BOA Annual Congress 2013

Pu ng Evidence into Ac on

Annual Congress 2013Birmingham ICC 1st – 4th OctoberIn Associa on with the Specialist Socie es

@BritOrthopaedic #BOAAC

Final Programme and Abstracts

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11:59

1BOA Congress 2013FINAL PROGRAMME

Dear Friends and Colleagues,

Welcome to the BOA Annual Congress

2013 will be remembered as the year of great change, transformation andchallenge in the NHS and UK health and care system: the NHS underwent oneof the biggest re-organisations and restructures in recent times, which saw thecreation of new bodies, departments and changes to existing roles. We alsosaw the publication of Sir Robert Francis QC’s second report on MidStaffordshire, followed by the government’s wide ranging proposals torevolutionise care and embed high standards in the NHS. Other developmentsthis year included the introduction of revalidation, affecting all licenced doctorsin the UK. For 10 surgical specialities, including ours, there has been a push forgreater transparency of surgical outcomes, and this is likely only to increase.

Against this backdrop of change and transition, there is a growing anddeepening financial challenge at the heart of the NHS, and so throughout thesetough times, it is critical that the orthopaedic profession uses evidence tosupport and underpin best practice. This is why the theme of our 2013Congress is Putting Evidence into Action.

It is likely to be the largest Congress the BOA has staged, with over 1400 perhaps even 1500 attendees, and we believe wehave all the ingredients for a vibrant and informative event. We have created an exciting programme for delegates aroundthis theme and we hope that the sessions, seminars and lectures stimulate further discussions and debate not only duringCongress, but with colleagues long after it is finished. Running alongside the official Congress programme is a much lessformal social programme, and I do hope you take advantage of the social events we have planned. I am particularly lookingforward to the Jam House for an evening of music and light entertainment, and I’m just sorry we couldn’t fit more of you into enjoy what promises to be an excellent evening.

Many of our seminars and sessions are designed to support revalidation and we have developed these in collaboration withour Specialist Societies. We also have several new additions to the programme, including the session on GPs andCommissioning of healthcare, Good Clinical Practice training and the Trauma Boot Camp. I hope you find these newadditions to our standard programme useful and interesting.

In summary I hope that this year’s Congress is a chance for us to discuss, debate, share ideas and best practice in order torise to the challenges now and in the future. I look forward to speaking with many of you over the course of the four days,and I hope that, together, we make this year’s Congress a highly successful and enjoyable event.

Martyn Porter – BOA President

General Information 3

AGM Agenda and Notes 6

Tuesday 9

Wednesday 15

Thursday 19

Friday 25

Exhibition 29

Abstracts 49

Abstract Information 51

Index of Authors 52

Wednesday 61

Thursday 87

Friday 117

Poster Abstracts 123

Contents

President’s Message

2 British Orthopaedic AssociationCaring for Patients; Supporting Surgeons

BOA COUNCIL 2013

OFFICERSPresident M L Porter (Wrightington) Immediate Past President J J Dias (Leicester)Vice President T W Briggs (Stanmore)Vice President Elect C R Howie (Edinburgh)Honorary Treasurer A J Timperley (Exeter)Honorary Secretary D Stanley (Sheffield)

ELECTED MEMBERSB D Ferris (London) A C W Hui (Middlesbrough)J P Hodgkinson (Wrightington) M F Gargan (Bristol)P G Turner (Manchester) M G Matthews (Buckinghamshire)I G Winson (Bristol) A M Nanu (Newcastle)D J McBride (Newcastle) A J Stirling (Birmingham)R Ravikumar (Middlesex)

EX OFFICIO MEMBERSChair, Council of Management of the Bone and Joint Journal N P Thomas Chair, Specialty Advisory Committee in Trauma and Orthopaedics M L GoodwinChair, Education Committee D L LimbChair, Scottish Committee for Orthopaedics and Trauma C R Howie (Vice President Elect)Chair, Welsh National Specialist Advisory Group for T&O N K MakwanaChair, N Ireland Regional Orthopaedic and Trauma Committee I BrownChair, BOA Research Board A CarrPresident, British Orthopaedic Trainees Association J Palan Chair, British Orthopaedic Directors Society D Clark

HONORARY POSTSEditorial Secretary B J OllivereArchivist I B M StephenWorkforce Liaison Officer G W Bowyer

AWARDS & PRIZE WINNERSThe BOA is delighted to use the Annual Congress as an opportunity to publicise and celebrate the following awards and prizes granted by the Association in 2013;

HONORARY FELLOWSProfessor Sir Keith PorterProfessor Charles GalaskoMr James Scott

PRESIDENTIAL MERIT AWARDSue Miles

ROBERT JONES MEDAL WINNERMr Jaykar Panchmatia

HONG KONG AMBASSADORDr Chun-Hoi Yan


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The Registration and Information desks arelocated at the top of the escalators.Onsite Registration must be done online atcongress.boa.ac.uk – delegates can access thewebsite in order to register by visiting the deskswithin the registration area; staff are on hand toassist.

General Information

Tuesday 1st October 7:30am – 6:00pm CLOSED

Wednesday 2nd October 7:00am – 7:00pm 7:00am – 5:00pm

Thursday 3rd October 7:00am – 7:00pm 9:45am – 5:00pm

Friday 4th October 7:00am – 4:00pm 9:45am – 2:00pm

Registration Exhibition HallOpening times Opening Times

Registration

Delegate Packs

Finding Your Way Around

Full meeting delegates will receive:• Delegate Bag containing Final Programme and other

congress materials • Name Badge permitting access to all sessions • Complimentary invitation to opening reception • Issue 2 of the Journal of Trauma and Orthopaedics, the

BOA’s new journal

One Day Delegates will receive:• Delegate Bag containing Final Programme, and other

congress materials • Name Badge permitting access to all

sessions for the day(s) of attendance

• Complimentary Invitation to opening reception (ifregistered for Wednesday)

• Issue 2 of the Journal of Trauma and Orthopaedics, theBOA’s new journal

All accompanying persons, Wives/Partners must beregistered.Accompanying Persons receive:• Access to Sessions (space permitting)• Complimentary invitation to opening reception

The Venue – ICC BirminghamThe halls/rooms that the BOA will beusing during the Congress are onvarious levels. Hall 1 is the mainauditorium and where all plenaries willtake place.

Hall 3 is the main Exhibition area; allcatering will be served within this area. The halls/rooms that the BOA will beusing throughout the Congress are signposted and there are also Hosts onhand to help and assist with directions.

ExhibitionThere are over 100 companiesshowing their continued support tothe BOA within the exhibition areas.We would encourage all delegates tovisit the exhibition stands including theInternet Café located on the balcony.The exhibition floor plan and list ofexhibitors can be found at the back ofthis programme.

CloakroomThe cloakroom is situated on the Mallon the ground level next to theStarbucks coffee shop. Those using thecloakroom will be charged £1 per item.

Cloakroom Opening Times:-Tuesday 1st October . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06:30 – 17:30Wednesday 2nd October . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06:30 – 20:00Thursday 3rd October . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06:30 – 19:30Friday 4th October . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06:30 – 17:00

Prayer RoomIs located off the main mall past ‘The Oak Kitchen’ and is accessed via a securitykeypad at the entrance door. Those wishing to use this room should request thesecurity code from the staff on the registration desk.


BOA Congress 2013FINAL PROGRAMME

General Information

Making the Most of Congress

Scanning of badges & CPD Points Please ensure that your badge is scanned before you enterany of the session rooms and auditorium. Your attendancemakes up the amount of CPD points you will be awardedduring the Congress. CPD points cannot be added after; itis each delegate’s responsibility to have their badgescanned throughout their attendance at Congress.

Following the Congress, you will be able to access anddownload a record of your CPD points. Up to 24 CPD pointscan be awarded by the BOA for your attendance atrevalidation and instructional sessions at the BOACongress. Where you attend free paper sessions, you cangain CPD points but this must be through self-accreditationrather than the BOA system.

Session attendanceThe BOA Congress has been more popular than ever thisyear and we envisage that some sessions will be close tofull capacity. Therefore, we advise that you to arrive ingood time for the start of each session you wish to attend.We will do our best to accommodate as many delegates aspossible within each session; however, we reserve the rightto refuse entry to delegates if any session becomes full toensure the comfort and safety of all.

However, the following two sessions have limited capacityand will be open only to those who pre-booked using the

online survey: • Good Clinical Practice• Clinical Examination for FRCS(Orth)We apologise for any inconvenience but no other delegateswill be permitted in these sessions.

BOFAS Clinical Examination Course – by invitation only,not included in the programmeTuesday 1st & Wednesday 2nd October – Rooms: Hall 6A &Exec Rooms 4, 5 & 6

Poster DisplayPosters will be displayed in Hall 3 on the balcony within theexhibition area and outside Hall 3 along the back wall.ARUK Posters will be displayed within the registration area.Transitional Fellows Posters will be displayed on thebalcony in Hall 3.

Podium Presentations Authors can download their presentations in the MediaSuite. Use of this room is for authors who are presentingonly.

Annual General MeetingThe Annual General Meeting of the British OrthopaedicAssociation will be held on Thursday 3 October, 12:30pm.All members are entitled to attend and speak, but voting isrestricted to Fellows only.

Refreshments, Lunches and Congress Dinner

Refreshments Tea and coffee will be served to all delegates during themid-morning and afternoon breaks.

LunchA lunch bag contains: sandwich, fruit, snack bar, crisps anda hot or cold drink.

Delegates who have pre-ordered their lunch bags onlinewill find a lunch voucher(s) attached to their Congressbadge, each pre-ordered lunch bag contains a prize draw

ticket (please see ticket for details). Pre-ordered lunch bagscan be collected from the various catering points withinthe exhibition area, including the balcony, in Hall 3 – excepton Tuesday when they will be available within theregistration area.

Those wishing to purchase a lunch bag onsite can visit thecash catering points. On Tuesday these will be within theregistration area and on Wednesday to Friday within theexhibition area at the catering point next to the stage.

Congress Dinner at The Jam House NOW FULLY BOOKED Wednesday 2nd October

The Jam House is your one stop destination for food, drink and live music!This is one venue where you can eat, drink and dance to your heart’s content.

3-5 St Pauls Square, Birmingham, B31QUWebsite: www.thejamhouse.com/birmingham, Phone: 0121 200 3030 Twitter: @TheJamHouse

If you have booked to attend the Congress dinner, your ticket(s) will be attached to your Congress badge (please see yourticket for more information). Those attending should make their own travel arrangements to and from the dinner venue.


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General Information

Important InformationHotelsIf you are still in need of accommodation, or you have aquery on your TSC booking, please contact TSC solutions:tel. +44 (0)1335 345 655 or fax +44 (0)1335 348 114 –www.thesolutionscompany.co.uk/event_society.php?e=120.

Travel PolicyEvent participants are responsible for making their owntravel and/or hotel arrangements. The BOA does notassume financial responsibility for penalties or expensesincurred by registrants who must cancel travelarrangements due to course cancellation.

In case of an emergencyPlease note the various fire exits around you in case of anemergency. Listen to all public announcements and makeyour way carefully to the nearest fire exit if requested to doso. If First Aid is required, please ask a member of Staff orHost for help and assistance.

Declarations of Interest All those presenting at the BOA Congress will be asked tomake their declarations of interest on a slide at the start oftheir presentation, as discussed and agreed at the BOAAGM last year.

CopyrightThe papers to be presented at this Congress have beenprepared by the individual named authors. The papersrepresent the authors’ views of certain types of diagnosis,treatment or procedure. They are not represented as theonly or best methods of diagnosis, treatment or procedure,nor are they represented as being appropriate for thediagnosis or treatment of individual patients who must beassessed by specialists according to their own individualcircumstances.

Accordingly, neither the authors concerned nor the BOAaccept any liability for any injury, damage or loss caused toany person by reliance upon or use of any diagnosis,treatment or procedure presented, described or discussedat this Congress.

Copyright and similar rights in the papers and othermaterial presented are owned by the individual authors

concerned [or in some cases by their employinginstitutions]. The BOA does not have any authority to allowthe reproduction or use of those papers or materials anddelegates wishing to do so must seek the permission of theindividual authors concerned or their employingauthorities.

The abstract memory stick sponsored and supplied byHeraeus has been produced under agreement with theBOA, and the same Copyright applies as stated above.

Other informationThe British Orthopaedic Association does not acceptliability or responsibility for third party exhibitors or theirexhibits and the BOA does not endorse any of theproducts, items or processes exhibited.

Filming, recording or photography during the Congress isStrictly Prohibited unless by prior agreement with the BOA.

Badge typesGold VIPLilac/Purple Guest SpeakerBlue Delegate (Member)White Delegate (Non-member)Pink Partner / accompanying personGrey Visitor/PressRed StaffGreen ExhibitorOrange GP Day Delegates

Invited GuestsCarousel PresidentsAAOS John Tongue AOA Scott Boden AusOA John OwenCOA Edward Harvey NZOA Richard Lander SAOA Johannes de Vos

Other PresidentsIOA(Irish) Raymond Moran

IOS (UK) Venu Kavarthapu

Hong Kong Young Ambassador Chun Hoi Yan

Notes


BOA Annual General Meeting 2013

The Annual General Meeting of the Association will take place in Hall 1 of the International Convention Centre, Birminghamon Thursday 3rd October 2013 from 12.30-13.30 under the Chairmanship of Mr Martyn Porter, BOA President. The agenda isbelow.

PROXY NOTICE: A member of the Association who is entitled to attend, speak and vote at the above-mentioned meetingis entitled to appoint a proxy to attend and vote instead of him or her. For details please see the note at the foot of thisagenda.

AGENDA

1. Membership issuesa) Deaths [see annex 1]b) Resignations [see annex 2]c) New members [see annex 3]

2. Matters arising from 2012 AGMa) Disclosures of conflicts of interest

3. Electionsa) President: September 2015 – 2016

To report the result of the Trustees’ ballot: • Mr Timothy Wilton

b) Council: 2014 – 2016

To report the result of the Home Fellows’ ballot:• Mr Adam Brooks• Mr Grey Giddins• Mr Ian McNab• Mr Phillip Mitchell

c) Honorary Secretary: 2014 – 2016

To report the result of the Home Fellows’ ballot:• Mr David Limb

4. Honorary Treasurer’s Report and Financial Statements for 2012a) Annual Report of Trustees Financial Statements 2012 – see link below:

www.boa.ac.uk [see quick links on BOA home page]

b) Resolution 1: To confirm the Auditors for 2014 – Crowe Clark Whitehill

c) Resolution 2: To approve membership subscription rates for 2014 [see annex 4]

5. Resolution regarding the appointment of Honorary Treasurer[see Resolution 3 in annex 5]

6. Presentation and discussion of options for a revised Council structureThese are likely to necessitate a change to the rules at the 2014 AGM

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7. Presentation on implementation of BOA Research Strategy and implications for Joint Action

8. President’s report

9. Any other business

10. Date of next meetingCombined EFORT meeting – 4 – 7 June 2014 – London, under the Chairmanship of Prof. Tim Briggs and Dr ManuelCassiano Neves.

BOA Members only meeting – 12 – 13 September 2014 – Brighton, under the Chairmanship of Prof. Tim Briggs.

11. Future BOA and Allied MeetingsBOA Annual Congress – September 2015 – Liverpool, under the Chairmanship of Mr Colin Howie.

EFORT Congress – 27 – 30 May 2015 – Prague

NOTEBOA Home Fellows received the AGM notification and proxy form by post in advance of this meeting, explaining thearrangements for appointing a proxy. The BOA must be notified of any proxies at least 72 hours in advance of themeeting.

Items for discussion under ‘Any other business’ should preferably be advised to the Honorary Secretary at least 72 hoursin advance of the meeting, by contacting the BOA (contact details above).

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Tuesday 1st October

TUESDAY 1st OCTOBERHall 5 / Hall 10 Hall 9 Hall 7 Hall 6A

8.30 BJJOrthopaedic publishing in 2013

Primary Care at the BOA – Fillingthe Information Gap betweenPrimary and Secondary Care in

Orthopaedics**

10.00 COFFEE

10.30Infection in Orthopaedics –Assessment Diagnosis and

Management*

Simulation & TechnologyEnhanced Learning in Trauma and

Orthopaedics

BJJOrthopaedic publishing in 2013


Orthopaedics**

12.00 LUNCH

13.00Infection in Orthopaedics –Assessment Diagnosis and

Management*

Simulation & TechnologyEnhanced Learning in Trauma and

Orthopaedics

BJJOrthopaedic publishing in 2013


Orthopaedics**

14.30 TEA

15.00

17.30

Infection in Orthopaedics –Assessment Diagnosis and

Management*

Simulation & Technology Putting Simulation into Practice


Orthopaedics**

*This session is expected to be popular and overflow will operate with a live video link in Hall 10 if Hall 5 reaches capacity.

**Timings for these sessions vary from the rest of the programme. For full details of times see p14.

Notes


Tuesday 1st October

Simulation & Technology; Enhanced Learning in Trauma & OrthopaedicsSurgical simulation has been demonstrated to have validity in preparing surgeons for operative situations; however, time,commitment, and a structured approach are crucial to successful integration into training. Trauma and orthopaedics has a long andestablished track record in the areas of simulation and Technology Enhanced Learning (TEL). Whilst we must embrace newtechnologies, our priority must be the expert supervision of trainees and appropriate preparation of trainers. We will exploreaspects of simulation and TEL, which can be easily and inexpensively accessed by T&O trainers and trainees throughout thecountry. T&O surgeons then need to decide, based on intended specialty, identified learning gaps and resources available, how toachieve learning outcomes faster with minimal risk to patients. A section of the programme will be spent on planning options forintegration into practice.

The day will run from 10:30 to 16:30 and by the end, participants will be able to:1) Define the role of simulation and TEL in the wider context of surgical training2) Integrate new ideas for simulation and TEL into their own practice3) Identify sources of funding 4) Map simulation and TEL opportunities to the T&O curriculum

C Munsch – The Global Viewa) Contextualise lessons learned from overseas initiatives to the UKb) Explain how cardio-thoracic surgeons have integrated simulation into their curriculumc) Identify suitable sources of fundingd) Outline pearls of wisdom and potential pitfalls identified by other specialties

B Bhowal, J Nichols & V Roberts – E-learning and Monthly Case-Based discussiona) Describe the virtual learning environment in Leicester and its role in surgical trainingb) Identify own needs as a trainer to support engagement with TEL

C Colton – Wikipaedics a) Explain the future role of Wikipaedics within the wider context of e-learning

P Fearon – T&O Boot Campa) Describe the aim, process and costs of the Newcastle boot campb) Identify the key components of evaluationc) Consider options for national roll out

C Kellet – Putting Simulation into Practicea) Link simulation strategy to the T&O curriculumb) Formulate a simple SWAT analysis for their own area of practice

A Gandhe – Touch Surgerya) Download Touch Surgery and use itb) Evaluate ways of integrating into practice

Revalidation/Instructional10:30 – 14:30

Hall 9

10:30 – 12:00

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Tuesday 1st October

N Kumar – Establishing a simulation facilitya) Formulate a strategy for setting up a simulation facilityb) Consider options for funding and maintenancec) Incorporate demonstrations of simulation technology into a conference / symposium

M Alfa-Wali – Keep it Simple and Think Creativelya) Outline the evolution of the home simulatorb) Plan ways of encouraging T&O trainees and trainers to create effective and efficient approaches to simulation.

J Barrie – Maximising Blackboard as an E-Learning Interfacea) Evaluate options for supporting e-learningb) Plan simple ways of using Blackboard in the surgical setting

T Lewisa) Access suitable medical apps for T&O practice/trainingb) Evaluate current options

P Turner & L Hadfield-Law – Putting Simulation into PracticeParticipants will have an opportunity to work up plans to develop and integrate simulation into the T&O curriculum

DISCUSSION

Lunch12:00 – 13:00

Registration Area

13:00 – 14:30

Tea Break14:30 – 15:00

Registration Area

15:00 – 16:00

Notes


Tuesday 1st October

Bone & Joint Journal Orthopaedic Publishing in 2013Orthopaedic Publishing in 2013 provides an essential guide for orthopaedic surgeons and researchers on all aspects of writing andpublishing. Presented by the highly experienced editorial and publishing staff of The Bone & Joint Journal (formerly known as JBJSBr), topics will include peer review, statistics, publishing metrics, fraud, editing and marketing scientific journals, and many more.You will also find sessions on what journal editors are seeking, and on what to expect once your paper has been accepted.Whether you are aiming to publish your first paper, or are already an experienced author, reviewer or even editor, thiscomprehensive update of current publishing practice will prove invaluable.

Introduction – F Haddad Ups and downs of peer review – F HaddadThe History of The Bone & Joint Journal – J Scott Publishing metrics – a simple guide – Peter Richardson

Making sense of outcomes – M Costa What an author seeks – J WittStatistics for the busy clinician – A Petrie What a trainee seeks – J PalanSpotting the fraudulent paper – N Parsons So you want to write a novel? Publishing for the mass market – R SwiftWhat an editor seeks – F Haddad

Seeking perfect English – G Scott Marketing a scientific journal – L StephensonHelping staff to publish – R Field So your paper has just been accepted? – E VoddenCME in orthopaedic publishing – D Limb Video in orthopaedic publishing – A BajwayEditing a specialist journal – R Spencer Social media and orthopaedics – V Khanduja

Discussion / Closing Remarks – F Haddad

Coffee10:00 – 10:30

Registration Area

10:30 – 12:00

08:30 – 10:00

Lunch12:00 – 13:00

Registration Area

13:00 – 14:30


Hall 7

Tea Break14:30 – 15:00

Registration Area

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Tuesday 1st October

Update on Infection in Orthopaedics

Chairs: Professor I Stockley & Dr M Morgan

Microbiology for Orthopaedic Surgeons – Dr R Townsend, Consultant MicrobiologistPrevention of Infection – M Reed, Consultant Orthopaedic SurgeonAntibiotics and Biofilms – Dr R Bayston, Associate Professor & Reader in Surgical Infection

Chairs: Dr R Townsend & E Smith

Super bugs – Dr M Morgan, Consultant MicrobiologistSurgical Management of Soft Tissue Infection – A Fitzgerald, Consultant Plastic and Reconstructive SurgeonOsteomyelitis – M Dennison, Consultant Orthopaedic Surgeon

Chairs (a) A Cole & (b) J Webb

DISCUSSION

Clinical Manifestations of Infection(a) Spines(b) Arthroplasty

Lunch12:00 – 13:00

Registration Area

Tea Break14:30 – 15:00

Registration Area


Hall 5 / Hall 10

Session 110:30 – 12:00

Session 213:00 – 14:30

Session 315:00 – 16:30

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Tuesday 1st October

Primary Care at the BOA;Filling the Information Gap between Primary and Secondary Care in Orthopaedics

Evidence Based Referral Pathways – J Dias MSK Commissioning – The GP Perspective – T MarghamGetting it Right First Time – T Briggs How Commissioning Will Work – Commissioner tbc

The Weak/Stiff/Unstable Shoulder – D Clark The Tingling Hand – J DiasSubacromial Shoulder Pain – R Kulkarni

Hip Pain – J Timperley Foot and Ankle Pain – I WinsonSurgery for Painful Knee Arthritis – A Price

Neck Pain – A ColeLower Back Pain – J Carvell

Roundup and RoundtablePanel – J Dias, T Margham, L Horman, T Briggs, W Savior

Coffee10:30 – 11:00

Registration Area

Lunch12:30 – 14:00

Registration Area

Tea Break15:30 – 16:00

Registration Area


Hall 6A

Session 1: Commissioning of Care09:00 – 10:30

Session 2: Upper Limb11:00 – 12:30

Session 3: Lower Limb14:00 – 15:30

Session 4: Spine and Roundtable16:00 – 17:30

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Wednesday 2nd October

WEDNESDAY 2nd OCTOBERHall 1 Hall 11b Hall 9 Hall 8 Hall 11A Hall 10 Hall 7a Hall 7b

8.00

Free PapersHip 1

Revalidation /Instructional

MedicolegalPractice

Pain,Percentages,

Advancement/Accelleration

and other nebulous

concepts inMedicolegal

practice


TraumaBootcampSession 1

Upper Limb

Free PapersKnee

Free PapersElbow &Shoulder


Infection vsTumour

GCPMandatoryTraining for

OrthopaedicSurgeons

Good Clinical(Research)Practice:Annual

MandatoryTraining

Session 1 –Theme:

Regulations forClinical***

Introduction toBasic Science

Course forRevalidation &Preparation for

FRCS(Orth)

9.30 COFFEE

10.00


Hips– Instabilityafter THR


Arthritis &Arthroscopy inWrist & Hand

Surgery

Free PapersTrauma 1


AnteriorCruciateLigamentRupture


The stiff andpainful Elbow

Free PapersBOOS &

Education

GCPSession 2 –

Theme:Process of

ClinicalResearch


TraumaDebates in

OrthopaedicPractice –

Conservative orSurgical

Managementof Clavicular

Fractures

11.30 Opening Ceremony (Hall 1)

12.00 Housekeeping HOT TOPIC 1 (Hall 1)

12.15 Howard Steel Lecture – Mark Stevenson “The Big Shift” (Hall 1)

13.00 LUNCH

13.45 Presidential Guest – Henrik Malchau “Putting Evidence into Action” (Hall 1)

14.30 An interview with Keith Willett (Hall 1)

15.15

Free PaperHip 2

Free PapersHands

Free PaperTrauma 2

Adrian HenryBasic Science of

LigamentBalancing inTotal Knee

ReplacementJames Stiehl [US]


BESSUpdate onProximalHumeralFractures

The Future ofOrthopaedic

Education – Around TableDiscussion

GCPSession 3 –

Theme:Challenges in

ClinicalResearch

ARUK ClinicalStudies Group

16.00 CharnleyEthics Probity

and Science. Thehistory ofThrombo-

prophylaxis inHip and KneeReplacement

Surgery Robert Barrack

[US]

16.45 TEA

17.15 Walter Mercer Lecture – Jimmy Hutchison “Lessons from Beyond the Grave” (Hall 1)

18.00 CONGRESS RECEPTION (6pm – 7:30pm)

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Hip 1Chairs: A Manktelow, A HowellDetails available on page 61

Medicolegal PracticePain, Percentages,Advancement/Acceleration and otherNebulous Concepts in Medicolegalpractice

The Legal Perspective – G Eyre (Barrister)The Pain Perspective – Dr C Pither(Consultant Anaesthetist/PainManagement)The Psychiatrist's Perspective – Dr L Neal(Consultant Psychiatrist)The Orthopaedic Perspective – M Foy(Consultant Orthopaedic Spinal Surgeon)

Trauma: Bootcamp Session 1 – Upper LimbSession I: Upper Limb – Chairs: E Harvey/A Oppy

Clavicle- Fix it or Leave it? – B OllivereHumerus – Nail or Plate or Leave? – M KellyElbow- Get Out of Jail Cards – D StanleyWrist- K-Wire/Plate or Ex Fix? – M CostaCases and Discussion – All

Free Papers08:00 – 09:30 BHS

Hall 1


Hall 11B


Hall 9

Knee 1Chair: TBCDetails available on page 64

Elbow & ShoulderChairs: D Tennant, T LawrenceDetails available on page 68

Infection vs TumourOsteomyelitis or Bone Sarcoma – M McNallyCritical Imaging for Infection or Sarcoma– S OstlereThe Infected EndoprostheticReplacement – L JeysInfection or Soft Tissue Sarcoma – TBC

Session 1Regulations for Clinical ResearchCertificate awarded for completed course(continues at 10:00)

Free Papers08:00 – 09:30 BESS

Hall 11A

Revalidation/Instructional08:00 – 09:30 BOOS

Hall 10

GCP Mandatory Training forOrthopaedic Surgeons

08:00 – 09:30

Hall 7A

Free Papers08:00 – 09:30 BASK

Hall 8

Introduction to Basic ScienceCourse for Revalidation &Preparation for FRCS(Orth)

Instability after THRCauses and Prevention of Dislocation- J TimperleyWhen Dislocation Occurs – R FieldAlgorithm of Managing Early Dislocation– P KaySurgery for Recurrent Dislocation– G BannisterThe Scale Cost and Potential Solutions– F Haddad

Arthritis & Arthroscopy in Wrist& Hand SurgeryCurrent state of PIP Joint Replacement –A Watts / J HobyWhat’s new in Basal Thumb Arthritis– I TrailSLAC/SNAC and Wrist Replacement– G PackerArthroscopic Advances – C Heras-Palou

Coffee09:30 – 10:00

Hall 3

Revalidation/Instructional10:00 – 11:30 BHS

Hall 1

Revalidation/Instructional10:00 – 11:30 BSSH

Hall 11B


Hall 7B

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Trauma 1Chairs: B Ollivere, M KellyDetails available on page 71

Anterior Cruciate LigamentRuptureBasic Science – A AmisHistory and Risk Factors – R ParkinsonNatural History – D DeehamSurgical Management – T SpaldingRehabilitation – T Smith

The Stiff and Painful ElbowClassification and Aetiology – T LawrenceOpen Surgical Management– L RymaszewskiArthroscopic Treatment – A Watts

Oncology & EducationChairs: M Gibbons, G CribbDetails available on page 74

Revalidation/Instructional10:00 – 11:30 BASK

Hall 8

Revalidation/Instructional10:00 – 11:30 BESS

Hall 11A

Free Papers10:00 – 11:30 BOOS

Hall 10

Free Papers10:00 – 11:30 BTS

Hall 9

Session 2Process of Clinical ResearchCertificate awarded for completed course(continues at 15:15)

Trauma: Debates inOrthopaedic PracticeConservative or Surgical Management ofClavicular Fractures

The Big ShiftMark Stevenson

Revalidation/Instructional10:00 – 11:30 BTS

Hall 7B

Opening Ceremony11:30 – 12:00Hall 1

Housekeeping & Hot Topic 112:00 – 12:15Hall 1

Howard Steel Lecture12:15 – 13:00Hall 1

Lunch13:00 – 13:45

Hall 3


10:00 – 11:30

Hall 7APutting Evidence into ActionHenrik Malchau

Professor Keith WillettNational Director of Acute Episodes

Hip 2Chairs: A Acornley, J NolanDetails available on page 77

HandsChairs: L Leonard, I ChakrabartyDetails available on page 79

Trauma 2Chairs: T Chesser, N RossiterDetails available on page 82

Free Papers15:15 – 16:00 BHS

Hall 1

Free Papers15:15 – 16:45 BSSH

Hall 11B

Free Papers15:15 – 16:45 BTS

Hall 9

An Interview with Keith Willett14:30 – 15:15Hall 1

Presidential Guest Lecture13:45 – 14:30Hall 1

Notes



BASKLigament Balancing with Computer-AidedSurgery – J Stiehl

Update on Proximal HumeralFracturesCurrent Concepts and Update on PROFRTrial – A RanganThe Evaluation of Proximal HumeralFracture Treatment – M Robinson

A Round Table DiscussionChair: D StanleyImproving Education for OrthopaedicSurgeons – J Owen – President – AOARecertification of Orthopaedic Surgeons– R Lander – President – NZOAThe Intercollegiate Speciality Examinationin Trauma & Orthopaedics – D Stanley –Honorary Secretary – BOA

The Future of OrthopaedicEducation

15:15 – 16:00

Hall 10

Adrian Henry Lecture15:15 – 16:00

Hall 8

Revalidation/Instructional15:15 – 16:45 BESS

Hall 11A

Session 3Certificate awarded for completed courseChallenges in Clinical Research

Ethics, Probity and ScienceThe History of Thromboprophylaxis in Hipand Knee Replacement Surgery – R Barrack

Lessons from Beyond the Grave – J Hutchison (Introduced by I Ritchie,President RCS Ed)

Walter Mercer Lecture17:15 – 18:00Hall 1

Congress Reception18:00 – 19:30

Hall 3

Charnley Hip Lecture16:00 – 16:45 BHS

Hall 1

Tea Break16:45 – 17:15

Hall 3

ARUK Clinical Studies Group15:15 – 16:45

Hall 7B


15:15 – 16:45

Hall 7A

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Thursday 3rd October

THURSDAY 3rd OCTOBERHall 1 Hall 10 Hall 9 Hall 8 Hall 11A Hall 7 Hall 6

8.00

The New Cultureof Data Collectionin Orthopaedics

Free PapersFoot & Ankle Best of the Best Free Papers

Research

Free PapersBLRS/BTS

General Trauma


BASSThe management

of lumbardegenerative

disorders and rootcompression

Best of the Best:CSOS Free papers

9.30 COFFEE

10.00

NJR – TenthAnnual Report

VideoPresentationMTP Fusion/

Cheilectomy –How I do it

J Baumhauerand Faculty

Best of the Best


Research

Research inOrthopaedic

TissueEngineering;

Focus onTranslation


Muller, Ilizarovand the

Management ofPeri-Articular

Fractures

Free PapersSpine

Free PapersKnee, EnhancedRecovery, NICE &Clinical Practice10.45

Naughton DunnLecture

Evidence VersusAnecdote in Foot& Ankle Surgery

J Baumhauer

Roadway Trauma –A Rapidly

ProgressingProblem

WorldwideJohn Tongue

(AAOS)

11.30 Housekeeping HOT TOPIC 2 (Hall 1)

11.45 Robert Jones Lecture – Peter Kay – Innovation and Safety – Who should be Responsible? (Hall 1)

12.30 AGM

13.30 LUNCH

14.15 Revalidation /InstructionalNJR UpdateHow does

evidence drivepractice in hip andknee arthroplasty

surgery?


BOFASForefoot Surgery –Current Treatment

Options


CSOSManagement of a

severelytraumatised limb


Research inOrthopaedics and

Trauma

Free PapersPaediatrics


BOTAYou’re hired –

Confessions of anew Consultant

Free PapersComputer

Assisted Surgery,Audit &

Management

15.45 TEA

16.15

NJR Q&A Revalidation /Instructional

RASSThe Rheumatoid

Foot & Ankle

Free PapersGeneral

BORS / BOTAPrize Papers


BSCOS – Bone &Joint Infection in

the Child

The safe use ofBone

MorphogenicProtein – A 2013Update and Lookinto the Future

Scott Boden (AOA) TPD Forum(closed session)Paul Manning17.00 Arnott

Demonstration(from RCS Eng)Arthroscopic

Anatomy of theHip Joint

Vikas Khanduja

Free PapersAudit &

Management

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Notes

British Orthopaedic AssociationCaring for Patients; Supporting Surgeons


The New Culture of DataCollection in OrthopaedicsNon Arthroplasty Hip Register (NAHR) –M BankesBritish Spine Register (BASS) – L BreakwellKnee Ligament Register – S O’LearyNational Hip Fracture Database (NHFD) –D MarshBSCOS Register – T TheologisBSSH Hand Audit – S FulliloveFoot and Ankle Outcome Data (BOFASSOFA) – A GoldbergShoulder Register – J ReesMy Clinical Outcomes – D WilliamsChanging the Culture for data collectionin Orthopaedics. The UK – leading theworld? – J TimperleyRegisters: an overview from NICE – Dr H Patrick Consultant Clinical Adviser

Foot & AnkleChairs: M Solan, R RussellDetails available on page 87

Best of the BestChair: T BriggsDetails available on page 90


Hall 1

Free Papers08:00 – 09:30 BOFAS

Hall 10

Free Papers08:00 – 09:30

Hall 9

ResearchChairs: A McCaskie, A SprowsonDetails available on page 90

Limb Reconstruction,General TraumaChairs: S Royston, M JacksonDetails available on page 93

The Management of LumbarDegenerative disorders andRoot CompressionNeurogenic Claudication: Presentation,Diagnosis, Management – A WaySciatica: Conservative and SurgicalManagement – J LangdonDegenerative Spondylolisthesis– R NaderajahLumbar Degenerative Disease: SurgicalOutcomes – R Shetty

Best of the Best: CSOS FreePapersChair: J Getty, G Hill


Hall 11A

Revalidation/Instructional08:00 – 09:30 BASS

Hall 7


Hall 8


Hall 6

NJR – Tenth Annual ReportChair: P Gregg, Vice Chairman, NJRSteering CommitteeOpening Remarks – L Powers-Freeling –Chairman NJR Steering Committee10th Annual Report – Keynote Findings –M PorterViews From a Patient – S Musson –Patient Representative – NJR SteeringCommitteeClinician Feedback Update – P HowardData Quality and Surgeon Engagement –P GreggODEP for Knees and Beyond ComplianceUpdate – K TuckerReport from the Current NJR ResearchFellow – J PalanMortality after Hip Replacement– A Blom

DISCUSSION

MTP Fusion/CheilectomyChair: James DavisHow I do it – J Baumhauer

Evidence Versus Anecdote inFoot and Ankle SurgeryJ Baumhauer

Coffee09:30 – 10:00

Hall 3


Hall 1

Video Presentation10:00 – 10:45

Hall 10

Naughton Dunn Lecture10:45 – 11:30

Hall 10

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Best of the BestChair: T BriggsDetails available on page 90

Roadway TraumaChair: T BriggsA Rapidly Progressing ProblemWorldwide – J Tongue – AAOS PastPresident

Orthopaedic TissueEngineering; Focus onTranslationIntroduction – A McCaskieStem Cells to Heal Meniscal Tears– A HollanderEnhancing Bone Remodelling Around theImplant Interface Using Stem Cells– G BlunnClinical Trials for Cartilage Repair – J RichardsonSkeletal Stem and Progenitor Cells forBone Regeneration – R OreffoClinical Trials For Bone Repair – D DunlopDiscussion – A McCaskie


Hall 9

Current Concepts10:45 – 11:30

Hall 9


Hall 8

Muller, Ilizarov and theManagement of Peri-ArticularFractures

Historical Review – M JacksonThe Simple Peri-Articulr Fracture (Case-based Discussion) – S Royston, C MoranThe Complex Peri-Articular Fracture(Case-base discussion) – S Royston & C MoranBone Loss and Non-Union (Case baseddiscussion) – S Royston & C MoranPros, Cons & Common Ground – Ilizarov– S RoystonMuller/AO – C Moran

SpineChairs: J Langdon, A StirlingDetails available on page 97

Knee, Enhanced Recovery, NICE & Clinical PracticeChairs: I Winson, D ClarkDetails available on page 100


Hall 11A

Free Papers10:00 – 11:30 BASS

Hall 7


Hall 6

Housekeeping & Hot Topic 211:30 – 11:45

Hall 1

Innovation & SafetyWho Should be Responsible? – Peter Kay

NJR UpdateHow does Register EvidenceDrive Practice?Chairs:

What is Evidence? – A CarrHow does Registry Evidence drive HipPractice? – F HaddadHow does Registry Evidence drive KneePractice? – C EslerViews from the recent NJR Research Fel-lows: Hip – S Jameson, Knee – P BakerReport from the Current NJR ResearchFellow – J PalanHow to become an Outlier OrthopaedicSurgeon – P Howard

Robert Jones Lecture11:45 – 12:30

Hall 1

BOA Annual General Meeting12:30 – 13:30

Hall 1

Lunch13:30 – 14:15

Hall 3


Hall 1

Notes



Forefoot Surgery – CurrentTreatment OptionsBiomechanics of the Foot and Ankle – N MakwanaHallux Valgus – Complications and Howto Manage Them – F RobinsonHallux Rigidus – Complications and Howto Manage Them – J BaumhauerLesser Toe Disorders – Jim Barrie

Amputations & ProstheticsManagement of a severely traumatisedlimb – Role 3 Initial management– Lt Col D GriffithsManagement of a severely traumatisedlimb – Role 4 Reconstruction – Wing Cdr J KendrewRehabilitation and prosthetics – Lt Col R Phillips

Research in Orthopaedics and TraumaPortfolio Trials in T&O – Current Activityand Future PlansRoyal College of Surgeons of England’sClinical Research Initiative – Centres andSpecialty LeadsRole of the UKCRN


Hall 10


Hall 9

Revalidation/Instructional14:15 – 15:45 BORS

Hall 8

PaediatricsChairs: C Bruce, J Robb, M GarganDetails available on page 103

You’re hired – Confessions of anew ConsultantHow to get that Consultant Job; What theNHS Trust wants from you – R Hurd, ChiefExecutive of RNOHConfessions of a New Consultant – S Cook – BOTA Trainer of the Year 2012Starting a Private Practice

Computer Assisted Surgery,Audit & ManagementChairs: T Hui, D O’DohertyDetails available on page 106

Revalidation/Instructional14:15 – 15:45 BOTA

Hall 7


Hall 6

Tea Break15:45 – 16:15

Hall 3

Free Papers14:15 – 15:45 BSCOS

Hall 11A

NJR Q & AChair: C HowiePanel representatives of the NJRcommittees: Your opportunity to probethe NJR

Arthroscopic Anatomy of theHip JointV Khanduja

The Rheumatoid Foot & AnkleModern Perspectives on the RheumatoidFoot – C BlundellHow to Manage the RheumatoidHindfoot – P LaingTotal Ankle Joint Arthroplasty in theRheumatoid Patient – S Dhar

GeneralChair: TBCDetails available on page 109


Hall 10


Hall 9

Arnott Demonstration (RCS England)

17:00 – 17:45

Hall 1


Hall 1

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BORS / BOTA PrizeChairs: A McCaskie, A SprowsonThis session features the collaboration ofthe British Orthopaedic Research Societyand the British Orthopaedic TraineesAssociation. Earlier in the year thecompetition was launched and thissession sees the highest ranking paperspresented in order to select the prizewinner.

