Introduction

The use of reverse total shoulder arthroplasty (RSA) is becoming increasingly common in the treatment of rotator cuff arthropathy. Standard RSA technique involves medialising the centre of rotation (COR) maximising the deltoid lever arm and compensating for rotator cuff deficiency. However reported complications include scapular notching, prosthetic loosening and loss of shoulder contour. As a result the use of Bony Increased Offset Reverse Shoulder Arthroplasty (BIO-RSA) has been gaining in popularity. The BIO-RSA is reported to avoid these complications by lateralising the COR using a modified base plate, longer central post and augmentation with cancellous bone graft harvested from the patients humeral head.

Introduction

The use of reverse total shoulder arthroplasty (RSA) is becoming increasingly common in the treatment of rotator cuff arthropathy. In recent years indications for use have expanded to include elderly patients in whom either internal fixation is not possible due to fracture configuration, poor bone quality, or presence of a rotator cuff deficiency. There is however relatively little evidence to support its use in these circumstances.

Introduction

Snapping scapula symptoms occur due to disruption of the smooth gliding motion between scapula and thoracic cage. Patients present with pain in the scapulothoracic area aggravated by overhead and repetitive shoulder movements. It is often associated with audible and palpable crepitus, clicking, crunching, grating or snapping sensation. Open or arthroscopic scapulothoracic surgical treatment is an option when non-operative treatment modalities fail. The aim of our study was to assess the outcome of scapulothoracic arthroscopic treatment in patients with painful snapping scapula.

4 years of follow-up study on 27 patients who had biological reverse total shoulder replacement 12 patients who had Bio-RSA by using Tonier Aequalis reversed implants with bone graft extracted from the head of humerus before humeral shaft was prepared. The average age of this group of patients is 77. The average pre-operative shoulder abduction on the affected side is 52 degrees and forward flexion of 90 degrees. Indication for surgery in all those cases are due to cuff tear. The average post-operative abduction is 90 degrees and forward flexion of 97 degrees. The average follow-up period is 9 months with a range from 4 to 18 months. Two patients from this group failed to make an improvement in the range of their shoulder movements post-operatively.

15 underwent Bio-RSA by using Delta XTEND reverse shoulder system without bone graft. The average age of this group of patients is 73. The average pre-operative shoulder abduction is 35 degrees and forward flexion of 37 degrees. Indication for surgery again in most of the cases is due to cuff tear, except one case was due to proximal humeral fracture. The average post-operative abduction is 96 degrees and forward flexion of 101 degrees. The average follow-up period is 19 months with a range of 4–42 months. Only one patient failed to make an improvement post-operatively. This is the patient who had Bio-RSA due to a proximal humeral fracture. 6 patients out of this group also had previous resurfacing which has failed in comparison to the bone graft group which none had previous resurfacing surgery.

We undertook 37 reverse total shoulder replacements within a 2 yr period for chronic complex shoulder conditions. All cases were undertook by one of two upper limb consultant orthopaedic surgeons. At time of listing for operation, the decision as to whether to undertake a bony-increased offset reverse total shoulder was made. Retrospective data was collected on the need for analgesia at final follow up and range of movement.

Of the 37 patients, 12 underwent BIO-RSA procedures. Indications for surgery was predominantly rotator cuff arthropathy (n=9) but two patients had severe OA and one had a complex proximal humeral fracture. The average age of the patient was 76.6 yrs (69–87 yrs) with a mean follow-up of 6.8 months (6 weeks to 1 yr).

The remaining 25 patients were similar in terms of indication, with 18 patients with cuff tear arthropathies and 7 with severe OA. Average age was slightly lower at 74.9 years (50–85).

In terms of range of movement, outcomes between the two groups were broadly similar; those receiving BIO-RSA having an active forward flexion of 90.5° (50–130°) and abduction 88.6° (40–160°). Both groups had excellent analgesic effect with 92% in each either being completely painfree (33.3% BIO-RSA and 44% RSA) or requiring only occasional analgesia. The vast majority of patients were either very satisfied or satisfied with the outcome of the surgery, with one patient in the BIO-RSA group being slightly dissatisfied and three in RSA group.

If grafting is necessary, the use of BIO-RSA within this centre seems to have comparable results to those undergoing standard RSA.

