abnormality detected through either clinical examination or USS was referred to a special orthopaedic/USS clinic. However, in the majority of the cases, subsequent assessments were normal and only 23 babies required treatments. In these cases, the majority had not shown any signs of clinical abnormality. However, serial USS had shown persistent abnormality of at least Graf grade II or higher. The average time from birth to a treatment with a Pavlik Harness was 35 days and the average duration of a treatment was 48 days. Those with Graf III or higher at initial presentation, but spontaneous reduced without treatment were follow-up to one year. The acetabular index in these cases was normal. Apart from one case, all the babies were treated successfully. The unsuccessful cases had a Graf grade IV at the presentation and had shown no sign of improvement on sequential USS. While the sensitivity of detecting DDH through clinical examination remains poor, USS has become an essential tool in our screening programme. Many initial abnormalities are secondary to hip immaturity and they tend to resolve. Those with clinical instability and persistent USS Graf grade II or higher should be treated with early Pavlik Harness. Early detection has led to better results than late diagnosis, and in addition to this, the overall number of operations required could be reduced

The first United Kingdom In-training Examination (UKITE) was held in 19 training programmes during December 2007. The aims of the project are to offer a national, online examination (providing immediate results to trainees) and to allow practice for the ‘real’ FRCS T& O examination with similarly formatted questions based on the UK T& O curriculum. All Speciality training years (StR2, StR3 and above, and all SpRs) and all deaneries will participate in the future. A total of 450 trainees sat this first examination. This is an online exam (accessed through the eLogbook/OCAP website) which is voluntary and has no bearing on RITA outcomes. To take part in the exam trainees were asked to provide 3 questions for a bank which can be used in subsequent years for both UKITE and the FRCS T& O examination. The exam was 3 hours and questions were of multi-choice (MCQ) and extended matching question (EMQ) style covering all aspects of orthopaedics. Correct answers and explanations were available to the trainee after their answer had been submitted. Final scores ranged from 35% to 92%. Mean scores increased from 48% (StR2) to 73% in SpR year 5 (StR7 equivalent). This was followed by a drop off in performance in the final year of training. Three candidates had equal top scores at 92%. 97% stated they would sit the UKITE again and 93% felt there was educational benefit. The length and level of difficulty of the exam was felt to be satisfactory. Improvements were suggested for question quality. The UKITE is a powerful tool for self-assessment of trainees. This analysis establishes a baseline for future years