Details available on page 113

ResearchChairs: A McCaskie, A SprowsonDetails available on page 114

Bone & Joint Infection in the ChildThe Microbiology of Bone and JointInfection – M KatchburianDiagnosis and Investigation – C BruceManagement – D Rowland


Hall 11A


Hall 8


Hall 8

The Safe Use of BoneMorphogenic ProteinChair: J DiasA 2013 Update and Look into the Future– S Boden

Audit & ManagementChairs: A Nanu, G MatthewsDetails available on page 115

Closed Session for Training ProgrammeDirectors only.

TPD Forum16:15 – 17:45

Hall 6


Hall 7


Hall 7



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Friday 4th October

FRIDAY 4th OCTOBER

Hall 1 Hall 10 Hall 9 Hall 11A Hall 7 Hall 8A Hall 8B

8.00

TraumaBOOTCAMP

(OTS)

Free PapersGeneral


The Value of thePatient Voice?

ProfessionalIssues

FinancialPlanning for

Surgeons

Free PapersSports Trauma

including Foot &Ankle

ClinicalExaminationCourse***


8.45 CurrentConcepts

The Assessmentand

Management ofthe Painful Stiff

Knee afterArthroplasty

SurgeryJohannes Devos

(SAOA)


MusculoskeletalClinical

Networks in theNew NHS

9.30 TEA BREAK

10.00

TraumaBOOTCAMP

(OTS)

NHFDThe NHFD 2012-

13 Report


BODSAppraisal /

RevalidationUpdate

ARUKYoung

Investigators’Award


Sport &Osteoarthritis



11.30 Putting Leadership into Action: Perspectives from T&O (Hall 1)

13.00 Closing Ceremony / Housekeeping HOT TOPIC 3 (Hall 1)

13.45 LUNCH

14.30

TraumaBOOTCAMP

(OTS)


BOSA and theNew NHS

AGMTalkback


CAOSTechnology: It’svalue and the

evidence


WOCDeveloping a

consultant led,NHS linked,

trainingfellowship in

Cambodia



16.00 Close of Meeting

***Session has limited capacity and will only be open to those who pre-booked using the online survey. These attendees have beenpre-notified via email.

Notes


Friday 4th October

Trauma Boot Camp (OTS)Session II: Lower LimbChairs: Professor C Moran, A OppyHip Fractures – Importance of MakingTariff – K WillettFemoral Fractures;Bifocal/Segmental/Retrograde Nails – M KellyDistal Femoral Fractures – A GrayTibial Plateau Fractures; Two PlatesBetter than One? – J Keating Pilons – Remember the PosteriorApproach – D NoyesCases and Discussion – All

GeneralChairs: J Hodgkinson, R RavikumarDetails available on Page 117

Chair: C HowieThe Assessment and Management of thePainful Stiff Knee after ArthroplastySurgery – J Devos [SAOA President]

The Value of the Patient Voice?The Value of the PLG – a Surgeonsperspective – D McBrideFrom Patient to Patient Champion – J Fitch


Hall 1


Hall 10


Hall 10


Hall 9

How the Patient Voice can Improve thePatient Pathway – D Twigg

Musculoskeletal ClinicalNetworks in the New NHSARMA and its Clinical Network Project –D MarshMusculoskeletal Services and NHSEngland – P KayThe BOA’s Drive to Modernise Services –M Porter

Financial Planning for SurgeonsThe Changing Face of RetirementPlanning – I Price, Division DirectorPension at St. James’s Place WealthManagementAlternative Tax Efficient InvestmentStrategies – S Ruthers, Oxford CapitalPartnersMedical Indemnity Insurance – G Monaghan, Director, PMPPrivate Practice Structures and ExitStrategies – S Norris and T Rust, PetersElworthy & Moore AccountantsFinancial Planning Solutions for Surgeons– A Hodgson, Partner Practice at St.James’s Place Wealth Management

Sports Trauma and Foot & AnkleChairs: M Carmont, M DobsonDetails available on page 118


Hall 9

Professional Issues08:00 – 09:30

Hall 11A


Hall 7

Clinical Examination CourseSession 1: Clinical Examination LecturesChair: F AliExamination of the Hip – P BanaszkiewiczExamination of the Knee – J WilliamsExamination of the Foot and Ankle– S JonesExamination of the Spine - I BraithwaiteExamination of the Shoulder and Elbow –S ShahaneExamination of the Hand and wrist –J Garcia

Trauma Boot Camp (OTS)Session III Multiple injuries/High EnergyTraumaChair: Dr John Tongue/Mike KellyWho’s in Charge?; What we HaveLearned Across 22 MTCs – C MoranOperating at Night; The MythsSurrounding Open Fractures andCompartment Syndrome – T WhitePriorities for Fixation; Best GuessOrthopaedics – D ForwardCases and discussion – All

Coffee09:30 – 10:00

Hall 3


Hall 1


Halls 8A and 8B

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Friday 4th October

The NHFD 2012-13 Report – R WakemanFracture Liaison Services – D MarshHow to improve Hip Fracture Care in yourHospital; 10 little things that make a bigdifference – A RuckledgeDiscussion – All

Appraisal / Revalidation UpdateRCS/BOA Perspective – D LimbMedical Director’s Perspective – D Wise

Arthritis Research UK will updatedelegates on key new developments andhighlight research strategy and fundingopportunities. The session will alsoshowcase excellence in orthopaedicresearch as the finalists of the ArthritisResearch UK young investigator awardwill present from the podium.

Chairs: Brigitte Scammell and AndrewMcCaskie

ARUK Young Investigators’Award

10:00 – 11:30

Hall 11A


Hall 9

NHFD 2012-13 Report10:00 – 11:30

Hall 10

Sport and OsetoarthritisDoes Exercise Cause Osteoarthritis; HowWill We Ever Know the Answer?– N Arden

What Exercise Minimises the Risk of OAin the Adult – M BattWhat Exercise is Best in Managing Adultswith Established OA – J NewtonHow do we Minimise the Risk of OA afterInjury and Surgical Reconstruction?

Shoulder – S RobertsKnee – F HaddadAnkle – N Maffuli

Clinical Examination CourseSession 2 Clinical Examination Practicein Small Groups in RotationShoulder – S ShahaneElbow – J WrightHand and Wrist – J GarciaPeripheral Nerves – J Fernandes and F AliSpine – I BraithwaiteHip – P BanaszkiewiczKnee – J WilliamsFoot and Ankle – S Jones

A case-based panel discussionChair: M PorterPanel – T ClaysonProf Sir K PorterJ PalanS YoungR Middleton

Putting Leadership into Action – Perspectives from T&O

11:30 – 13:00

Hall 1


Hall 7


Halls 8A and 8B

Trauma Boot Camp (OTS)Session IV: Strategies for Complex CasesChair: N RossiterAcute pelvic (and Acetabular) injury-binders and ex-fixes, c-clamps – T ChesserPeriprosthetics- burn the strut grafts? –M MoranDelayed union, Malunion Non-union –When fractures misbehave – M JacksonUpper limb Tips and Tricks – Clavicle,Shoulder, Humeral shaft, Distal Humerus,Elbow, WristPelvis and Femur tips and tricks – Pelvicex-fix, Femoral head, Intertrochanteric,Subtrochanteric, Distal femurTips and Tricks tibia – Plateaus, Tibiashaft, Pilons, Ankle, Calcaneum, FootClosing Remarks – M Kelly

Lunch13:45 – 14:30

Hall 3


Hall 1

Closing Ceremony & Presidential Handover

13:15 – 13:45

Hall 1

Housekeeping & Hot Topic 313:00 – 13:15

Hall 1

Friday 5th October

British Orthopaedic AssociationCaring for Patients; Supporting Surgeons28

Notes

BOSA and the New NHS –Maintaining Standards and BestPatient CareThe New NHS – Prof T BriggsThe GMC Perspective – D MerciecaThe Intercollegiate FRCS T&OExamination – D StanleyThe SAS Orthopaedic Surgeon in the NewNHS – S Shalaby

With the BOA Officers

Technology: Its Value and theEvidenceThe Critical Margin in OrthopaedicOncologic Surgery – Cutting Edge withNavigation Guidance? – A Mahendra, S PattonSurgical Techniques; Surgery Made Easierwith Technology – Is it True? – D Nathwani, A Tom, R StrachanOutcomes: Does the Technology Make itBetter? – K Mahalkar, M Sanjiv, F RodriguezCAS/Robotic Technique for a VeryExperienced Surgeon – Professor L Dorr


Hall 11A

AGM Talkback14:30 – 16:00

Hall 9


Hall 10

World Orthopaedic ConcernChair: S MannionDeveloping a Consultant-led, NHS linked,Training Fellowship in Cambodia – F MonsellCapacity buidling in Afghanistan – H BuddThe Challenge of rquipping healthcarefacilities effectively in the developingworld – T BeaconFree Papers

Clinical Examination CourseSession 3: Continuation of Session 2 (seeabove)


Hall 7


Hall 8A and 8B

Friday 4th October

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Exhibition

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Acumed Ltd 108Huebner House, The Fairground, Weyhill,SP11 0QN, United KingdomTel: +44 (0) 1264 [email protected]

http://www.acumed.net

A world leader in orthopaedic solutions,Acumed® has built a reputation on ourunwavering commitment to theCollective Outcome – successfulprocedures for the patient, surgeon andhospital. From our patented headlesscompression screws, to the mostinnovative instruments currently indevelopment, every Acumed product isdesigned with the single goal of creatinga more effective, and efficient medicalprocess. We’re creating tools intended tominimize time in the operating room andimprove patient success rates, which allcontribute to the hospital’s bottom line.This dedication to the communityextends beyond healthcare, too, as westrive to make a positive impact at theglobal level through

Adler Ortho 170Via dell’Innovazione 9, 20032 Cormano(Milano), ItalyTel: +39 02 [email protected]

Adler Ortho is an Italian Companyspecialized in developing andmanufacturing state of the art Hip andKnee Implants. Continuous innovation,responsiveness, and focus on customersatisfaction are the Company mainqualities.

Adler Ortho is particularly proud ofoffering the widest product portfolio ofPowder Manufactured implant on themarket, and of having developed Ti-Por®,the monolithic 3D surface, build tomaximize primary stability and bone

ingrowth.Adler Ortho is focused on making

surgical procedures easier, and morereproducible.

An example of that is the Genus MagicBlock a device able to assist to provideproper knee alignment in extension andflexion without violating the femoralcanal.

Advance Recruitment 18Stafford Court, 145 Washway Road, Sale,Cheshire, M33 7PETel: 0161 969 [email protected]

Advance Recruitment are specialists inmedical sales and marketing recruitmentfor leading healthcare, pharmaceutical,dental and veterinary companiesthroughout the UK. Our business hasbeen built on achieving results in thesearch and selection of Medical SalesProfessionals, Sales Managers,Marketing Personnel, Trainers, NurseAdvisors and Field Service Engineers. Werecruit at all levels from Graduate orRGN Trainee through to ExperiencedSales Executives, Managers and Directorswith companies involved with a range ofmedical products. Our infrastructureallows us to deal with clients, both largeand small, throughout the UK.

Visit stand 18 and we will get thesearch underway immediately.

Advancis Surgical 56Lowmoor Business Park, Lowmoor Road,Nottingham, NG17 7JZ, United KingdomTel: 01623 [email protected]://www.advancissurgical.com

Advancis Surgical has been developed tobring to market new and excitinginnovative technology. We prideourselves on the ability to take ideas,develop them and create products thatbring increased benefits to patients butalso offer surgeons, anaesthetists andperfusionists a new way of improving theblood recycling process.Hemosep, the first product to belaunched through Advancis Surgical, isdesigned to recover blood spilled duringopen-heart and major trauma surgeryand concentrate the blood cells fortransfusion back to the patient. Theprocess reduces the volume of donorblood required and the problemsassociated with transfusion reaction.

Aesculap Academia 42Thorncliffe Park, Sheffield, S35 2PW,United KingdomTel: 0114 225 [email protected]://www.aesculap-academia.co.uk

Globally recognised Aesculap Academia,created in 1995, aim to deliver highquality education programmes for allhealth-care professionals.

Our dedicated team of eventspecialists can realise your objectives,offering creative & economically feasible

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solutions to deliver & support you &your event.

We work closely with health-careprofessionals, both nationally &internationally, from those at thebeginning to those at the very pinnacleof clinical practice.

We can identify the need for training& draw together relevant faculties &programmes to create innovativeeducational events of the highest calibre.

We look forward to discussing futureworking partnerships with you.

Angiotechhttp://www.quilldevice.com 66355 Burrard St, Vancouver, V6C 2G8,Canada

The Quill™ Knotless Tissue-ClosureDevice is indicated for soft tissueapproximation.

It is designed with barbs helicallyarrayed around a suture material, inopposing directions, on either side of atransitional segment. The device isdouble-armed with surgical needles andcomes in both absorbable and non-absorbable materials.

The Quill™ device eliminates both thetying of knots to secure closure and theneed for a third hand.

Quill™ allows for a more evendistribution of tension on the soft tissuesas they are approximated, with tensiondistributed along the entire length of thewound.

AOUK 58AOUK, Marlborough House, YorkBusiness Park, York, YO26 6RW, UnitedKingdomTel: 01904 [email protected]://aouk.org

The AO Foundation is a charitableorganisation, which is dedicated to thepromotion of excellence in surgery ofmusculoskeletal trauma. AOUK is theAnglo-Irish section of the foundation andthrough its education departmentdelivers non-profit making courses in theUK & Ireland to train young surgeons andoperating room personnel in the theoryand practice of trauma.

The membership of AOUK consists of agroup of established surgeons and ORPswho freely give their time to teach onthe 30 courses that are run by AOUKannually.

AOUK also offer research grants andfellowships.

AposTherapy 50300 Grays Inn Road, London, WC1X 8BPTel: 0800 909 8009www.apostherapy.co.uk

AposTherapy offers a new approach forthe treatment and management of kneeconditions based on the latest scientificevidence regarding the central rolebiomechanics plays in the patho-physiology of knee OA and other kneepathologies. By combining optimal bodyalignment with controlled perturbationwhile walking as part of daily routine,AposTherapy restores neuromuscularcontrol, instilling desirable patterns ofmotion for significant reduction in pain,and improvement in function and qualityof life.

Arthrex Ltd 102Unit 5, 3 Smithy Wood Drive, SmithyWood Business Park, Sheffield, S35 1QN,United KingdomTel: 0114 232 [email protected]://www.arthrex.com/

Medical Education is at the very core ofArthrex’s foundations. Our uniquecommitment to dynamic medicaleducation is showcased at this year’sBOA Congress. The Mobile Lab, Europe’sfirst mobile surgical skills lab, is rollinginto the ICC to provide surgeons andhealthcare professionals with theopportunity for one-on-one educationaltraining and open sessions, where alldelegates can view the unique potentialof this new training method. VisitArthrex at Stand 102 for Mobile Labbookings and further information on oureducational programmes, includingeBooks, the new Arthrex.com, LiveSurgery courses, the Essential Skills Labin Sheffield, ArthroLab in Munich andmuch, much, more…

Arthritis Research UK 12041 Portland Place, London, W1B 1QHTel: +44 (0) 300 790 [email protected]

Arthritis Research UK are the leadingauthority on arthritis in the UK, fundingresearch into all types of arthritis andrelated musculoskeletal conditions. Ourfunding opportunities include schemessupporting individuals in developingtheir career in musculoskeletal research.These schemes range from PhD trainingand educational approaches, to large-scale programme grants andmulti-centre clinical trials. We are proudto sponsor a Young Investigator award at

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the Annual Scientific Congress this year,comprising two prizes. In conjunctionwith the BOA, we are committed to thefuture of UK orthopaedics. To find outmore visit our websitewww.arthritisresearchuk.org, or comeand meet us at stand 120.

ArthroCare UK Ltd 212St James Business Park, 9 Grimbald CragCourt, Knaresborough, HG5 8QB, UnitedKingdomTel: 01423 [email protected]://www.arthrocare.com/international

ArthroCare® has a different perspective,a global organisation dedicated toimproving outcomes by focusing oninnovation within the field of minimallyinvasive surgery. We don’t see the statusquo; we see opportunities to improve.

Our high-performance products arethe result of innovative thinking andpractical application of science andtechnology. Our goal is to give surgeonscomplete confidence in their tools anddeliver the accuracy, speed and precisionthey need to deliver better outcomes fortheir patients.

ArthroCare’s internationally patentedCoblation® Technology has significantlyimproved many existing surgicalprocedures and continues to enable newminimally invasive proced

Bauerfeind UK 194229 Bristol Road, Birmingham, B5 7UBTel: ++44 121 446 [email protected]

Bauerfeind is one of the world’s leadingmanufacturers of medical aids with 80years of experience & offers the medical

professional a wide range of qualityproducts within the following fields:Orthopaedics, Phlebology & FootOrthopaedics.

Orthopaedics. Our products are usedfor the treatment of injuries, post-operative & degenerative change – forrapid recovery and mobilisation.

Phlebology. We manufacture a widerange of medical compression stockingsfor the systematic treatment of mild tosevere venous disorders &Lymphoedema.

Foot Orthopaedics. The range includesfoot imprint systems, therapy shoes,support orthoses, and a foot care systemfor patients with foot problems.

Measurement Technology. Bauerfeindhave a range of innovative measuringsystems that have the ability to performrapid, exact measurements for the foot,spine and compression stockings.

B. Braun Medical Ltd 4Thorncliffe Park, Sheffield, S35 2PW,United KingdomTel: 0114 225 [email protected]://www.bbraun.co.uk

The Aesculap Orthopaedic Division of B.Braun Medical Ltd offer a comprehensiverange of primary and revision prosthesesfor both hip and knee arthroplasty, allsupported by the World LeadingNavigation System Orthopilot®. The newsoftware approaches navigation with areduced workflow and advancedalgorithms to provide optimized implantpositioning for the individual patient.

New material developments see theintroduction of Vitelene VitE XLPE andAS ceramic coated knee implants forallergy prevention and enhanced wearproperties.

Biocomposites 128Keele Science Park, Keele, Staffordshire,ST5 5NL, United KingdomTel: +44 (0) 1782 338 [email protected]://www.biocomposites.com

A Solution for Infection.Biocomposites is a privately held

orthobiologics company that designs,manufactures, markets and sells groundbreaking products. Our leadingtechnology, Stimulan®, is a patentedbiomaterial used internationally bysurgeons to combat infection associatedwith osteomyelitis, diabetes, surgery andhaematogenous complications.Stimulan is producing patient outcomespreviously unachievable with pre-existing materials in the fields ofinfection and bone regeneration.

Biomet 54Brocastle Avenue, Waterton Ind Estate,Bridgend, CF31 3XATel: 01656 [email protected]

Headquartered in Warsaw, Indiana,Biomet Inc. and its subsidiaries currentlydistribute reconstructive products inapproximately 90 countries. With annualsales well in excess of $2 billion and over7,000 team members worldwide Biometlooks to the future with a focus oncontinued growth and innovation.

Biomet’s portfolio reflects our heritageof clinically proven implants throughoutour Knee and Hip offerings. With anumber of 10A ODEP rated Hip productsand outstanding Knee survivorship rates,the pedigree of our implants is proven.

With its European headquarters inDordrecht, Netherlands and representedby subsidiaries in 22 European countries,including five manufacturing sites, acrossthe continent, Biomet offers aspecialised focus on European

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healthcare and orthopaedics. With ahistory of innovation andentrepreneurial flair, Biomet iscontinuously expanding its presence,with our service offerings of RapidRecovery and Theatre Care Rapidecontinuing to pursue ground-breakingconcepts for the European market place.

Bioventus 30International Headquarters BioventusCoöperatief U.A.Taurusavenue 31, 2132 LS Hoofddorp,The NetherlandsTel: +31 (0) 23-554-8888Customer Freephone: 00800-02-04-06-08www.BioventusGlobal.com

Bioventus is a biologics company thatdelivers clinically proven, cost-effectiveproducts that help people heal quicklyand safely. The company’s innovativeproducts include market-leading devices,therapies and diagnostics that make it aglobal leader in active orthopaedichealing. Built on a commitment to highquality standards, evidence-basedmedicine, and strong ethical behaviour,Bioventus is a trusted partner forphysicians worldwide. The company isthe recognized leader in bone healingdevices and among the leadingdistributors of osteoarthritis injectiontherapies.For more information, visitwww.BioventusGlobal.com

Blue Belt Technologies 44Office number 207, 3000 Aviator Way,Manchester Business Park, Manchester,M22 5TGTel: 07791198363www.bluebelttech.comContact info: Mr John Tierney – GeneralManager / VP Europe Email:[email protected]

Blue Belt Technologies, Inc is aninnovative medical technology companycommercialising the NavioPFS™orthopedic surgical system for initial usein Uni-compartmental KneeReplacement(UKR). NavioPFS™ providesa less invasive solution for partial kneereplacements, bringing to the operatingroom advanced robotic technologycoupled with intuitive and powerfulintra-operative planning and navigationsoftware. NavioPFS™ intelligenthandheld instrumentation providesrobotic enhancement in accuracy andrepeatability for the technicallychallenging UKR procedure, makingavailable to patients a solution which canadd years to the life of their knees.

Bluespier International 106Bluespier, Gaudet Luce Golf Club, MiddleLane, Droitwich, Worcestershire, WR97JR, United KingdomTel: 08450 62 62 [email protected]://bluespier.com/

Bluespier provides clinical systems forhospitals and Private Practice. They aredesigned to be part of normal workroutines, are highly configurable, capturekey clinical data and provide

administrative data as a by-product. Wespecialise in theatre and stockmanagement, trauma centremanagement, electronic clinical records,clinical correspondence, electronicdischarge, outpatient and pre-admissionclinic management. Data and reportingavailable from the system is used todrive efficiencies and help improvepatient care. Data is available on income,costs, utilisation, CQUINs, targetmanagement, registries and datasetreturns. Data is easily retrievable in realtime, accurate and detailed.

Bone & Joint Journal (formerly JBJS Br) 74The British Editorial Society of Bone &Joint Surgery, 22 Buckingham Street,London, WC2N 6ET, United KingdomTel: 020 7782 [email protected]://www.bjj.boneandjoint.org.uk

Visit stand 74 and be one of the first toreceive the new addition to The Bone &Joint Journal (formerly JBJS Br): BJJNews! Find out more about this excitinglaunch and how it complements theJournal.

We will also be offering a 10%discount on subscriptions, includingBone & Joint 360, our concise, global andessential digest journal for busyorthopaedic surgeons.

If you are a BOA member, you canactivate the online portion of yourmember benefit subscription to TheBone & Joint Journal quickly and easily atthe stand!

Plus, get information on the free Bone& Joint Journals app and sign up to alertsfor new research published on ourspecialty channels.

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CareFusion 2CareFusion, The Crescent, Jays Close,Basingstoke RG22 4BS, Basingstoke,RG22 4BS, United KingdomTel: 0800 917 [email protected]://www.carefusion.co.uk

CareFusion combines proven clinicaltechnologies with actionable intelligenceto improve patient care. Our employeesare focused on developing and bringingto market, solutions to today’s majorhealthcare challenges, for examplehealthcare associated infections (HAIs).

The CareFusion Infection Preventionmission is to deliver clinicallydifferentiated evidence-based productsand services that support the globaleffort to reduce HAIs.

ChloraPrep is illustrative of this focus.The only 2% chlorhexidine & 70% alcoholbased skin preparation system, licensedfor cutaneous antisepsis prior to medicaland surgical invasive procedures.

CeramTec GmbH 72CeramTec Platz 1 – 9, 73207 Plochingen,GermanyTel: 00497153611-0www.biolox.com

CeramTec’s BIOLOX® materials are themost widely used ceramic componentsin arthroplasty. They are extremely wear-resistant and biocompatible, helping toavoid particle disease and allergicreactions. Since 1974 more than ninemillion ceramic BIOLOX® ball heads andcup inserts have been used in hip joints.Ceramic components for knee joints arecurrently being introduced clinically.

Customers from the medical devicesindustry are constantly asking CeramTecabout new capabilities and uses ofbioceramics, therefore CeramTec isanalysing the market as well as themarket potential of new ceramic

applications such as for the spinal, dentaland shoulder arthroplasty as well assurgical instruments.

CeramTec GmbH is also aninternationally leading supplier ofinnovative technical ceramics for theelectronics, telecommunications,automotive, machinery, metal, electrical,and chemical industries.

C.J. Coleman & Company Limited 206Portsoken House, 155 Minories, LondonEC3N 1BTTel: +44 (0)20 7488 2211www.cjcoleman.comContact: [email protected] –07747 624080

C J Coleman “CJC” is the affinity schemebroker for members of the BritishOrthopaedic Association with over 25years experience in supplying indemnitydefence coverage to healthcareprofessionals. A well regarded insurancebroker in the international insurancemarket, CJC has the specialist knowledgeto find competitive indemnity solutions.CJC works for Orthopaedic Professionals,sourcing insurance with secure ‘A’ ratedinsurers, supporting them intoretirement with indemnity insurance,defensive insurance and 24/7 medico-legal advice.

C J Coleman & Company Ltd is anindependent Lloyd’s Broker authorisedand regulated by the Financial ConductAuthority.

Cover My Cast 18062 Aylesbury Crescent, Plymouth, Devon,PL5 4HXTel: [email protected]

The CastCooler addresses the two long-standing issues associated with cast

wearing – odour and itch. The root causeof these problems is moisture in thelining of the cast, as bacteria grow in thecast lining, odour and itch result. Untilnow, there was no way to effectivelyremove this moisture from the cast liningwithout touching the patient. TheCastCooler requires no changes to thecast application process or materials.The CastCooler is designed to be usedwith all breathable (fibreglass) casts andsimply connects to a domestic vacuumcleaner.

Cover My Cast are pleased to bringthis product to UK health professionalsalong with their range of washable fabriccast and splint covers.

Corin Group PLC 46Corin Group PLC, The Corinium Centre,Love Lane, Cirencester, GL7 1YJ, UnitedKingdomTel: 01285 [email protected]://www.coringroup.com

As a leader in orthopaedic innovation,Corin has pioneered a number oflandmark developments since itsfoundation. It is proud to have been ableto improve the quality of life ofthousands of patients around the worldthrough these groundbreaking productsand its commitment to ResponsibleInnovation. Associated with some of themost important technologicaldevelopments over the last 20 years,Corin’s portfolio today includes ECiMa™vitamin E HXLPE, Unity Knee™ 5thgeneration knee, Trinity™ acetabularsystem, MiniHip™ bone-conserving hip,TriFit TS™ and MetaFix™ cementlessfemoral stems, TaperFit™ cemented hip,Uniglide™ unicondylar knee, Zenith™ankle and LARS™ soft tissue internalfixation.

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Crowther Ballantyne Associates Ltd 124Northgate Business Centre, 38Northgate, Newark on Trent,, NG24 1EZ,United KingdomTel: 01636 [email protected]://cbasearch.com

Crowther Ballantyne Associates havebeen leading the way in OrthopaedicSales and Marketing recruitment for thelast 15 years and are happy to supportthe BOA once again this year.

A large number of companyrepresentatives exhibiting at thisconference have long standingrelationships with our company andmany will have been placed in theircurrent role. We are proud to have beenresponsible for enhancing so manycareers and look forward to helpingmore people realise their potential in thefuture.

If you need our help with your nextmove or you are an employer looking fora new hire then please come and talk tous at stand 124.

DePuy UK 52 and 68Capitol Boulevard, Capitol Park, LeedsLS27 0TS, ENGLANDTel: +44 113 387 [email protected]://www.depuy.com/uk

DePuy Synthes Companies offer theworld’s most comprehensive portfolio oforthopaedic products and services forjoint reconstruction, trauma, spine,sports medicine and cranio-maxillofacialtherapies. DePuy Synthes Companies arealso a global leader in neurologicalsolutions with products and services forneurosurgery, neurovascular, spine andcranio-maxillofacial therapies. Wedeliver a broad array of orthopaedic and

neurological solutions—inspiredsolutions that go beyond qualityimplants and include services, education,instruments, and emerging technologies.We are inspired to advance patient carein orthopaedics and neurologicaltherapies by listening carefully to whatour customers and their and patientshave to say, and then developing totalsolutions that go beyond the productsthemselves.

The Joint Reconstruction businessmarkets orthopaedic devices, solutionsand supplies for hip, knee and extremityreconstruction, in addition to cementand operating room products.

The Sports Medicine business offersorthopaedic sports medicine products,soft tissue repair devices, jointmovement solutions and minimallyinvasive and arthroscopic solutions.

The Trauma business offers a broadportfolio of orthopaedic fracture fixationproducts, including screws, plates, nailsand other implants used to fix brokenbones.

The Biomaterials group provides awide range of innovative products suchas bone graft substitutes thatcomplement the use of traditional metalimplants.

The Power Tools division offers acomprehensive range of air, electric, andbattery-driven high and low powerinstrument systems, including drills,reamers and saws.

The unmet needs in orthopaedic andneurological care are significant. Withinsights from patients, physicians,providers, payors and policymakers toguide us, DePuy Synthes Companies areuniquely positioned to meet these needsand deliver life-changing medicalinnovation. At DePuy SynthesCompanies, we aspire to be your partnerof choice, delivering high standards ofquality in everything we do.

DGL Solutions 8242 Ball Moor, Buckingham IndustrialPark, Buckingham, MK18 1RQ, UnitedKingdomTel: 01280 [email protected]://www.dgl-solutions.com/

DGL Solutions is the UK’s leadingsoftware provider for the private medicalsector, with more than 4500+ licencessold. Its comprehensive software suiteprovides consultants, secretaries, clinicalstaff and managers with a total solution,from booking to billing, throughdiagnosis and treatment.

Designed and developed in-house, itssoftware is powerful and flexible, yetintuitive and easy to use, enabling yourpractice to run more efficiently, andreducing the time required forcompleting administrative tasks. DGLSolutions recognises that every practice,clinic and hospital is unique, and itssoftware is designed to offer a bespokepackage that is right for you.

Dynamic Despatch 162Office 31, Sugar Mill, Oakhurst Avenue,Leeds, LS11 7HL, United KingdomTel: 0113 [email protected]://www.dynamicdespatch.co.uk

Specialist courier services to the medicalsector, Dynamic has been focused in themedical logistics sector for over adecade. We have invested heavily inspecialist vehicles, computer softwareand hardware to enable us to offer someunique services to the medical sector.

We have developed excellent workingrelationships with nearly all UK hospitals

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both public & private and are in a verystrong position to bring the benefits ofour experience to companies looking toadd value to their business.

Through our parcel tracking software,we can provide a wide range of tailoredservices including online booking, onlinetracking, electronic signature capture,instant POD & photo capture.

EOS imaging 2410 rue Mercoeur, Paris, 75011, FranceTel: [email protected]://www.eos-imaging.com/

Born from a technology awarded by theNobel Prize for Physics, the EOS® systemis the first imaging solution designed tocapture simultaneous bilateral longlength images, full body or localized, ofpatients in a weight bearing position,providing a complete picture of thepatient’s skeleton at very low doseexposure. EOS enables globalassessment of balance and posture aswell as a 3D bone-envelope image in aweight-bearing position, and providesautomatically over 100 clinicalparameters to the orthopedic surgeonfor pre- and post-operative surgicalplanning.

Expert Witness 208The Expert Witness Journal Ltd, TheLandmark, 17-21 Back Turner Street,Manchester, M4 1FRTel: 0161 834 [email protected]

Established in 1996 in Directory format,Expert Witness is the preferredreference for Instructing Solicitors andBarristers for sourcing robustmedicolegal opinion.The No.1 Google ranked websiteexpertwitness.co.uk is bookmarked bythe leading Personal Injury and MedicalNegligence lawyers to fast track theinstruction process.The Expert Witness Journalcomplements these two formats,stimulating dialogue and relationshipbuilding between the medical and legalcommunities.As ‘Orthopaedics’ is the main searchterm, Expert Witness meetsrequirements for instant reference to abank of reliable Consultants andSurgeons who can submit reports ormake court appearances.

GE Healthcare 21871 Great North Road, Hatfield, AL9 5EN,United KingdomTel: 01707 263570http://www3.gehealthcare.co.uk/

GE Healthcare provides transformational

medical technologies and services tomeet the demand for increased access,enhanced quality and more affordablehealthcare around the world. GE (NYSE:GE) works on things that matter – greatpeople and technologies taking on toughchallenges. From medical imaging,software & IT, patient monitoring anddiagnostics to drug discovery,biopharmaceutical manufacturingtechnologies and performanceimprovement solutions, GE Healthcarehelps medical professionals deliver greathealthcare to their patients.

Gilbert & Mellish Limited 883 Lightning Way, West Heath,Birmingham B31 3PHTel: 0121 475 [email protected]

Gilbert & Mellish are a leading privatehealth care company that has beenoperating in the field of Orthotics forover 50 years. Our long-standingreputation has been maintained, bydistributing Orthotic products of thehighest quality.

G&M play a major role as distributorsfor a number of manufacturers includingPiedro, Jobskin, Med Spec, VQOrthocare, Cybertech., Knit-Rite andmore…

Through our passion and thecommitment of helping aid the needs ofindividuals, Gilbert & Mellish is a highlyrespected and trusted member of aspecialist industry and a maincontributor towards its future.

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Healthcare Business Solutions UK 376 Thorpe Road, Brough, HU15 1BS,United KingdomTel: 0845 619 [email protected]://hbsuk.co.uk

At HBSUK we set-up and managehealthcare businesses on behalf ofConsultants for patients. We remove allconflicts of interest between consultantsand their NHS Trust and provideCommissioners with a model to flexiblymanage capacity at optimal cost.

Our services include: BusinessManagement, Commercial Management,Infrastructure & Investment, BusinessDevelopment and Governance &Efficiency.