Whilst the use of reverse total shoulder arthroplasty is becoming more common for the treatment of rotator cuff arthropathy, there is still relatively little evidence with regards to its use in complex fractures of the proximal humerus in the elderly. It is increasingly felt to be of use in those patients in whom either internal fixation is not possible due to fracture configuration or bone quality, or in whom there is a rotator cuff deficiency.

We report the outcomes of 14 patients with complex 3- or 4-part humeral fractures or delayed presentation of dislocation treated with reverse TSR. Patients were treated within a two year period from January 2011 to December 2013. The average age at time of operation was 75 (50–91 years) with a mean follow-up of 7 months (2–13 months). One patient moved out of area and one lost to follow-up two months following procedure.

Reverse TSR was considered a salvage procedure for patients with comminuted proximal humeral fractures or those who presented with irreducible non-acute dislocations. At time of last follow-up all 14 patients were satisfied with the results of their operation and functionally independent with activities of daily living. Range of movement post-operatively was good with mean active forward extension 97° (70–150°) and abduction 101° (80–170°). 43% of patients were pain-free, whilst the remainder only required the use of occasional analgesia. No major post-operative complications were reported.

Patients who underwent reverse TSR for dislocation fared better than for those with proximal humeral fractures. The mean active forward extension was 107.5° (90–150°) and abduction 112.5° (90–170°) in the dislocation group (n=5) compared with those who had a fracture in which the forward extension was 91.4° (70–120°) and abduction 95° (80–120°).

The results of these patients demonstrate that reverse TSR should be considered in patients with complex proximal humeral fractures or delayed presentation of fractures. It seems to provide consistently excellent pain-relief for patients, with patients either reporting being pain-free or requiring only occasional analgesia. In addition, all patients treated were functionally independent following operation. Range of movement, particularly for those with dislocation, appear good. Further follow-up is required to ensure sustained results but early studies are encouraging.

The study was designed to look at canine related injuries presenting to the orthopaedic department at a small rural district general hospital and to assess their cost to the NHS.

A retrospective review of case notes and x-rays of all dog related injuries presenting to the orthopaedic services at our hospital over a one year period starting January 2011 was undertaken. The injuries involved and the treatment provided along with the direct financial cost of these services were calculated from trust tariffs.

Dog related injuries accounted for 84 out of a total of 48,405 patients presenting to the accident and emergency services over the index period. Of these, 29 required orthopaedic input with 57% of injuries resulting from trying to restrain a dog and the rest from being attacked by a dog. 14 patients were admitted to the wards with 11 among them requiring orthopaedic interventions ranging from wound wash outs and debridement to open reduction and internal fixation of fractures. These procedures cost £38,951 to the NHS. There were a total of 38 inpatient days involved costing another £9,196. A further 28 clinic visits were billed at £4,032. The total cost for the orthopaedic services provided was £52,179. There were no mortalities associated with these injuries over the time period.

Canine related injuries are costly and avoidable. General public awareness of the problem coupled with appropriate legislation and its strict enforcement may be necessary to protect people from our canine companions.

Since November 2003 there have been 62 Metacarpophalangeal Joint (MCPJ) replacements carried out on 16 patients at Macclesfield District general hospital. 11 of the patients were female and 5 were male. The mean patient age at procedure was 64.9 years, with an age range of 28 to 80. Of the 62 MCPJ replacements carried out, 58 (93.5%) were as a result of rheumatoid arthritis, with only 4 (6.5%) as a result of osteo-arthritis. The primary objective of this study is to assess their outcomes to date. Data was collected retrospectively by means of case note review. Outcomes measured were patient rating of pain and function at post operative review and post operative complications. All operations were carried out by a single surgeon, using his standard operative technique, and all replacements used the Neuflex Finger Joint Implant System. All 16 patients attended for post operative review. At the time of discharge 13 patients rated their outcome as excellent to good, 1 patient was deceased and 2 patients are currently under follow up with no reported complications. Mean time to discharge was 19 months (2–68). Of the total 62 joints replaced, 10 revisions were carried out. Of these, 3 were as a result of dislocation, 6 were for subluxation and 1 as a result of failure of the prosthesis. There were 3 other post operative complications; 1 was for superficial wound infection, 1 resulting from a prominent prosthesis and 1 hypertrophic scar. Results showed that 81.3% of patients rated their range of movement as good to excellent and 87.5% reported an improvement in pain. Overall, 81% of patients rated their outcome at discharge as good to excellent. From the data available we conclude that the Neuflex system is an effective treatment method with a low complication rate.

