Extensor tendon ruptures have been reported in up to 8.8% of patients after volar plating and long screws have been implicated. The dihedral dorsal surface of the distal radius hinders accurate screw length determination using standard radiographic views (lateral; pronation and supination). A ‘dorsal tangential’ view has recently been described, but has not been validated.

To validate this view, we mounted a plate-instrumented sawbone onto a jig. Radiographs at different angles were reviewed independently by 11 individuals. Skyline views clearly demonstrated all screw tips, whereas only 69% of screw tips were identifiable on standard views.

With screws 2mm proud of the dorsal surface, skyline views detected 67% of long screws (sensitivity). The best of the standard views achieved only 11% sensitivity. At 4mm long, skyline sensitivity was 85%, compared with 25% for standard views. At 6mm long, 100% of long screws were detected on skylines, but only 50% of 8mm long screws were detected by standard views. Inter and intra-observer variability was 0.97 (p=0.005).

For dorsal screw length determination of the distal radius, the skyline view is superior to standard views. It is simple to perform and its introduction should reduce the incidence of volar plate-related extensor tendon rupture.

Introduction

The addition of hydroxyapatite in cementless total knee arthroplasty is believed to reduce the time for implant fixation and rehabilitation, reduce the incidence of RLLs and provide long lasting implant stability, through improved osseointegration. We report the results of a prospective, randomised controlled single blinded study comparing the post operative pain, biological fixation and clinical outcomes with the LCS Complete Porocoat and the hydroxyapatite-coated, LCS Complete Duofix mobile-bearing knee systems.

Introduction: To compare olecranon screw traction with percutaneous pinning for the treatment of Gartland III supracondylar fractures in children.

Methods: This was a retrospective study of 151 patients between 1986 and 1996 treated with olecranon screw traction and 92 patients between 1996 and 2002 treated with percutaneous pinning. Both sets of patients were followed up clinically and radiologically following their injuries until there was evidence of fracture union and the child could demonstrate a satisfactory range of movement. Data recorded included demographics, fracture information, neurovascular injury, operation details, length of stay, length of follow up and clinical outcome. Radiographs were used to measure initial and final Baumann angles to give an indication of outcomes of distal humerus alignment.

Results: Results are shown for the percutaneous pinning group with the olecranon screw traction results in brackets for comparison.

The percutaneous pinning study included 54 (88) males and 38 (63) females with 63% (63%) left and 37% (37%) right elbow fractures. 46% (29%) of fractures occurred at home, 46% (56%) sustained the injury whilst playing and 7% (7%) occurred at school/nursery. The mean age was 6.0 (6.8) years with a range of 21–165 (12–168) months. The radial pulse was absent in 12% (13%). None of the fractures were open (compared with 5%). There were neurological deficits in 20% (17%). The median time to surgery was 5 hours. The fracture needed to be opened in 12% of cases as satisfactory reduction could not be achieved closed. The median stay length was 1 day (compared to a median stay on traction of 14 days). Mean follow up was 15.2 weeks. (Compared to 38.0 weeks). 2 % (3%) had cubitus varus detectable clinically. Median time to recovery for neurological deficit was 24 weeks (18 weeks). Mean initial Baumann’s angle was 74.6 degrees (73.7degrees). Mean final Baumann’s angle was 75.3 degrees (76.0 degrees)

Discussion: Outcomes achieved from percutaneous pinning of displaced supracondylar fractures are similar to those from olecranon screw traction. The advantage of percutaneous pinning to both patient and provider is the reduced hospital stay and duration of follow up. Olecranon screw traction remains a possible treatment option for the management of this injury.

Aim: To determine the ultimate strength at failure of three different methods of repairing meniscal tears Method: Artiþcial tears were created in 21 fresh bovine menisci. These were then divided into three groups. Group one were repaired using a single 2–0 Ticron vertical suture. Group 2 were repaired using a single Clear-þx meniscal screw. Group 3 were repaired using a single Mitek fastener from the Mitek meniscal repair system. The repaired constructs were then loaded onto a tensiometer and distracted at a rate of 16mm/min. The extension during loading, maximum tensile strength and mode of failure were all recorded.