HBSUK’s focus is excellence, notcompliance. We provide solutions thatare sustainable and scalable to meettomorrow’s healthcare challenges. Webelieve now is the time to challenge thenorms and build a healthcare servicethat plays to the strengths of allstakeholders.

Healthcode Ltd 78Healthcode Ltd, Swan Court, WatermansBusiness Park, Kingsbury Crescent,Staines-upon-Thames, Surrey, TW18 3BA,United KingdomTel: 01784 263 [email protected]://www.healthcode.co.uk/BOA-2013

The Professional’s Choice… ‘code forsuccess

Healthcode’s ePractice system isdesigned and tailored to the needs of

private practices. Whether you’re juststarting out, or already established inprivate practice, it delivers high quality,cost effective, online practicemanagement solutions, providing youwith the latest tools to take directcontrol to expand your practice… ‘codefor success. With an established secureonline network, Healthcode is a trulymulti-locational system that is trusted byleading insurers, hospitals and privatepractices. Visit us at stand no. 78 formore information and a demonstration.

Heraeus Medical GmbH 80Heraeus Medical, Oxford House, OxfordHouse, 12-20 Oxford Street, NewburyBerkshire, RG14 1JB, United KingdomTel: +44 (0) 1635 [email protected]://www.heraeus-medical.com

Heraeus MedicalExpertise in Infection Management,

Heraeus Medical concentrates onmedical products for orthopaedicsurgery and traumatology. As industryleader for bone cements, the companydevelops, produces, and marketsbiomaterials and accessories to make anessential contribution to

improving surgical results in bone andjoint surgery as well as infectionmanagement.

Impact Medical Ltd 214Unit 7J, Topham Drive, Aintree, Liverpool,L9 5ALTel: +44 (0)151 [email protected]

Impact Medical are market leaders andinnovators in Extracorporeal ShockwaveTherapy (ESWT).

Utilising the focussed Richard WolfPiezowave, we are UK agents for Elvation

GmbH, worldwide distributors forRichard Wolf Shockwave devices, toprovide sales/lease/rental in addition toour extensive clinical expertise as aresult of our comprehensive visitingclinical services.

Impact Medical – ‘Taking care further’

Ideal Med Ltd 186Suite F8 Oaklands Business Park, HootonRoad, Hooton, CH66 7NZ, UnitedKingdomTel: 0844 218 [email protected]://www.idealmed.co.uk

Founded in 2011, Ideal Med specialisesin distributing Orthopaedic products forall aspects of limb reconstruction and isthe only company dedicated to the areaof Orthopaedics.

The company portfolio is constantlydeveloping under the management teamwhich has over 50years experience infracture management and orthopaedics,gained from working within the NHS andwith multi-national manufacturers.

Being independently owned allowsIdeal Med to acquire a range ofinnovative, quality products for its locallyserved markets at a competitive price.

Our commitment to service includescustomer support, education andtraining with leading surgeons withworld renowned reputations.

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JRI Orthopaedics Ltd 2618 Churchill Way, 35A Business Park,Chapeltown, Sheffield, S35 2PY, UnitedKingdomTel: 0114 [email protected]://www.jri-ltd.co.uk

JRI Orthopaedics looks forward towelcoming you to our technical exhibitwhere you can review our latestinnovations including:• Furlong Evolution Femoral Stem,

incorporating the clinically provenprinciples of the Furlong H-A.CFemoral Stem into a contemporarystem design with enhanced surgicaltechnique.

• The Unique Custom Hip Stem, CTbased design for complex primary hipreplacement.

• The Trekking Total Knee TotalArthroplasty System, withcomprehensive implant options andoptimised surgical technique to meetpatients’ requirements and clinicalpreferences

• VAIOS, our versatile shoulder systemdesigned, with maximum flexibilityand minimum complexity, to enhancepatient outcome

Kaiser Medical Technology Ltd 210The Tramshed, Beehive Yard, WalcotStreet, Bath, Somerset, BA1 5BBTel: 01225 [email protected]

KMT Ltd develops and markets a rangeof innovative Single Use Surgical PowerTools for use in Orthopaedic Surgery.We are based in the United Kingdom anddistribute through most EU countries.Together with our design andmanufacturing partners we aim to offera versatile and cost-effective solution tomeet any Power Tool requirements.In the Solomax range we offer disposablePower Tools for use in large & small bonesurgery and battery powered PulseLavage Systems with accessories.

KCI Medical 7611 Nimrod Way, East Dorset Trade Park,Ferndown Industrial Estate, Wimborne,Dorset, BH21 7SH, United KingdomTel: 0800 980 [email protected]://www.kci-medical.com

At KCI, we are devoted to advancing thescience of healing and positivelyimpacting patient care by developingcustomer-driven innovation to meet theevolving needs of healthcareprofessionals. For over 35 years, KCI haveled the way in the development of newtechnologies for negative pressurewound therapy, medicines and therapiesdesigned to make wound healing moremanageable for caregivers and morecomfortable for patients around theworld.

Maquet UK Ltd 11414 – 15 Burford Way, Boldon BusinessPark, Sunderland, NE35 9PZ, UnitedKingdomTel: 0191 519 [email protected]://www.maquet.com

MAQUET, a trusted partner for hospitalsand physicians for over 175 years, is theglobal leader in providing medicalsystems that meet the needs of the mostmedically challenging patients, whileexceeding the expectations of thehospital teams that care for them.MAQUET designs, develops anddistributes innovative therapy solutionsand infrastructure capabilities for high-acuity areas within the hospital includingthe operating room (OR), hybrid OR/cathlab and intensive care unit (ICU) as wellas intra and inter hospital patienttransport.

Mathys Orthopaedics Ltd 28Unit 6 Riverwey Industrial Park, NewmanLane, Alton, GU34 2QL, United KingdomTel: 08450 [email protected]://www.mathysmedical.com

Mathys Orthopaedics Ltd …togetherwith passion!

For over 40 years, Mathys Ltd hasdedicated itself to maintaining themobility of human beings. The productportfolio of artificial joint replacementshas brought us from being a smallbusiness to a worldwide activeenterprise.

With you as an expert andexperienced partner, Mathys developsinnovative products and user friendlyinstruments. Your input, proven

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concepts and high quality Swiss madestandards in manufacturing and traditionare the guiding principles of this familyowned company.

MatOrtho 104MatOrtho Limited, 13 Mole BusinessPark, Randalls Road, Leatherhead,Surrey, KT22 7BA, United KingdomTel: +44 (0)1372 224 [email protected]://www.matortho.com

MatOrtho® was established by MikeTuke in 2010 to continue the pioneeringwork of almost four decades conductedby his previous company, FinsburyOrthopaedics Limited.

Based in Leatherhead, MatOrtho®continues to employ many originalFinsbury staff as well as the equipmentmanufacturing the supply ofinternationally-recognised orthopaedicimplant devices such as the MedialRotation Knee™, the BOX® Total AnkleReplacement and the Saiph® KneeSystem.

Our heritage is a true reflection of ourcommitment and responsibility assuppliers to medical professionals and,through continued investment in newtechnologies and product development,we aim to further demonstrate thatcommitment.

Medacta UK Limited 11016 Greenfields Business Park, WheatfieldWay, Hinckley, LE10 1BB, UnitedKingdomTel: +44 (0) 1455 [email protected]://www.medacta.com

Medacta® International is a Swisscompany developing, manufacturing anddistributing orthopaedic medical devicesworldwide. Responsible productinnovation and best-in-class medicaleducation are key to the company’ssuccess. Medacta® is a recognised leaderin THR due to AMIS® Anterior MinimallyInvasive Surgery, and MyKnee® patientmatched TKA instruments. In 2009Medacta® entered the spine businessfocusing on anatomical design, implantmodularity and efficientinstrumentation.

Medartis Limited 62Medartis Limited, Suite 63, Annexe 4,Batley Business Park, Technology Drive,Batley, WF17 6ER, United KingdomTel: 01924 [email protected]://www.medartis.com

Medartis develops, manufactures andsells titanium screws and plates, surgicalinstruments and system solutions forfracture fixation. Our motto is “Precisionin fixation”.

The APTUS brand coverspredominantly upper limb (Hand &Wrist, including Arthrodesis, Elbow andShoulder) and also covers Foot trauma.All APTUS products are anatomicallydesigned and feature a low plate profileand TRILOCK locking technology.

A new generation of cannulatedscrews completes the APTUS portfolio.

The patented SpeedTip polygonalgeometry and a precision-manufacturedthread saves the surgeon time and effortduring implantation.

The Medical Defence Union (MDU) 10230 Blackfriars Road, London, SE1 8PJ,United KingdomTel: 0800 716 [email protected]://www.themdu.com

BOA Annual Scientific Congress – visitthe MDU on stand 10

The MDU is a not-for-profitorganisation wholly dedicated to ourmembers’ interests, providing expertguidance, personal support and robustdefence in addressing medico-legalissues, complaints and claims. Weprovide high quality, specialised medico-legal advice, 24 hours a day, 7 days aweek.

Our team is led and staffed by doctorswith real-life experience of the pressuresand challenges faced in practice.

We would be delighted to meet you atour stand where our team can answerany membership questions you mayhave and you can also collect a free copyof our orthopaedic factsheet ‘Bones ofContention.

Mediracer UK Ltd 32Technology Centre, WolverhamptonScience Park, Wolverhampton, W.Midlands, WV10 9RUTel: +44 844 800 [email protected]://www.mediracer.com

Mediracer®NCS is a hand held nerveconduction device used to test for CarpalTunnel Syndrome and Ulnar Nerve

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Entrapment at the elbow. Testing isconducted in your clinic by your staff andour consultants will interpret the resultsand provide the you with a report within48 hours.

National Joint Registry at theHealthcare Quality ImprovementPartnership 48Holland House, 4 Bury Street, LondonEC3A 5AWTel: NJR Centre: 0845 345 [email protected]

National Joint Registry for England,Wales and Northern Ireland (NJR)The NJR monitors the performance ofhip, knee, ankle, elbow and shoulderjoint replacements to improve clinicaloutcomes for the benefit of patients,clinicians and industry. We collectrelevant, high quality data in order toprovide quality, robust evidence tosupport decision-making in regard topatient safety, standards in quality ofcare and overall cost effectiveness injoint replacement surgery.

In our 10th anniversary year, theregistry now holds more than 1.4 millionrecords. We support and enable researchto maximise the value of the informationwe hold and collaborate internationallyto foster greater knowledge andunderstanding.

Come and see us to find out more andcollect a copy of our 10th Annual Report.Plus, see a demonstration of NJRClinician Feedback and find out about itsproposed developments to supportrevalidation and appraisals.

Neoligaments 20Springfield House, Whitehouse Lane,Leeds, LS19 7UE, United KingdomTel: [email protected]://www.neoligaments.com

Neoligaments specialises in sterileimplantable scaffolds and fixationdevices for the sports medicine andorthopaedic markets. Our extensiveportfolio comprises some of the world’sleading prosthetic ligament productsincluding Poly-Tapes and the Leeds-Keioligament range, and incorporates generaland speciality textile devices. Ourgeneral devices are available in a rangeof sizes, to repair a range of soft tissueinjuries. Our speciality devices have beenspecifically designed and optimised torepair injuries in the shoulder, knee andankle joints. Our scaffolds are used bysurgeons worldwide; over 150,000patients’ injuries have been successfullytreated, restoring their quality of life.

NHS Blood and Transplant 192Estuary Commerce Park, 14 EstuaryBanks, Speke, Liverpool, L24 8RBTel: 0151 268 7019www.nhsbt.nhs.uk/tissueservices

NHS Blood and Transplant (NHSBT) is aSpecial Health Authority. We manage thenational voluntary system for blood,tissues, organs and stem cells turningthese precious donations into grafts thatcan be used safely to the benefit of thepatient.We offer a wide range of tissue forgrafting/transplantation in variousspecialties including:orthopaedics,burns, cardiovascular, ocularOur orthopaedic grafts include femoral

heads, tendons, ground bone anddemineralised bone matrix (DBM) pasteand puttyWhy you should come to us first:Ethically sourced from UK donorsFrom the NHS for the NHSUse with confidence – a specialist serviceProvided direct from the NHS’s ownTissue ServiceLargest Tissue Bank in the UKCost Effective

NHS Supply Chain 118NHS Supply Chain, West Way, Cotes ParkIndustrial Estate, Alfreton, Derbyshire,DE55 4QJ, United KingdomTel: +1773 [email protected]://www.supplychain.nhs.uk

The greater use of procurementintermediaries such as NHS Supply Chainand the development of more focusedand committed relationships betweenthem and trusts is cited in theProcurement Strategy as key to reducingprocurement costs across the NHS.

Our work to date with County Durhamand Darlington NHS FT has deliveredsavings of over £450K across theirorthopaedic procurement, whilstmaintaining clinical choice.

Operated by DHL as Agent of the NHSBusiness Services Authority, NHS SupplyChain has so far delivered savings of over£600 million to the NHS.

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Olympus Biotech International 200Raheen Business Park, Limerick, Irelandwww.olympusbiotech.eu

Olympus Biotech International,headquartered in Limerick, Ireland, is aleading innovator in Biomaterial andRegenerative Medicine technologiesindustry for orthopaedics and wound-care regeneration market.Our Vision at Olympus Biotech is toimprove patient’s quality of life bydeveloping and distributing RegenerativeMedicine that stimulates the intrinsicHealing Capacity in the living body by thetechnological development of signals,scaffolds and stem cells.

Orthodynamics Ltd 36Industrial Park, Bourton-on-the-Water,Gloucestershire, GL54 2HQ, UnitedKingdomTel: +44 (0) 1202 [email protected]

Orthodynamics develops, manufacturesand supplies orthopaedic accessoriesand specialist implants to the worldwideprimary, revision and trauma markets.The company’s innovative and expandingportfolio contains the followinginnovative solutions:• Serf Novae® Dual Mobility Acetabular

Cup• Cannulok® Plus – a unique revision

femoral stem with a distal lockingintramedullary nail

• aMace® AcetabularRevision/Reconstruction System

• HemaClear® – the only sterile, singleuse exsanguinating tourniquet

• Vancogenx & Gentamicin Spacers for 2stage revision & Bone Cement

• HiVac™ bone cement mixing productrange

• Cerament™ Bone Void Filler with andwithout Gentamicin

Ortho Executive 40Dukesbridge House, 23 Duke Street,Reading, RG1 4SA, United KingdomTel: 0118 990 [email protected]://www.orthoexec.co.uk

Ortho Executive is a rapidly expandingsearch company that focuses solely onproviding candidates within sales andmarketing in the orthopaedic industry.

Partnering with businesses of all sizes,we tailor every search specifically toeach customer, visiting you when weundertake a search assignment to get areal understanding of your values andneeds.

With our tight focus withinorthopaedics we go that extra mile todeliver quality placements and look afteryour long-term interests.

Orthofix Limited 225 Burney Court, Cordwallis Park,Maidenhead, Berkshire, SL6 7BUTel: 01628 [email protected]://www.orthofix.co.uk

Orthofix research and provide innovativesolutions to Orthopaedic surgeons fortrauma and elective surgeries, with afocus on complex procedures. Orthofix iscurrently implementing a 360° approachto offer different solutions to effectivelyaddress complex distal radius fractures.2013 will see the launch of the ContoursVPS3 distal radius plate and Galaxy WristExternal Fixator.

Contours VPS3 is an anatomical,comprehensive volar plating system. Ithas an extensive selection of platewidths and lengths designed to fit theanatomies surgeons encounter in the

operative room for a more aligned bone-plate interface.

Galaxy Wrist is a line extension to theGalaxy External Fixation system andspecifically engineered for the treatmentof complex distal radius fractures.

Come and visit us at Stand 22 to findout more!

OrthoLink (Scotland) Ltd 1721 Wester Shawfair, Shawfair Park,Edinburgh, Scotland, EH22 1FDTel: +44 (0) 131 660 1961www.ortholink.co.uk

OrthoLink strive to bring you the latestmedical technologies and the most up todate implants and instruments. We prideourselves on our medical expertise andcustomer service. From theatreequipment to staff training, OrthoLinkhave something for everyone and arealways happy to help.

Whether you are a new or existingcustomer, we will supply you with all thehelp and support we can in and out ofthe operating theatre.

For more information about whatOrthoLink could offer you, then pleasefeel free to get in touch via the detailsbelow and see if we can become……“The Link to All Your OrthopaedicNeeds”

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Orthopaedic Research UK 98Furlong House, 10a Chandos Street,London, W1G 9DQ, United KingdomTel: 020 7637 [email protected]://www.oruk.org

Orthopaedic Research UK is a charitableorganisation which funds high qualityresearch and training in orthopaedics.

An independent body dedicated toadvancing orthopaedic knowledge, wealso organise training events whichpromote collaboration betweenorthopaedic surgeons, scientists,engineers and industry.

Today we are one of the mostsignificant funders of orthopaedicresearch in the UK, working alongsidemany leading academic institutes. Wehave invested over £7.5m in researchwith over 35 research institutes over thelast 10 years.

We are a member of the Associationof Medical Research Charities (AMRC)and the National Institute for HealthResearch (NIHR).

OTSIS – Orthopaedic and TraumaSpecialists Indemnity Scheme 67 Blighs Walk, Sevenoaks, TN13 1DB,United KingdomTel: 0845 094 [email protected]://www.otsis.co.uk

The Orthopaedic and Trauma SpecialistsIndemnity Scheme (OTSIS) providescomprehensive indemnity exclusively fororthopaedic surgeons. OTSIS is a not-for-profit company, which is owned by its

members, so offers unbeatable serviceand value in challenging times, deliveringthe security and expertise you requirefor your NHS and independent sectorpractice.Benefits of OTSIS membership:• Insurance contract providing defined

not discretionary benefits• 24/7 expert medico-legal advice• Meets independent sector hospital

requirements• Extends 10 years into retirement• Indemnity you can rely on

PG Mutual 8611 Parkway, Porters Wood, St Albans,AL3 6PA, United KingdomTel: 01727 [email protected]://www.pgmutual.co.uk

PG Mutual is a not-for-profitmembership organization specializing inproviding income protection forprofessionals since 1928. As a FriendlySociety, they don’t have outsideshareholders, and therefore return anyprofit to its members.

PG Mutual offers an Income ProtectionPlan which will pay you a regular incomeif you can’t work due to illness or injury.The plan also includes an investmentelement which pays out at maturity ofthe policy.Features:• Protection that can start from first day

of illness or injury• Cover lasts until you can return to your

professional career• No penalty for making a claim

Plasma Biotal Ltd 168Unit 1 – 5 Meverill Road IndustrialEstate, Whitecross Road, Tideswell, SK178PY, United KingdomTel: +44 (0) 1298 [email protected]://www.plasma-group.co.uk

Manufacturers of CalciumHydroxylapatite (HA) and Beta Tri-Calcium (bTCP) Orthophosphatepowders for various specializedapplications in biomedical products andfor manufacture of composite materials.

Providers of HA and Titanium coatingservices for orthopaedic devicemanufacturers.

Quality systems audited to ISO 13485.Hydroxylapatite Captal®30 coatings

registered with FDA under theirmasterfile system.Suppliers to the worldwide marketplace.

PPM Software Limited 34The Business Centre, 100 Honey Lane,Waltham Abbey, Essex, EN9 3BG, UnitedKingdomTel: 01992 [email protected]://www.ppmsoftware.com

‘PPM’ – PRIVATE PRACTICE MANAGER –Perfect for your Practice!

Please visit STAND 34 to find out whymany of your colleagues haveimplemented

‘PPM’- Private Practice Manager‘PPM’ will provide all the facilities for

the complete Administration andFinancial Control of your Private Practice.

The service includes on site installation

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and personal training. In addition, theflexibility of the software means it canbe customised to your particularrequirements in many area’s.

Alternatively, if you would like toarrange a demonstration, after theexhibition, contact Tom Hunt

on either 01992 655940 or 07860525831, write to the address above or e-mail – [email protected]

Premium Medical Protection 6068 Pure Offices, Plato Close, TachbrookPark, Leamington Space, Warwickshire,CV34 6WETel: 0845 308 2350admin@premiummedicalprotection.comwww.premiummedicalprotection.com

Premium Medical Protection is anestablished provider of MedicalMalpractice Insurance.

Over 700 Consultants currently havecover with us and our system ofindividual assessment may giveconsiderable savings.

Our policies are unique and thecombination of features offered cannotbe found elsewhere. We can offer:• Choice of policies from various

underwriters• Indefinite run off into permanent

retirement or after death• Structured no claims discount• Public Liability included in the wording• Policies accepted by all hospital groups

With our latest product, PMP Plus, wecan now offer medical malpracticeinsurance, packaged with office basedinsurances to provide a one stop solutionfor today’s business minded Consultant.Terms & conditions apply

Premium Medical Protection Limited isan Appointed Representative of HarleyStreet Insurance Group Limited which isauthorised and regulated by theFinancial Conduct Authority no 570717.

Royal Naval Reserve 166Tel: 0845600 32 [email protected]/navyreserves

The Royal Naval Reserve is an integralpart of the Royal Navy with a longhistory of supporting the regular force inmajor crisis and enduring operations.Medical Officer reservists work in both atrue ‘reserve’ capacity but also augmentthe enduring medical supportrequirements of the Royal Navyworldwide. As a reserve Medical Officerof whatever discipline you will carry therank prefix of ‘Surgeon’ and proudlywear the distinction lace of blood red inyour rank epaulettes.The RNR is an important part of ourdefence structure and anyone wishing tojoin should expect to be mobilised onoperations based at sea or on land in theUK and abroad.

SANOFI 214One Onslow Street, Guildford, Surrey,GU1 4YSTel: 01483 505515www.sanofi.co.uk

Sanofi, a global and diversifiedhealthcare leader, discovers, developsand distributes therapeutic solutionsfocused on patients’ needs. Sanofi hascore strengths in the field of healthcarewith seven growth platforms: diabetessolutions, human vaccines, innovativedrugs, consumer healthcare, emergingmarkets, animal health and the newGenzyme. Sanofi is listed in Paris(EURONEXT: SAN) and in New York(NYSE: SNY).

Sawbones Europe AB 122Krossverksgatan 3, 216 16 Malmoe,SwedenTel: +46 406 [email protected]

Sawbones are the worldwide leaders tooffer you:• Training and educational models for

hands on training• Demonstration models for display

purposes• Great capabilities to customize models

for any needs you have.

SECTRA 92Teknikringen 20, Linköping, 583 30,SwedenTel: +46 13 23 52 [email protected]://www.sectra.com

Sectra provides industry-leadingPACS/RIS and orthopaedic solutions.With more than 20 years of leadinginnovation, Sectra maintains its positionat the forefront of medical ITdevelopment thanks to closecooperation with top research centersand more than 1,100 customers.Sectra’s orthopaedic solutions enableorthopaedic surgeons to utilize digitaltechnology to reduce costs and increaseproductivity. They also significantlyincrease precision in choosing templatesin the pre-operative planning phase. Theoffering comprises a complete set of pre-operative planning tools, Sectratemplates service and Sectra’sCalibration Unit.

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SEMPRIS 90Bridge House, 273 Brighton Road,Belmont, SM2 5SU, United KingdomTel: 020 8652 [email protected]://www.sempris.co.uk

SEMPRIS was launched in late August2010 in response to the introduction ofrestrictive guidelines and withdrawal ofcritical aspects of indemnity cover bytraditional MDOs for doctors treatingprofessional sportsmen and women.Developed in conjunction with doctors,medico-legal advisers and insurers, thescheme provides the mostcomprehensive medico-legal supportand indemnity available from any insureror medical defence organisation in theUK. Membership covers all aspects ofsport and non-sport related independentpractice and professional issues notcovered by NHS indemnity.

SEMPRIS is a division of HealthPartners Europe Ltd., Official HealthcareAdvisers to the Premier League & ECB.

Single Use Surgical Ltd 190BBIC, Innovation Way, Barnsley, S75 1JL, UKTel. +44 (0)1226 732 [email protected]

Looking for disposable power tools? Weare developing single use drills, reamersand saws that eliminate contaminationissues and reduce capital outlay. Visit ourstand to help shape the design of these

instruments to meet your needs. Alsoavailable:

– MicroAire Single Use Pulse Lavage– Single Use Kerrisons– Single Use Suction Tubes

Smith & Nephew Advanced SurgicalDevices 116 and 202Cardinal Park, Godmanchester,Cambridgeshire, PE29 2SN, UnitedKingdom01480 423 [email protected]://www.smith-nephew.com/

Smith & Nephew Advanced SurgicalDevices is a world leader inorthopaedics, offering medicalprofessionals a comprehensive range oftechnologies across the fields ofarthroscopy, joint reconstruction andfracture fixation. Our product portfoliocaters for the full continuum of care inorthopaedics, including framing systemsfor correcting limb deformity, HDcameras to visualise damaged joints,devices to resect or repair soft-tissuesand implants to replace wornarticulating surfaces. In addition, ourTrauma range incorporates plate andscrew and intramedullary nailing systemsfor the acute management of bonefractures. Please come and visit usduring the BOA for more information.

St. James’s Place Wealth Management 16The Priory, 7 Market Place, Grantham,NG31 6LJ, United KingdomTel: 01476 [email protected]://www.sjpp.co.uk/andrewhodgson

Hodgson Wealth Management SolutionsLtd specialises in wealth managementsolutions ensuring personal wealth andassets are protected and managed in atax efficient way. This approach,combined with over 30 years’ experienceensures client relationships are built ontrust, respect and loyalty.

Hodgson Wealth ManagementSolutions Ltd is a Partner Practice of theSt. James’s Place Wealth ManagementGroup.

Star 96Assembly House, 34-38 Broadway,Maidenhead, SL6 1LU, United KingdomTel: 01628 581 [email protected]://www.starmedical.co.uk

Star is a full service recruitment agency.We have a dedicated team of MedicalDevice specialists whose knowledge andexperience covers all of the industry’ssectors; they recruit on a permanent,contract or Master Vendor basis. Theteam’s account management approachenables them to listen and understandtheir clients and candidates, tailor theirapproach and deliver the best solutions.

Star’s within the top 3% highestperforming ‘Investors in People’

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organisations and was ranked the 3rdbest small company to work for by TheGreat Place to Work Institute’s UK BestWorkplaces Programme 2012.

Our credentials attract the bestconsultants, candidates and clientswhich works for everyone.

Streamwave Medical Ltd 191Elfed House, Oaktree Court, MulberryDrive, Cardiff Gate Business Park, Cardiff,Glamorgan, CF23 8RSTel: 0800 [email protected]://streamwavemedical.com

Streamwave Medical Limited is aninnovative distribution company,working with some of the World’sleading orthopaedic devicemanufactures to deliver high qualityproducts. We offer a unique service tothe healthcare sector working with ourpartners to provide a team of fullytrained individuals to support surgeonsand theatre staff in their day to day useof our products and surgical devices. Ourproduct range is well accepted inhospitals throughout the world, clinicallyproven with tried and tested technology.Customer support and training is at theheart of our company’s philosophy.

Stryker 112Stryker House, Hambridge Road,Newbury, RG14 5AW, United KingdomTel: 01635 [email protected]://www.stryker.com

Stryker is one of the world’s leadingmedical technology companies with themost broad based range of products inorthopaedics and a significant presence

in other medical specialties. Strykerworks with medical professionals to helppeople lead more active and satisfyinglives.The Company’s products includeimplants used in hip and kneereplacement, trauma, craniomaxillofacialand spinal surgeries; biologics, surgical,neurologic, ENT, and interventional painequipment; endoscopy and surgicalnavigation.Stryker offers a unique range of solutionsand continues to improve this offeringvia meaningful innovation.Visit us on Stand 112 for a cup ofexcellent coffee and a chat!

Surgionix Limited 188G5.2(B), Adelphi Mill, Grimshaw Lane,Bollington, SK10 5JB, United KingdomTel: +44 1625 453017http://www.surgionix.co.uk

SurgionixTM challenges century-oldtrauma technique!

SurgionixTM, is set to challengeconventional orthopaedic technology byintroducing its innovative SLICK Drill bit.The SLICK Drill Bit combines the drillingand measurement steps of screw holepreparation into single action, while stillsharing the performance andcompatibility of standard drill bits. SLICKdrill-bit’s design includes a retractablewire that extends near the tip of the drillbit, acting like the hook of depth gauge.This allows the surgeon to take accuratemeasurements from the drill bit,eliminating the need for depth gauge.

The SLICK Drill System is a completeorthopaedic drilling solution!

Visit us at stand 188

The Royal College of Surgeons ofEdinburgh 8Nicolson Street, Edinburgh, EH8 9DS,United KingdomTel: +131 527 [email protected]://www.rcsed.ac.uk

Established in 1505, and with a globalmembership, The Royal College ofSurgeons of Edinburgh (RCSEd) is one ofthe world’s oldest and largest surgicalestablishments, with some 20,000Fellows and Members based in almost100 countries worldwide.

As well as striving for excellencethrough education and examinations,RCSEd is committed to advancingsurgical training. The recently launchedFaculty of Surgical Trainers welcomesmembership to all those who have anactive interest or involvement in surgicaltraining in the UK and internationally.The College also welcomes the surgicalcommunity to debate and discuss‘emergency surgery in the 21st century’at its annual President’s Meeting 2014.

The Royal College of Surgeons ofEngland 1235-43 Lincoln’s Inn Fields, London, WC2A3PE, United KingdomTel: 020 7869 [email protected]://www.rcseng.ac.uk

The Royal College of Surgeons of Englandis committed to enabling surgeons toachieve and maintain the higheststandards of surgical practice and patientcare.

Notes


Providing support and educationopportunities for surgeons through allcareer stages, we supervise training,examine trainees, promote and supportsurgical research.We provide:• Affiliate scheme, events, career advice

and support for UK trainees andstudents

• Support and information for Women inSurgery

• Education courses to support allsurgical specialties and themultidisciplinary team

• Examinations in the UK andinternationally

• Publications including the Annals ofthe Royal College of Surgeons ofEngland

Trifibre Ltdhttp://www.trifibre.co.uk 6417 Boston Road, Gorse Hill IndustrialEstate, Leicester, LE4 1AW, UnitedKingdomTel: 0116 [email protected]://www.trifibre.co.uk

We specialise in casing and packagingsolutions for orthopaedic implants,medical instruments and other medicalequipment and have supplied many ofthe world’s leading medicalorganisations. Our flight cases are madein our 70,000 sq ft factory in the UKusing the highest quality materials toensure that your vital equipment is fullyprotected in transit.

We design and manufacture cases toyour exact specification. A range of ofpull-out drawers, shelves, lift-out trays,doors and shutters can be integratedinto the case. Case walls can beproduced in many colours to match yourcorporate image and can be screenprinted with your logos and branding.

Trust Health Limited 9476 Park Street, Horsham, West Sussex,RH12 1BX, United KingdomTel: 01403 [email protected]://www.trusthealth.co.uk

Trust Health Ltd is the UK’s leadingprovider of commissioning and businesssupport services to clinical partnerships.We establish clinical partnerships(Limited Liability Partnerships) andprovide the legal, financial and businesstrading framework for clinicians toprepare for business in the changing UKhealthcare environment. We do thisthrough detailed business planning,contract negotiation and management,and a portfolio of business services.

Trust Health has been established forover seven years, managing clinicalpartnerships across the UK. It is thelargest UK provider of business andmanagement services for consultants inthe UK.

Visit us on stand 94 for moreinformation

Wardray Premise Ltd 201Hampton Court Estate, Summer Road,Thames Ditton, Surrey, KT7 OSPTel: 020 8398 9911www.wardray-premise.com

Wardray Premise is a long establishedcompany specialising in manufacturingof all types of Radiation Shielding formedical and industrial applicationsincluding RF Cages.X-ray protective products include LeadAprons, Screens, Doors, Lead GlassWindows and Workstations. Accessoriesinclude x-ray Patient Trolleys, Scoliosisand Proctology chairs.In addition Wardray Premisemanufacture several MR SafeAccessories for the MRI Departmentincluding Patient Trolleys, Paediatric and

Adult versions, Portering chairs, andUtility Trolleys. We can also offerbespoke products to suit customer’srequirements.Other MR Accessories available:Paediatric coils, Patient Monitoring,Audio Visual Entertainment system andLED Relax and View® Image collection.

Warwick Medical School 164The University of Warwick, Gibbet Hill,Coventry, CV4 7AL, United KingdomTel: +44 (0) 2476 574 [email protected]://www.warwick.ac.uk/fac/med

Warwick Medical School, is part of TheUniversity of Warwick and one the UK’sleading health education providers.

We offer a wide range of innovativeorthopaedic courses delivered in aflexible, modular format to meet thevaried needs of healthcare professionals.Acknowledged for our excellence inteaching and research we offer twomasters programmes, the MSc in Traumaand Orthopaedic Surgery and the MSc inHealth Sciences (Musculoskeletal Care),as well as numerous PostgraduateAwards (short courses).

Our courses encourage clinicians topractice evidence based medicine, whiledeveloping skills to gather and criticallyappraise evidence of diagnostic andtreatment effectiveness.

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Wesleyan Medical Sickness 33Colmore Circus, Birmingham, B4 6ARTel: 0808 100 1884www.wesleyan.co.uk

Personal financial planning for doctorsWesleyan Medical Sickness have beenproviding financial advice to doctors forover 120 years and look after thefinancial needs of over 90,000 medicalprofessionals across the UK.

Our Financial Consultants are trainedto understand the specific needs ofhospital doctors, dentists and GPs andare dedicated to helping you plan for amore secure financial future.

We understand that our customershave a unique career path with differentfinancial needs at every stage. As yourfinancial circumstances change, so willour recommendations and we work hardto understand the issues that affect yourcareer.

To arrange a no-obligation financialreview call 0808 100 1884 or visitwww.wesleyan.co.uk to find your localFinancial Consultant

World Orthopaedic Concern [email protected]

World Orthopaedic Concern UK is a longestablished charitable organisation witha membership of over 300 mainly UKOrthopaedic Surgeons. The objectivesare to improve the standard oforthopaedic, trauma and reconstructivesurgery in developing countries. Ourwebsite www.wocuk.org provides muchinformation about the organisation,countries we support, how to volunteerto help and how to join.

Wisepress Medical Bookshop 9925 High Path, Merton Abbey, London,SW19 2JL, United KingdomTel: +44 20 8715 [email protected]://www.wisepress.com

Wisepress are Europe’s principalconference bookseller. We exhibit theleading books, sample journals anddigital content relevant to this meeting.Books may be purchased at the booth,and we offer a postal service. Visit ouronline bookshop for special offers andfollow us on Twitter for the latest news@WisepressBooks.

Wright Medical UK Ltd 35Poulton House, Bell Meadow BusinessPark, Pulford, Cheshire, CH4 9EPTel: 01244 [email protected]://www.wmt.com

We are a global orthopaedic medicaldevice company specialising in thedesign, manufacture andmarketing of reconstructive jointdevices. Our product portfolio includes;• Large joint implants for the hip, knee

and revision• Power Tools & Disposables – exclusive

UK distributor for MicroAire®.Wright is a leading provider of innovativesolutions in the hip and knee market. Weplace a strong focus on technicalsupport, medical education andcustomer service, with a network ofaccount managers and productspecialists.Our total knee replacement theAdvance® medial pivot is increasinglybeing recognised as the clinically proveninnovator to total knee replacement.Offering enhanced confidence andstability to daily patient activitiesthrough medially pivoting kinematics,constant radius and mid flexion balance.

Its outcomes offer clinically provenpatient preference from over 15 years ofimplantation.Similarly our Profemur® hip systemoffers multiple philosophy options,paired with modular neck balancing tohelp surgeons address multiple hipanatomies off the shelf. Ensuringappropriate fit and fill and the flexibilityto enhance stem to cup soft tissuebalance, alignment and reconstruction.An ODEP rated proven technologysupported with over 24 years history.

X-Bolt Orthopaedics 126Bristol & Bath Science Park, Emerson’sGreen, Bristol, BT16 7FRTel: +44 1172 [email protected]

The incidence of hip fractures continuesto rise (70,000 p.a.) with an annual costof £1.7 billion to the NHS and social careservices – almost 2% of the NHS annualbudget.

The X-Bolt® systems, developed by Mr.Brian Thornes, MCh, FRCSI, givesignificantly better hold vs. existing hipscrew systems. The X-Bolt® is expandedor retracted with a standard screwdriver,and has concise instrumentation makingsurgery easier and faster. Better fixationallows greater confidence to mobiliseFWB; reduces complications and bedstay; providing significant healthcaresavings.

Notes


Xpert Orthopaedics / Lima UK 14Unit 2, Campus 5, Third Avenue,Letchworth Garden City, SG6 2JF, UnitedKingdomTel: +44 [email protected]://www.xpertortho.co.uk

Xpert Orthopaedics combines optimalsolutions from Lima and Merete: Lima’srange of Hip & Shoulder productsinclude the Delta TT range of acetabularcups separating fixation (with TrabecularTitanium) from biomechanics with facechanging cups providing optimalstability. The SMR shoulder system is theonly ‘True’ platform system with over 10years of clinical experience.

Merete’s BioBall taper adaptor fitsonto the trunion of a well fixed stem toprovide a new taper whilst allowingchanges in neck length & version. Theirosteobridge system provides macro bonereplacement in diphyseal and kneerevision cases.

Take time to come to the stand todayand see for yourself how we can helpyou

Zenopa 100Zenopa Ltd, The Three Pines, ChurchRoad, Penn, HP10 8EG, United Kingdom+44 (0) 1494 [email protected]://www.zenopa.com

Zenopa are recruitment specialists in theHealthcare industry. Incorporated in1991 we operate across the UK andEurope and have demonstrated fantasticgrowth over the past 10 years. The keyto our success is that we continuallyadapt our service to keep pace withinever-changing markets.

