Fractures of the proximal humerus account for 4–5% of all fractures with 80% requiring no surgical treatment. However, the management of the other 20% remains controversial. Multiple surgical modalities have been examined with no consensus as to which if any is the most effective.

This study followed a series of 27 patients who had PHILOS plate fixation of their proximal humeral fractures. All patients were followed up clinically and radiologically for at least one year to a mean of 27.6+/−7.8 months.

We reviewed 27 patients with a mean age of 62.2 years (16 patients were aged at least 60 years). The patients were classified as per the AO system into type A (n=11), type B (n=12) and type C (n=3) fractures. The mean DASH score was 51.8. The mean SF-36 scores for physical and social functions were 68.7 and 88.0 respectively. The mean Constant score was 50.5%.

These results how that the PHILOS plate offers good functional outcomes across a spectrum of fracture severities and in an older population group. Its use should be considered where appropriate in the management of displaced proximal humeral fractures.

Aims: Treatment options for proximal humeral fractures are not very clear, specially in osteoporotic bones. Non operative treatment if on one hand leads to unpredicted and poor outcomes, the operative treatment on the other hand leads to devascularization of fractured fragments and implant failure leading to unacceptable results. Newer interlocking plates, which are applied with minimum soft tissue stripping of fractured fragments and better fixation abilities seems a promising alternative. We present our experience with such plates.

Patients and Methods: Over a period of two years 2002 and 2003, we used 50 plates to treat Neer’s two and three parts and surgical neck of humerus fractures. We reviewed our clinical results with PHILOS plates, which is in interlocking plate. Average age was 34 (24–82). 21 Male and 29 Females. We followed them clinically and radiologically for healing. The shoulder function was assesses with DASH scoring system. The DASH system questionnaire was filled by patients before the fracture and after healing of the fractures. We used a regimen of progressive rehabilitation of shoulder from immediate post operative period. All the complications including union issues, shoulder function, wound problems, nerve injuries, infection and implant failure were noted. Two different techniques were used to fix the fracture with the plate.

Statistical analysis was performed on the data collected through DASH questionnaires along with multivariate and univariate analysis and t-tests.

Results: We were able to follow all the patients who filled the pre fracture and post healing DASH system questioner. X-rays and clinical findings were available for all the patients in the study. All the patients united with average length of 6 weeks (5–12 weeks). All the fractures united. There were no deep infections; however, two patients had to have a week of oral antibiotics for superficial wound infection. There were no permanent nerve injuries. Eight patients had transient axillary nerve paresis, which resolved after 10–15 days. Patient satisfaction with the procedure was high.

48 % of patients showed a rise in DASH scores after the fracture healing, indicating decrease shoulder function. This was statistically analysed and failed to reach any significance p=0.867. There was no difference between the two techniques in terms of complications and union rates.

Conclusions: PHILOS interlocking plates in our study showed 100% union rate with no or minimal complications and preservation of shoulder function. They are technically not difficult to apply and allow immediate post operative mobilization. Hence we recommend their use in primary fixation of proximal humerus fractures.

This paper outlines and defines a research, which was conducted in order to gauge the efficiency of the Elective Orthopaedic Assessment Clinic in the Department of Orthopaedics, Kilcreene Orthopaedic Hospital, Kilkenny, Ireland. The study was conducted in the year 1999. During this year, 380 patients were seen in the clinic. Of these, 328 patients were on the waiting list for joint replacement and 52 were on the waiting list for other elective procedure. In the process of the study it was observed that 204 patients were found fit on their first preassesment visit. Of all the 328 patients on the waiting list, 48 of those who were awaiting joint replacement were found to have dental caries or infected gums and 28 were diagnosed with some minor infective foci elsewhere in the body. However as according to procedure the patients that did not meet the preassessment criteria due to infection, but were pronounced fit for an operation had to wait for the infection to settle before they could be rescheduled for surgery.

The study in question has proved that the clinic acts as an intermediary between the patients and the operation theatre, by determining patient’s fitness for surgery and appropriately placing them on the corresponding waiting lists. This fact is of primary importance as it aids in preventing possible and sometimes last minute cancellations, thereby attesting to the effectives and efficiency of the clinic. The clinics efficiency can also be measured by the fact that it has initiated a number of improvements, such as the introduction of a checklist card for patients on the waiting list for joint replacements. This checklist includes dental health, and also arranges for patients to be examined by their general practioners and dentists before the preassesment checkup.

The fact that a multitude of procedures exist for the correction of hallux valgus indicates that there is no ideal operation for this problem. Hallux valgus correction can be significantly improved by scarf first metatarsal osteotomy. The surgical technique is versatile and strong internal fixation allows early functional recovery. The aim of our study is to analyse the clinical, radiological and functional outcome after scarf osteotomy for hallux valgus correction.

Material and Methods: The scarf osteotomy was performed on 65 feet of 48 patients between 1996 and February 2001. The indication was a symptomatic hallux valgus with increased intermetatarsal angle (IMA). The osteotomy was fixed with one/two 2.3mm screws. Mobilisation was allowed with full weight bearing with forefoot orthesis. Fifty-one cases in 39 female patients (12 bilateral feet) were available for follow-up. The mean follow-up was 14 months (range 3–36 months). Patients were interviewed, clinically examined and standing radiographs of operated foot were taken. They were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalyngeal Inter-phalyngeal clinical rating system in which 100 point are used to compare preoperative and postoperative pain, function and range of motion, shoe wear comfort and activity level and alignment.

Results: All osteotomies healed at the time of follow-up. The average value of AOFAS scale was 92 points. Five patients had removal of screws. There were 4 cases of superficial wound infection. All patients have excellent cosmetic and functional results.

Conclusion: Our study has demonstrated that scarf osteotomy has proven to offer easy postoperative care and has excellent stable long-term results.

Proprioception was measured in the knees of 20 subjects with instability of the anterior cruciate ligament and compared with 17 age-matched control subjects. There was diminished position sense and threshold for movement detection in the injured patients compared with the control group. The proprioceptive deficit recorded from the injured knee showed a significant correlation with the hamstring/quadriceps power ratio recorded from the injured leg.