Purpose

Plating remains the most widely employed method for the fixation of displaced diaphyseal clavicle fractures. The purpose of this study was to assess the efficacy and outcomes of diaphyseal clavicle fractures treated with intramedullary fixation using the Rockwood clavicle pin.

Background

Volar locking plates have revolutionised the treatment for distal radius fractures. The DVR (Depuy) plate was one of the earliest locking plates which were used and they provided fixed angle fixation. Recently, newer volar locking plates, such as the Aptus (Medartis), have been introduced to the market that allow the placement of independent distal subchondral variable-angle locking screws to better achieve targeted fracture fixation. The aim of our study was to compare the outcomes of DVR and Aptus volar locking plates in the treatment of distal radial fractures.

The aim of the study was to compare the radiological findings of wrist arthrogram with wrist arthroscopy. This allowed us to establish the accuracy (sensitivity, specificity) of MRI arthrogram as a diagnostic tool. Thirty patients (20 female and 10 male) have undergone both wrist MRI arthrogram and wrist arthroscopy over the last 3 years at Macclesfield District General Hospital. The mean age at arthrogram was 42.4 years with an average 6.7 month gap between the two procedures.

The MRI arthrogram was reported by a consultant radiologist with an interest in musculoskeletal imaging and the arthrosopies performed by two upper limb surgeons. Patients undergoing both procedures were identified. The arthrogram reports and operation notes were examined for correlation. Three main areas of pathology were consistently examined: TFCC (triangular fibrocartilage complex), scapholunate and lunatotriquetral ligament tears. The sensitivity and specificity of arthrogram was calculated for each. Other areas of pathology were also noted.

In the case of TFCC tears MRI arthrogram had a 92.3% sensitivity and 54.6% specificity. The lunatotriquetral ligament examination with this technique was 100% sensitivity and specificity. However for scapholunate ligament tears it only had 50% sensitivity and 77.8% specificity.

Wrist arthrogram and arthroscopy are both invasive techniques and equally time consuming. In cost terms the arthrogram remains cheaper but is superseded by arthroscopy as it is both diagnostic and therapeutic.

Introduction: We present a double blinded prospective randomized controlled trial between viscoseal and intraarticular diamorphine injection in shoulder arthroscopy.

Materials & Methods: Twenty adult patients undergoing arthroscopic subacromial decompression were randomised into two groups. The Viscoseal group received 10ml of Viscoseal and 10ml of 0.5% bupivacaine injected into the subacromial bursa at completion of the procedure (n=10). The matched control group received 10mg diamorphine and 10mls of 0.5% bupivacaine (n=10). All procedures were performed by the senior author. The patients were blinded to the injections given. Post-operative regimes were standardised and all patients were assessed by visual analogue pain scores at recovery and 1, 2, 6, 12 & 24 hours post-operative. The presence or absence of nausea and time to discharge were also noted.

Results: The mean age of the Viscoseal group was 53 (range 34–70) years and in the control group 59 (32–85) years. In the Viscoseal group 40% of patients were discharged on the same day, while there were no early discharges in the diamorphine group this difference did not reach statistical significance (P=0.054 by Fisher’s exact test). There were no significant differences in post-operative pain score or the fraction pain-free between the two groups or in supplementary analgesic drug doses given (all P> 0.08). Only 10% of the Viscoseal group were nauseous post-operatively compared to 60% of the control group (P=0.03 by Fisher’s exact test).

Discussion: Arthroscopic surgery has never been more popular. Patients like smaller scars, early discharge and quick return to daily life and work; for surgeons arthroscopic surgery is skilful, satisfying and digitally recordable; and the NHS benefits from reduced hospital stay and post-operative complications.

Review of the literature involving the use of viscoseal in shoulder surgery revealed no direct comparison with diamorphine, but only to bupivacaine alone.

Many methods of post-arthroscopic pain relief are available. In our hospital diamorphine with bupivacaine is standard, at £2.57 per treatment. In the present study nausea was significantly lower in the Vicoseal group, but no significant intervention was required and oral anti-emetics sufficed. Pain was not significantly different, and there were no significant differences in supplementary analgesia or in early discharge. In our opinion, the significant improvement in nausea alone is not enough to justify the high price of £52.88 per Vicoseal treatment. We believe that the benefits for routine use have not been demonstrated.