We offer a team of dedicated AccountManagers committed to connectingtalent to organisations to enable the bestpossible access for society to the mostbeneficial products and services.

Whether you’re looking to exploreyour career options or expand yourteam, our qualified and experiencedconsultants offer you market insight andadvice on how to achieve your goals.

Visit us on stand 100.

Zimmer Ltd 38The Courtyard, Lancaster Place, SouthMarston Park,Swindon SN3 4FPTel: 01793 [email protected]

Zimmer is a world leader in musculo-skeletal health and a creator ofinnovative and personalised jointreplacement technologies. After nearly acentury, we remain true to our purposeof restoring mobility, alleviating pain,and helping millions of people aroundthe world find renewed vitality. Foundedin 1927 with headquarters in Warsaw,Indiana, Zimmer designs, develops,manufactures and markets orthopaedicreconstructive, spinal and traumadevices, dental implants, and relatedsurgical products.

Zimmer’s Trabecular Metal™Technology is among the greatestinnovations in orthopaedics in the last15 years. Made of tantalum, it has morethan 15 years clinical history, and theperformance of specific components hasbeen well-documented in over 250 peer-reviewed journal articles and abstracts.

15th EFORT CongressA combined congress with BOA sessions

London, United Kingdom: 4 - 6 June 2014

Congress Highlights - Main Theme: Patient Safety

15th EFORT Congress 2014

www.efort.org/london2014

General Orthopaedics Reconstruction on upper limb Salvage procedures for hip & knee

replacement What is evidence based orthopaedics? How to diagnose deep infection? Sarcopenia and osteoporosis Pain control in Paediatric Orthopaedics ACL revision The championship of materials

Upper Limb Finger fractures The complicated reverse shoulder

Spine Spine Surgeon: European Diploma

Lower Limb Ankle fusion or arthroplasty? Conservative approaches Knee osteoarthritis

Trauma The periprosthetic fracture Treatment of bone defects Polytrauma in the elderly

Paediatrics New approaches in managing children`s pain

Abstract submission open

Abstract submission open

1 Aug - 1 Nov 2013A combined congress with BOA sessionsBritish Orthopaedic Association

Key datesAbstract submission & registration opens: 1 August 2013Abstract submission closes: 1 November 2013Early Registration Deadline: 31 January 2014On-site rates apply: 16 May 2014

ABSTRACTS

Notes


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POSTER ABSTRACTS

ABSTRACT

INFO

RMATION

Over the last 3 years I have tried to increase the Instructional/Revalidation Sessionsat our Annual Meeting in order to provide a “One Stop Revalidation Service” forOrthopaedic Surgeons. Associated with this there has been a deliberate reductionin “Free Papers” in order to make the accepted Podium Presentationsmore Prestigious and of Higher Standard – only the best get accepted as far as canbe judged by the abstracts.

I thought that as a result of these changes it was important to explain the processof Free Paper selection. Essentially all who submit an abstract are allowed toidentify which section of the programme they wish to enter ie Hip, Knee, Shoulderand Elbow etc. The abstracts that are received are then forwarded to the relevantSpecialist Societies who are asked to provide a minimum of 3 reviewers toscore each abstract. The scores are then returned to the BOA and a preliminaryselection of papers is made by the Hon Sec based on the scores achieved and theability to fit them all into the programme. All abstracts above the cut point (basedon programme space) are accepted. Abstracts receiving the same score are not inany way judged as being more or less acceptable for podium presentation. Theyare either all “in” or all “out” depending on space available.

Finally there is a BOA Programme Selection Meeting comprising the BOA Executive Group (the elected officers and the CEO),the Editorial Secretary, and a representative from the BJJ. This group look at the titles of all the abstracts that have beenpreliminarily accepted to make sure that there has been no “salami slicing” by individual authors or institutions. It is onlywhen this has been completed that confirmation of acceptance or rejection is made to individual authors.

The accepted papers therefore are the best that we have received and as such I would like to congratulate the authors andtheir institutions for having their work accepted for Podium Presentation. I would also like to thank the Specialist Societiesfor all the hard work they have done reviewing the abstracts - without this work we would not be able to achieve our aim ofhaving high quality Free Papers at our Annual meeting.

David StanleyHonorary Secretary

Abstract Information

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Index of Authors

Aarvold, Alexander 53 Knee Surgery Wednesday 09:15Abual-rub, Zaid 567 General Orthopaedics Thursday 16:23Afinowi, Rasheed 216 Tumors Wednesday 10:20Aframian, Arash 579 Sports Trauma Friday 08:00Aframian, Arash 877 Audit & Management Thursday 15:10Ahmad, Sarfraz 419 Sports Trauma Friday 08:28Ahmad, Mubashshar 862 Children’s Orthopaedics Thursday 15:36Ahmed, Usman 556 Spinal Surgery Thursday 10:39Ahmed, Usman 788 Hand Surgery Wednesday 15:19Akhtar, Shahid 551 Foot & Ankle Surgery Thursday 09:16Akhtar, Kash 939 Trauma Wednesday 16:33Akhtar, Kash 946 Knee Surgery Wednesday 09:23Akhtar, Kash 959 Sports Trauma Friday 09:13Al-Azzani, Waheeb A K 639 Foot & Ankle Surgery Thursday 09:08Al-Nammari, Shafic 344 General Orthopaedics Wednesday 11:21Alva, Avinash 684 Limb Reconstruction Thursday 08:25Alva, Avinash 685 Hand Surgery Wednesday 15:27Amiri, Amir Reza 197 Spinal Surgery Thursday 11:09Anand, Bobby 622 Sports Trauma Friday 08:12Andrews, Barry 615 Knee Surgery Thursday 10:04Aranganathan, Shreedhar 282 Children’s Orthopaedics Thursday 15:32Aranganathan, Shreedhar 750 Computer Assisted Orthopaedic Surgery Thursday 14:36Asopa, Vipin 696 Foot & Ankle Surgery Friday 08:24Asopa, Vipin 705 Trauma Wednesday 16:37Atwal, Navraj 470 Sports Trauma Friday 08:59Avasthi, Adhish 953 Audit & Management Thursday 10:34Bali, Navi 929 Children’s Orthopaedics Thursday 15:09Berber, Onur 630 General Orthopaedics Thursday 17:30Berber, Onur 637 General Orthopaedics Thursday 17:38Berko, Boris 633 Research Thursday 09:10Bezzaa, Sabrina 188 Hand Surgery Wednesday 16:20Bhamra, Jagmeet 224 Audit & Management Thursday 10:42Bhamra, Jagmeet 654 Audit & Management Thursday 14:58Bhamra, Jagmeet 655 Limb Reconstruction Thursday 08:12Bilal, Ahmed 867 Foot & Ankle Surgery Thursday 09:12Blyth, Mark 275 Knee Surgery Wednesday 08:28Bolland, Ben J R F 374 Hip Surgery Wednesday 09:19Bolland, B J R F 408 Hip Surgery Friday 08:12Bonner, Tim J 515 Research Thursday 08:16

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Booth, Louise 513 Research Thursday 09:06Bradley, Ben 892 General Orthopaedics Thursday 16:31Brigstocke, Gavin 380 Research Thursday 09:02Brigstocke, Gavin 382 Hand Surgery Wednesday 16:32Brigstocke, Gavin 431 Research Thursday 16:23Brogan, Kit 497 Foot & Ankle Surgery Thursday 08:29Brown, Matthew Thomas 104 Tumors Wednesday 10:32Brueton, Richard 264 World Orthopaedic Concern Friday 14:45Buchanan, James 642 Hip Surgery Wednesday 08:08Buddhdev, Pranai 920 World Orthopaedic Concern Friday 15:00Bugler, Kate 807 Trauma Thursday 09:16Bugler, Kate 814 Foot & Ankle Surgery Thursday 09:04Burston, Ben J 101 Hip Surgery Friday 08:04Callachand, Fayaz 627 Research Thursday 08:24Carrothers, Andrew Douglas 417 Hip Surgery Wednesday 08:58Changulani, Manish 954 Audit & Management Thursday 15:31Chitre, Amol 521 Trauma Wednesday 15:40Clement, Nicholas 851 Tumors Wednesday 10:48Cohen, Daniel 828 Hip Surgery Friday 08:16Connelly, Clare Louise 796 Trauma Wednesday 10:32Cooney, Alan David 246 Elbow and Shoulder Surgery Wednesday 09:16Craig, Richard 603 Hip Surgery Wednesday 08:41Cunningham, Ian K T 326 General Orthopaedics Thursday 16:51Dacombe, Peter 1005 Trauma Wednesday 15:19Davidson, Donald 581 General Orthopaedics Wednesday 11:17David-West, Kenneth 299 Foot & Ankle Surgery Thursday 08:08Dawe, Edward 154 Trauma Wednesday 16:16Dean, Benjamin 181 Elbow and Shoulder Surgery Wednesday 08:00Dean, Fraser 516 Audit & Management Thursday 15:02Deep, Kamal 951 Research Thursday 16:32Dhokia, Rakesh 701 Spinal Surgery Thursday 10:00Dhokia, Rakesh 710 Spinal Surgery Thursday 10:04Diamond, Owen 490 Research Thursday 16:27Dick, Alastair 341 Trauma Wednesday 10:36Dimitriou, Rozalia 213 Children’s Orthopaedics Thursday 15:13Donnelly, Thomas Davis 476 Hand Surgery Wednesday 15:50Dorman, Sara 549 Combined Services Orthopaedic Surgery Friday 14:50Dowen, Daniel 21 Foot & Ankle Surgery Thursday 08:00Dudhniwala, Abdul Gaffar 779 Knee Surgery Thursday 10:20


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Dziadulewicz, Nik 933 Audit & Management Thursday 11:03Edwards, Huw 29 Sports Trauma Friday 09:09El-daly, Ibraheim 160 Trauma Wednesday 15:31Elfaki, Ahmed 780 Children’s Orthopaedics Thursday 14:27Elkhouly, Amr 650 Hand Surgery Thursday 08:55Elnikety, Sherif 522 Research Thursday 08:20Evans, Scott 11 Hand Surgery Thursday 08:47Evans, Jonathan 189 Trauma Wednesday 16:04Fagg, James 368 Children’s Orthopaedics Thursday 15:17Faimali, Martina 836 Audit & Management Thursday 10:38Farooq, Assad 903 Children’s Orthopaedics Thursday 14:38Fawi, Hassan 1006 Spinal Surgery Thursday 11:21Fawi, Hassan 1010 Trauma Wednesday 11:12Fenton, Paul 414 Limb Reconstruction Thursday 08:29Ferguson, Kim 377 Audit & Management Thursday 17:16Ferguson, Jamie 659 Limb Reconstruction Thursday 08:04Franklin, Marieta Dilani 142 Sports Trauma Friday 08:40Gaden, Mark T R 243 Trauma Wednesday 16:25Gaden, Mar T R 247 Trauma Wednesday 16:29Gaden, Mark T R 248 Children’s Orthopaedics Thursday 15:05Gandhi, Maulik Jagdish 298 Computer Assisted Orthopaedic Surgery Thursday 14:15Gaston, Czar Louie 625 General Orthopaedics Thursday 17:06Gbejuade, Herbert 523 Research Thursday 08:00Gbejuade, Herbert 875 Research Thursday 08:08Gbejuade, Herbert 879 Hip Surgery Wednesday 08:37Ghosh, Subhajit 237 Elbow and Shoulder Surgery Wednesday 08:08Gibbs, Victoria N 553 Knee Surgery Thursday 10:12Gillespie, James A 288 Sports Trauma Friday 09:17Gogna, Rajiv 494 Hip Surgery Wednesday 15:48Gogna, Rajiv 496 Hip Surgery Wednesday 08:16Goulding, Krista 321 Tumors Wednesday 10:00Goulding, Krista 938 Tumors Wednesday 10:52Graham, Simon Matthew 547 Children’s Orthopaedics Thursday 14:19Green, Carl 508 Tumors Wednesday 10:08Green, Carl 568 Tumors Wednesday 10:12Griffin, Xavier Luke 245 Research Thursday 16:15Griffin, Xavier Luke 265 Trauma Thursday 09:04Griffiths, Emmet 366 Trauma Wednesday 10:00Griffiths, Jamie 591 Limb Reconstruction Thursday 08:33


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Gupte, Chinmay M 131 Audit & Management Thursday 17:04Hannan, Cathal 464 Elbow and Shoulder Surgery Wednesday 09:24Haque, Syed 156 Spinal Surgery Thursday 10:56Haque, Aziz 795 Trauma Wednesday 10:40Hartwright, David 621 Knee Surgery Wednesday 09:11Hassan, Sami 850 Elbow and Shoulder Surgery Wednesday 08:34Hassan, Sami 861 Foot & Ankle Surgery Friday 08:32Hawkins, Simon 734 Research Thursday 08:28Higgins, Joanna 656 Hip Surgery Wednesday 15:19Hindle, Paul 743 Knee Surgery Wednesday 08:59Holt, Edward 398 Elbow and Shoulder Surgery Wednesday 09:20Hopper, Graeme Philip 194 Knee Surgery Wednesday 08:55Horriat, Saman 52 Audit & Management Thursday 10:59Hughes, Adrian 800 Foot & Ankle Surgery Thursday 08:42Hughes, Adrian 806 Trauma Friday 08:33Jack, Chris 118 Hip Surgery Wednesday 15:44Jameson, Simon 660 Hip Surgery Wednesday 08:00Jameson, Simon 663 Hip Surgery Wednesday 09:02Jameson, Simon 668 Hip Surgery Wednesday 08:04Jameson, Simon 669 Hip Surgery Friday 08:00Javed, Saqib 912 Foot & Ankle Surgery Thursday 08:21Javed, Saqib 923 Foot & Ankle Surgery Thursday 08:12Jenkinson, Mark 392 Hand Surgery Wednesday 15:46Jensen, Cyrus 628 Trauma Wednesday 10:16Jeys, Lee 141 Tumors Wednesday 10:44Johal, Simranjeeev 894 Children’s Orthopaedics Thursday 15:28Jones, Stephanie 390 Children’s Orthopaedics Thursday 14:54Joyce, Tom 126 Elbow and Shoulder Surgery Wednesday 09:00Kaminaris, Michail 921 Limb Reconstruction Thursday 08:08Karam, Edward 761 Trauma Thursday 09:20Karia, Monil 984 Computer Assisted Orthopaedic Surgery Thursday 14:40Karunathilaka, Chandana 736 World Orthopaedic Concern Friday 14:55Kayani, Babar 687 Tumors Wednesday 10:24Kazi, Hussain Anthony 139 Hip Surgery Wednesday 15:15Kellett, Catherine F 969 Hip Surgery Wednesday 08:29Kennedy, John W 82 Knee Surgery Wednesday 08:04Khakha, Raghbir Singh 348 Computer Assisted Orthopaedic Surgery Thursday 14:32Khakha, Raghbir Singh 616 Computer Assisted Orthopaedic Surgery Thursday 14:44Khan, Sameer 396 Hip Surgery Wednesday 15:32


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Khan, Sameer 397 Research Thursday 16:19Khan, Mohammad Shahnawaz 869 Computer Assisted Orthopaedic Surgery Thursday 14:23Kheiran, Amin 586 Foot & Ankle Surgery Thursday 09:20Kumar, Amit 918 Foot & Ankle Surgery Friday 08:20Kurien, Thomas 632 General Orthopaedics Thursday 17:02Lakkol, Sandesh 735 Spinal Surgery Thursday 10:12Lammin, Kimberly Ann 948 Hip Surgery Wednesday 08:12Lavery, Jonathan 506 Knee Surgery Wednesday 08:00Lawrence, Neil 428 Hip Surgery Wednesday 15:36Leong, Wei Yee 713 General Orthopaedics Thursday 16:43Leonidou, Andreas 109 Trauma Wednesday 15:23Lidder, Surjit 26 Hand Surgery Wednesday 15:31Machin, John T. 256 General Orthopaedics Thursday 17:22Mackie, Alasdair 600 Knee Surgery Wednesday 09:07Mahmoud, Samer SS 843 Hip Surgery Wednesday 15:23Mahmoud, Samer SS 898 Hip Surgery Friday 08:08Makki, Daoud 570 Children’s Orthopaedics Thursday 14:50Makki, Daoud 911 Audit & Management Thursday 10:46Malak, Tamer 306 Hip Surgery Wednesday 09:15Malhas, Amar 167 Children’s Orthopaedics Thursday 14:46Marenah, Kebba 931 Hand Surgery Wednesday 15:23Marsland, Daniel 353 Hand Surgery Thursday 08:51Marson, Ben 623 Audit & Management Thursday 11:11Marson, Ben 624 Sports Trauma Friday 09:21Mcgarvey, Ciaran 981 Sports Trauma Friday 09:05McLoughlin, Louise 149 Children’s Orthopaedics Thursday 14:23Miller, Clare 737 Hand Surgery Wednesday 16:07Mohanlal, Paraskumar 712 Elbow and Shoulder Surgery Wednesday 08:16Morrell, Rebecca 409 Trauma Wednesday 10:56Mussa, Mohamed Altayeb 839 Trauma Thursday 09:08Myatt, Richard 184 Trauma Wednesday 10:28Naik, Kumar 900 Spinal Surgery Thursday 10:31Nancoo, Tamara 174 Sports Trauma Friday 08:04Nancoo, Tamara 205 Sports Trauma Friday 08:08Nancoo, Tamara 606 Knee Surgery Wednesday 08:43Nancoo, Tamara 978 Knee Surgery Wednesday 08:47Neelapala, Venkata 686 Tumors Wednesday 10:04Newman, Simon 773 General Orthopaedics Wednesday 11:13Nisar, Aamer 214 Hip Surgery Wednesday 08:25


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Norton, William 793 Audit & Management Thursday 10:55Nzeako, Obi 477 Trauma Friday 08:25O Eseonu, O 804 Spinal Surgery Thursday 10:48Odumenya, Michelle 971 Knee Surgery Wednesday 08:32Okoro, Tosan 524 Research Thursday 08:50Oluwasegun, Akilapa 55 Foot & Ankle Surgery Thursday 08:50Osagie, Liza 70 Audit & Management Thursday 15:27Palan, Jeya 724 Audit & Management Thursday 15:23Palial, Vishal 833 Trauma Wednesday 10:44Panchani, Sunil 707 Foot & Ankle Surgery Thursday 08:25Patel, Vishal 290 Knee Surgery Thursday 10:00Patel, Nimesh 519 General Orthopaedics Thursday 17:10Patel, Akash 609 Foot & Ankle Surgery Thursday 08:04Patil, Sunit 845 Hip Surgery Wednesday 09:06Peck, Christopher 369 Knee Surgery Wednesday 08:08pentlow, Alanna 930 General Orthopaedics Wednesday 11:09Pickering, Greg 66 Hand Surgery Wednesday 16:28Prinja, Aditya 219 Trauma Wednesday 15:27Promod, Prakash 777 Children’s Orthopaedics Thursday 14:42Prteous, Andrew 982 Knee Surgery Wednesday 08:16Rachha, Rajesh 758 Foot & Ankle Surgery Thursday 08:54Rahman, Jeeshan 742 Limb Reconstruction Thursday 08:37Ramakrishna, Sushmith 945 Spinal Surgery Thursday 10:08Ramasamy, Vijayaraj 653 Elbow and Shoulder Surgery Wednesday 08:12Ramsingh, Vasanthakumar 249 Foot & Ankle Surgery Thursday 08:46Rao, Biyyam 651 Trauma Thursday 09:12Rao, Biyyam 799 General Orthopaedics Thursday 16:39Raza, Mushahid 360 Trauma Wednesday 16:00Razik, Aisha 379 Trauma Wednesday 16:12Reddy, Krishna 319 Tumors Wednesday 10:56Reidy, James 202 Trauma Wednesday 15:48Ribee, Helen Kathryn 441 General Orthopaedics Thursday 16:19Ribee, Helen Kathryn 445 Research Thursday 08:46Robati, Shibby 658 Audit & Management Thursday 15:06roberts, Gareth 210 Tumors Wednesday 10:40roberts, Gareth 940 Limb Reconstruction Thursday 08:21Robinson, Patrick G 85 Hip Surgery Wednesday 15:40Rogers, Benedict Aristotle 363 Hip Surgery Wednesday 08:54Rollins, Katie 987 Trauma Wednesday 16:08


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Roushdi, I 610 Hand Surgery Wednesday 15:15Rudd, J 815 Spinal Surgery Thursday 11:17Rushton, Paul 38 Hand Surgery Wednesday 16:03Sankar, Biju 801 Computer Assisted Orthopaedic Surgery Thursday 14:19Savaridas, Terence 116 General Orthopaedics Thursday 16:15Sawalha, Seif 485 Audit & Management Thursday 17:08Scally, Mark Daniel 65 General Orthopaedics Wednesday 11:05Scally, Mark D 231 Hip Surgery Wednesday 08:33Schindler, Oliver 35 General Orthopaedics Thursday 17:34Scott, Chloe E H 863 Knee Surgery Wednesday 08:24Shah, Amit 927 Audit & Management Thursday 10:30Shahid, Mohammad 75 General Orthopaedics Thursday 17:26Shahid, Mohammad 157 Tumors Wednesday 10:28Shahid, Mohammad 159 Hand Surgery Wednesday 16:24Shahid, Mohammad Kamran 437 Foot & Ankle Surgery Friday 08:48Shaw, Colin 105 Elbow and Shoulder Surgery Wednesday 08:26SHIVJI, FAIZ 647 Trauma Wednesday 15:52Sidaginamale, Raghavendra Prasad 858 Research Thursday 08:32Siddiqui, Nashat 665 Hand Surgery Wednesday 15:42Siddiqui, Nashat 675 Elbow and Shoulder Surgery Wednesday 08:38Sigamoney, Kohila 934 Foot & Ankle Surgery Thursday 08:38Singh, Amresh 51 Knee Surgery Wednesday 09:19Singh, Satya 119 Elbow and Shoulder Surgery Wednesday 08:30Sisodia, Gurudattsingh 9 Hip Surgery Wednesday 08:50Smith, James R A 979 Knee Surgery Wednesday 08:36Soon, V-Liem 393 Knee Surgery Thursday 10:08Soon, V-Liem 525 Audit & Management Thursday 11:07Soon, V-Liem 526 General Orthopaedics Thursday 17:14Soueid, Hassan 199 Trauma Wednesday 10:04Spalding, Tim 926 Knee Surgery Wednesday 08:51Spence, David James 255 Spinal Surgery Thursday 11:13Spiegelberg, Ben 648 Trauma Wednesday 11:08Stevenson, Ciara 576 Spinal Surgery Thursday 10:27Stirling, Paul 132 Audit & Management Thursday 15:35Swayamprakasam, Anand Prakash 509 Audit & Management Thursday 17:12Syme, Grant 362 Spinal Surgery Thursday 10:52Talbot, Chris 134 Children’s Orthopaedics Thursday 14:15Thambapillay, Sivaharan 565 Knee Surgery Thursday 10:16Thiagarajah, Shankar 725 Research Thursday 08:54


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Thomas, William 411 Sports Trauma Friday 08:55Tomlinson, James 284 Trauma Wednesday 11:16Trompeter, Alex 94 Trauma Wednesday 15:44Tsitskaris, Konstantinos 337 Spinal Surgery Thursday 10:16Uhiara, Okezika 964 Spinal Surgery Thursday 11:00Uri, Ofir 533 Elbow and Shoulder Surgery Wednesday 08:56Vannet, Nicola 71 Limb Reconstruction Thursday 08:00Venkataraman, Raja 531 General Orthopaedics Thursday 16:47Venkatesan, Muralidharan 558 Trauma Wednesday 10:12Venkatesan, Muralidharan 564 Spinal Surgery Thursday 10:35Vinayakam, Parthiban 584 Trauma Wednesday 10:08Wallace, D 827 General Orthopaedics Thursday 16:58Waterson, Ben 6 Knee Surgery Wednesday 08:12Wek, Caesar 732 Elbow and Shoulder Surgery Wednesday 08:52White, Jonathan James Edward 661 Elbow and Shoulder Surgery Wednesday 08:04Whittington, Lisa 759 Research Thursday 08:04Widnall, James 98 Audit & Management Thursday 17:00Williams, Huw 854 Trauma Friday 08:29Wilson, Lyndsay 416 Trauma Wednesday 11:04Winter, Alison 201 Hand Surgery Wednesday 15:59Wright, Jonathan 54 Elbow and Shoulder Surgery Wednesday 09:12Wright, Jonathan 370 Trauma Wednesday 11:00Wronka, Konrad 291 Elbow and Shoulder Surgery Wednesday 09:08Wu, Feiran 173 Hand Surgery Wednesday 16:16Yalamanchili, Seema 135 Trauma Wednesday 15:15Yates, Jonathan 588 Foot & Ankle Surgery Friday 08:44Yeoh, Clarence 446 Audit & Management Thursday 15:14Youssef, Bishoy 61 General Orthopaedics Thursday 16:27


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Hip 1660 08:00

Have cementless andresurfacing componentsimproved hip replacementfor younger patients? Ananalysis of patientreported outcome scoresand implant survivalS Jameson, P Baker, J Mason, P Gregg, D Deehan,M ReedDurham University, Durham

Revision and PROMs were comparedacross implant types in 24,709 patients>60 years, with reference to a standardTHR (cemented stem and polyethylenecup, standard sized head). In females,revision was significantly higher in hardbearing cementless implants (HR=3.34,p=0.041) and large head resurfacings(RH=4.78, p=0.013). Significantly greaterimprovements in PROMs were seen inhybrid and hard bearing cementlessimplants. In males, revision and PROMsimprovement was equivalent across alltypes. Hybrid implants may offer thebest balance between early outcomescore improvement and revision risk infemales. In males there were no benefitsof cementless and resurfacingcomponents.

08:00 – 09:30Hall 1

668 08:04

Is hip replacement using allcemented fixation and aconventional polyethylenebearing the gold standardfor patients aged over 60years? An analysis ofpatient reported outcomescores and implant survivalS Jameson, P Baker, J Mason, P Gregg, D Deehan,M Porter, M ReedDurham University, Durham

Revision and PROMs were comparedacross implant types in 79,995 patients>60 years, with reference to a standardTHR (cemented stem/polyethylenecup/standard head size). In males, afterselecting components with lowestrevision risk, revision was stillsignificantly higher in cementless(HR=1.99, p=0.003) and resurfacings(HR=3.82, p< 0.001). There were nosignificant differences in PROMsimprovement. In females, revision wassignificantly higher in cementless(RH=2.17, p< 0.001), but improvement inOHS was also higher (20.2 versus 21.8,p< 0.001) although clinically thisdifference is small. Hybrid replacementswere equivalent. Fully cementedimplants are currently the gold standardin this group.

642 08:08

Review of ceramic –ceramic bearings inhydroxyapatite ceramiccoated hip implants: aclinical and radiologicalevaluation with up totwenty year follow-upJ Buchanan, D FletcherSunderland Royal Hospital, Sunderland

Aims: To demonstrate the success ofHydroxyapatite hip (HA) arthroplastywith ceramic bearings. Methods: This isa 20+ year study of 627 HA hiparthroplasties with ceramic bearings.

Alumina ceramic in 467 hips. ZirconiaToughened Alumina (ZTA) in 160 hips.Results: Aseptic loosening (3 of 1254components, 0.24%). Five aluminacomponents broke (0.39%). No failure ofZTA ceramic. No thigh pain. Noosteolysis. No debris disease. Overallrevision rate 2.8% (for co-morbidproblems). Conclusions: HA hiparthroplasty with Ceramic bearingscauses few complications and succeedsfor patients of any age and either sex.

948 08:12

The outcome of theBirmingham hipresurfacing with aminimum ten years followupKA Lammin, S Sharma, M PorterWrightington Hospital, Wigan

We report the outcome of a singlesurgeon series of Birminghamresurfacings with a minimum ten-yearfollow up. 85 were performed in 75patients. The male:female ratio was55:20, and mean age 50 years. Meanfollow up was 132 months. Indicationsfor surgery were osteoarthritis,developmental dysplasia, post-traumaticarthritis, SUFE, and AVN. The meanmodified Oxford score pre-operativelywas 17, at one year 42, and ten years 42.The revision rate was 9%. Indicationswere failure of socket integration 1%,infection 1%, aseptic loosening 2% andALVAL 5%. The highest failure rate waswith head sizes less than 50.

496 08:16

Cemented hip replacementwith the Exeter UniversalCemented stem; long termresults from anindependent centreR Gogna, J Phillips, C Stevens, G Mundy, P HowardRoyal Derby Hospital, Derby

Our aim was to establish the long-termsurvivorship of the Exeter femoral stem


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at an independent centre. Patients whoreceived a primary cemented Exeterstem with a cemented acetabularcomponent were identified from 1992 to1997. The primary outcome measurewas revision of the stem. 371 patients,with 403 primary cemented Exeter hipreplacements were identified with amean age of 69.6 years. 230 patientsdied prior to the latest follow up (61%)with no revised stems. Of the 124surviving patients, there were 3 revisedstems (2.2%). We report a survivorshipof 97.8% at a mean follow-up of 14.6years.

DISCUSSION 08:20

214 08:25

Can we predict whichdysplastic hips will requireacetabular augmentationat total hip replacement?A Marsh, A Nisar, M El Refai, RMD Meek, S PatilSouthern General Hospital, Glasgow

The study looks at predictors ofacetabular augmentation in dysplastichips. We looked at preoperativelyradiographs for classification of hipdysplasia, centre edge (CEA), Sharp andTonnis angles. Templating was done onAP and lateral view radiographs. 31/128hips underwent acetabularaugmentation. Comparing theaugmented with nonaugmented group,there was no difference in the mean CEA(p = 0.19) and Tonnis angles (p = 0.32).Crowe Type 2 or greater was more likelyto require augmentation (p = 0.00274).Preoperative templating can predictwhich hips would require acetabularaugmentation during total hipreplacement in dysplastic hips.

969 08:29

Mid term results of the cupcage construct fortreatment of massiveacetabular defectsCF Kellett, AE Gross, D LewallenGolden Jubilee National Hospital, Glasgow

32 patients (mean age 64.9, range 45 to83 years) with massive un/containeddefects underwent revision arthroplastywith a cup cage. Complications: threedeaths unrelated to surgery, oneinfection, two recurrent dislocationsrevised to capture liners. Onecomponent migration. 5 lost to followup. Harris Hip Scores averaged 45 pre-opand 77 post-op. Minor radiolucent linesat inferior flange in 14 patients.Survivorship was 87% for the patientsfollowed up at 80.4 months. The midterm Cup Cage results show excellentrates of initial implant stability and bonegraft remodelling.

231 08:33

Intraoperative fractures inthe early experience ofusing the Corail femoralstem for the treatment offemoral neck fracturesMD Scally, A Jain, SM LiewThe Alfred Hospital, Melbourne, Australia

Abstract not provided

879 08:37

The impact ofsupplementaryDaptomycin andVancomcyin on the elutionof commercially addedGentamicin fromPolymethylmethacrylatecementH Gbejuade, A Lovering, A Blom, J Webb Musculoskeletal research Unit, AvonOrthopaedic centre, Microbiology research unit,Southmead Hospital, Bristol

Increasing antimicrobial resistance is aconcern with the use of antibiotic loadedacrylic cement (ALAC), prompting theuse of combination antimicrobialtherapy. We studied antibiotic elutionfrom different combinations of ALAC.ALAC prepared with gentamcin,vancomycin and daptomycin incombinations,were eluted for 1h-90 daysand antibiotic concentrations assayedthereafter. The mean 90 day gentamicinrecovery was 1.1 mg with half mostlyeluted within the first 24 hours. 60%increase in gentamicin elution occurredin the presence of daptomycin (p=0.004).The significant increases in gentamicinelution in the presence of daptomycin,along with the superior antimicrobialdaptomycin activity, may offer the bestcombination

603 08:41

Can frozen sectionhistology be used toreliably rule out suspectedprosthetic joint infection inrevision arthroplastysurgery?R Craig, C Fortescue, S Iyer, G Kingston, T Pollard,A Andrade, J MorleyRoyal Berkshire Hospital Foundation Trust,Reading

Based on recent literature, we adopted anew protocol for the use of frozensection histology to diagnose prostheticjoint infections. A cut-off of 23

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polymorphonuclear neutrophils per tenhigh powered microscope fields wasapplied. Between 2010 and 2011 wecollected data for 62 revision hip andknee arthroplasty cases, comparinghistological to microbiological andclinical diagnosis. In this group ofpatients the pretest probability was low.Frozen section histology allowed intra-operative diagnosis of seven patientswith infection. There was one falsepositive result. There was agreementbetween histology and clinical outcomefor 20/21 second stage procedures.

DISCUSSION 08:45

363 08:50

Can the pre-operativewestern Ontario andMcMaster (WOMAC) scorepredict patient satisfactionfollowing total hiparthroplasty? An analysisof patient-reportedoutcomes for jointreplacementBA Rogers, A Carrothers, H Kreder, R JenkinsonBrighton and Sussex University Hospitals,BrightonDoes pre-operative Western Ontario andMcMaster Universities (WOMAC)osteoarthritis scores predict satisfactionfollowing total hip arthroplasty.

This prospective study compared pre-operative and one-year post-operativeWOMAC scores for 439 hip replacement439 patients with aexpectation/satisfaction questionnaire.Satisfaction scores were dichotomizedinto either an improvement ordeterioration relative to pre-operativeexpectations and compared usingreceiver operating characteristic (ROC)analysis against; pre-operative, post-operative and delta-WOMAC scores.Statistical analysis showed norelationship between WOMAC andpatient satisfaction. Thus, pre-operativeWOMAC does not predict patientsatisfaction and does not support theuse of pre-operative WOMAC scores inprioritizing patient care.

417 08:54

Does total hip replacementhave an effect on patientactivity levels or actualpatient activityprecipitation one year postsurgery? An analysis ofpatient-reported outcomesfor joint replacementAD Carrothers, B Rogers, T Vasarheyli, SJ MacDonald, HJ Kreder, RJ JenkinsonAddenbrooke’s Hospital, Cambridge; SunnybrookHealth Sciences Centre, Toronto, Canada

Anecdotally patients aspire to higheractivity levels post Total Hip Arthroplasty(THA). 460 patients underwent primaryTHA and a standardized rehabilitationprotocol. Prospectively demographics,THA type and bearing combinations,activity data and WOMAC scores, priorto and one-year following surgery, wereindependently recorded. Fifty differentactivity categories were analyzed withthe actual time spent engaged in eachactivity. Basic physical activitiesincreased but analyzing actualhobby/sporting activities, no increasereached statistical significance nor wasthere statistical change in BMI. Popularretirement activities such as golf did notshow an increase in participation norparticipation duration post THA.

663 08:58

The impact of body massindex (BMI) on earlyfunctional outcomefollowing primary hipreplacement – AN analysisof national patientreported outcomemeasures (PROMs) dataS Jameson, P Baker, J Mason, D Elson, D Deehan,M ReedDurham University, Durham

Patient outcomes following 2656 THRswere compared across different BMIs,using NJR-PROMs linked data. When

compared with the reference BMI group,obese class I patients (30.0-34.9 kg/m2)had a lower improvement in OHS (18.9versus 20.5, p< 0.001) and a greater riskof wound complications (OR=1.57,p=0.006). For obese class II/III patients(35.0kg/m2+), there was a lowerimprovement in OHS (18.7 versus 20.5,p< 0.001) and a greater risk of woundcomplications (OR=2.06, p< 0.001),readmission (OR=1.99, p=0.001) andreoperation (OR=2.73, p=0.003). Therewere large improvements in PROMsirrespective of BMI. Complication rateswere higher with increasing BMI.

845 09:02

Outcome of openreduction and internalfixation of Vancouver typeB fractures around acemented taperedpolished stemS Patil, S Goudie, S Patton, J Keating Edinburgh Royal Infirmary, Edinburgh

We retrospectively identified thepatients with Vancouver type B fracturesaround a cemented tapered polishedstem (CTPS) treated with ORIF. Bicorticalscrew fixation was obtained in theproximal and distal fragments. Of the 70patients with a minimum 6 month followup, 63 united. 3 patients developedinfected non-union and 4 aseptic failure.Infection, lack of anatomical reductionand inadequate proximal fragmentfixation were the most commonpredictors of failure. This is the largestseries of a very specific group ofperiprosthetic fractures treated withosteosynthesis. We recommendosteosynthesis provided these fracturescan be anatomically reduced andadequately fixed.

DISCUSSION 09:06

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306 09:10

All-cause mortalityfollowing total hiparthroplasty: Cement vs.Cementless vs. HybridT Malak, D Prieto-Alhambra, K Javaid, F Pallisó,A Carr, M Espallargues, C Cooper, N Arden, A Judge, S Glyn-JonesNuffield Orthopaedic Centre, Oxford

The recent National Joint Registry (NJR)report showed increased mortality rateswith use of cement following primaryTotal Hip Arthroplasty (THA). Causes mayinclude patient, surgical and implant-related variables, but data is scarce.RACAT is a local record of hipreplacements performed matchedclosely to GP records. We conducted aretrospective cohort study examining theassociation between cement use andmortality following THA surgery. Overallmortality showed a Hazard Ration1.94[1.11-3.37] for cemented versuscementless fixation Independent of age,demographics, pharmaceutical use, co-morbidities, socio-economic status andlife-style factors. This increase wasdriven by early mortality rates.

