Background Our hospital operates a consultant led rapid review process of X-rays and case notes of patients referred to fracture clinic from Accident & Emergency (A& E) and General Practitioners (GP) on a daily basis. This compares with other centres where patients are reviewed in outpatient fracture clinics soon after injury.

Aim Evaluate effectiveness of consultant led rapid review process compared to standard consultant fracture clinics.

Patients and Methods Prospective study of the rapid review process over 4 weeks of all patients referred to fracture clinic by A& E and GPs. Total number of patients referred per day, time taken to review these patients case notes and X-rays, number of recalls and reason for recall were documented. This was compared to consultant led fracture clinics, which included time taken to review patients.

Results 797 patients were processed through the rapid review over 4 weeks. 53 (6%) patients were recalled, 32 (4%) for a change of management and 21 (2.6%) because of lack of information. The mean number of patients referred per day was 28 taking a mean of 28 minutes; thus the mean time to review one patient was 1.0 minute. The mean number of patients recalled per day was 2. The mean time taken to review a patient in a standard fracture clinic was 11 minutes. Therefore, the total time that would have taken to review 28 patients in the standard fracture clinic would be 308 minutes.

Conclusion A consultant led rapid review process of all patients referred to fracture clinic is a very efficient process. Rapid review process saves clinic time and resources, minimises delays in clinical decision-making and saves the patient an unnecessary visit to the outpatient department.

Background Adhesive capsulitis of the shoulder is a painful condition that results in gradual loss of joint movement. Numerous treatment modalities have been utilised with variable benefits. Because of the risk of brachial plexus injury and fracture, manipulation under anaesthesia is considered with caution.

Aim To determine the rate of manipulation under anaesthesia (MUA) following primary distension arthrogram for adhesive capsulitis of the shoulder.

Patients and Methods The case notes of 40 patients (42 shoulders) between 1998 to 2004 at Glenfield Hospital, Leicester under the care of one consultant with adhesive capsulitis of the shoulder treated with distension arthrogram by using intra-articular injection of local anaesthetic, corticosteroid, contrast media and air were reviewed.

Results Capsular disruption into the subscapular bursa was demonstrated in all cases. 15 of 42 (36%) shoulders underwent MUA following distension arthrogram. The average period of pain prior to distension arthrogram for these patients was 42 weeks (range: 7–156). 35 of 40 (88%) patients were pain free following primary distension arthrogram.

One patient experienced a vasovagal episode during the distension arthrogram.

Conclusion Distension arthrogram can be used as a therapeutic procedure for achieving symptomatic pain relief in the early phase of adhesive capsulitis and decreasing the risk of MUA of the shoulder.