We present a retrospective study of comparision between two types of aritifical boen graft substitues. There is an overwhelming marketting drive on part of companies to sell alternative bone grafts/BMP. We in this study compae two such producsts and their cost effectiveness

This is an interventional, retrospective, non consecutive, non randamised case series study of 27 patients. Type I bone graft is Mini MIIG which is surgical grade calciun sulphate which is osteoconductive. Type II bone graft is Allomatrix which conatins bone marrow aspirate, bone morphogenic protein, concellous bone chips and surgical grade calciun sulphate which is osteogenic, osteoinductive and osteoconductive. In this study 14 cases were treated with Mini MIIG and 18 with Allomatrix. There were 24 primary fractures with bone defect, 2 non union and 1 delayed union. Complete bony union were seen in all 27 patients. Average time to heal since bone grafting is 3 months. Complications are extrubent callus formation, bone formatiom in soft tissue, but no patient required secondary procedure to trim the bone. Cost for Allomatrix is £ 356.00 and Mini MIIG is £348.00. Use of such artificial bone grafting avoids the complication of autografting which includes bone graft side morbidity like pain, bleeding and neurvascular damage. For fresh fractures useage of such artificial bone grafts doesnt shorten the healing time, doesnt prevent collapse at fracture site and it is not cost effective. For non union and delyaed unions it avoids the cost for artifical bone grafting. But autograft also incurs the cost of removing, theatre timing. human resources cost and hospital inpatient costs. There is no difference between one type of bone graft over the other and for fresh fracture both of them has no advantage over using no bone grafts.

Our study concludes artifical bone graft is of no advantage for fresh fractures and for non union and delayed unions it is too small a number to come to any conclusion.

We are presenting a prospective study of 25 patients with clavicle fracture treated with Rockwood Intramedullary pin fixation. Operative management is required for open fractures, neurovascular injury or compromise, displaced fractures with impending skin compromise and displaced middle third fractures with 20mm or more shortening. Plate osteosynthesis or intramedullary fixation devices are used for operative management.

Patients and Methods: 25 patients with clavicle fractures underwent fixation of clavicle fractures with threaded intramedullary Rockwood pin. The indications for internal fixation were persistent wide separation of fracture with interposition of soft tissue in 12, symptomatic non-union in 3, associated multiple injuries in 3,one of them had a floating shoulder, impending open fracture with tented skin in 4 and associated acromioclavicular joint injury in 3 and one of whom had bilateral fracture clavicle.. All patients underwent open reduction through an incision centred over the fracture site along the Langer line. Intramedullary pin was inserted in a retrograde manner. Autologous bone grafting from iliac crest was done in all patients with nonunion. Radiographic and functional assessment conducted using DASH scores.

Results: There were 21 male and 4 female patients with a mean age of 34 yrs (range 17 to 64 yrs). Mean follow up was 12 months (range 5 months to 30 months). Radiographic union occurred in all patients within 4 months. In our study the commonest indication for Rockwood pin fixation was displaced middle third clavicle fracture followed by impending open fractures. Commonest complication was skin irritation at the distal end of the pin with formation of a tender bursa occurring in 9 patients, 3 of whom had skin breakdown. Fracture union occurred in all these patients with no further intervention and wounds healed completely after removal of the pin. One patient developed non-union and was later treated with ORIF with DCP and bone-graft. There were no deep infections, pin breakage or migration or re-fractures after pin removal. At the time of last follow up the average DASH score was 25 with a range of 18 to 52.

Conclusion: Open reduction and intramedullary fixation of clavicle fractures with Rockwood pin is a safe and effective method of treatment when surgical fixation of displaced or non-union of middle third clavicle fracture is indicated. This technique has an advantage of minimal soft tissue dissection, compression at the fracture site, less risk of migration and ease of removal, along with early return to daily and sports activities.

Aim: Aim of this study is to determine if cubital tunnel view radiograph of the elbow is useful in the investigation and treatment of Ulnar nerve entrapment at the elbow.