374 09:15

Mortality Following HipReplacement – Resultsfrom the UK National JointRegistryBJRF Bolland, SL Whitehouse, JR Howell, R Crawford, AJ TimperleySouthampton General Hospital; Instituteof Health and Biomedical Innovation,QUT, Australia; Princess ElizabethOrthopaedic Centre, Exeter

To determine if a true cause and effecton mortality risk by hip fixation typecould be established using NJR data.Analysis performed using Coxproportional hazards regression using allrelevant variables from NJR dataset.Postcode data included determiningeffect on model. Mortality rates werelower than in age-matched populationacross all hip types. Multiple variables

had significant effect on mortality rates.Approach was not significant. With theaddition of postcode data to the model,approach became significant. This studydemonstrates that true cause and effecton the risk of mortality cannot beadequately modelled from currentlyavailable Registry data.

DISCUSSION 09:19

Knee506 08:00

The validity and reliabilityof the modified forgottenjoint scoreJ Lavery, I Anthony, M Blyth, B JonesUniversity of Glasgow, Glasgow

The Modified Forgotten Joint Score(MFJS) is a new patient-reportedoutcome measure in hip and kneearthroplasty which we have validatedagainst the UK’s gold standard OxfordHip and Knee Scores (OHS/OKS). TheMFJS measures a new appealingconcept; the ability of a patient to forgetabout their artificial joint in everydaylife. Postal questionnaires were sent to400 THR and TKR patients, with a returnof 212 questionnaires. The resultsshowed that the MFJS provided a moresensitive assessment of hip/kneearthroplasties especially in the wellperforming patients and thereforeshould be used as adjunct to theOKS/OHS.

08:00 – 09:30Hall 8

82 08:04

Total knee replacement inoctogenarians: does agematter?JW Kennedy, L Johnston, L Cochrane, PJ Boscainos Ninewells Hospital & School of Medicine,University of Dundee, Dundee

Total knee arthoplasty (TKA) is one of themost commonly performed proceduresin the elderly, yet whether ageinfluences postoperative outcomes is notfully understood. We retrospectivelyreviewed 438 patients over 80 years whounderwent primary TKA between 1995and 2005. We established a comparatorgroup of 2754 patients younger than 80years. We found no difference in painscores at 3, 5, and 10 years betweengroups. The Knee Society Score wascomparable at Year 5, but the KneeSociety Function Score was lower in theelderly. Major complication rates werehigher in the over 80’s group.

369 08:08

Poorer Outcomes of TotalKnee Replacement in EarlyRadiological Stages ofOsteoarthritisC Peck, J Childs, G McLauchlanLancashire Teaching Hospital NHS Trust, Preston

We identified 63 primary total kneereplacements in 61 patients with aKellgren-Lawrence grade of three or less.The mean (SD) age was 63 (9.2) yearsand the mean reoperative OKS was 15(6.0). At a mean follow-up of 38 monthsthe mean OKS was 30 (10.1) and only 44patients (70%) were either satisfied orvery satisfied. Eleven knees (17%)underwent a further procedure, themajority (6) being manipulation underanaesthesia. This study shows thatoutcomes of TKR in patients with earlyradiological changes of OA are inferior tothose with significant changes andshould be performed with caution.

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6 08:12

Early outcome andeconomic benefits usingthe ShapeMatch TotalKnee Replacement withkinematic alignmentphilosophyB Waterson, A TomsRoyal Devon and Exeter foundation trust, Exeter

We identified 63 primary total kneereplacements in 61 patients with aKellgren-Lawrence grade of three or less.The mean (SD) age was 63 (9.2) yearsand the mean reoperative OKS was 15(6.0). At a mean follow-up of 38 monthsthe mean OKS was 30 (10.1) and only 44patients (70%) were either satisfied orvery satisfied. Eleven knees (17%)underwent a further procedure, themajority (6) being manipulation underanaesthesia. This study shows thatoutcomes of TKR in patients with earlyradiological changes of OA are inferior tothose with significant changes andshould be performed with caution.

982 08:16

Early experience of 100cases of primary TKA usingPatient Matched CuttingBlocks (PMCB)A Porteous, M Hassaballa, J Robinson, J MurrayBristol knee group, Avon Orthopaedic centre,Bristol

Aim: To assess the process of radiologicalinvestigations, plan and variations fromplan of our first 100 cases using PMCB.Method: The plans and operation notesfor our first 100 cases were compared toassess the alignment measurements andsizes predicted on the plans and sizesactually used in theatre. Results: 93cases had detailed operation notes: allfemoral blocks were reported to have anexcellent fit. Good or excellent block fitreported for 99.5% of blocks. Conclusion:The technology was able to make blocksthat provided excellent match to theintra-operative femoral and tibialsurfaces.

DISCUSSION 08:20

863 08:24

Proximal tibial strain inunicompartmental kneereplacements: Abiomechanical study ofimplant designCEH Scott, RW Nutton, P Pankaj, MJ Eaton, SL EvansUniversity of Edinburgh, Edinburgh, CardiffUniversity, Cardiff

The effect of UKR implant design andmaterial on proximal tibial cortical strainand cancellous microdamage wasexamined using digital image correlation(DIC), and acoustic emission (AE). Fixedbearing all-polyethylene (FB-AP), fixedbearing metal-backed (FB-MB), andmobile bearing metal-backed implants(MB-MB) were cemented into compositetibias and loaded to 2500N. Intact tibiaswere used as controls. Differencesexisted in cortical strain in the proximal10mm (p<0.001) with strain shielding inmetal-backed implants. FB-AP implantsshowed 14x the microdamage (AE hits)of controls, FB-MB 5.5x and MB-MB 2.5x.Microdamage was significantly greater inFB-AP implants at all loads (p=0.001).

275 08:28

Does robotic surgicalassistance improve surgicalaccuracy in uni-compartmental kneereplacement?M Blyth, B Jones, A MacLean, I Anthony, J Smith,P RoweGlasgow Royal Infirmary, Glasgow

100 patients were randomised to receiveUKA with or without the aid of RoboticAssistance. Post-operative CT scans wereused to calculate the deviation fromplanned target for both tibial andfemoral implant position in 3 planes:varus/valgus, flexion/extension andinternal/external rotation. In 5 of 6dimensions measured a significantdifference was found between the

accuracy of Robotic Assisted andtraditional surgery. Robotic Assisted UKAusing the MAKO RIO system enhancesthe accuracy of implant placementduring surgery. Lower early post-operative pain scores and greater 3month clinical scores were also noted inthe Robotic Assisted group.

971 08:32

The uniglideunicompartmental kneereplacement: earlyfunctional outcomes andsurvivorship from anindependent centreM Joseph, C Downham, C Richmond, T Spalding,P ThompsonUniversity of Warwick, Clinical Science ResearchInstitute, Warwick

We present the early to mid-term resultsof a prospective, consecutive, single-surgeon series of 128 Uniglideunicompartmental replacements withmean four year follow-up. Ninety-fiveper cent of cases had medial OA treatedwith cemented components and mobilebearing. The differences in pre-operativeand post-operative functional scoreswere all statistically significant (P <0.001). X-ray analysis revealed femoralflexion/extension angle as the mostcommon error. Four knees were revisedto TKR for aseptic loosening (2) anddisease progression (2). The survival at 7years was 96%. The Uniglide offersexcellent survivorship with good relief ofsymptoms and return to function.

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979 08:36

Fixed bearing lateralunicompartmental kneearthroplasty - short tomidterm survivorship andknee scores for 101prosthesesJRA Smith, JR Robinson, JRD Murray, AJ Porteous,MA Hassaballa, N Artz, JH NewmanNorth Bristol NHS Trust, Bristol

Lateral unicompartmental kneearthroplasty (UKA) constitutes only 1% ofall knee arthroplasty performed. Unlikemedial UKA, results of lateral UKA havebeen mixed. We present the largestseries to date using a single prosthesis.Survivorship for 101 prostheses usingrevision for any cause as the end-pointwas 98.7% and 95.5% at 2 and 5 yearsrespectively. 33 knees were fully scoredat 5 years. Mean AKSS, OKS and WOMACscores were 159, 37, and 22 respectively.Unicompartmental knee arthroplastyprovides a valuable alternative to totaljoint replacement in the treatment ofisolated degenerative lateral tibio-femoral joint disease.

DISCUSSION 08:40

606 08:43

The evolving indicationsfor osteotomies aroundthe knee. Analysis of earlyresults from a UK centreT Nancoo, G Cox, M Risebury, N Thomas, A WilsonBasingstoke and North Hampshire Hospital NHSFoundation Trust, Basingstoke

The introduction of strong, fixed angle,locking plates has reduced the risk ofloss-of-correction and allowed anexpansion of the patient-specificindications (e.g. BMI, age, gender) forosteotomy. Traditionally, the idealcandidates have been thin, young,active, non-smoking, male, manuallabourers with symptomatic early uni-compartmental osteoarthritis and frontalplane joint malalignment. Analysis of 3.5year results from the Basingstoke

Osteotomy Database challenge thesetraditional indications suggesting thatgood outcomes can be achieved whenthe lower limb is accurately aligned(mean weight-bearing axis pre-op=25.1±11.6% changed to 55.9±10.8%post-op). Results were independent ofage, gender, BMI and grade of arthritis.

978 08:47

The influence ofradiological parameters onclinical outcomes afteropen wedge high tibialosteotomyT Nancoo, G Cox, M Risebury, N Thomas, A WilsonBasingstoke and North Hampshire Hospital NHSFoundation Trust, Basingstoke

Based on Bonin´s work, it is now widelyaccepted that tibial bone varusangle(TBVA) is the primary radiologicalparameter for predicting clinicaloutcomes after medial-open-wedge hightibial osteotomy(MOWHTO). Wehypothesised that radiologicalparameters of varus malalignment,including TBVA, are all positiveprognostic factors for clinical outcomes.Prospectively collected data from 156consecutive MOWHTOs were analysed.Interestingly, increasing TBVA did notcorrelate with better outcomes. The onlystatistically significant correlation wasfound between the pre-operativeweight-bearing axis (mean 24.2%±11.8%)and postoperative Oxford Knee Scoressuggesting that the WBA is the onlyfactor that should be used to determineprognosis after MOWHTO.

926 08:51

Outcome of meniscalallograft transplantationrelated to chondral wear:advanced degenerativechange should not be acontraindicationT Spalding, C Robb, P Kempshall, A Getgood, P ThompsonUniversity Hospital, Coventry

Outcome following Meniscal AllograftTransplantation (MAT) in 29 knees withbare bone (ICRS grade 3b/3c group B)was compared to 36 patients with goodsurfaces (group G). Mean follow-up 2.3years, age higher in group G (37 v 20).Outcome scores significantly improved inboth groups at 1 year with no differencebetween groups. Group B showed highercomplication rate implant removal 5v1 atmean 1.0 years (0.47-1.77). 2 yr Kaplan-Meier implant removal survival was95.5%(G) and 82.2%(B) (p=0.043). MATin presence of bare bone is thereforeacceptable at short term follow-up andshould not be discounted as an option.

194 08:55

Radiographic factors infailure of medialpatellofemoral ligamentreconstructionGP Hopper, JA Wells, WJ Leach, BP Rooney, CR Walker, MJ BlythGlasgow Royal Infirmary, Glasgow

This study determines the relationshipbetween trochlear dysplasia, femoraltunnel placement and outcomefollowing MPFL reconstruction. 68patients with recurrent dislocation of thepatella underwent MPFL reconstruction.Mean follow-up was 31.3 months.Clinical outcomes and radiographicparameters were recorded. The meancongruence angle, lateral patellofemoralangle and patellar height improvedsignificantly. 12 patients hadpostoperative patellar dislocationsrelating to raised trochlear boss height,high grade trochlear dysplasia and non-

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anatomical femoral tunnel placement.This study demonstrates the importanceof anatomic restoration and proposesthat this procedure not be performed inisolation in patients with high gradetrochlear dysplasia.

743 08:59

Cell viability ofchondrocytes seeded ontoa collagen I/III membranefor matrix-assistedautologous chondrocyteimplantationP Hindle, A Hall, L BiantRoyal Infirmary of Edinburgh, University ofEdinburgh, Centre for Integrative Physiology,Edinburgh

Confocal laser scanning microscopy wasused to image live and deadchondrocytes on a collagen membrane.Cell density ranged from 1.14-1.67x106cells/cm2, in specimens withoutsignificant trauma, to 2.58x105 cells/cm2in the specimen grasped with forceps.The percentage of live cells on deliverygrade membrane was 86.6%. Thisdropped to 76.4% after handling and33.9% after crushing. Where themembrane was cut there was a band ofcell death and the viability dropped to16.6%. Visualisation of the cells using thex63 objective revealed cells that did nothave the typical rounded phenotype ofchondrocytes.

DISCUSSION 09:03

600 09:07

How does post op BMIchange after TKA impacton outcome?A Mackie, K Muthumayandi, C Gerrand, D DeehanFreeman Hospital, Newcastle upon Tyne

This study aimed to examine themedium term relationship betweenoutcomes after primary TKR and changein BMI one year after surgery. We haveexamined a consecutive cohort ofprospectively studied patients who haveundergone knee replacement in a singleinstitution. We have found a significantnegative association betweenimprovement in key patient reportedoutcome measures and post-operativeweight gain, increasing weight met withlower final functional score. This effectwas gender specific with malesexhibiting a greater improvement thanfemales. A threshold of 10% BMIincrease significantly was associatedwith reduced pain relief following jointreplacement.

621 09:11

Effect of Body Mass Index(BMI) on the results ofPrimary Total KneeArthroplasty (TKA)D Hartwright, A Ncholls, S Ahmad, E Matthews, J WaldingHampshire Hospitals Foundation Trust,Winchester

A prospective cohort of 315 consecutivepatients (319 TKAs) were divided into 3groups according to BMI (≥35, 30-35, <30). Groups were compared using:Oxford Knee Score (OKS), EQ-5D, EQ-VAS,blood loss, Length of Stay (LoS), pain andsatisfaction (VAS). Assessments weremade pre-operatively, at 6 weeks, 6, 12and 24 months post-operatively.

Patients with a high BMI presentedearlier for TKA surgery. All patients,regardless of BMI, demonstratesignificant improvements followingprimary TKA surgery. Those, however,with a lower BMI have better early

results and are more satisfiedparticularly when compared againstthose with a BMI >35.

53 09:15

MRI performed ondedicated knee coils isinaccurate formeasurement of tibialtubercle trochlear groovedistanceA Aarvold, V Sakthivel, R AyersPoole Hospital NHS Foundation Trust, Poole;University Hospital Southampton, Southampton

Initially described on scans of knees infull extension, the introduction ofdedicated knee MR coils has resulted inTTD measurements performed on scansof partially flexed knees. Comparison of TTD of 32 knees scannedin a both an MR body coil (that permitsknee extension) and a dedicated kneecoil revealed a significant difference inmean TTD measurement (20.0mmversus 11.3mm respectively, p< 0.0001).Falsely low TTD measurements fromdedicated knee coils may result insymptomatic patients being falsely re-assured or erroneously denied surgery. Itis critical for surgeons and radiologistsmanaging patello-femoral instability toappreciate this profound difference.

51 09:19

Anterior tibio-femoralimpingement in thehyperextending knee – acause for anterior kneepainA Singh, B SinghSunderland Royal Hospital, Sunderland

We present a case series of elevenpatients with anterior knee pain andhyperextension. The aim is to highlightanterior tibio-femoral impingement ascause for this pain. Conservativetreatment failed to resolve symptomsand an arthroscopy was performed tolook for the cause. We observed

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evidence of clear impingement and thiswas recorded using intraoperativepictures and video. Subsequentphysiotherapy was aimed at hamstringstrengthening and limitinghyperextension. All patients hadsignificant improvements by 12 months.Anterior tibio-femoral impingement is apoorly recognized cause of anterior kneepain and current methods ofrehabilitation may actually exacerbatethe problem.

946 09:23

Skills assessment in KneeArthroscopyK Akhtar, S Bayona, A Dodds, J Lee, J Cobb, C GupteImperial College, London

A Delphi method was used to develop adetailed Global Rating Scale (GRS) forassessing knee arthroscopy. Thisconsisted of 10 dimensions, each gradedon a 5-point scale. 50 subjects werefilmed performing 2 different exercisesusing a virtual reality knee arthroscopysimulator and two blinded surgeonsassessed all 50 subjects using the GRS.The GRS was seen to have high internalconsistency and excellent inter-raterreliability and offers a more thoroughapproach to assessing technicalperformance. The dimensions coveredprovide detailed information on surgicalskills and support its use as a tool forfeedback and assessment.

DISCUSSION 09:27

Elbow & Shoulder661 08:00

Study of rotator cuffpathology using the healthimprovement networkdatabaseJJE White, AG Titchener, AA Tambe, A Fakis, RB Hubbard, DI ClarkRoyal Derby Hospital, Derby

We have undertaken an epidemiologicalstudy of rotator cuff pathology using alarge general practice database. Theincidence rate of rotator cuff pathologywas 87 per 100,000 person-years. Thiswas more common in women than inmen. The highest incidence rate of 198per 100,000 person-years was found inthe age group 55 to 59 years. Regionaldistribution analysis demonstratedWales as an outlier with a significantlyhigher incidence. The lowestsocioeconomic group had the highestincidence rates. Incidence rates haverisen since 1987 and as of 2006, show nosigns of plateau.

237 08:04

Use of Isolated LatissimusDorsi Tendon toreconstitute ExternalRotation in Adult BrachialPlexopathy patientsS GHOSH, V Singh, L Jeeyaseelan, M FoxNorth West Thames Orthopaedic TrainingProgramme, Peripheral Nerve Injury Unit,Stanmore

In adults with brachial plexus injuries,lack of active external rotation at theshoulder is one of the most commonresidual deficits. We present ourexperience of isolated latissimus dorsimuscle transfer to achieve activeexternal rotation. The meanimprovement in active external rotation

08:00 – 09:30Hall 11A

from neutral, arc of rotation and powerof the external rotators was 24°,52° andwas 3.5 MRC grades. A total of 21patients (88%) were back in work, 13had returned to their pre-injuryoccupation. This is a simple and reliablemethod of restoring useful activeexternal rotation in this group ofplexopathy patients.

653 08:08

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712 08:12

How effective ishydrodistension foradhesive capsulitis ofshoulder?P Mohanlal, A TolatMedway Maritime Hospital, Medway

A prospective study was done to analyseoutcome of hydrodistension for adhesivecapsulitis of shoulder. There were forty-six patients with an average age of 56.7(31-80) years. Females predominated inthe study. With an average follow-up of19.3 (3-55) months, the mean pre-opDASH scores improved from 55.4 (23.3-87.5) to 28.7 (0-87.5). The mean pre-opOxford scores improved from 17.1 (3-36)to 34.8 (3-48). There were no intra-operative complications. Three patientssubsequently needed arthroscopicrelease for recurrence after one year.Hydrodistension is a safe and effectiveprocedure in the treatment of adhesivecapsulitis of the shoulder, with minimalrisks.

DISCUSSION 08:16

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105 08:20

Displaced olecranonfractures: outcome in abusy district generalhospitalC Shaw, G Ayana, J Badhesha, S SpenceRoyal Alexandra Hospital, Paisley

Methods: All olecranon fracturesadmitted in calendar years 2007-2010were identified. Xrays were analysed toclassify the fractures and assess outcomeof treatment. Results: Average DASHpost scores improved for all groups.Mayo Classification: Type I A: 5 (7.8%) alltreated CONS; Type I B: 2 (3.1%) - alltreated CONS | Type II A: 35 (54.7%)TREATED:1 PLATE/6 CONS/28 TBW |Type II B: 16 (25%) TREATED:5 PLATE/1CONS/10 TBW | Type III A: 3 (4.7%)TREATED:2 PLATE/1TBW | Type III B: 3(4.7%) TREATED:3 PLATE Conclusion: Wehave demonstrated lower metalwareremoval with a high rate of patientstreated conservatively who do well.

119 08:26

A case series of oldneglected fracturedislocation of elbow withentrapped medialepicondyleS Singh, Dr Anand SwaroopDr Ram Manohar Lohia Hospital, New Delhi

Achieving a functional elbow afterfracture dislocation is challenge for anysurgeon. The goal of study was to assessthe outcome after surgical release anddebridment of joint and reattachment ofmedial epicondyle. Study included 12cases of old, neglected, elbowdislocation with intra-articular entrappedmedial epicondyle. Surgery was followedby early supervised physiotherapy.Outcome was measured by MAYO’ sscore. In our study ten out of twelveachieved excellent result. All werepainless and stable except two caseswhich were mild painful and moderatelyunstable.

850 08:30

Short- to mid-termoutcomes of complexradial head fracturestreated by a modular radialhead replacementS Hassan, O Salar, M Espag, T Cresswell, D ClarkEast Midlands Deanery (North), Derby

Purpose: To report functional and post-operative outcomes of complex radialhead fractures with elbowinstability,treated by arthroplasty usinguncemented modular anatomicprosthesis. Methods: Over 3-year period(2007-2010), 21 patients (mean-age 51.9years; mean-F/u 27.1 months) weretreated. Data was collectedretrospectively, including: Oxford ElbowIndex, Quick-DASH, and Mayo ElbowPerformance Score, and radiographicassessments. Results: Mean Scores:Oxford Elbow=34.80; Quick-Dash=26.01.Mayo Performance= 6 scored excellent.11 patients had an associatedligamentous injury of which 6 wereTerrible Triad, 7 patients’ radiographsshowed early signs of implant loosening.3 patients underwent further surgery.Conclusion: Patient scores showed goodfunctionality and satisfaction despiteradiographic loosening. Findings supportuse for this prosthesis in complex elbowfractures and dislocations.

675 08:34

Recovery of grip strengthafter surgical release oflateral epicondylitisN Siddiqui, J Sonderegger, M RobinsonPrincess Alexandra Hospital, Brisbane, Australia;Avon Orthopaedic Centre, Bristol

Loss of grip strength may be used as partof the decision-making process to enlistpatients for surgery for lateralepicondylitis. A consecutive series of 55patients with unilateral lateralepicondylitis were surgically treated withopen release, debridement and repair.We assessed bilateral grip strength pre-and post-operatively. Mean grip strengthof the affected side compared to the

unaffected side was 55.6% (SD 20.9)preoperatively, 40.8% (SD 20.1) at twoweeks, 72.2% (SD 17.7) at six weeks,80.7% (SD 21.4) at 12 weeks and 85.5%(SD 20.9) at 18 weeks. Grip strength hadreturned to pre-operative levels by 26days.

IOS(UK) 08:38

Effectiveness ofextracorporeal shock wavetherapy, injection andphysiotherapy in lateralepicondylitis in long termfollow upR Mittal, A Malpura, HL Nag, S GamanagattiAll India Institute of Medical Sciences, New Delhi

Type of study - Prospective randomizedtrial. Objective - To evaluate theeffectiveness of extracorporeal shockwave therapy, injection steroid andphysiotherapy in lateral epicondylitis inlong-term. Methods - Adults (N = 90;ages, 18-55) with clinically diagnosedlateral epicondylitis were selectedaccording to preset inclusion criteria.Patients were randomized and assignedto 1 of 3 interventions: extracorporealshock wave therapy, injection steroidand physiotherapy. All the patients wereadvised daily activities modifications andfollowed up at one month, threemonths, six months and one year aftertreatment. The functional outcome wasmeasured at each visit in all three groupsusing visual analogue scale (VAS) forpain, Mayo performance elbow score(MEPS) for function of elbow and SF-12questionnaire for general healthoutcome. Results - The groups did notdiffer in demographic data and VAS,MEPS and SF-12 scores at beginning ofthe study. VAS at the end of 12 monthswas 1.69 +/- 1.834, 5.24+/-2.641, 5.0+/-1.678 for the EWST, steroid injection andphysiotherapy groups respectively. MEPSat the end of 12 months was 86.21+/-10.910, 64.66+/-15.349, 66.25+/-9.682for EWST, steroid injection andphysiotherapy groups respectively. SF-12(MCS) at the end of 12 months was

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56.197+/-6.6862, 34.689+/-13.8918,41.711+/-32.97 for the EWST, steroidinjection and physiotherapy groupsrespectively. SF-12(PCS) at the end of 12months was 51.366+/-7.5317, 34.086+/-10.6813, 40.829+/-7.7093 for EWST,steroid injection and physiotherapygroups respectively. Conclusions - Ourstudy found that ESWT is most effectivetreatment for lateral epicondylitis inlong-term at one year. Although steroidinjection was effective in short term, butthere was high rate of recurrence.

DISCUSSION 08:42

732 08:46

Histological evaluation ofretrieved copeland re-surfacing shoulderarthroplastiesC Wek, CP Kelly, J John, G BlunnUniversity College Hospital, John Scales Centrefor Biomedical Engineering, London

We performed a histological andhistomorphometric analysis of sixretrieved Hydroxyapatite-coatedCopeland humeral resurfacingprostheses to determine if osteonecrosiswas a mechanism of failure. Thespecimens were analysed using Light andBack-scattered electron microscopy. Wefound no evidence of osteonecrosis inthe revised specimens as the vasculaturewas intact under the surface of theimplant. Bony ongrowth was observed atthe bone-implant interface and theaverage bone-implant contact rangedfrom 11.1-36.6% between thespecimens. In this study, we foundevidence of good osteointegration withinthe prosthesis with no evidence ofosteonecrosis as a mechanism of failure.

533 08:52

Clinical outcome ofrevision surgery for failedhumeral head replacementfollowing shoulder traumaO Uri, V Beckles, S LambertRoyal National Orthopaedic Hospital NHS Trust,Middlesex

Late complications of humeral headreplacement (HHR) may necessitaterevision surgery. Clinical outcomes of 67patients, who underwent revision forfailed HHR following proximal humerusfracture, were evaluated in a mean of 34months post operatively. Clinical scoresand pain rating improved significantly inall the patients. Active range of motionincreased in patients who were revisedwith anatomical total shoulder orreverse total shoulder implants but notin patients with glenoid deficiency whounderwent revision with hip-inspiredglenoid-shell implant. Revisionarthroplasty for failed post-traumaticHHR remains challenging. Glenoiddeficiency seems to be associated withinferior clinical outcomes.

126 08:56

A multi-stationglenohumeral prosthesiswear simulatorT Joyce, L Li, G Johnson, S SmithNewcastle University, Newcastle upon Tyne

Wear of polymeric components has beenidentified as a cause of loosening andfailure of shoulder implants in vivo. Amulti-station shoulder simulator wasdesigned which moves five testglenohumeral prostheses simultaneouslyin the flexion-extension, abduction-adduction, and internal-external rotationaxes. ‘Mug to Mouth’ was selected as anactivity of daily living for initial testing inthe simulator. A 2 million cycle wear testwas performed with JRI OrthopaedicsReverse VAIOS shoulder prosthesestested in 50% bovine serum. The averagepolymeric component wear rates were14.1 ± 2.1 mm3/106cycles. The multi-

station shoulder simulator is the first ofits kind.

DISCUSSION 09:00

291 09:04

Incidence of symptomaticvenous thrombo-embolism(VTE) following shouldersurgery. Review of 2341cases.K Wronka, A Sinha West Wales General Hospital, Carmarthen; GlanClwyd Hospital, Rhyl, Background: This study was performedto establish incidence of symptomaticVTE complicating shoulder surgery.Methods: Retrospective review of clinicalrecords of 920 consecutive patients whohad any shoulder surgery in Glan ClwydHospital-North Wales and further 1421consecutive patients operated inMorriston and Singleton Hospitals, SouthWales. Records were assessed for: re-admissions due to proven VTE;radiological results suggestive of VTE;deaths. Results: In 2341 patientsidentified, there was 1 fatal PE. Therewere further 3 cases of symptomatic PEand 4 of DVT (lower limb). The incidenceof symptomatic VTE is: -0.43% after anyprocedure; -1.11% after shoulderarthroplasty; -0.23% after arthroscopy.

54 09:08

Acromioclavicular jointreconstruction - outcomesfrom the Surgilig device ina non-specialist centreJ Wright, D Osarumwense, Y Umebuani, F Ismail,S OrakweQueen Elizabeth Hospital, London

Surgilig is a braided polyester prostheticligament used to reconstruct thecoracoclavicular ligaments followingacromioclavicular joint dislocationTwenty-one patients with ACJ dislocationwere reconstructed using Surgilig.Clinical and radiographic follow up wasto a mean of 30 months (7-67). Twentypatients were satisfied with theiroutcomes (95%). The mean Constant

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score for the group was 88.4 (62-100),with an Oxford score of 43.1 (28-48).One implant failed following furthertrauma. Surgilig has been shown in thiscohort of patients to have a goodoutcome in reconstruction ofacromioclavicular disruption with a lowrate of complication in a non-specialistunit.

246 09:12

The outcome ofscapulothoracicarthrodesis using allograftin facioscapulohumeraldystrophyAD Cooney, I Gill, PR StuartFreeman Hospital, Newcastle upon Tyne

We report the early results of 14consecutive scapulothoracic arthrodesesin patients with facioscapulohumeraldystrophy. Shoulder movement, DASHscores and forced vital capacity (FVC)were recorded pre and six monthspostoperatively. Forward flexionimproved from 70o to 115o (p=0.001).DASH scores improved from 48 to 34(p=0.005). FVC decreased from 98% to92% predicted (p=0.021), although thiswas not clinically significant. Onesymptomatic non-union occurred.Scapulothoracic arthrodesis can beperformed successfully with allograft.The non-union and complication ratesare similar to the existing literature. Asmall decrease in FVC does occur but notto a clinically significant level.

398 09:16

Objective PracticalAssessment Tool (OPAT): Anew training tool fordiagnostic shoulderarthroscopyC Talbot, E Holt, D TennentUniversity Hospital of South Manchester,Wythenshawe; St George’s Hospital, London

An Objective Practical Assessment Tool(OPAT) has been developed to helptrainee shoulder surgeons improve their

surgical technique in carrying out adiagnostic shoulder arthroscopy. Aquestionnaire was circulated to UKOrthopaedic trainees. 140 responseswere obtained. When comparing theOPAT with the current PBA as anassessment tool, 82% of respondentspreferred the OPAT. The shoulder OPAT isa simple, easy to use online basedtraining tool which enables both traineesand trainers to monitor the progressionof arthroscopic skills and helps thetrainee, through objectivemeasurements, in advancing theirshoulder arthroscopy skills.

464 09:20

Investigation into variationin the path of thesuprascapular nerve,morphology of thesuperior transversescapular ligament, andprevalence of thespinoglenoid ligamentC Hannan, A Al-Modhefer, M EamesQueen’s University Belfast, Belfast

Suprascapular nerve entrapmentsyndrome (SNES) is estimated to accountfor 1-2% of shoulder pain. Commonlythis entrapment occurs as the nervepasses under the superior transversescapular ligament (STSL) andspinoglenoid ligament. Anatomicalvariations of these ligaments may makeentrapment more likely. 28 formalinfixed cadaveric scapulae were dissectedto visualize the suprascapular andspinoglenoid notches. An anatomicalvariation was observed, with 1 of the 28(3.6%) scapulae having an ossified STSL,a known risk factor for SNES. Aspinoglenoid ligament was present in82% of specimens: 17% of theseligaments were found to be moresubstantial type 2 ligaments.

DISCUSSION 09:24

Trauma 1366 10:00

Timing of surgery forinternal fixation ofdisplaced intracapsular hipfractures; a clinical studyof 962 patientsE Griffiths, R Brankin, P Domos, M ParkerPeterborough Hospital, Peterborough

Patients who had undergone internalfixation of an intra-capsular fracturewere identified from a prospectivedatabase. Those suffering fromsubsequent AVN or non-union werecompared to those that had had anuneventful recovery. We revieweddifferences between rates ofcomplication and time to surgery andalso compared the adequacy ofreduction with outcome. There was noobvious trend towards earlier surgeryleading to reduced rates of AVN or non-union. However, surgery undertakenbefore 18 hours had a significantlyreduced chance of these complications(p=0.0001). Adequacy of reduction hadno significant impact on rate of non-union or avascular necrosis.

199 10:04

Time to Internal fixation offemoral neck fracture inpatients under 60 years –does this matter in thedevelopment of avascularnecrosis of femoral head?H Soueid Guy’s & St Thomas’ NHS Trust, LondonWe aim to assess the effect of time delayand method of internal fixation on thedevelopment of AVNFH in those lessthan 60 years of age. We retrospectivelyanalysed 182 patients presenting with

10:00 – 11:30Hall 9

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#NOF with 92 under 60 years. 92 ICF, 46CS, 37 DHS, and 9 both. These patientswere subdivided into Groups A to Fbased on time delay between injury andfixation. 13 patients (14.1%) developedAVNFH, the highest incidence being in CSgroup with an AVNFH rate of 26%. wedemonstrated that the method of IFrather than delay in IF was predictive ofAVNFH.

584 10:08

Raised white cell count inpatients admitted withfractured neck of femur:Should there be a delay insurgery?P Vinayakam, M Prasad, A Aframian, PJS JeerQEQM, Margate

Introduction: To examine associationbetween fracture neck of femur patientsadmitted with raised white cell count(WCC) with clinically proven concurrentinfection & delay in surgery, and woundinfection & mortality. Methods: 100consecutive patients. Results: 51% ofpatients had raised WCC on admission,of which 23 % had clinical evidence ofinfection. No deep infection or increaseddeaths in raised WCC group. Conclusion:Our findings suggest no correlationbetween clinically proven infection andraised WCC and no association betweenraised white cell count on admission andpost-operative wound infection or oneyear mortality. We recommend WCCalone does not delay surgery.

558 10:12

Serum lactate is aprognostic indicator inpatients with hip fracture:prospective studyM Venkatesan, S Balasubramanian, A Khan, R Smith, C Uzoigwe, T Coats, S GodsiffUniversity Hospitals of Leicester, Leicester

In this prospective study we sought todetermine if admission serum venouslactate can predict 30-day mortality andearly survivorship in patients with hipfractures. Over a 12-month period theadmission venous lactate of all patientspresenting to our institution with hipfractures was prospectively collated.770patients were included in the study. Themean age was 80 years. The overall 30-day mortality for this cohort was 9.5%.Admission venous lactate was associatedwith 30-day mortality and earlysurvivorship. Mortality rate in those witha lactate level of less than 3mmol/L was6.8% and 24% for those whose level was3mmol/L or greater (p< 0.0001).

DISCUSSION 10:16

184 10:20

The financial cost ofmanaging tibial plateaufractures at a specialisttrauma centreR Myatt, J Miles, G Matharu, S Cockshott, J KendrewQueen Elizabeth Hospital, Birmingham

This study aimed to determine the costof treating tibial plateau fractures. Over15 months 40 patients presented withtibial plateau fractures. Mean treatmentcost per injury was £4941.31 (median£3113.67). Ward costs were responsiblefor 57.6%, operative costs 34.1%,imaging 4.6% and lab investigations1.3%. Mean cost of managing fractures

sustained in polytrauma (£7669.65) wasgreater than managing isolated fractures(£3304.30). There was no specific injurycode for tibial plateau fractures. The costof managing tibial plateau fractures wasgreatest when sustained as a componentof polytrauma. Ward costs accounted forthe majority of total expenditure.

341 10:28

Open tibial fractures – amajor trauma centreexperienceA Dick, A Trompeter, C Hing, M Vesely, D NielsenSt George’s Hospital, London

St George’s Hospital became a MajorTrauma Centre (MTC) in 2010. Aretrospective review of open tibialfracture management in the three yearssince found a decreased proportion ofpatients attended another hospitalbefore reaching definitive care (47% to17%) with a significant reduction inmean transfer time from 31h to 4h(p=0.032). Appropriate antibioticprescription improved (59% to 77%) andtime to administration decreased (94minto 67min). Time to initial debridement,definitive soft tissue coverage andskeletal stabilisation remained withinBOA/BAPRAS guidelines. Quality of carewas found to have improved with theestablishment of a regional MTC.

795 10:32

Locking plate fixationversus circular framefixation for distal tibialmetaphyseal fracturesA Haque, R Berber, S Ahmed, A AbrahamLeicester Royal Infirmary, Leicester,

The aim of our study was toretrospectively compare clinical andfunctional outcomes between lockingplates and circular frames for thetreatment of distal metaphysealfractures of the tibia. We identified AO43-A, B1, C1 fractures over an 18 monthperiod and compared clinical outcomessuch as radiographic time to union, non-union, infection rates and re-operation

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rates. Functional outcomes werecompared using a postal questionnaires,which included a modified AOFAS score,an O&M score and a customquestionnaire. We received 20completed responses (10=Frame,10=Plate) and found no difference ineither clinical or functional outcomesbetween the two groups.

833 10:36

Distal tibial fractures – anantero-lateral or medialplate? A comparative studyof 43 patients.V Palial, A Arora, S Daivajna, V KhandujaAddenbrooke’s Hospital, Cambridge

A retrospective comparative study wasundertaken on 43 patients whosustained a distal tibial fracture treatedwith either an antero-lateral or mediallocking plate. The average radiographicand clinical follow-up was 13 months. 29patients had a medial plate while 14 hadan antero-lateral plate. No differenceswere found in time to union betweenthe two groups. The majority of patientstreated with an antero-lateral plate hadan intra-articular fracture (86%)compared to those who had a medialplate (42%). There were morecomplications of plate prominence andsuperficial infection in the medial plategroup.