Results: The single vertical suture failed by breaking at the knot at a mean load of 64.38N and mean extension of 19.91mm. The Clearþx screw failed by pulling out of the peripheral portion of the meniscus. The mean load at failure of the Clearþx screw was 38.06N and mean extension was 17.10mm. The Mitek fastener failed by pulling out of the peripheral meniscus at a mean load of 15.50N and mean extension of 13.87mm.

Conclusion: The single vertical suture failed at higher loads than both the Mitek fastener and the Clearþx screw in the bovine meniscus.

Objective: To assess whether Webb Morley Instrumentation had satisfactory long term results.

Design: A retrospective review of 52 patients who underwent fusion and instrumentation with Webb Morley Instrumentation between 1991–1997.

Subjects: 52 patients were reviewed, 32 patients with idiopathic scoliosis who underwent isolated anterior fusion, 19 patients with neuromuscular scoliosis who underwent anterior and posterior surgery.

Outcome measures: Preoperative and postoperative radiographs, ISIS scans, and patient review. The in-patient notes were assessed for duration of surgery, blood loss, hospital stay and complications. Correction of Cobb angle and union were assessed.

Results: In the idiopathic group Cobb angle improved by 57%, apical rotation by 36% and tilt angle by 56%. There were no major complications and all united. The implant has a tendency to kyphose the spine, and an average of 7 degrees of kyphosis was seen across the implant. In the neuromuscular group Cobb angle improved by 52%, apical rotation by 21% and tilt angle by 57%. There was one asymptomatic pseudarthrosis, two rod breakages and two posterior rod dissociations. Only one patient complained of significant back pain.

Conclusions: Webb Morley instrumentation offers results as good as most other anterior implant systems. The flexibility of the rods may be a relative advantage, with a high union rate. Although the implant tends to kyphose the spine this has not been a problem clinically at follow-up of 4-11 years. This may help in design of future implants.

Introduction

Inclusion of foot dominance in clinical examination of foot disorders is not routinely practised. The existence of foot dominance is not reported in the orthopaedic literature. We have evaluated foot dominance in a normal population and correlated it with hand dominance to highlight its existence and also to bring it into common practice.

Materials and methods

Demographic data was obtained from 468 healthy adult subjects. Those with pre-existing lower limb pathology were excluded from the study. Hand dominance was noted and each subject was then assessed for foot dominance by a blinded method. During the study all subjects were invited to come and stand on a set of weighing scales, and the leading foot was regarded as the dominant one. This was repeated three times for each subject.

Results

Two hundred and fifteen (46%) were males. Two hundred and fifty-three (54%) were females. Three hundred and ninety (83%) were right handed and 78(17%) were left-handed. Three hundred and fifty (75%) were right footed and 118 (25%) were left footed. Eighty-four per cent (328) of the right-handed lead with their right foot and 16% (62) lead with their left foot. Seventy-seven per cent (60) of the left-handed lead with their left foot and 23% (18) lead with their right foot.

Conclusion and Discussion

Foot Dominance seems important to recognise in the same way that we always ask about hand dominance. Further study obviously needs to be carried out to relate foot dominance with lower limb pathology. Are we more likely to injure or stress the dominant lower limb and is this reflected in the incidence of conditions such as fractured necks of femur, lower limb arthritis or foot disorders? We would certainly expect a correlation with the speed of rehabilitation of lower limb disorders depending on which limb is affected, and some existing evidence and the experiences of our physiotherapists support this. Further research is being undertaken to investigate this.

Instability may present at a different level after successful stabilisation of an unstable segment in apparently isolated injuries of the cervical spine. It can give rise to progressive deformity or symptoms which require further treatment. We performed one or more operations for unstable cervical spinal injuries on 121 patients over a period of 90 months. Of these, five were identified as having instability due to an initially unrecognised fracture-subluxation at a different level. We present the details of these five patients and discuss the problems associated with their diagnosis and treatment.