Patients and Methods: 28 patients presenting with symptoms suggestive of ulnar nerve entrapment at the elbow were prospectively studied. Detailed history and clinical examination was elicited in each patient and classified according to McGowan’s classification. Diagnosis of ulnar nerve entrapment at the elbow was confirmed by nerve conduction studies. Cubital tunnel view radiographs were taken and evaluated for any evidence of bony encroachment of the ulnar nerve bed in the cubital tunnel. Those patients with normal cubital tunnel view radiograph underwent simple ulnar nerve decompression where as those with significant bony encroachment of ulnar nerve bed underwent anterior transposition of the ulnar nerve. The results of surgery were assessed at follow up using the Wilson and Krout criteria. The difference in results in two groups was statistically analyzed by applying student ‘t’ test.

Results: There were 20 patients (male=14, female 6) in the simple ulnar nerve decompression group with a mean age of 52 yrs (range 32 to 61 yrs) and 8 patients (male=6, female=2) in anterior transposition group with a mean age 59 yrs (range 45 to 69 yrs). Mean follow up was 25months (range 9 months to 32 months). According to McGowan’s classification there were 5 grade I, 9 grade II and 6 grade III patients in simple decompression group where as there were none grade I, 3 grade II and 5 grade III in anterior transposition group. All patients had neurophysiological evidence of ulnar nerve entrapment in pre-operative nerve conduction study. Wilson and Krout grading at final follow up showed 15 good, 4 fair and 1 poor result in simple decompression group and 5 good, 2 fair and 1 poor result anterior transposition group. There was no statistically significant difference between the two groups (p value < 0.001).

Conclusion: Cubical tunnel view radiographs are valuable in the management of ulnar nerve entrapment at the elbow. Patients with normal radiograph can be treated by simple nerve decompression

We present a unique prospective study which estimates the median sustained stage related improvement in pain and hand function predicting symptomatic relief period with high accuracy with a single steroid injection.

Patients were grouped into stages, I to IV according to the Eaton and Glickel radiological criteria. The steroid injection contained 40mg triamcelone and 1% lido-caine. The response was assessed by DASH and a visual analogue score before and at six-week interval. We used the Kaplan-Meier method to estimate median length of sustained improvement by grade of disease, with 95% confidence interval. All the patients were injected by an upperlimb physiotherapist (DD). Post injection review was carried out by an independent observer(MK).

Forty patients were studied: 33 females and 7 males. The age ranged from 53 to 81 years, (mean 65years). No patient was lost to follow-up. Mean duration of symptoms were 36 months. Six patients has stage I disease(15%), eighteen patients had stage II disease (45%), ten patients had stage III disease (25%) and six patients has stage IV disease (15%). Pain score ranged from 4 to 9 on visual analogue score. Reduction in pain visual analogue score was noticed in all but 3 patients. With the exception of Grade III patients, DASH scores decreased significantly at 6 weeks (Grade I 14.9, Grade II 19.3, Grade III 6.2 and Grade IV 10.0.). With the exception of Grade IV patients, pain scores decreased significantly at 6 weeks. In Grade II patients, over half had sustained symptomatic relief at 6 months. So on average, we can expect grade I patients to sustain symptomatic relief for an average of 17 weeks. The true average is likely to be between 13 and 21 weeks. For grade II patients, most will still have improved at 6 months. Grade III and IV patients have an identical prognosis of 4 weeks, though the true prognosis may be between 2 and 6 weeks.

In conclusion it is possible to predict the period of symptomatic improvement in each of the four disease stages. This allows the treating clinician to discuss the outcome of treatment with reasonable accuracy.

A prospective study of early operative treatment of unstable elbow dislocations using a surgical algorithm, we present the early results of nine such injuries including five terrible triads of the elbow and four elbows which redislocated in plaster. All except two were high energy injuries. The lateral collateral ligament complex was found to be avulsed proximally in all cases and was reattached using a bone anchor. The common extensor origin was also torn to a variable extent in all cases and was repaired end to end. In the terrible triads, the coronoid fracture as fixed with a transosseous suture and the radial head reconstructed or, in one case with gross comminution, replaced. In the four redislocations, full stability was only restored when the medial collateral ligament was also reattached. Mobilization without a hinged external fixator was allowed from day one, but the elbows were protected in a hinged splint in between exercise sessions. Patients were assessed for stability, ROM, and functional disability using the DASH score at an average of 12 months.

No elbows redislocated post-operatively and no patients complained of instability. Mean extension was 18° (95% CI 7° – 28°), flexion 131° (124° – 137°), pronation 76° (56° – 96°), and supination 82° (75° – 90°). Mean DASH score was 14.6 (95% CI 0.7 – 28.5) though this result was skewed by one patient who developed RSD and had a DASH score of 67.2. This was however the only complication.