DISCUSSION 10:40

409 10:44

Patient reported outcomemeasures in the non-operative management ofclavicle fracturesR Morrell, R Jeavons, J Kent, A GowerNorthern Deanery, Newcastle

Optimal management of adult claviclefractures remains debatable: weanalysed Patient Reported OutcomeMeasures (PROMs) retrospectively in117 clavicle fractures treated non-operatively. Fractures were classifiedusing Craig Modified Allman

Classification. Patients received OxfordShoulder Scores (OSS) and Quick DASHScores. Mean age was 42 years.Response rate was 83%. 53 Type I, 34Type II and 3 Type III fractures. MeanOSS was 56.2, 48.5, 53 in Type I/II/IIIfractures, respectively; mean QDASH was10.5 in Type I/II, 18.2 in Type III. 64.2%Type I reported OSS reflecting excellentoutcomes. PROMs data suggests non-operatively treated Type I claviclefractures have excellent outcomes withType II/III being less favourable.

370 10:48

Are standardAnteroposterior and 20degree caudal radiographsa true assessment ofmidshaft clavicularfracture displacement?J Wright, C Heuvelings, L DiMascioBarts and The London NHS Trust, London

Assessment of clavicle fracturescommonly utilises standard antero-posterior and cephalic tilt radiographs.Displacement and shortening wasassessed on standard views and axial CTimages of 26 clavicle fractures.Displacement measured on the CT was amean of 19% (p=0.019) greater than theAP view and 11% (p=0.211) greater thanthe 20 degree caudal. There were nosignificant differences found betweenthe two modalities on assessment ofshortening. Plain radiographs give anaccurate representation of theshortening present in midshaft clavicularfractures. Displacement however may beunderestimated if the standard AP and20 degree caudal views alone are reliedupon.

416 10:56

Proximal humerusfractures - how serious arethey?L Wilson, B Gooding, P Manning, J GeogheganNottingham University Hospitals, Nottingham

This retrospective review ofprospectively collected data of proximalhumerus fractures over an 11-yearperiod is the first to combine theepidemiology and risk factors formortality with socioeconomic rank. 529patients (28%) died within the studyperiod with a 10.1% one-year mortalityrising to 28.9% at five years. Femalegender, operative management,increasing age and increased number ofco-morbidities were independentvariables for increased mortality. One-year mortality risk is twice that of thebackground matched population; therisks and benefits of operative treatmentneed to be balanced against a furtherindependent increase in mortality risk byperforming surgery.

648 11:00

An anatomical study: riskof axillary nerve injuryduring proximal humeralintramedullary blade nailfixationB Spiegelberg, N Riley, G TaylorBuckinghamshire NHS Trust, Wycombe

Methods: 26 shoulders underwentinsertion of an antegrade proximalhumeral blade nail via a deltoid split. Theproximity of the axillary nerve to thescrews was measured. Results: Thenerve lay closest to the distal bladefixation screw (4.9mm [0-19]). In threecases there was macroscopic evidence ofdamage to the nerve from screwinsertion. Conclusion: The axillary nerveis at risk during insertion of screwsdespite use of protection sleeves. Wefeel these results are transferrable toother designs of nail incorporatingmultiple locking screws. We advocatethat when using these devices an

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extended anterolateral acromialapproach is undertaken.

1010 11.04

The results of treatingdistal third diaphysealhumeral fractures with theLCP DHP Plate: A two-yearprospective study.H Fawi, P Rao, D Parfitt, J Lewis, A Ghandour, KMohantyUniversity Hospital of Wales, Cardiff

Objectives: To evaluate the benefits oftreating distal humeral extra-articularfractures with the new Synthes LCP D.H.plate. Two years prospective study.Methods: Nineteen patients withdisplaced fractures (13-A(1-3))underwent fixation between April 2010 -May 2012. Post- operative care involvedpoly-sling immobilisation for two weeksfollowed by physiotherapy. Results:Seven females and twelve males,average age was 38 years. Radiologicaland objective assessments follow-upwere very satisfactory. Average time tounion was 3 months. Conclusion:Managing extra articular fractures of thedistal humerus with this plate hasbecome the technique of choice in ourdepartment due to the excellent results.

284 11:08

Ulna nightstick fractures -simple fracture, complexproblem?J Tomlinson, R Stevens, J WrightChesterfield Royal Hospital, Chesterfield

Introduction: The optimum treatment ofisolated ulna shaft fracture or ‘nightstick’injuries is still unknown despite thesimple nature of the injury.

Methods: All cases of nightstick fractureover a five year period wereretrospectively reviewed with treatmentmethod, time to union, stiffness andneed for physio all documented. Results:86% of patients were treatedconservatively. The immobilisationmethod varied widely. Stiffness rates

were high with above elbow casts (57%)but non-union rates were low (6%)versus short arm cast (21%). Conclusion:There is wide variation in the treatmentof this simple injury. The optimaltreatment remains unclear.DISCUSSION 11:12

BOOS & Education321 10:00

Should magneticresonance imaging fortumours of themusculoskeletal system beperformed in a sarcoma-designated health carecentre?K Goulding, H D’Sa, K McWatters, Y Chang, M Schweitzer, J WerierUniversity of Ottawa, Canada; RoyalOrthopaedic Hospital, Birmingham

A retrospective review identified 304consecutive surgical referrals to a multi-disciplinary sarcoma centre with an MRIperformed in a referring centre from2007 to 2011. An adjudication panel oftwo musculoskeletal-trained radiologistsand one orthopedic oncologist evaluatedall studies; 197 of 304 reports (65%)showed discordance between the initialreport and secondary interpretation. Themost frequent errors were those oftumour description and interpretation;55% of discordant reports had thecapacity to alter clinical care. Moreaccurate reporting for suspectedmusculoskeletal neoplasia may beachieved by synoptic reporting, or byreferral to a centre with expertise inmusculoskeletal neoplasia.

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686 10:04

Which is more important,margins or necrosis inprediction of localrecurrence and survival inhigh grade osteosarcoma?V Neelapala, L Jeys, S Vaiyapuri, R GrimerRoyal Orthopaedic Hospital NHS FoundationTrust, Birmingham

193 patients high grade osteosarcomaincluded. All had neoadjuvantchemotherapy. Percentage necrosisaffected survival and local recurrence ina stepwise manor (p-0.012 for LR; P-0.003 for survival). Neither surgical orpathological margins were anindependent risk factor. Metastasis atdiagnosis effected survival at 5 years (p-0.001). Patients with >90% necrosis and>2mm resection margin onhistopathology had a 5 year survival of84% and 3% chance of local recurrence.Conclusion: Local recurrence andsurvival following osteosarcoma isdependent upon chemotherapyresponse. Tumours with < 90% and>2mm histopathological margin had 19%LR and 65% of survival at 5 years.

508 10:08

Myxofibrosarcoma:medium-term results froma specialist centreC Green, J Daniels, A Freemont, A PaulManchester Royal Infirmary, Manchester

29 patients (mean age 61 years) weretreated within our centre between 2001-2012 following diagnosis ofmyxofibrosarcoma, with 26 patientspresenting with primary disease. Allunderwent initial limb-salvage surgerywith 22 patients receiving adjuvantradiotherapy and three receiving neo-adjuvant radiotherapy. Tumour excisionwas complete in 25 cases with threepatients requiring further resection andone treated with further radiotherapy.Local recurrence was present in 7patients (24.1%) with six requiring aboveknee amputation. Metastatic diseasedeveloped in 7 patients (24.1%). 5-year

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survival is 8 of 9 patients (88.9%) withsufficient follow-up. Our results comparewell with the current literature.

568 10:12

Early results of theoutcome of myxoidliposarcoma of the lowerlimb managed with neo-adjuvant or adjuvantradiotherapyC Green, N Nguyen, J Wylie, A Choudhury, A Freemont, J GregoryManchester Royal Infirmary, Manchester

14 patients were treated between 2006-2012 following a diagnosis of lower limbmyxoid liposarcoma within our centre.Mean follow-up was 26.1 months. Sixpatients received neo-adjuvantradiotherapy and showed a meanreduction in maximal tumour diameterof 93.8mm to 69.4mm, with all showingnegative margins on resection and threepatients developing minorcomplications. Eight patients weretreated with adjuvant radiotherapy, withtwo patients showing positive marginson resection and three developing minorcomplications. TESS scores were similarfor both groups. Initial results show neo-adjuvant radiotherapy may conferbenefits to patients due to a loweradministered dose of radiotherapy.

DISCUSSION 10:16

216 10:20

Eight year experience of abone metastasis mdt at anacute teaching hospitaland its impact on patientcareR Afinowi, R Barton, N Kumar, D Nag, R Raman,R Hamilton, H CattermoleHull and East Yorkshire NHS Trust, Hull

BOA/BOOS guidelines recommenddedicated metastatic bone disease MDTled by a consultant orthopaedic surgeon.We describe the impact of a dedicatedBone Metastasis MDT on patient care in

an acute teaching hospital with a cancercentre. 199 new patients were discussedat the MDT over 7 yrs. After an initial risedue to the awareness of a new service,there was a sustained reduction inpatients referred with pathologicalfracture, and a corresponding increase inreferrals of patients without fracture forconsideration of prophylactic surgery. Ithas increased awareness and uptake ofsurgical prophylaxis and reducedincidence of pathological fractures.

687 10:24

Prognostic factors in theoperative management ofsacral chordomas at aspecialist referral centreB Kayani, SA Hanna, RC Pollock, JA Skinner, SR Cannon, WJ Aston, TWR BriggsRoyal National Orthopaedic Hospital, Stanmore

Sacrococcygeal chordomas are rare, lowto intermediate grade tumours with atendency for late metastases. This studypresents the results of 58 patientsundergoing sacrectomy for sacralchordomas at a specialist oncologiccentre. The aim of the study was toidentify prognostic factors associatedwith increased risk of disease recurrenceand reduced survival. The averageoverall follow-up time was 45.3 months.The presence of large tumour size,sacroiliac joint infiltration andinadequate surgical margins wereassociated with increased risk of diseaserecurrence and reduced survival. Wewould advocate regular long-termfollow-up to enable early identificationand treatment of recurrent disease.

157 10:28

Outcomes after surgicaltreatments forperiacetabular metastaticlesionsM Shahid, T Saunders, A Kotecha, L Jeys, R GrimerRoyal Orthopaedic Hospital, Birmingham, UnitedKingdom

Abstract not supplied

104 10:32

How safe is curettage oflow-grade cartilaginousneoplasms followingradiological diagnosisalone?MT Brown, PD Gikas, JS Bhamra, JA Skinner, RC Pollock, WJS Aston, A Saifuddin, TWR BriggsRoyal National Orthopaedic Hospital, London

The aim of this study was to review theaccuracy and safety of MRI grading ofcartilaginous neoplasms. Retrospectivereview of long bone chondrosarcomasmanaged as low-grade between 2001-2012 [54 cases; mean age 47.6 years (8 -71); 23 males, 31 females]. Pre-operativediagnoses were from radiology alone(n=36) or with additional needle biopsy(n=18). Surgical histology confirmed 2enchondroma, 50 low-grade and 2 high-grade chondrosarcoma. Local recurrenceoccurred in three low-grade and onehigh-grade case. Cartilaginousneoplasms identified as low-grade onpre-operative imaging can be safelymanaged as low-grade without pre-operative histology. High-grade cases didnot affect recurrence rates.

DISCUSSION 10:36

210 10.40

A discrete finite elementanalysis model for theassessment of pathologicalfracture riskG Roberts, J Jones, I PallisterSwansea

The accurate diagnosis of pathologicalfracture risk remains difficult andchallenging even for the mostexperience practitioner. Recently anumber of studies have suggested thatFinite Element Analysis could aid in theassessment of metastatic fracture risk.These studies however are difficult tointerpret for the non-engineer. Wepresent a method which uses discretefinite element analysis (Elfen, Rockfield)to model pathological fracturesoccurring during falling and daily

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activities. The advantage of this methodis its dynamic nature which means that itis easily interpreted by both the clinicianand the patient.

141 10:44

Computer navigationassisted surgery for pelvicand sacral tumours:lessons learnt from thefirst 25 casesL Jeys, G Matharu, R Nandra, R Grimer Royal Orthopaedic Hospital, Birmingham

This study reports our initial experiencewith computer navigation assistedsurgery for 25 pelvic and sacral tumours(16 primary malignant bone tumoursand 9 metastases). In all cases meanregistration error was <1mm and thebony resection margins were wide(>5mm). In 2 cases there was tumourcontamination. There have been nocases of local recurrence to date.Navigation allowed more complexresections and reconstructions to beperformed by avoiding hindquarteramputations (n=3), preserving sacralnerve roots (n=4), and resectingotherwise inoperable disease (n=4). Thistechnique has reduced our intralesionalresection rate and allowed morecomplex surgery and reconstruction.

851 10:48

Forearm deformity inpatients with hereditarymultiple exostoses:predicting function andradial head dislocationN Clement, D PorterUniversity of Bath Edinburgh, Edinburgh

One-hundred and six patients withhereditary multiple exostoses aged <16years old were identified from apreviously complied database. One inseven patients had a dislocated radialhead. Radial head dislocation (p<0.001)and proportional ulna shortening(p<0.001) were confirmed to be

independent predictors of forearmrotation on multivariable regressionanalysis. In addition proportional ulnalength was also an independentpredictor of radial head dislocation(p<0.001). Hence, proportional ulnalength could be used as a tool to identifypatients at risk of diminished forearmmotion and radial head dislocationduring childhood.

938 10:52

Giant cell tumour of thedistal radius: a review of75 casesK Goulding, A Gulia, A PuriUniversity of Ottawa, Ottawa, Canada; TataMemorial Hospital, Mumbai

Seventy-five consecutive patients withGiant Cell Tumour (GCT) of the distalradius from 2005 to 2011 wereretrospectively analysed. Thirty-eightpatients presented with a primary GCT;37 had recurrences initially treated atperipheral hospitals. Grade 3Campanacci lesions were present in 53patients. The mean follow-up was 24months. Nineteen patients (25.3%) had alocal recurrence. Previous intervention,intralesional excision and Grade 3Campanacci lesions were significantlyassociated with an increased risk of localrecurrence. Similar functional results(MSTS) were observed in intralesionalexcision and wide resection, the latterbeing the preferred option forCampanacci Grade 3 lesions.

319 10:56

Aneurysmal bone cysts -Does simple treatmentwork?K Reddy, L Gaston, R Nandra, F Sinnaeve, R GrimerRoyal Orthopaedic Hospital, Birmingham

Numerous treatments have beendescribed for Aneurysmal bone cysts(ABCs). We observed that a number ofABCs will ‘heal’ following biopsy alone.We describe a novel biopsy techniquecalled curopsy. Two hundred consecutive

patients, diagnosed with an ABC wereincluded. 102 patients had abiopsy/curopsy. Of these 102 patients,82 (80%) required no further treatment.Twenty patients had no evidence ofhealing at 6 weeks and underwentdefinitive curettage. Overall recurrencerate in these 200 patients was 15%. Curerates following curopsy/biopsy aloneneeds consideration when evaluating theresults of treatments for ABC, suggestingsimple treatment strategies work forABCs.

DISCUSSION 11:00

65 11:05

Can medical studentssuccessfully engage withtheir peers to encourageinterest in musculoskeletalmedicine and surgery? Thefirst NationalUndergraduateMusculoskeletalConferenceMD Scally, KA WattUniversity of Glasgow, Glasgow

In 2012 the University of GlasgowOrthopaedic and Rheumatology societyextended the educational opportunitiesthey offer beyond Glasgow by hostingthe first NUMC. All UK medical studentsand FY1s were invited and delegatesevaluated each component of the dayusing a 5-point Likert scale and free textcomments. 75/97 delegates returnedtheir questionnaire. The main clinicalinterest was orthopaedics (48%),rheumatology (16%) or both (20%).100% rated the day as good, very goodor excellent and 93% stated they wouldre-attend suggesting that enthusiasmexists amongst undergraduates to fostera musculoskeletal career at an earlystage in their education.

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930 11:09

How educationallyvaluable do orthopaedictrainees and trainersregard work-basedassessments?A pentlow, F Bintcliffe, J FieldBristol Royal Infirmary, Bristol

Aims: This study explores theeducational value of work-basedassessments (WBAs), identifying barriersto learning. Methods: Questionnaireswere sent to Severn Deaneryorthopaedic trainees and Consultants.Results: 59% of trainees had difficultycompleting WBAs. Lack of Consultant’stime was the commonest problem. 27%of Consultants and 11% of traineesidentified education as the purpose ofWBAs. Procedure-based assessmentswere the most valued assessment. 52%of trainees found them helpful.Respondents wanted fewer, higherquality WBAs. Over 85% felt 40 per-yearwas too many. Conclusions: Moreengagement, training and a smallerburden of assessments could improvethe educational value of WBAs.

773 11:13

Is the quality ofOrthopaedic researchgetting better?S Newman, A Dodds, D SpicerSt Mary’s Hospital, London

The top 10 clinical orthopaedic journalsby impact factor in 2002 and 2012 wereidentified. The clinical papers publishedbetween January and June wereindependently reviewed by twoorthopaedic surgeons and assigned alevel of evidence according to the 2011Oxford Centre for Evidence BasedMedicine guidelines. The numberpublished had increased dramatically(379 to 642). The quality of methodologyhad also improved (e.g. Level 1-3 to 26),but not at the same rate as overallnumbers. This study suggests thatquality of orthopaedic research is

improving, but the majority of currentpublished output is of lowmethodological standard.

581 11:17

The validity of claims madein orthopaedic printadvertisementsD Davidson, K Rankin, C Jensen, A SprowsonSt Mary’s Hospital, London

The purpose of this study was to re-evaluate the claims made in orthopaedicprint journal advertisements. Fifty claimsfrom fifty advertisements were chosenrandomly from six highly respected peer-reviewed orthopaedic journals. Theevidence supporting each claim wasassessed and validated. The assessors,blinded to product and company, ratedthe quality of supporting evidence andwhether the claim would influence theirpractice. Only twelve claims wereconsidered to cite high-quality evidenceand only eleven claims were consideredto have enough support to influenceclinical practice. Orthopaedic surgeonsrequire high-quality evidence toinfluence practice and must remainsceptical about print advertising claims.

344 11:21

The portrayal ofOrthopaedics in the UnitedKingdom PressS Al-NammariThe Royal London Hospital, London

The press play an important role ineducating and informing the generalpublic. The stories they cover and howthey cover them has a powerfulinfluence on public perceptions.LexisNexisTM Professional search engineutilised to retrieve articles from nationalnewspapers over a one year period inthe United Kingdom containing theterms “orthopaedic” (May 2009 - May2010). 504 relevant articles retrieved.Orthopaedics receives considerableattention in the UK press. Most of this ispositive. Unfortunately those concerningorthopaedic surgeons were significantly

more likely to be of an overall negativetone than other articles (p=0.002Fisher’s Exact Test).

DISCUSSION 11:25

Hip 2139 15:15

Ceramic on metal total hiparthroplasty (tha): earlyresults, metal ion levelsand chromosome analysisHA Kazi, JR Perera, E Gillott, FA Carroll, TW BriggsWirral University Teaching Hospital NHSFoundation Trust, Upton; Royal NationalOrthopaedic Hospital, Stanmore

We prospectively assessed the efficacyof a ceramic on metal hip couple. 94arthroplasties were performed in 83patients (M:F - 1:0.73, mean age 58years). Functional scores significantlyimproved (p<0.05). Whole blood metalions and chromosomal analysis wasperformed at 2 years. All metal ionsexcept for vanadium were elevated.Chromium, cobalt, molybdenum andtitanium were significantly higher in thebilateral group (p<0.0001). Chromosomeanalysis revealed structural andaneuploidy mutations. There weresignificantly more breaks and losses thanthe normal population (p<0.0001). Shortterm efficacy has been confirmed. Thesignificance of chromosomal aberrationis unclear.

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656 15:19

Prospective randomisedcontrolled trial comparingceramic-on-metal versusmetal-on-metal THR –early results of metal ionanalysis and functionaloutcome scoresJ Higgins, A Pearce, T Briant-Evans, M Price, K Conn, G Stranks, J BrittonBasingstoke and North Hampshire Hospital NHSFoundation Trust, Basingstoke

Introduction and Methods: We recruited163 patients to an ethically approved,double-blinded prospective randomisedcontrolled trial comparing ceramic-on-metal with metal-on-metal bearings inlarge head THRs. We present the earlyresults of metal ion analysis performedat 1 year, functional scores and revisionrate with average follow up 2.7 years. Allpatients received a cobalt-chromeacetabular component with either ametal or ceramic femoral head. Resultsand conclusion: We found cobalt andchromium levels to be significantly lowerin the ceramic-on-metal group. Therewere 4 all-cause revisions in each group,and no difference in functional outcomesat short term follow up.

843 15:23

Effect of implantmodularity on metal onmetal ion levels in patientswith the Birmingham HipbearingSS Mahmoud, I Malik, R Gwyn, D Woodnutt, A John, S JonesUniversity Hospital of Wales, Swansea

There is increasing concern over thebiological effect of metallic debrisproduced from modular junctions in THAbut limited data is available on this. Ouraim was to study the effect of increasingmodularity with the same bearing tounderstand the influence of taperjunctions and how that can also be usedas guidance for patient management and

follow-up. A retrospective cohort of 616patients was studied and statisticalanalysis using linear regression modeldemonstrated a significant positivelinear relationship between number ofmodular junction and the observedserum cobalt level.

DISCUSSION 15:27

396 15:32

The ‘Enhanced Recovery’programme for primary hipand knee arthroplasty:short-term results from6000 consecutiveprocedures.S Khan, A Malviya, S Muller, P Partington, M ReedNorthumbria Healthcare NHS Trust, Ashington

We commenced an enhanced recovery(ER) programme for lower limbarthroplasty in May 2008. We report theresults of a consecutive series of 6000procedures, half of which (‘ER-3000’)were performed according to thisprotocol and 3000 using traditional pre-ER protocol (‘Trad-3000’). The meanlength of stay and blood transfusionrates reduced significantly in ER-3000(both p<0.05). ER-3000 suffered fewerMIs and deaths at 30 days (both p<0.05)and had fewer returns to theatre(p=0.05). This is the largest study yet toreport patient safety data in enhancedrecovery arthroplasty, confirming it assafe, implementable and cost-effective.

428 15:36

Utility of novel boneturnover markers forscreening patients forosteolysis after total hiparthroplastyN Lawrence, R Jayasuriya, F Gosseil, M WilkinsonThe University of Sheffield, Sheffield

Serological or urinary biomarkers mayprovide a useful alternative to plainradiography for screening patients forimplant failure. We examined the utility

serum CTX-MMP, Dkk-1, Sclerostin andTrap5b, and urinary ααCTX-I, measuredin 24 subjects with osteolysis versus 26subjects of similar age and sexdistribution but without osteolysis afterTHA. We were able to conclude that CTX-MMP is a highly sensitive biomarker fordetecting periprosthetic osteolysis. Dkk-1shows potential as a specific biomarkerfor detecting osteolysis around theacetabular portion, and Trap5b showspotential as a specific biomarker fordetecting osteolysis around the femoralportion of a prosthesis.

85 15:40

Noise Characteristics intwo types of total hiparthoplasties: Acomparative cohort studyPG Robinson, I Anthony, B Jones, A Stark, R IngramGlasgow Royal Infirmary, Glasgow

This study assesses the incidence ofnoise in ceramic on ceramic (COC)bearings compared to metal onpolyethylene (MOP) bearings. Wedeveloped a noise characterising hipquestionnaire and sent it along with theOxford Hip Score (OHS) to 1000 patients;509 respondents, 282 COC and 227MOP; median age 63.7 (range 45-92),median follow up 2.9 years (range 6-156months). 47 (17%) COC patientsreported noise compared to 19 (8%) ofthe MOP patients (P=0.048). 9 COC and 4MOP patients reported their hip noise assqueaking. We therefore believe thesqueaking hip phenomenon is notexclusive to hard bearings.

118 15:44

Cementless total hipreplacements in sickle celldiseaseC Jack, M Bankes, R Keese-Adu, J HowardGuy’s & St Thomas’ NHS Trust, London

Sickle Cell disease affects 12,000 in theUnited Kingdom. Forty per cent ofpatients will get avascular necrosis of thefemoral head often necessitating total

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hip arthroplasty. Since 2002 52 primaryTHAs were carried out in 40 patients.Average age was 36 years (17-54).Exchange Blood Transfusion wasfavoured. No patients were lost to followup. All components have in-grown ataverage 5 year follow up (2-10.1) with nosign of osteolysis or loosening. Amultidisciplinary approach anduncemented implants with ceramic onceramic bearings has made THA inpatients with SCD a safe and reliableprocedure in our hospital.

494 15:48

Is the patient warmenough? Perioperativecore temperatures inarthroplasty patientsR Gogna, R Westerman, J RowlesRoyal Derby Hospital, Derby

Intraoperative hypothermia (coretemperature < 36oC) is associated withincreased surgical blood loss, cardiacmorbidity, delayed wound healing andprolonged hospital stay. We performed aprospective, consecutive cohort study of300 elective Total Hip (THR) and TotalKnee (TKR) Replacements, comparingthem to our fractured Neck Of Femur(NOF) population. Elective arthroplastypatients were cooler, with mean post-operative core temperature 35.7o (THR)and 35.8o (TKR), than NOF patients(36.4o). 62% of THR and 58% of TKRpatients were found to be hypothermic.In contrast, only 28% of NOF patientswere hypothermic. Intraoperativehypothermia remains common inelective arthroplasty patients.

DISCUSSION 15:52

Hands610 15:15

A case series of perilunatedislocations: outcomes andlesson learntI Roushdi, S Cerovac, S UmarjiSt George’s Hospital NHS Trust, London

19 perilunate dislocations between 2009and 2012 had surgical repair of allinjuries and an aggressive hand therapyprogramme and followed up for 19months. 89% of patients returned towork at 6 months f and 61% hadreturned to sport at 8 months. The PEMscore was 36, DASH was 24, and SF-12physical score was 53, SF-12 mentalscore was 50. The arc of flexionextension was 107 degrees and gripstrength was 58% of normal. Earlysurgery resulted in improved outcomes.We recommend prompt anatomicalreconstruction of damaged structuresand neural decompression to optimizeoutcomes.

788 15:19

Outcomes of scaphoidfracture fixation using theHeadless CompressionScrew®: The BirminghamHand Centre experienceU Ahmed, S Malik, C Simpson, S Tan, D PowerQueen Elizabeth Hospital, Royal OrthopaedicHospital, Birmingham

The Headless Compression Screw® (HCS)is a cannulated non-variable pitch screwthat allows compression of fracturefragments before allowing the screwhead to be countersunk into subchondralbone. The HCS has been used at ourinstitution since 2010 for acute fracturesand non-unions of the scaphoid. Weretrospectively evaluated 57 patients(between 2010-2012) and determined a

15:15 – 16:45Hall 11B

good outcome (union with nocomplications) for the acute fractures,however, 4/30 non-union fixations hadscrew protrusion. Our results suggestthe HCS is adequate for treatment ofscaphoid fractures, but the rate of screwprotrusion indicates the importance ofscrew selection and surgical technique.

931 15:23

Fixation of scaphoid non-union with 3.0 mmheadless cannulatedcompression screw:Breakage of guide wiresand drill bits and theirmanagement – a report of4 casesK Marenah, Y Morar, A AryaKings College Hospital, London

We use AO Headless Cannulated Screwsfor fixation of scaphoid non-unions. Weencountered previously unreportedproblems in 4 cases, such as intra-operative breakage of the guide wire ordrill bit; and had to use a differentstrategy in each case to salvage thesituation, with no adverse outcomes. Webelieve that the AO headlesscompression screw is a safe and simplesystem to use, but like any otherimplant, thorough knowledge of thesystem as well as the potential pit fallsmust be known to ensure safe andeffective usage.

685 15:27

Failed Trapeziectomies: Anearly report of SalvagetechniquesA Alva, CY Ng, M Hayton, SC TalwalkarWrightington Hospital, Wigan

Trapeziectomy is an effective treatmentof thumb carpometacarpal arthritis.However some patients maysubsequently develop proximalmigration of the metacarpal leading topain and loss of function. We report ourexperience of managing failed

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trapeziectomy. We identified 5 patientswho developed painful subsidence of themetacarpal following trapeziectomiesfrom the database. Three patients weretreated with fusion of the bases of thefirst and second metacarpals using K-wires or compression screw. 2 patientsunderwent a mini tight-rope suspensionreconstruction. Average preoperativepain on Visual Analogue scale was 8which improved to 3.4 at final follow up.

26 15:35

Wrist denervation of theposterior interosseousnerve through a volarapproach: A newtechnique with anatomicalconsiderations.S Lidder, M Dreu, C Dolcet, P Sadoghi, S Grechenig, M Champion, W GrechenigEastbourne District General Hospital, Eastbourne

Chronic wrist pain can be treated bydenervation of the wrist. Wehypothesized that the PosteriorInterosseous Nerve (PIN) can bedenervated through a volar approach tothe wrist. The course of the AIN, PIN andinterosseous artery were identified in 20cadavers. In a further 20 specimens, avolar approach to the wrist wasperformed to transect the PIN via asingle volar incision. This was successfulin 18 out of 20 forearms studies. In thisstudy we show that the posteriorinterosseous nerve can also bedenervated through a volar approach tothe wrist.

DISCUSSION 15:35

665 15:42

Nocturnal variation inupper limb volume as acontributory factor tocarpal tunnel syndromeN Siddiqui, M Wiemann, K Krishna, M RobinsonAvon Orthopaedic Centre, Bristol; PrincessAlexandra Hospital, Brisbane

We believe there is a tendency for the

volume of the whole arm to increase atnight while lying down, due toredistribution of extra-cellular bodyfluid. This results in greater pressurewithin the carpal tunnel, contributing toworsening of carpal tunnel symptoms atnight. We measured arm volumes of 15healthy volunteers. Volume on waking inthe morning was 43.9 cm3 (range 0-80,SD 5.74) greater than the night before.Thirty minutes later the increasedvolume had dropped to 15.6 cm3 (range0-60, SD 4.3). The nocturnal increase involume may be enough to cause carpaltunnel symptoms at night.

392 15:46

Carpal tunnel syndrome intwo groups ofmetalworking fittersexposed to vibratingmachineryM Jenkinson, P JenkinsonAltnagelvin Area Hospital, Londonderry

Vibrational exposure and forceful grip invarious industries have been linked withthe development of CTS. The prevalenceof CTS was determined from the healthsurveillance data of 1143 metalworkingfitters divided into 2 groups determinedby assessing their weekly exposure tovibrating machinery. 59 of 943 of thelower exposure group were diagnosedwith CTS compared with 20 of 200 of thehigher exposure group. The populationwith a higher exposure to vibratingmachinery requiring a forceful grip weresignificantly more likely to develop CTSthan the population with less exposure.They develop CTS younger, after shorteremployment.

476 15:50

Non-absorbable vsAbsorbable skin closure inCarpal tunneldecompression: Functionaloutcome and woundcomplication.TD Donnelly, Y Khan, P Ralte, S Morapudi, J Fischer, M WaseemMacclesfield District General hospital,Macclesfield

Data was collected prospectively on 53patients over 8 months. Patients werereviewed preoperatively as well as twoand six weeks post procedure with aQuick Disabilities of Arm, Shoulder andHand (QDASH) as well as a VAS of thewound. 24 had absorbable skin closureand 29 had non-absorbable. Mean preand post-operative QDASH scores forabsorbable closure were 49.39 and 18.54whilst being 38.63 and 17.70 for non-absorbable closure. Mean VAS scoreswere 0.61 and 0.42 respectively. Ourstudy did not demonstrate anystatistically significant differenceregarding postoperative functionaloutcome, wound healing or complicationrate.

DISCUSSION 15:54

201 15:59

Haemoglobin A1c inpatients undergoingsurgery for stenosing flexortenosynovitisA Winter, H Bradman, A Hayward, A Stirling, S GibsonAyr Hospital, Orthopaedics, Ayr

The aim of our study is to quantifyglycaemic control in patients undergoingsurgical A1 pulley release. Guidelines onmanagement of diabetes suggesttreatment should aim to maintain HbA1cat <6.5%. We retrospectively reviewedthe blood results of 78 patients whounderwent FTS surgery. 27 of these hadan HbA1c checked within 6 months oftheir surgery and we therefore

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presumed these patients were diabetic.In this cohort 33% of patients werepresumed diabetic and 74% of these hada documented HbA1c above the nationaltarget suggesting a significant numberpresenting for surgery have poorglycaemic control.

38 16:03

Steroid injections fortrigger finger; delaying theinevitable?P Rushton, S Thomas, C GibbonsWansbeck General Hospital, Ashington

longer term. We retrospectively assessedthe outcome of injections in a singlesurgeons clinic. Of 104 consecutive digitsinjected 78% had a resolution ofsymptoms for a time. Yet recurrence ofsymptoms was common with 61% of alldigits eventually being releasedsurgically. All digits receiving 2 injectionswent on to surgery. Surgeons andpatients should be aware that whilststeroid injections may be successfulinitially many of this group will go on tosurgery. Repeated injections do notappear beneficial

737 16:07

X- Ray guided steroidinjections forinterphalangeal jointarthroses of the fingersC Miller, S Dalgleish, Q CoxNHS Highland, Orthopaedics, Inverness

Intra-articular steroid injections arefrequently used for osteoarthritis of theProximal Interphalangeal Joint (PIPJ) ofthe hand; but there is little researchassessing this treatment option. This wasa prospective audit of patientsundergoing intra-articular steroidinjections into the PIPJ under imageintensifier guidance. The aims were toassess the effects on hand function,range of movement and pain relief. 50injected joints were followed up at 6weeks, 3 and 6 months. There weresignificant improvements in both therange of movement and pain scores for

up to 3 months, but these haddeteriorated by 6 months.

DISCUSSION 16:11

173 16:16

Audiovisual distraction asan adjunct to anxiety reliefin hand surgery withregional anaesthesiaF Wu, M Shahid, M Lawson-Smith, S Hayward, G rees, M WaldramQueen Elizabeth Hospital, Birmingham

This study reports the effects of usingtablet-computers as audio-visualdistraction devices for anxiety relief inpatients undergoing hand surgery. Fortypatients undergoing elective and traumahand surgery under regional anaesthesiawere randomly allocated to receivetablet-computers + standard-care orstandard-care alone. Anxiety wasevaluated subjectively with a visual-analogue-scale (VAS) and objectively byrespiratory-rate and heart-ratemonitoring. Patients using tablet-computers were found to experiencesignificantly lower anxiety intra-operatively and post-operativelycompared to standard-care alone. Inconclusion, tablet-computers are usefuldistraction tools for the alleviation ofpatient anxiety undergoing hand surgerywith regional anaesthesia.

188 16:20

Predicting need for follow-up using patient-centredoutcome measures in daycase hand surgeryS Bezzaa, A Marthi, A Procter, B Ollivere, P JohnstonUniversity of Cambridge, School of ClinicalMedicine, Cambridge University Hospitals NHSFoundation Trust, Addenbrooke’s Hospital,Cambridge

The aim of this study was to assess howclosely two PROMs (PEM and qDASH)correlate with surgical outcome andwhether it was possible to define athreshold score to limit unnecessary

clinic visits. Surgical outcomes weredefined using postoperative letters as:‘Good’ (no concerns, discharged);‘Moderate’ (some patient concerns,reassured, discharged) and ‘Poor’(requiring further follow-up/referral).ROC analysis assessed each PROM indistinguishing patients requiring follow-up (‘Moderate’ and ‘Poor’) from thosenot (‘Good’).Threshold/Sensitivity/Specificity (95%CI): PEM 25/0.77 (0.64-0.90) / 0.72(0.58-0.86); qDASH 33/0.64 (0.49-0.79) /0.81 (0.67-0.92). Post carpal tunnelrelease, patients with PEM < 25 orqDASH < 33 at 6 weeks can safely bedischarged without review.

159 16:24

Effect of sex and ethnicityon range of movement ofhand and wrist joints innormal subjectsM Shahid, S Mahroof, K Bourne, F Wu, C Simpson, M Lawson-Smith, R Jose, G TitleyQueen Elizabeth Hospital, Birmingham, UnitedKingdom

Abstract not supplied

66 16:28

The in-vivo measurementof DRUJ translation inforearm rotation and wristdeviationG Pickering, H Nagata, G GiddinsRoyal United Hospital Bath NHS Trust, Bath

We developed a jig to measure DRUJinstability. Methods: We assessed 50healthy adult volunteers and patientswith instability. Results: Normal meanDRUJ translation is 6.1mm (SD 1.0). Theintra-class correlation coefficient was0.93. There was no difference betweenmen and women. DRUJ translationreduced significantly with the wrist ulnaror radially deviated, or the forearm intopronated or supinated. The meantranslation in patients with instabilitywas 14.5mm (p< 0.001). Discussion: Wehave also defined the normal ranges ofDRUJ shear translation and for the first

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382 16:32

In-vivo confirmation of theuse of the dart thrower’smotion during activities ofdaily livingG Brigstocke, A Hearnden, C Holt, G WhatlingRoyal Surrey County Hospital NHS FoundationTrust, Guildford; University of Wales, Cardiff

Global wrist motion of ten right handdominant male volunteers was recordedusing a 3D optoelectronic motioncapture system. Analysis of global wristmotion during ADL tasks revealed thatwrist motion approximated to the dartthrower´s motion when hammering anail, throwing a ball, drinking from aglass, pouring from a jug and twisting offand on the lid of a jar. This study predictsthat arthrodesis of the radiocarpal jointinstead of the midcarpal joint for carpalinstability refractory to soft tissuestabilisation procedures will allow betterwrist function during most ADL tasks bypreserving midcarpal motion.

DISCUSSION 16:36

Trauma 2135 15:15

Audit of severe openfractures at Barts and TheLondon and compliancewith BOAST-4 nationalguidelines.S Yalamanchili, K Eseonu, P Vulliamy, J Shepherd,S Myers, P BatesBarts and The London NHS Trust, London

Introduction: Poor compliance withBOAST-4 standards at The Royal London

15:15 – 16:45Hall 9

Hospital in 2011 promptedimplementation of a weekly Plasticstrauma consultant rota and subsequentimprovement in outcomes. Method:Prospective data was collected on 11open tibial fractures over 3 monthsfollowing the introduction of the rota.Results: There were improvements intime to definitive cover (8 to 1.8 days),length of stay (from 32 to 13 days), deepinfection rates (from 60% to 40%) andoverall BOAST-4 compliance (from 30 to60%). Conclusion: A dedicated weeklyPlastics Trauma consultant can confermarked improvements in outcomes ofopen tibial fractures.

1005 15:19

Improving compliance withBOA/BAPRAS standards foropen lower limb fracturemanagement in a level 1trauma centre.P Dacombe, M Fell, R Clancy, U Khan North Bristol NHS Trust, Bristol

Introduction: This audit assessescompliance with BOA/BAPRAS guidelinesbefore and after Frenchay became aMajor Trauma Centre. Methods:Retrospective review of Gustillo 3 opentibial fractures against BOA/BAPRASguidelines for a 6 month period beforeand after Frenchay became a MajorTrauma Centre. Results/Discussion:Initially 95% had first debridementwithin 24 hours, 85% had soft tissuereconstruction within 7 days, 40% attime of skeletal fixation. At re-audit thishad improved to 100%, 86% and 50%.Conclusion: This study demonstrates amodest improvement in open fracturecare between periods before and afterFrenchay Hospital became a MajorTrauma Centre.

109 15:23

The effect of the timing ofantibiotics and surgicaltreatment on infectionrates in open long-bonefractures: a 6-yearprospective study after achange in policy.A Leonidou, Z Kiraly, H Gality, S Apperley, S Vanstone, D WoodsGreat Western Hospitals NHS Foundation Trust,Swindon

We reviewed our results following ournew policy to treat open fractures on ascheduled trauma list. Surgicaldebridement was performed within 6hours of injury in 45% of cases and after6 hours in 55%. Overall infection rateswere 11% and 15.7% respectively(p=0.49). Intravenous antibiotics wereadministered within 3 hours of injury in80% of cases and after 3 hours in 20% ofcases. Overall infection rates were 14%and 12.5%, respectively (p=1). Thechange in our policy may havecontributed to an improvement of theoverall deep infection rate to 4.3% fromthe previous figure of 8.5%.

219 15:27

The incidence ofthromboembolic events inpatients with lower limbinjuriesA Prinja, J Singh, A Alswadi, V Mula, M LoefflerColchester Hospital University NHS FoundationTrust, Colchester

Lower limb fractures and castimmobilization are well-recognised riskfactors for the development of venousthromboembolism (VTE). We conductedthis study to establish the incidence ofthromboembolic events in patients withlower limb injuries. Patients whopresented to our centre with lower limbinjuries (excluding hip and femoral shaft)were identified using coding data. Of the2251 patients included, 53 wereinvestigated for DVT/PE of which 13 werepositive. Overall, the incidence of VTE

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was 0.5%. On the basis of our findings,we would argue that the routine use ofextended thromboprophylaxis for thesepatients is not justified.

160 15:31

Thromboprophylaxis inpatients with pelvic andacetabular fractures: Ashort review and keyrecommendationsI el-daly, J Riedy, P Bates, P CulpanThe Royal London Hospital, London

Thromboprophylaxis in trauma patients,particularly those with pelvic andacetabular fractures, remainscontroversial. Despite anticoagulation,venous thromboembolism (VTE) remainsa common cause of surgical morbidityand mortality in this high-risk group. Inthe absence of large, well-designedclinical trials and with conflictingretrospective literature, this reviewexplores options for preventativetreatment and the role of screening. Theevidence behind prophylactic IVC filtersis also considered, along with reportedcomplication profiles. We conclude witha proposed protocol for use in majortrauma centres for the prevention of VTEin trauma patients with pelvic andacetabular fractures.

DISCUSSION 15:35

521 15:40

Pelvic and AcetabularTrauma: are we living up tothe BOAST?A Chitre, S Ross, H Wynn Jones, N Shah, A ClaysonWrightington Hospital, Bolton

In December 2008 the 3rd BOA Standardfor Trauma relating to pelvic andacetabular trauma was issued. Withinwere 4 timeframes to obtain andtransfer images and formulatemanagement plans. We reviewed notesfor the 154 such injuries which werereferred to our unit within a 12 monthperiod and assessed whether the

specified time frames were beingachieved. Our results show the specifiedtargets being met infrequently, rangingfrom 14% to 74% compliance. We arefailing to meet the BOA Standard forTrauma regarding pelvic and acetabularsurgery. The major failing is theaccessibility and transfer of relevantimaging.

94 15:44

Management of complexacetabular fractures in theelderly with fracturefixation and primary totalhip replacement; earlytotal weight bearingshould be the aim.A Trompeter, J Young, R Pearce, M Hamilton, M RickmanSt George’s Hospital NHS Trust, London

Osteoporotic acetabular fractures in theelderly are becoming more common. Inthe neck of femur fracture model,surgery allows immediate weightbearing. We present 24 cases of complexacetabular fractures in elderlyosteoporotic patients, managed withfracture fixation and simultaneous THR.Immediate full weight bearing wasallowed in all. No component migrationwas seen; return to mobility wasexcellent; 30 day mortality was 5%.

The surgery however is complex andrequires a mixed skill set of acetabularfracture fixation and complex hiparthroplasty. Peri-operative managementis critical in this elderly group, but ifdone well few complications are seen.

202 15:48

Transsacral screw fixationof posterior pelvic injuries:clinical outcomes includingcontralateral si joint painand iatrogenic neurologicalinjuryJ Reidy, E Massa, I El-Daly, J Stammers, P Culpan,P BatesBarts Health, London

The Treatment of Posterior Pelvic injuriesby percutaneous sacroiliac screws is welldescribed, safe and effective.Increasingly transsacral screws are beingused, which pass right across the sacrumand into the contralateral ilium. There isscant literature surrounding outcomes oftranssacral screws, in particularregarding contralateral SIJ pain andiatrogenic nerve injury. Since 2010, 176patients underwent pelvic surgery at ourunit. Of those, 74 had either one or twotranssacral screws as their posteriorpelvic fixation. The incidence ofuninjured contralateral SI pain was 1%,iatrogenic nerve injury was 0%.

647 15:52

The perils of pelvicbinders: experience fromthe east midlands majortrauma centreF SHIVJI, T Kurien, B Ollivere, D ForwardQueen’s Medical Centre, Nottingham

Aims: The aim of this study is to highlightunexpected sequelae associated withpelvic binders. Methods: A retrospectivereview of all pelvic fractures with an ISSof >8 admitted to our centre in theprevious 4 years. Results: From a total of282 pelvic fractures, four patients had A-P injuries missed on radiographs and CTdue to reduction via pelvic binders. Onepatient had intravenous accessobstructed. One patient sufferedhaemodynamic compromise fromdisplacement of a LC injury. Conclusions:Orthopaedic surgeons should be awareof the potential pitfalls of pelvic binders.A post binder radiograph of the pelvis is

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DISCUSSION 15:56

360 16:00

Safe Cervical SpineClearance in adultobtunded blunt traumapatients on the basis of anormal Multidetector CTscan - A RetrospectiveCohort study and Meta-analysis of 1850 patientsM RazaFrimley Park Hospital, Camberley

The objective of this study is todetermine whether in obtunded adultpatients with blunt trauma, a clinicallysignificant injury to the cervical spine beruled out on the basis of a normalmultidetector cervical spine computedtomography (MDCT). A total of 10studies involving obtunded blunt traumapatients with initial normal cervical spineCT scan were analysed. The cumulativenegative predictive value and specificityof cervical spine CT was 99.7%. In theretrospective review of 53 obtundedblunt trauma patients selected, nonewas later diagnosed to have significantcervical spine injury.

189 16:04

Spinal assessment in thetrauma patient – acompleted audit cycleJ Evans, J MarkRoyal Cornwall Hospital, Truro

This completed audit cycle evaluatedspinal clearance practices in a DistrictGeneral Hospitals EmergencyDepartment. Standards were set inaccordance with the British OrthopaedicAssociation Standards for Trauma: SpinalClearance in the Trauma Patient (BOAST2) and College of Emergency MedicineGuidelines. Primary audit identified poorcompliance with audit standards andhence an education programme andproforma were implemented. Following

this intervention, documented evidenceof thorough spinal examinationimproved substantially. However,documented evidence of removal ofspinal precautions remains poor. Thepotential morbidity associated withprolonged spinal immobilisation remainsa concern and has become a focus offurther intervention.

987 16:08

The prognostic value ofvenous lactate in traumaresuscitationK Rollins, A Das, CG Moran, B OllivereQueen’s Medical Centre, Nottingham

Lactate has become a standardmeasurement in resuscitation; howeverits diagnostic value is unclear. Thisprognostic study evaluated the use ofvenous lactate as a marker for injuryseverity and outcome in patientspresenting to a major trauma centre.Venous lactate had a statisticallysignificant correlation with ISS (p<0.0001). ROC analysis identified lactateas an excellent predictor of injury:lactate > 1.0 was 93% sensitive and 74%specific for any injury (AUC=0.70).Venous lactate can be used to identifypatients with significant injuries,correlating well with ISS, demonstratinggood sensitivity and specificity inpatients with significant injuries.

379 16:12

Managing acute kidneyinjury in hip fractures. Arewe maintaining a standardlevel of care?A Razik, Z Al Shameeri, R BajekalBarnet Hospital, London

We assessed the trend in renal functionin patients with hip fractures duringhospital stay and correlated it withmortality and discharge delays. Aprospective study of 110 patients over a6 month period on patients admittedwith neck of femur fractures wasperformed. 16% of patients admittedhad impaired renal function. Using the

KDIGO classification criteria, 64% hadimproved their SCr level immediatelypost-surgery, however only 51%maintained equal or better SCr duringthe rest of their admission. There was atotal of 9% 30-day mortality. Our datasuggests that renal function improves inmany patients immediately post-surgery.

154 16:16

Vitamin D and calciumsupplementation in elderlypatients suffering fragilityfractures; the road nottakenE Dawe, A Saini, S Thompson, J RossonRoyal Surrey County Hospital, Guildford

This study assesses the rate of Vitamin Dinsufficiency in hip fracture. Wemeasured the proportion of those with aprevious fragility fracture who attendedtaking Vitamin D. Methods: Aprospective 12 month study. Vitamin Dlevels (25-OH D3) were measured.Results: 161 patients, median age of 85years (IQR 79 - 89). 66 (41%) had VitaminD deficiency. 25 patients (35%) hadinsufficient Vitamin D. 47 patients(29%)suffered a previous fragility fracture.Nine such patients (19%) were takingVitamin D. Conclusions: This studydemonstrates how few patients withprevious fragility fractures are takingVitamin D when suffering a hip fractureseveral years later.

DISCUSSION 16:20

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243 16:25

Comprehensiveorthogeriatric medicalreview as a singleintervention improvesoutcome for elderlypatients with fractures ofthe proximal femur: Astudy of 845 patientsMTR Gaden, AM Taylor, BJ Ollivere, CG MoranNottingham university hospitals, Nottingham

Our unit has recently introduced anorthogeriatric service for elderly hipfracture patients available on weekdays.We analysed prosepectively collecteddata to compare outcomes for thosepatients who had comprehensivepreoperative orthogeriatric review andthose who did not. 865 consecutivepatients were included in the study.Those recieving comprehensive reviewhad a signifigantly lower 30 day mortality(10.85% vs 6.99%, P=0.0021) and lowercomplication rates (30.2%vs 24.7%,P=0.067). Observed 30 day mortality wasindependently higher for patientsadmitted on both weekend days(sat=13.64%, sun=10.78%), We believecomprehensive orthogeriatric review hasa positive effect on outcomes for thisgroup of patients.

247 16:29

The introduction of anorthogeriatric service to alarge teaching hospitalimproves outcomes forelderly patients with aproximal femoral fractureMTR Gaden, AM Taylor, CG MoranNottingham University Hospitals, Nottingham

We analysed prosepectievly collecteddata from our unit’s hip fracturedatabase comparing outcomes forpatients admitted over the year beforeand after the introduction of anorthogeriatric service. 1642 consecutivepatients were included. The 30-day

mortality decreased (RR=0.95) 70 deaths(8.44%) compared with 75 (9.23%). Inpatients developing a complication therisk of death was reduced (RR=0.83p=0.081). Our delay to theatre fell.Following our intervention package over70% of patients were operated on within40 hours compared to 55% before(p<0.0001). In our centre theintroduction of an orthogeriatric serviceimproved outcomes for this group ofpatients.

939 16:33

Performance on a traumasimulator correlates withsurgical exposureK Akhtar, K Sugand, A Chen, J Cobb, C GupteImperial College, London

20 participants (5 each in 4 cohorts ofdiffering experience) performed fixationof a femoral neck fracture on a VR DHSsimulator. There was a significantdifference in performance between allcohorts, especially with regards to totalfluoroscopy time, TAD and theprobability of cut-out. SpRsdemonstrated the lowest TAD andextrapolated failure rate. This may bebecause SpRs had performed the mostDHS procedures in the preceding 24months and may be more demanding intheir final lag screw position. Repeatedexposure to simulation may provide ameans of optimising DHS performanceprior to entering the operating theatre.

705 16:37

Simulation trainingimproves the safety oftrauma patientsV Asopa, A Montanez, R Gupta, D SpicerImperial College Hospitals NHS Trust, London

Simulation training is an innovative styleof teaching being developed by unitsaround the world. It is based on theprinciple of repetitive simulation in asafe environment with a focus oneffective communication and teamworking. 10 junior doctors who hadpreviously worked in T & O for 4 months

were randomly split into 2 groups. GroupA underwent a simulation scenariobased on an Accident and Emergencydepartment, and Group B, underwentde-briefing followed by a similarscenario. We demonstrate that themanagement of trauma patients byjunior doctors can be improved throughde-briefing and simulation training.

DISCUSSION 16:41

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11:59

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Foot & Ankle21 08:00

Mobility vs. Salto totalankle replacement – ispost-operative medial painan issue?D Dowen, T Brock, S Chambers, P Baker, G FerrierCumberland Infirmary, Carlisle

Medial ankle pain is a recognisedcomplication of total ankle replacement.We aimed to determine if this wasdependent on implant type. 41 totalankle replacements (Mobility & Salto)performed by the senior author wereincluded. Medical notes were analysedspecifically for outcome and medial painup to 1 year. At 1 year, 12 patients (63%)with the Mobility prosthesis had medialpain, compared to no patients with theSalto prosthesis (p<0.001). In our series,the Mobility prosthesis is associated witha significantly higher proportion ofmedial pain compared to the Saltoprosthesis.

609 08:04

Five-year results of 1stmetatarsal headresurfacing prostheses(Hemicap) used for thetreatment of advancedMTPJ osteoarthritisA Patel, M Tahir, F Syed, A Anand, K Eleftheriou,P RosenfeldImperial College Hospitals NHS Trust, London

Aim: To prospectively evaluate mediumterm results of 1st metatarsal headresurfacing for patients with advancedosteoarthritis. Method: Thirty-fiveprocedures in 32 patients wereperformed. Outcome measures includedrange of movement, AOFAS/VAS painscores, revision rate and complications.

08:00 – 09:30Hall 10

Results: Average age was 56 years, with10 men and 22 women. Mean follow-upwas 59.6 months. Range of movement,AOFAS, and VAS scores all improved(p<0.01). Three patients hadmanipulations under anaesthesia forstiffness and 3 patients underwentrevision to fusion for various reasons.Conclusion: First metatarsal headresurfacing has good medium termresults in patients with severedegeneration.

299 08:08

Hemiarthroplasty forOsteoarthritis ofMetatarsophalangeal Jointwith Townley Implant.K David-West, A KhanCrosshouse Hospital, Kilmarnock

Osteoarthritis of themetatarsophalangeal joints (MTPJ)commonly affect the first MTPJ, initialtreatment is conservative. In the severecases and where a conservative majorhas failed, the surgery options arefusion, hemiarthroplasty or total jointreplacement. Townley-hemiarthroplastyfor grades 3 and 4 osteoarthritis (52joints). 40-females and 8-men. Meanfollow-up of 4.4 years. No significantchange in range of movement, meanpre-operative AOFAS (52) and post-operative AOFAS (82). The visualanalogue scale for pain improved from 6to 2.1. One infection and implantremoved and had fusion. The outcomewas very satisfactory and most patientswere pleased, with very fewcomplications in the short-term review.

923 08:12

Results of a SurgicalStrategy for Salvage ofFailed Silastic JointReplacementsS Javed, R Rachha, O Alasawaf, G Lattouf, A ShoaibStockport NHS Foundation Trust, Stockport

Background: Despite high complication

rates documented in the literature,silastic toe joint replacements are stillcommonly implanted. Methods: Patientssymptomatic following silastic jointreplacement failure were treatedsurgically. Iliac crest graft was used toproduce a congruent bone block whichwas implanted. Results: 10 patientsunderwent surgery. All had painful jointsand 8 had transfer metatarsalgia.Significant bony lysis was seen in 7 ofthese patients. After 6 weeks, 9 werealmost pain free. Conclusion: Ourtechnique was reliable in achieving bonyunion in all patients in this series, andthe mean improvement in AOFAS scorewas statistically significant.

DISCUSSION 08:16

912 08:21

Changes in footdimensions after forefootsurgery – what canpatients expect?S Javed, R Rachha, Z Hakim, P Heire, G Lattouf, A ShoaibStockport NHS Foundation Trust, Stockport

Introduction: Patients with hallux valgusoften complain of difficulty in findingsuitably sized footwear bothpreoperatively and postoperatively.Methods: Preoperative andpostoperative weight bearing APradiographs were analysed in 91 feet tomeasure the soft tissue and bonyforefoot width and the soft tissue height.Results: Bony reductions of forefootwidth were noted post-operatively.However, the soft tissue height of thefoot increased and this was statisticallysignificant. Conclusion: This study hasidentified that the reason that patientscontinue to have footwear difficultiesafter forefoot surgery is the change invertical height of the forefoot.


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707 08:25

Inter- and Intra-observererror when assessing theposition of the lateralsesamoid in Hallux ValgusS Panchani, J Reading, Y Agarwal, A Desai, J MehtaPennine Acute trust, Oldham

Background: We assessed the inter- andintra-observer error of a newclassification system for the assessmentof Hallux Valgus. Methods: Fiveorthopaedic consultants and registrarsassessed 152 weight-bearing radiographsof feet. Grading included normal (0%),mild (≤ 50%), moderate (51% – ≤99%) orsevere (≥ 100%) depending onpercentage lateral sesamoid bodydisplacement from the lateral cortex ofthe first metatarsal. Results: Consultantand Registrar intra-observer variabilityshowed good agreement (Consultantsmean Kappa = 0.75, Registrar meanKappa 0.73) and intra-class correlationswere high. Conclusion: The newclassification system for assessing HalluxValgus shows high inter- and intra-observer reliability.

497 08:29

3rd generation minimallyinvasive distal metatarsalosteotomy for correctionof hallux valgusK Brogan, T Voller, SL Whitehouse, S Morgan, SH PalmerWestern Sussex NHS Trust, Worthing;Queensland University of Technology, Brisbane,Australia

Background: Aim – evaluate outcomes ofnew, 3rd generation MIS technique forhallux valgus correction. Methods: 45consecutive feet, with painful mild-to-moderate hallux valgus, underwent a 3rdgeneration percutaneous distalcorrective chevron osteotomy. Meanfollow-up 9 months. All patients,prospectively, radiographically andclinically (MOXFQ) evaluated. Results:Statistically significant (p<0.001)improvement in all three domains of the

MOXFQ. Mean HVA decreased from30.54o to 10.41o (p<0.001), and meanIMA from 14.55o to 7.11o (p<0.001). Nosignificant complications. Conclusions:3rd generation MIS correction of halluxvalgus is reliable and safe – short term.

DISCUSSION 08:33

934 08:38

Long term follow up ofoutcome of anklearthrodesis surgeryK Sigamoney, SV Karuppiah, S Yallappa, S Yellu, S MillerRoyal Derby Hospital, Derby

Introduction: Ankle arthrodesis has goodsurgical outcome in terms of pain reliefand mobility in the early post operativeperiod. However, there is limitedevidence assessing the long term benefitof ankle arthrodesis. Aim: We aim toassess the outcome of long termfunctional and symptomatic benefit afterankle arthrodesis. Methods: Patientsnotes and x-rays were assessed for dataand all patients were interviewed viatelephone. Results: The MOXFQ andAOFAS scores showed good results.There were low rates of complicationswith high patient satisfaction.Conclusion: Ankle arthrodesis surgery isgood treatment for severe osteoarthritiswith long term patient satisfaction.

800 08:42

Arthroscopic triple fusionperformed via a lateral twoportal technique. Acadaveric study to evaluatesafety and efficacy.A Hughes, O Gosling, R Amirfeyz, J McKenzie, I WinsonAvon Orthopaedic Centre, Bristol

Arthroscopic triple fusion offerspotential advantages over opentechniques. Preliminary techniques usefive portals with risks to neurovascularstructures. Four cadavers werearthroscopically prepared for a triplefusion using two lateral portals. Once

dissected the distance from portal tosubcutaneous nerve was measured aswell as the percentage joint surface. Themean distance from the midlateral portalto the sural nerve was 22mm and fromthe dorsolateral portal to the superficialperoneal nerve was 8mm. Jointpreparation was 62%/63% fortalonavicular joint, 75%/74% forcalcaneocuboid joint. This is comparableto multiple portal techniques butwithout the significant neurovascularrisk.

249 08:46

Safe zone for minimallyinvasive calcanealosteotomyV Ramsingh, A Ahmad, S KadambandeRoyal Gwent hospital, Newport

Three individual observers assessed 100consecutive MRI scans of ankle toidentify a safe zone to do minimallyinvasive calcaneal osteotomy. Thedistance of the neurovascular bundle onthe medial side from a fixed bonyprominence at the level of Achillestendon insertion was measured. Over allmean distance measured by eachobserver was 23.0 mm. Mean inter-observer variations was 1.1 mm. Over all95% confidence interval ranges from22.8 – 23.2 mm. Intraclass correlationcoefficient is 0.7, which indicates strongagreement between the observers. Thesafe zone is at least 18 mm from thelevel of Achilles tendon insertion.

55 08:50

Middle Facet TalocalcanealCoalitions withConcomitant Severe FlatFeet: “To Resect,Reconstruct or Both?”A Oluwasegun, A Sharma, H PremBirmingham Children’s Hospital, Birmingham

The management of symptomatic middlefacet tarsal coalitions (mftcs) withconcomitant severe flat feet ischallenging due to debatable

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assumptions about the source of pain.We identified thirteen patients (15 feet)between 2003 and 2011 who hadisolated resections of mftcs with orwithout flat feet reconstructions andcompared the clinical outcomes.Coalition resection combined with flatfeet reconstruction (calcaneallengthening osteotomy) provided bettersymptomatic relief for pain withexcellent mean AOFAS scores (91)compared to isolated resections (85.8).Concomitant rigid flat feet should beconsidered as a significant contributor tothe pain complex in patients withsymptomatic mftcs.

758 08:54

Proximal Tibial BoneGrafting in Foot and AnkleSurgeryR Rachha, H Kassam, S Javed, R DalalStockport Hospital NHS trust, Stockport

We present our results with proximaltibial bone grafting for foot and ankleprocedures. Graft was harvested fromproximal tibia in 45 procedures. Meanfollow up was 14 months (3-36 months).Post operatively, pain, donor sitemorbidity and overall satisfaction werenoted. 36 patients (80%) were pain freeat 6 weeks and 44 (95.5%) were painfree at 3 months. 1 patient had afracture through the graft area followingsignificant trauma at 6 weeks post-surgery. Union rate was 95.5% for fusionprocedures. Overall patient satisfactionwas 95.5%. We strongly recommend itfor most foot and ankle fusionprocedures.

DISCUSSION 08:58

814 09:04

The epidemiology of openankle fractures: change inincidence over a twenty-three year period.K Bugler, N Clement, A Duckworth, T White, M mcqueen, C Court-BrownRoyal Infirmary Edinburgh, Edinburgh

This study investigated the epidemiologyof open ankle fractures. 178 patientswith open ankle fractures presenting toour unit from 1988 to 2010, wereincluded. The mean age was 55 years,with the highest incidence in womenover 90. The most common mechanismwas a simple fall and 82% were isolatedinjuries. The mean age increased from44 to 64 over the twenty-three yearstudy period and the prevalentmechanism of injury from predominantlyroad traffic accidents to simple falls.Open ankle fractures have become lowenergy injuries affecting particularlyelderly women. This has implications forservice planning and training.

639 09:08

Comparison ofcomplication rate followingtraditional screw fixationto tightrope surgicalfixation in anklesyndesmotic injuries.WAK Al-Azzani, T Sabah, A Ved, V Paringe, D O’DohertyUHW, Cardiff

Ankle injuries are amongst thecommonest of bone and joint injuries.Traditionally, injuries involving the distaltibofibular syndesmosis have beentreated using syndesmotic metal screwsto prevent diastasis. However, the use ofscrews meant that physiological micro-movement between the tibia and fibulais lost and often results in loosening orbreaking of the screws. The presentstudy retrospectively compares tightropeFixation to metallic screw fixation in atotal of 85 patients. We found lower rateof return to theatre and lower rate ofinfections with fixation using tightropecompared to screw.

867 09:12

Acute Charcot Foot: Role ofSPECT/CT Bone Scan inEarly Diagnosis andMorphologicalClassificationA Bilal, K Boddu, R Chakravartty, N Mulholland,G Vivian, N Petrova, V Kavarthapu, M EdmondsKing’s College Hospital NHS Trust, London

We evaluated the role of SPECT/CT bonescan in early diagnosis andmorphological description of acuteCharcot foot. 134 consecutive diabeticpatients presenting with red, hot andswollen feet with peripheral neuropathyhad SPECT scans. SPECT was positive foracute Charcot in 108 feet (false positiverate of clinical examination 21%). 86(80%) of these had no deformities inplain radiographs. 93% showed highuptake at ligamentous insertions and33% at subchondral regions. Commonlyinvolved region was tarsometarsal joint(44%) and ligament was Lisfrancligament (24%). Impending ligamentavulsion may be a significant event in thepathophysiology of Charcot foot.

551 09:16

Hypovitaminosis D in footand ankle practice – Just acoincidence?S Akhtar, U ChoudhuriMorriston Hospital, Swansea

In orthopaedic practice, rarely do weinvestigate the metabolic picture of ourpatients. A series of foot and anklepresentations implicating underlyingtreatable metabolic abnormalities ispresented. 63 patients over a 15 monthperiod, consisted of M:23 and F:40 withmean age: 53. Presentations consisted ofpain (n=27), stress fracture (n=15), non-union (n=4), tendinopathy (n=4) andbony collapse (n=3) Underlyinghypocalcaemia (n=30),hypophosphataemia (n=9) andhypovitaminosis D (n=41) were noted.We believe such metabolic abnormalitiesare more widespread in orthopaedicpractice and recommend vigilance,

Notes


appropriate treatment in atypical cases,and more focussed study to demonstratea causal role.

586 09:20

Trainer supervisionreduces intraoperativeradiation usage amongstorthopaedic traineesduring ankle fracturefixationA Kheiran, D Makki, P Banerjee, D RickettsBrighton and Sussex University Hospitals,Brighton

Unstable ankle fractures are commonlytreated with operative fixation. Isolatedlateral malleolus fractures (Weber B) areoften operated by orthopaedic trainees.Operative fixation of these fractures isincluded in the index procedures ofprocedure based assessment (PBA). It isa common perception that trainees takemore time to fix these fracturescompared to trained consultants. Aretrospective review of fifty patientsundergoing operative fixation of WeberB were undertaken. Tourniquet time andintra-operative radiation dose wererecorded. This is the first study toindicate that patients are at risk ofhigher radiation exposure whenoperated by orthopaedic trainees.

DISCUSSION 09:24

Best of the BestUltrasonographic findingsduring Ponseti treatementfor clubfeet. Is ultrasounda reliable tool?P Nasr, A Rehm, L BermanAddenbrooke’s University Hospital FoundationTrust, Cambridge

08:00 – 09:30 & 10:00 – 10:45Hall 9

Is Congenital TalipesEquinovarus (CTEV)actually a risk factor forpathologicalDevelopmental Dysplasiaof the Hip (DDH)?S Hughes, Q Choudry, RW PatonEast Lancs Healthcare Trust

The Oswestry Risk Index(OSRI) – An Aid in theTreatment of MetastaticSpine DiseaseA Jaiswal, B Balain, JM Trivedi, SM Eisenstein, JH Kuiper, DC JafffrayRobert Jones & Agnes Hunt Orthopaedic HospitalNHS Foundation Trust

The use of ultrasound toassess screw penetrationfollowing distal radiusfixation: A Cadaveric studyJ Singh, D Williams, N Heidari, M Ahmad, A Noorani, L Di MascioRoyal London Hospital

Central Cord Syndrome:Early surgical interventionimproves neurologicaloutcomeC Stevenson, J Warnock, S Maguire, N EamesRoyal Victoria Hospital, Belfast

Effect of Triclosan-CoatedSutures on the Incidence ofSurgical Site InfectionFollowing Lower LimbArthroplasty:A double-blind, randomisedcontrolled trial of 2547proceduresC Jenson, A Sprowson, P Partington, I Carluke, K Emmerson, S Asaad, R Pratt, S Muller, MR ReedNorthumbria Healthcare NHS Foundation Trust

Quality of plastermoulding for distal radiusfractures is improvedthrough focussed tuition ofjunior doctorsDN Ramoutar, R Silk, JN Rodrigues, M HattonEast Midlands North

Intra-articular and portalinfltration versus wristblock following wristarthroscopy – Aprospective RCTY Agrawal, K Russon, I Chakrabarti, A KochetaRotherham District General Hospital, Rotherham

Hip fracture a ‘polytrauma’for the geriatric patient,serum lactate a prognosticmarkerR Smith, M Venkatesan, C Uzoigwe, A Khan, S Balasubramanian, S GodsiffUniversity Hospitals of Leicester

Sub acromial Impingementsyndrome – What can welearn from evolutionJ Craik, R Mallina, V Ramasamy, NJ LittleEpsom and St Helier Hospital

Locking plate fixation ofperiprosthetic fractures ofthe proximal femur arounda stable stem:biomechanical analysis offixation methodsSM Graham, Prof RK Wilcox, Prof E TsiridisCountess of Chester Hospital, Chester

The Triathlon TKR –evaluation of short termresultsP RobinsonNorth Bristol NHS Trust

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Injuries and outcomes: UKmilitary casualties fromIraq and Afghanistan 2003-2012JP Barwell, JRB Bishop, S Roberts, M MidwinterAcademic Department of Military Surgery andTrauma; Royal Centre for Defence Medicine(RCDM), Birmingham

Ability of orthopaedictrainees to correctly assessadequacy of reductionfollowing operative anklefracture fixationJ Wright, C Bagley, D Park, P RayBarnet General Hospital

[Additional late entries to this sessionwill be advised at the time.]

Research523 08:00

A characterisation ofbiofilm mediated bacterialgrowth on a novelantibiotic-bone cementcombination H Gbejuade, A Lovering, A Hidalgo-Arroyo, J Leeming, J WebbGolden Jubilee National Hospital, Glasgow

Biofilms are central to prosthetic jointinfections. We compared biofilmadherence to antibiotic-loaded acryliccement (ALAC). Batches of cementprepared with gentamicin, daptomycinand vancomycin were eluted for nil (T0),48 hr (T2) and 2 weeks (T14), thereafterexposed to biofilm formingStaphylococcus. T0 batch all inhibitedbiofilm growth except gentamicin onlyALAC. T2 batch all showed some biofilm

08:00 – 09:30Hall 8

colonization, the greatest on thegentamicin only ALAC and the lowest ondaptomycin ALAC. T14 batch all showsimilar growth but lowest on thedaptomycin ALAC. The daptomycin-gentamicin combination ALAC providedthe best and the gentamicin only, theworst biofilm protection.

759 08:04

Efficacy of alcoholicchlorhexidine (Chloraprep)for preoperative patientskin preparation forarthroplastyL Whittington, B Scammell, W Ashraf, M Hatton,R BaystonUniversity of Nottingham, Nottingham

The bacteria causing surgical siteinfection in arthroplasty are commonskin flora (Staphylococcus aureus, S.Epidermidis and Propionibacteriumacnes) and usually gain access to theprosthesis during surgery. Effective skinpreparation may reduce post-operativeinfection and this study looked at theefficacy of a unitized alcoholic-chlorhexidine preparation “Chloraprep”in reducing bacteria from the skin ofpatients undergoing hip and kneearthroplasty. Analysis of swabs and fullthickness skin biopsies identified viablebacteria in all samples suggesting thatChloraprep does not sterilise the skinand that viable bacteria remain with thepotential to cause surgical site infection.

875 08:08

Improved detection ofbiofilm associatedinfection by sonication ofpoylmethylmethacrylate(PMMA) cementH Gbejuade, J Webb, A Hidalgo-Arroyo, J Leeming, A LoveringAvon Orthopaedic centre, Bristol; SouthmeadHospital, Bristol

Sonication may improve infectiondiagnosis by dislodging biofilms fromsurfaces, which can then be cultured. We

investigated the effect of sonication ofbiofilm-colonized PMMA.Staphylococcus biofilm was grown onaseptically prepared PMMA beads, thenwashed in PBS to remove looselyadherent bacteria and thereafterimmersed in fresh sterile PBS. Viablebacteria counts were then undertakenbefore and after sonication andexpressed as colony forming units per ml(CFU/ml). Pre-sonication and postCFU/ml were 1.67 x 106 and 2.3 x 107respectively. The 10-fold increase inbacteria culture yield suggests sonicationof PMMA may improve the diagnosis ofbiofilm infection.

DISCUSSION 08:12

515 08:16

Rate-dependent materialproperties of the porcinestifle joint LCLTJ Bonner, N Newell, AD Pullen, AMJ Bull, SD MasourosImperial College, London, The Royal BritishLegion Centre for Blast Injury Studies, London

A porcine stifle joint lateral collateralligament experiment was conducted thatsimulated the strain rates that occuracross a full range of different humanknee ligament injuries. Tensile testingwas performed at five strain rates, eachan order of magnitude apart, in therange 100-104%/s. Tensile modulusincreased from 288 to 905 mpa (p<0.05), and tensile failure stress increasedfrom 39.9 to 77.3 mpa (p<0.05). Alogarithmic relationship between strainrate and both, tensile modulus andtensile failure stress was identified. Astrain rate sensitivity limit was observedat very high strain rates.

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522 08:20

A new application ofdemineralised bone astendon substitute; ovineanimal studyS Elnikety, C Pendegrass, G BlunnUCL, John Scales Centre for BiomedicalEngineering, Institute of Orthopaedics andMusculoskeletal Science, London

In severe tendon injuries with loss ofsubstance, tendon graft or a substitute isused, this is usually associated withdonor site morbidity and lack ofremodelling. We hypothesise thatdemineralised cortical bone (DCB)present in tendon environment willresult in remodelling of DCB intoligament. 6 sheep undergone resectionof the patellar tendon and repaired withDCB. None of the specimens showedevidence of ossification. Forceplateanalysis showed satisfactory progression,histology proved formation of neo-enthesis with evidence ofligamentisation. Results prove that DCBcan be used as tendon substitute,combined with correct technique earlymobilisation can be achieved.

627 08:24

Analysis of cementviscosity and its effect onmechanical properties in abovine vertebroplastymodelF Callachand, N DunneMusgrave Park Hospital, Belfast; Queen’sUniversity Belfast, School of Mechanical andAerospace Engineering, Belfast

Vertebroplasty involves thepercutaneous injection of cement into afractured vertebral body. The aim of thisstudy was to determine the effect ofcement viscosity on the mechanical

properties in a bovine vertebroplastymodel.

An anterior compression fracture wascreated in bovine vertebrae. Calciumphosphate cement was injected basedon 20% volume fill. Three differentliquid/powder ratios were used.Mechanical properties were determinedpre and post-augmentation. Injectabilityranged from 58-64%. A positivecorrelation existed between cohesionand higher viscosity (R2=0.885). The highviscosity cement restored strength andpartial stiffness, which is important inproviding relative stability for fracturehealing. 08:24

734

Cobalt and chromium ioninduced neurotoxicity inhuman neural cell cultureS Hawkins, R Richards, P Case, A Blom, M CaldwellUniversity of Bristol, Bristol

Elevated levels of cobalt and chromiumin the CSF of patients with poorfunctioning thrs has been reported tocause neurotoxic conditions. To assessthis we exposed the same levels of ionsto a co-culture of mature neural cellsdifferentiated from human neural stemcells. We found increased levels of DNAbreaks and cell death in our culture atconcentrations above 3µg/L of Co2+ andCr3+ ions, with astrocytes more affectedthan neurons. This was: mediated bycaspase 3 activation, not prevented byantioxidants and affected both gabaergicand cholinergic neurons. In humanneural culture Co and Cr ions areneurotoxic.