Early operative intervention with reconstruction of unstable elbow dislocations, including the terrible triad, prevents the poor results which are commonly found following non-operative treatment of such injuries. An external fixator is not usually required in the acute setting.

Distal radioulnar joint surgery has been dominated by different types of partial or complete ulnar head excision. This remains a reasonable option in rheumatoid surgery. However, in the long run, this can create a number of problems. We have used Herbert modular prosthesis to tackle these very difficult situations. This prosthesis comprises of a press fit stem in three sizes and a ceramic head, also available in three sizes.

In Wrightington hospital upper limb unit 61 patients underwent Herbert ulnar head replacement. Fifty-eight were clinically and radiologically reviewed.

Between December 1998 and December 2002 21 male and 27 female patients were operated. The mean age was 49.8 years with a range of 28–72 years. Twenty two left, eighteen right and two bilateral replacements were performed. The mean follow-up was 20.02 months with a range of 3–60 months.

All patients were reviewed by an independent observer using range of motion, grip strength and satisfaction as outcome.

Primary diagnoses included failed Darrach, Bower, Sauve Kapandji and traumatic ulnar head excision. Forty-five patients were satisfied with the outcome. Pain score showed a mean improvement of 4 with a range of 0–10. The grip strength compared to normal side was decreased in 50% of the patients. The range of motion compared to normal side improved by a mean of 10 degrees (range 3–20) in supination and 13 (range 4–23) in pronation.

Radiological review showed new bone (8) and notch formation (9). Stress shielding of 0–19mm was observed in distal ulna with revision or emergency stem.

Complication occurred in eight patients instability (4), RSD (1), implant failure (1) and two others. Twelve patients required further surgery. No loosening was observed at revision.

Conclusion: This is a suitable revision and primary replacement but no long term following is required.

Purpose: A prospective study of early operative treatment of unstable elbow dislocations using a surgical algorithm.

Methods: We present the early results of nine such injuries including five terrible triads of the elbow and four elbows which redislocated in plaster. The avulsed lateral collateral ligament complex was reattached using a bone anchor in all cases. Coronoid and radial head fractures were fixed. In the four redislocations, full stability was only restored when the medial collateral ligament was reattached. Mobilization without a hinged fixator was allowed from day one. Patients were assessed for stability, ROM, and functional disability using the DASH score at an average of 13 months.

Results: No elbows redislocated post-operatively and no patients complained of instability. Mean extension was 18° (95% CI 7° – 28°), flexion 131° (124° – 137°), pro-nation 76° (56° – 96°), supination 82° (75° – 90°). Mean DASH score was 11.0 (95% CI 3.5 – 18.6).

Conclusion: Early reconstruction of unstable elbow dislocations, including the terrible triad, prevents the poor results which are commonly found following non-operative treatment of such injuries. An external fixator is not usually required in the acute setting.

Aims: This study reports a retrospective review of notes and x-rays of 45 patients who underwent fixation of inter- and subtrochanteric fractures of the femur with the Intramedullary Hip Screw. Methods: 45 consecutive patients who underwent IMHS fixation between 1998 and 2001. Diagnoses: 24 intertrochanteric- and 15 subtrochanteric fractures, 2 prophylactic nailings for metastases, 4 reoperations for previously failed DHS/DCS. Data collected from patient notes included the intra-operative use of skeletal- vs. ski-boot traction, intra- and postoperative complications. X-ray review included classification of the fractures, grading of osteoporosis, measurement of neck-shaft angle, screw position in the femoral head, and distance from the screw to the nearest cortex. Results: The rate of intraoperative complications was 8,8%, post-operative complications occurred in 13,3% of the patients. The mortality rate within the first 3 months was 15,5%. Re-operations were necessary in 4,4% of the patients. The sliding screw was positioned in the middle sector of the femoral head in the coronal plane in 17 patients and in the sagittal plane in 14. Superior position occurred in 18 cases, inferior in 4, anterior in 4 and posterior in 16 patients. Conclusions: The main complication in our series was screw cut-out from the femoral head. This occurred in 4 patients, 2 of whom were previously failed DHS/DCS fixations. There was no single factor predicting implant failure. The results for primary fixations are comparable to most reported series in the literature and show that the outome is dictated by the original fracture pattern. There is a high failure rate if the implant is used for revision procedures.