858 08:32

Blood metal ion testing isan effective screening toolto identify poorlyperforming metal on metalbearing surfacesRP Sidaginamale, T Joyce, S Natu, A Nargol, D LangtonNewcastle University, Newcastle upon tyne;University Hospital Of North Tees, Stockton onTees

Aims; to record physiologicalconcentrations of blood Cr&Co; comparewith retrieved hip resurfacings; examinethe distribution/partitioning of theseions in serum and whole blood. 3042blood samples donated to the localtransfusion centre analysed. 91 hipresurfacings with pre-revision bloodmetal ion results underwent volumetricwear assessment. The relationshipbetween serum and whole bloodconcentrations of Cr&Co in 1048patients was analysed using BlandAltman charts. Only one patient in thetransfusion group had blood Co >2µg/l.Blood Co 4.5µg/l showed 94% sensitivityand 95% specificity for abnormal weardetection. Metal ions tended to fill theserum compartment preferentially.

DISCUSSION 08:34

445 08:46

Depression and anxiety inarthroplasty patients: isthere any correlation withseverity of osteoarthritis?HK Ribee, J Kozdryk, S Quraishi, M WaitesRobert Jones and Agnes Hunt Hospital, Oswestry

We asked all patients attending JointSchool to complete a Hospital Anxietyand Depression Scale (HADS) andcorrelated these to pre operative OxfordKnee and Oxford Hip Scores. Overall 107(56%) were either anxious, depressed orboth. We then grouped the OxfordScores according to the patient’s scoreon the HADS, and performed analysis ofvariance (ANOVA). There was a linkbetween Oxford Score and depression

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score (p=0.001377) and a significantdifference in Oxford Score betweenpatients designated as depressed or notdepressed (p=0.000297). There is a linkbetween severity of osteoarthritis andseverity of depression.

524 08:50

The effect of muscleinflammation on pain andfunction in patients withhip osteoarthritisT Okoro, A Lemmey, P Maddison, C Stewart, N Al-Shanti, JG AndrewBangor University, Bangor

Aim: To assess if symptom severityrelates to mrna expression of markers formuscle inflammation (tnfα, IL-6) in theproximal vastus lateralis (VL) of patientswith severe osteoarthritis undergoinghip arthroplasty. Methods: Musclebiopsies were obtained from 17 patientsintraoperatively. The Oxford Hip Score(OHS) was used for stratification, withmoderate symptoms (MS) > medianOHS, and severe symptoms (SS) <median OHS. Results: Compared to theMS group, the SS group had increasedtnfα expression (+28%, p=0.35) andreduced IL-6 expression (-44%, p=0.35),though not significantly. Conclusions:Functional deficit appears independentof muscle inflammation in patients withhip osteoarthritis.

725 08:54

Genome-wide scan showsgenetic risk loci for kneeosteoarthritis varies withanatomic compartmentsite: implications forunderstanding the geneticbasis of knee OA and theimportance of phenotypedefinition in geneticassociation studiesS Thiagarajah, K Panoutsopoulou, D-W Aaron, L Southam, C Arcogen, M Doherty, E Zeggini, JM WilkinsonUniversity of Sheffield, Academic Unit of BoneMetabolism, Sheffield

Few risk loci for knee osteoarthritis(KOA) have been discovered throughgenome-wide association (GWA) studiesdue to broad phenotypic definitions. Weaimed to phenotype KOA patients bycompartmental involvement andperform a GWA study. 2,010 patientswith KOA were phenotyped bypredominant pattern of radiographiccompartmental involvement. A GWAanalysis was performed comparing eachphenotype against non-OA controls.Analysis by compartmental involvementyielded 25 independent loci for KOA atP< 1x10-6. When the total KOA groupwas compared against the non-OAcontrols, only 1 signal at P< 1x10-6 wasidentified. Employing narrow phenotypicdefinition identified several novel signalsfor KOA.

380 09:02

The functional range ofmovement of the humanwristG Brigstocke, A Hearnden, C Holt, G Whatling Royal Surrey County Hospital NHS FoundationTrust, Guildford; University of Cardiff, Cardiff

The functional range of movement (rom)of the human wrist is poorly reported intoday’s literature. Therefore, weanalysed the global wrist motion of tenright hand dominant male volunteerswith a 3D optoelectronic motion capturesystem. The mean maximal wrist rangeof motion was 48 degrees of extension,84 degrees of flexion, 16 degrees ofradial deviation and 49 degrees of ulnardeviation. Healthy volunteers utilise anear maximal degree of wrist extension,radial deviation and ulnar deviation tocomplete ADL tasks however only amoderate degree of wrist flexion wasrequired.

513 09:06

Functional wrist motionrequired for gripping a carsteering wheel. Asimulated static analysisL Booth, T Okoro, R KanvindeYsbyty Gwynedd, Bangor

Aim: To investigate the functional wristrange of motion required for gripping acar steering wheel. Methods: An age andsex matched population was recruited.Participants´ in-car wrist range of motionfor gripping a steering wheel wasreplicated on a static steering wheelmodel (based on clock face positions).Results: 20 participants were recruited.The optimal steering wheel positions forassessing wrist motion (extension 12°-78°, ulnar deviation 2°-36°, supination6°-85° and pronation 3°-100° ) were 2, 5,7 and 10 o’clock (all values >0.68, p<0.01). Conclusion: The data provides abasis for further assessment offunctional wrist motion in wrist injuredpatients.

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633 09:10

Do neck of humerusfragility fracturespredispose to subsequentupper limb fragilityfracture?B Berko, P SmithamNorfolk and Norwich University Hospital,Norwich; University College London, London

Introduction: The burden of osteoporosisis huge with upper extremity fracturesconstituting a third of all fragilityfractures. This study researchessubsequent upper limb fracturesfractures occuring in cohorts of patientswith an index shoulder and hip fracture.Methods: Retrospective cohort design.Data on fractures of the shoulder (702)and hip (1465) was analysed. Results andconclusion: The study revealedstatistically significant evidence that ashoulder fracture predisposes to furtherupper limb fractures compared to a hipfracture. Also, findings in keeping withmuch of the literature were notedreinforcing the evidence that the firstyear following fracture is critical.

DISCUSSION 09:14

LimbReconstruction,General Trauma71 08:00

Infected Non-Unions:Lautenbach Principles andManagementN Vannet, R Morgan-JonesUniversity hospital wales, Cardiff

Lautenbach’s principles are used toachieve union and treat infection. We

08:00 – 09:30Hall 11A

present our case series of infected non-unions treated by intramedullary nailing.Methods: Seventeen infected non-unions treated with intramedullarynailing were reviewed (6 tibiae, 6 femursand 5 knee arthrodeses). Post-operatively patients were fullyweight-bearing, had 5 days IV antibioticsthen 6 weeks of oral therapy. Results:Early discharge was achieved in allpatients. The most common infectiveorganism was staphylococcus. This serieshad a union rate of 94% with 2amputations. Conclusions: Immediateintramedullary nailing is a valid optionfor these patients with early conversionto oral antibiotics.

659 08:04

The use of abiodegradeable antibioticloaded calcium sulphatecarrier containingtobramycin for thetreatment ofosteomyelitis: a series of198 casesJ Ferguson, N Riley, D Stubbs, B Atkins, M McNallyNuffield Orthopaedic Centre, Oxford

We report on the use of Osteoset T® in195 cases of chronic osteomyelitissurgery. There were 12 C-M Type I, 1Type II, 144 Type III and 48 Type IV cases.At follow-up (mean 3.7yrs) infectionrecurred in 18/195 (9.2%) at a mean of46 weeks (4-109). After furthertreatment 191/195 were infection-freeat final follow-up. Radiographic bonedefect filling was assessed; 35% had nodefect filling, 55% partial filling and 4%had complete filling. Nine sufferedfractures at a mean of 2.1yrs (0.4-4.9).Osteoset T® is an effective adjunct inchronic osteomyelitis, however bonedefect resolution is variable.

921 08:08

The emerging role or RIAfor the treatment ofchronic osteomyelitis; Auseful adjunct totreatmentM Kaminaris, S Daivajna, D Giotikas, A NorrishCambridge University Addenbrooke’s HospitalNHS Foundation Trust, Cambridge

Eradicating intramedullarymicrosequestra in chronic osteomyelitis(COM) is a challenging problem wherefailure leads to persistent infection. TheReamer-Irrigator-Aspirator (RIA) device,using simultaneous irrigation, bonereaming and aspiration of theintramedullary debris, may provide asolution. We report the outcome of thistechnique in 11 patients with COMtreated by a multidisciplinary approachas part of the surgical protocol. Ataverage follow-up of 6.3 months (range3-18 months) no patients had arecurrence of COM or required repeatoperation. Based on our short termresults, RIA may have a role to play ineradicating intramedullarymicrosequestra in patients with COM

655 08:12

The use of Silver CoatedMegaprostheses: a role ininfection?J Bhamra, P Gikas, E Gillott, J Miles, R Carrington, J Skinner, W Aston, G Blunn, T BriggsRoyal National Orthopaedic Hospital, Stanmore

We conducted a prospective study of 31patients with Agluna-treatedmegaprostheses and 35 controls. Meanage was 57.5 years and M:F ratio was1.3:1. 17% of patients received theirimplants for primary reconstruction, 46%for single-stage revision and 38% fortwo-stage revision surgery. Both groupswere compared for clinical andhaematological evidence of infection. Asignificant reduction in post-operativeCRP and ESR levels was seen in theAgluna group (p<0.01). The use of silvercoating is a promising technique, in

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reducing the risk of infection in complexoncological and end stage revisionsurgery.

DISCUSSION 08:16

940 08:21

The use of a novel rapidprototyping method in theplanning of correctiveosteotomies of the lowerlimbG Roberts, D Eggbeer, I PallisterSwansea

Rapid prototyping is increasinglybecoming affordable and accessible toorthopaedic surgeons. Its benefits havealready been shown, especially inmaxillofacial surgery. Currently it is usedalmost exclusively in the modelling andplanning of bony procedures. Howeverany corrective osteotomy also has asignificant effect on the soft tissues,particularly the muscles. We present amethod which has been usedsuccessfully to correct complexdeformities. This method involvescreating rapid prototype models withvarying materials which can simulateboth muscle and bone. Thus allowingboth muscle and bone to be taken intoaccount when planning correctiveosteotomies.

684 08:25

Lateral Opening versusMedial Closing WedgeDistal Femoral VarusOsteotomy – Is there adifference in achievingdesired realignment?A Alva, BD Coupe, PJ RaeWrightington Hospital, Wigan

A distal femoral varus osteotomy hasbeen advocated when the valgus kneedeformity exceeds 12 degrees and thedeviation of the joint line from thehorizontal is 10 degrees. As the results ofsuch surgery relies on precision ofangular correction we set out to

compare the lateral opening wedge andmedial closing wedge techniques inachieving planned correction. Angularcorrection achieved by lateral openingwedge technique was significantly closerto the desired correction as compared tothe medial closing wedge technique.

414 08:29

Patient based outcomesfollowing circular frametreatment of tibial non-unionP Fenton, D BoseRoyal Orthopaedic Hospital, Birmingham

Circular frames are valuable tools in thetreatment of non-union. Our aim was toassess patient reported outcomesfollowing treatment of tibial non-unionin circular frame. Twenty-one patientswere sent questionnaires utilising theEnneking scoring system and EQ-5Dquestionnaire, 14 responded. MeanEnneking score was 58.0% (34.3-77.1).Three patients would not repeat thetreatment. There was no significantdifference in the EQ VAS of overall healthfor treated patients compared with amatched population. Our study showspatients undergoing limb salvage withcircular frames for tibial non-unioncontinue to have significant symptoms,however most would undergo similartreatment again.

591 08:33

The use of bonemorphogenic protein(bmp) in trauma andelective orthopaedicsurgery. The Portsmouthexperience.J Griffiths, C Lewis, L Cannon, I Lasrado, S Hodkinson, C HandQueen Alexandra Hospital, Portsmouth

A retrospective analysis to quantify theeffects of BMP 7 and BMP 2 atstimulating bone union in both traumaand elective patients. Seventeen patientswere included. Nine patients received

BMP 7 and 8 received BMP 2. The overallunion rate following the use of BMP was94.1%. The union rate with BMP 7 andBMP 2 was 88.9% and 100% respectively.Following the use of BMP the averagetime to union was 117 days. Our resultssuggest both BMP 7 and BMP 2 to beeffective at stimulating bone formationand bone union in patients withestablished non-union.

742 08:37

Custom primary hingedtotal knee arthroplasty inpoliomyelitisJ Rahman, B Kayani, S Hanna, J Miles, R Carrington, J Skinner, T BriggsRoyal National Orthopaedic Hospital NHS Trust,Middlesex

Patients with poliomyelitis may havecomplex joint pathology that can makearthroplasty procedures technicallydemanding with poor clinical outcomes.We retrospectively reviewed outcomesof 14 tkrs performed using the StanmoreModular Individualised Lower ExtremitySystem (SMILES, Stanmore Implants, UK)in 13 patients with polio. The mean OKSimproved from 11.6 to 31.5 (p<0.001).92% patients were very satisfied orsatisfied after the procedure.Radiological evaluation showedsatisfactory alignment with no signs ofloosening or migration. Our resultsdemonstrate that the SMILES prosthesisis effective at relieving pain andimproving function in patients withpolio.

DISCUSSION 08:41

11 08:47

Distal radius volar plates:How anatomical are they?S Evans, A Ramasamy, S DeshmukhBirmingham City Hospital, Birmingham

Volar plates incorporate a volar corticalangle (VCA) of 25 degrees. Aim;determine whether the VCA in uninjureddistal radii corresponds with platedesigns. Retrospective analysis utilizingCT scans. Each distal radius was

Notes


subjected to 3 measurements of the VCAin the sagittal plane. 100 patients (67male; mean age 37.4 years). Mean VCA32.9 degrees. VCA in males wassignificantly greater than in females(33.6 vs 31.5 degrees; p=0.04).Statistically significant differencebetween the lateral VCA and medial VCA(32.2 vs 34.3 degrees, p=0.02).Conclusion: VCA is significantly greaterthan the volar angulation incorporatedwithin plate design.

353 08:51

The ‘carpal shoot throughview’: identification ofdorsal screw penetrationduring volar locking platefixation of distal radiusfracturesD Marsland, C Hobbs, P SauvéPortsmouth Hospital NHS Trust, Portsmouth

We report a ‘carpal shoot through view’(CSTV) of the distal radius to identifydorsal compartment screw penetrationwhen performing volar locking platefixation in 42 patients. All patients hadacute distal radius fractures fixed usingan Aptus locking plate. Intraoperativeposteroanterior (PA) and lateralradiographs were taken, followed by theCSTV. The CSTV revealed dorsal screwprotrusion in 6 cases and DRUJpenetration in one case, which was notdetectable on standard views (overallscrew exchange rate 17%). The CSTV isan easily obtained adjunct to helpidentify excessively long screws,potentially reducing the risk of extensortendon injury.

650 08:55

Corrective osteotomy andvolar locking plate formultiplanar maluniteddistal radius fractures: Dowe improve function oranatomy?A Elkhouly, N RoyHEY NHS trust, Hull

Malunion remains one of the mostcommon complications after distal radiusfracture. We Assessed functional andradiological outcome of multiplanarcorrective osteotomy , locking fixedangle volar plate for painful multiplanardistal radius malunions on 15consecutive patients who underwentopen wedge distraction osteotomy,locking volar plate and cancellous bonegrafting. 11 patients corrected 19°dorsaltilt to 9°volar tilt. 4 patients corrected26° of excessive volar tilt to 11°. Ulnavariance corrected to 0.96mm,Dorsiflexion palmarflexion supinationimproved significantly. SF12, VAS andDASH improved significantly. Thistechnique is an effective means to treatsuch deformities improving wristfunction and anatomy

DISCUSSION 08:59

265 09:04

Platelet-rich therapy in thetreatment of patients withfractures of the proximalfemur: a single centre,parallel group, participantblinded, randomisedcontrolled trial.XL Griffin, J Achten, N Parsons, ML CostaUniversity of Warwick, Warwick Medical School,Coventry

The aim of the study was to quantify theclinical effectiveness of platelet-richtherapy (PRT) in the management ofpatients with a typical osteoporotic hipfracture. Patients aged over 65 yearswith an intracapsular fracture of the

proximal femur were eligible. Theprimary outcome was failure of fixationwithin 12 months, defined as anyrevision surgery. There was an ARR of5.6% (95% CI -10.6 to 21.8%) favouringtreatment with PRT. There were nosignificant differences in any of thesecondary outcomes. Although therewas no significant treatment effect, wecannot definitively exclude a clinicallymeaningful difference.

839 09:08

External fixation oftrochanteric fracturesunder local anaesthesia.Outcomes of thetreatment of 200 patientswith a long follow up of 24months.MA Mussa, AR AhmedHull Royal Infirmary, Hull; Alexandria UniversityHospitals, Alexandria, Egypt

200 patients with intertrochantericfractures treated with a new externalfixator under regional block. Averagefollow up was 24 months, operative time26.22 minutes and fluoroscopy time16.67 seconds. Blood loss was negligibleand none received blood transfusion.Mean time for union was 10.5 weeks.Superficial pin tract infection occurred in8% and deep pin tract infection in 3.5%.This is a reliable and safe treatmentoption and could be considered as analternative for conventional methods offixation. It offers minimal operative andanaesthetic risks, no blood loss, earlymobilisation and short hospital stay, withlow mortality and morbidity.

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651 09:12

Management ofPeriprosthetic fracturesaround knee in elderlyusing Distal FemoralReplacement versusInternal Fixation –Comparison of outcomesand cost analysis.B Rao, T Tandon, A Avasthi, L Taylor, M MossSt. Richard’s Hospital, Chichester

This study was to compare the clinicaloutcomes and cost effectiveness of distalfemoral replacement (DFR) as analternative to fixation in management ofdistal femoral periprosthetic fractures. At2 year follow-up, mean length of hospitalstay was 11 days in DFR group (21patients; mean age 78 years) and 32 daysin fixation group (40 patients-Retrogradenailing/Locking plates, mean age 74years). Patients of DFR were full weightbearing by day ´3´ compared to 14 weeksin fixation group and had the betterclinical and functional outcomes. Therewere no major cost differences andassociated complications were less inDFR.

807 09:16

Gravity Stress Radiographs;Does A PositiveRadiograph Mean AnUnstable Ankle?K Bugler, G Smith, T WhiteRoyal Infirmary Edinburgh, Edinburgh

Assessment of stability in ankle fracturesis key in treatment planning. Stressradiographs are a method of assessment.We aimed to identify whether patientswith an apparently isolated lateralmalleolar fracture on presentation butwith a positive gravity stress radiographcould be successfully managed non-operatively. 155 patients were includedin our prospective study. Followingfracture union all had both goodreduction and good or excellentfunction. The MCS of 79% of patients

was greater than 4mm, in 19% it wasgreater than 6mm. Currently usedcriteria for measurements on stressradiographs may result in unnecessarysurgery.

761 09:20

What are the outcomes ofoperatively treated WeberB Fractures?E Karam, B Scammell, B OllivereUniversity of Nottingham, Nottingham

We conducted a retrospective study ofankle fractures in Nottingham. Patientswere assessed post-operatively using theAOFAS, Molander and VAS-FA functionaloutcome scores. Qualitative data wasalso collected. Over 4 years, 1085patients were operatively treated withankle fractures. We selected isolatedunimalleolar Weber B fractures. Meanoutcome scores (maximum score=100)were AOFAS 79.2 (SD ±19), Molander75.7 (SD ±25.6), VAS-FA 80.5 (SD ±19.3).Most patients (74%) reported a fullrecovery 24-36 months postoperative.Perceived outcome differed betweenpatients who exercised and those whodidn’t. Patients with higher expectationsfor their recovery had better outcomeand lower pain scores.

DISCUSSION 09:24

Spine701 10:00

Cervical Spine Trauma – Aten year experience fromThe Belfast spine unit(2000-2010)R Dhokia, S McDonald, N EamesRoyal Victoria Hospital, Belfast

Objectives: To record our experience inthe management of cervical injuries.Methods: A retrospective review ofNorthern Ireland Spine unit. 1674patients admitted with cervical injuries,between January 2000 and December2010. Results: Cervical traumarepresented a mean 46% of all spinaltrauma admissions per year. There is nosignificant increase in cervical traumaadmissions. There were 266 isolated PEGfractures (Mean, 24/year). Cervicaltumours are increasing at rate of 50%every 5 years. Conclusion: Cervicaltrauma admissions in Northern Irelandrepresent a steady but significantproportion of spinal trauma

710 10:04

Technical outcome ofatlantoaxial transarticularscrew fixation withoutsupplementary posteriorconstruct in rheumatoidarthritisR Dhokia, J Nagaria, P Thomas, D Cawley, C BolgerRoyal Victoria Hospital, Belfast, BeaumnontHospital, Dublin

Objective: To determine the technicaloutcome of RA patients who underwentatlantoaxial transarticular fixationwithout supplementary posteriorconstruct. Methods: 15 RA patients, C1-C2 TAS fixation without supplementary

10:00 – 11.30Hall 7

Notes


posterior construct. Minimum follow-up=24 months. Results: There was nosignificant difference between the pre-and post-operative means of all anglesmeasured. Following TAS fixation, meanADI shortened and mean PADIlengthened. There was no significantdifference in mean of C2-C3 ADH. Allpatients had evidence of C1-C2 bonyfusion. Conclusions: RA patients whohave C1-C2 TAS fixation in the absence ofa supplementary posterior construct, theoverall technical outcome appearsacceptable.

945 10:08

Anterior cervicalvertebrectomy andinstrumented cage fusionfor the management ofcervical myelopathy:experience from a UKdistrict general hospitalS Ramakrishna, H Dabasia, D Marsland, J HarveyQueen Alexandra Hospital, Portsmouth

Objectives/Methods: A retrospectivereview of consecutive proceduresperformed by a single surgeon over a 5-year period.Results: We assessed 26 patients, with amean age of 65.4 years. The meanfollow-up period was 3.20 years. Themean pre-operative and post-operativeNurick functional scores were 1.9 (range1 to 4) and 0.65 (range 0 to 5),respectively. For postoperative Odom’soutcome, 5 patients (19.2%) reportedexcellent, 9 patients (34.6%) good and 8patients (30.8%) fair. Dynamicradiography confirmed stability in 25 of26 patients (96.1%). Conclusions: This isan effective surgical technique for themanagement of patients with cervicalmyelopathy.

735 10:12

Is there any role forcervical disc replacementas an effective and safetreatment for cervicalspondylotic myelopathy –a systematic reviewS Lakkol, K Boddu, G Reddy, C Bhatia, T FriesemKings College Hospital, London

To authors knowledge, there has notbeen any review of literature evaluatingthe clinical effectiveness of cervical discreplacement (CDR) in cervicalspondylotic myelopathy (CSM). Thepurpose of this study is to review thesafety and efficacy of CDR in patientswith CSM. A detailed electronic andhand search was performed. Fivequantitative studies were includedreporting outcome of 233 CSM patients.Pooled data revealed statisticallysignificant improvement in NeckDisability Index scores. Despite earlystatistically significant clinical results ofCDR in myelopathy there is no strongevidence to favour CDR to fusion in CSM.

337 10:16

Clinical OutcomesFollowing Cervical TotalDisc Replacement. OurExperience with ThreeDevices.K Tsitskaris, TM BullUniversity College London, London

We report on a single surgeon series ofcervical total disc replacements (TDR),using three implants; the prodisc-C, thePrestige ST and the Mobi-C prostheses.The aim of the study was to assess thesafety and efficacy of cervical TDR whenperformed in low volumes andirrespective of the implant used. 27patients met the inclusion criteria andtheir clinical outcomes (NDI, VAS) wereanalysed preoperatively and at thedifferent post-operative time points.Complications and re-operations werealso assessed. Cervical TDR yielded

satisfactory clinical outcomes,irrespective of the cervical arthroplastydevice used or the volume of theprocedures undertaken.

DISCUSSION 10:20

576 10:27

Central Cord syndrome:Does surgical interventionimprove neurologicaloutcome?C Stevenson, J Warnock, N EamesRoyal Victoria Hospital, Belfast

The treatment of Central cord syndromeremains controversial. Aim: To reviewthe management of central cordsyndrome in Northern Ireland in 1 year.Information analysed includeddemographics, mechanism of injury andfunctional status. ASIA scores werecalculated at injury, pre-operatively,post-operatively and at follow-up. 27cords identified, 5 conservative and 22surgical. Motor scores in surgicalpatients improved from injury to follow-up from 51, 81, 83 and 90 respectively.Conservative patients improved frominjury to day 10 from 57 to 86, howeverat follow-up fell to 84. This reviewsuggests that patients treated withsurgery have improved motor scores atfollow-up.

900 10:31

The Fate of Admissionswith possible CaudaEquina Syndrome to aRegional Spinal CentreK Naik, L Charles, S Apperley, M Foy Great Western Hospital, Swindon


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564 10:35

Is subcutaneous fat apredictor of cauda equinasyndrome?M Venkatesan, C Uzoigwe, D Mahadevan, J Braybrooke, M NeweyUniversity Hospitals of Leicester, Leicester

No previous studies have sought todetermine if measures of patientparaspinal muscle and lumbar fatcontent could predict CES. Twoobservers reviewed MRI scans of 88consecutive patients why underwentlumbar discectomy to determine thethickness of subcutaneous fat, thicknessof the parspinal muscles and discsize/canal ratio. There were 30 patientswith CES and 58 patients with acutediscs requiring surgery but not causingCES. The mean subcutaneous fat washigher for those with CES compared tothose with acute disc prolapse but notCES (30mm v 22mm p=0.01). The onlypredictor of CES was subcutaneous fat.The odds ratio was 1.06.

556 10:39

The cost of metastaticspinal cord compressionU Ahmed, O Uhiara, A Stirling, M GraingerRoyal Orthopaedic Hospital, Birmingham

Metastatic spinal cord compression(MSCC) is a serious sequelae ofmalignancy. NICE recommends thatsuitable patients undergo surgery foranalgesia, spinal stabilisation andpreservation of neurological function.Our institution is a tertiary referralcentre for the provision of surgery forMSCC. A review of 38 consecutive casesrevealed a total cost of managing MSCCas £522475 however income was£421799; a loss of £100676(£2649/patient). The current tariff isinadequate, and fails to consider otherparameters such as disease extent. As avital part of cancer care, resourcesshould be made available to allow thisservice to remain financially viable.

DISCUSSION 10:43

804 10:48

Audit of first 100microdiscectomy &decompression proceduresas a spinal consultantO O Eseonu, H SharmaUniversity of Glasgow, Glasgow, DerrifordHospital, Plymouth

We reported first 100 cases ofmicrodiscectomy & decompressionprocedures as a first year spinalconsultant in the UK hospital. There wasa 2% incidental durotomy, 5% proneposition-related problems, 0% revision,0% nerve injury and 0% cauda equinasyndrome. Mean duration of operationwas 2.07 hrs in 1 level decompression(41 cases) & 1.6 hrs in microdiscectomy(59 cases). There was statisticallysignificant difference in the outcome forODI, VAS-LP & VAS-BP in both sub-groups. Complication rate wascomparable to the published literaturewith slightly longer duration ofoperation. We support dual peri-CCTspinal fellowships for new consultants.

362 10:52

Does obesity increase therate of recurrent herniatednucleus pulposus afterlumbar microdiscectomy?G Syme, C Quah, G Swamy, S Nanjayan, A Fowler,D CalthorpeRoyal Derby Hospital, Derby

The primary aim of this study is toinvestigate the relationship betweenobesity and recurrent intervertebral discprolapse (IDP) following lumbarmicrodiscectomy. A retrospective reviewof case notes from 2008-2012 wasconducted for all patients thatunderwent one level lumbarmicrodiscectomy performed by a singlesurgeon. A total of 283 patients wereavailable for analysis: 190 (67%) were inthe non- obese group and 93 (32.9%) inthe obese group. Obesity was found notto be a predictor of recurrent IDPfollowing lumbar microdiscectomy anddid not result in higher complication

rates than the non-obese cohort.

156 10.56

Relationship between fattydegeneration of spinalmuscle and outcome ofcaudal epidural InjectionS Haque, U Mohammed, A khan, O NLuton and Dunstable University Hospital NHSTrust, Luton

This is a prospective study aiming toassess the outcome of caudal epiduralinjection in low back pain, and it´srelation to fatty infiltration of paraspinalmuscles. The outcome of theintervention was assessed byimprovement of Oswestry disabilityindex (ODI) and visual analog pain score.The fatty infiltration was assessed onMRI (sagittal section T1 at lumbar 4/5disc level). Muscles were divided intotwo groups on either side and changeswere graded from 0 to 3 in each group,increasing in severity. Patients withsignificant fatty changes did notresponded well to the caudal epiduralinjection.

964 11:00

A retrospectivecomparison of dorsal ramiblock and epidural versussubfascial block withbupivacaine in 100 lumbardiscectomy cases forenhanced recoveryO Uhiara, P Sian, H Virdee, R Nandra, R Shellard,A Jackowski, A Stirling Royal Orthopaedic Hospital NHS FoundationTrust, Birmingham

Introduction: At our institution twodifferent practices are used to instill localanaesthetic intra-operatively duringelective spinal surgery: the first usesbupivacaine as dorsal primary ramiblock, epidural, and subcutaneously(group A); the second involves subfascialbupivacaine (group B). Method:Retrospective review of case notes of 50consecutive patients in each group.

Notes


Results: Intravenous morphine use in thefirst six hours of recovery was 2% inGroup A and 12% in Group B. ODI scoreand operative revision rates were similar.Conclusion: This study shows there was areduced use of post-operativeintravenous morphine in Group A versusGroup B.

DISCUSSION 11:04

197 11:09

Funding, level of evidenceand outcome of spinalresearchAR Amiri, K Kanesalingam, S Cro, A CaseyWhittington Hospital, London; UniversityHospital of South Manchester, Manchester

There has been increasing controversysurrounding the effects of fundingsource on the outcome of spinalresearch. This systematic review of 1356spinal research publications in the 20leading journals during 2010 aimed toinvestigate the association betweenfunding source, study outcome and levelof evidence. A large proportion ofindustry funded research was shown toprovide level IV evidence and reportfavourable outcome. The associatedodds ratio for reporting favourableoutcomes in industry funded studiescompared to studies with public andfoundation funding was 2.7 (95% CI: 1.4to 5.3), and 2.6 (95% CI: 1.3 to 5.2)respectively.

255 11:13

The Northern Irelandexperience with growthrods – improvingsignificant scoliosisdeformityDJ Spence, D Fee, EJ Verzin, GC McLorinan, A Hamilton, NWA EamesMusgrave Park Hospital, Belfast

The Northern Ireland experience withgrowth rods in the treatment of scoliosis.25 patient series over 8 years. 17 male, 8female. 9 patients single growing rodinserted with 6 converted to dual rods.

15 patients dual rods inserted primarily.1 patient VEPTR procedure. AverageCobb angle pre-op 70°. Initial follow-upCobb angle reduced to 44°. Last reviewaverage Cobb angle 40°. Complications:two broken rods, one rod cut outrequiring revision. Case series showedgrowth rods can dramatically improvesignificant scoliosis deformity. Themajority of improvement occurs at initiallengthening procedure. Insertion of dualrods is the preferred technique.

815 11:17

Physiotherapy-led backpain triage: Derrifordexperience of nearly 2000patientsJ Rudd, H Sharma, P Sinha, P Dowrick, S PritchardDerriford Hospital, Plymouth

Low back pain is common with manypatients not requiring investigation orintervention that have the potential tooverwhelm secondary and tertiaryservices. The aim of this study was toassess the efficacy and cost-effectivenessof a physiotherapy-led hospital basedtriage service. 1924 consultationsoccurred in the clinic, 40% of which wereseen and discharged without need forfurther referral. 21% patients were seenin neurosurgical clinics 42% of which hadsurgery, only 9% overall, with 10%referred on to another clinician. Thisstudy confirmed that the triage service isefficacious and cost-effective with an£85,782 saving identified. 11:17

1006 11:21

Return to driving followingLumbar Spine surgeryH Fawi, N Vannet, A Jones, P Davies, J Howes, S AhujaUniversity Hospital of Wales, Cardiff

Objectives: To identify the return todriving period post lumbar spinalsurgery. Methods: Retrospective audit 3months post surgery. Questionnairewere filled for type of surgery; return todrive; if not driving: reason; whether an

advice was given or not. Results: 37patients included. 18 males and 19females. By 3 months, 28 (76%) wereback to driving, 9 (24%) were not drivingyet. The mean time to return to drivingafter surgery was 5.9 weeks (1 week-12weeks). Conclusions: Majority of patientsreturned to driving by six weeks. Patientsneed formal advice about return todrive.

DISCUSSION 11:25

Knee, EnhancedRecovery, NICE &Clinical Practice290 10:00

Elective knee replacementrelated litigation in the UK:Patient safety in surgeryV Patel, C EslerEast Midlands Deanery (South), Leicester

Data obtained from the NHSLA revealedfrom 1999-2009 there were a total of454 incidents resulting in negligenceclaims. The NHLA paid out a total£14,051,693.38. Surprisingly a largeproportion of payments were due toincorrect implant size/ positioning. 35%(162) of claims stemmed frominadequate post-operative care resultingin Failure/Delay in Diagnosingcomplications particularly nerve andvessel damage resulting in foot drop andmore significantly amputation(£2,657,396.90). 3% claims arose fromissues arising from the consent processwhere patients were not fully informedof all significant risks.

10:00 – 11.30Hall 6

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615 10:04

A Cost-minimizationAnalysis of KneeArthroplasty Using DataFrom Two National JointRegistriesB Andrews, C Willis-Owen, A Aqil, J Cobb Charing Cross Hospital; Imperial University,London

A cost-minimization analysis of UKA vsTKA was performed, using the UKNJRand the AOANJRR and, uniquely,comprehensive revision data. The fivemost-common UKA and TKA implantswere identified. Implant costs weremean-weighted. Revision implant costswere calculated from AOANJRR data andsix peer-reviewed papers. Admission costwas added. Revision and mortalityprobabilities were calculated fromregistry data. A decision tree wasconstructed and analysed. Proceduralcost of UKA was £2080, TKA £2930,revision UKA £3943, and revision TKA£3926. The total cost of choosing UKA,when accounting for revision, was £2160in comparison to TKA cost of £2950.

393 10:08

The Berger protocol forassessing componentmalrotation in total kneearthroplasty: Analysis of 69casesV-L Soon, K Chirputkar, R Gaheer, N Corrigan, F PicardGolden Jubilee National Hospital, Glasgow

Assessment of component rotation usingcomputed tomography (CT) may beuseful in the painful knee when otherdifferentials have been excluded. Weaimed to determine the proportion ofpainful knees with componentmalrotation and how this relates tosubsequent management. Sixty-nineknees were identified between January2007 and April 2012. Overall, there were38 cases (55%) of malrotation, ten ofisolated femoral malrotation, 26 tibialmalrotation and two cases where both

components were malrotated. Twentytwo of these had further surgery. Ourstudy shows that the Berger protocol isuseful in identifying symptomaticpatients with component malrotation.

553 10:12

3D Gait Graphs: A Novel,Visual Outcome Measureto Discriminate BetweenHighly Functioning Patientsand Types of KneeArthroplastyVN Gibbs, BL Andrews, RC Marshall, SJ Harris, VL Manning, A Aqil, JP CobbImperial College London, London

This study presents novel 3D graphicalrepresentations of velocity-associatedgait changes using automating software.13 TKA and 14 muka patients weretested pre-operatively and 6 monthspost-operatively on an instrumentedtreadmill, and compared to 30 normalpatients. Ground force reactions (GFR)were plotted using custom-built C++software for comparative purposes (X-axis =% contact-time, Y-axis=body-weight-normalised force, Z-axis=Froude normalised walking speed) withmulti-angle viewing. A “plane-of-difference” was plotted: flat indicatingzero difference; uneven indicating GRFvariation. Using these graphs weillustrate the effect of GFR on increasingvelocity and demonstrate the ability todiscriminate between types of kneearthroplasty.

565 10:16

Outcome of ComplexPrimary Total KneeArthroplasty over 12 Yearsat a District GeneralHospitalS Thambapillay, S Kornicka, G ChakrabartyHuddersfield Royal Infirmary, Huddersfield

We present the outcome followingcomplex primary total kneereplacements by a single surgeon.

Method: 70 knees in 65 patients werefollowed up prospectively between1999-2011. Result: The mean age was70.5 years and the mean follow up was62.4 months. Stemmed implants wereused in general, with wedgeaugmentation, or bone grafting. Themean range of flexion was 112.5degrees. The mean preoperative OxfordKnee Score was 12.8, and 41.5postoperatively. 89.4% of patients hadeither excellent or good, and the rest afair outcome. None required revisionsurgery. Conclusion: 89.4% of patientshad excellent to good results.

779 10:10

One stage revision forinfected total kneearthroplasty: The NewStandard ?AG Dudhniwala, A Dosani, R Kotwal, R Morgan-JonesCardiff and Vale University Health Board, Cardiff

We present a series of 45 patients whohad one stage revision TKR for infection.The procedure consisted of Implantremoval, debridement andreimplantation. Post-op antibiotic werecontinued for 06 weeks. Pre-operatively12 patients had active sinuses and 30patients had previous surgicalprocedures for infection. Average follow-up period was 30 months. 4 patientspresented with recurrence of infection.Thus 90.7 % remained infection free withsatisfactory outcome. One stage revisiongives the benefits of a single operation,easier procedure, shorter inpatient stayand cost savings. With favourable resultsone-stage revision TKR for infectionappears to be an efficient option.

DISCUSSION 10:24

Notes


927 10:30

Enhanced Recovery. Doesit work? A patientperspective.A Shah, B Ilango, VL Moran, MP DeyFairfield General Hospital, Bury

The length of hospital stay associatedwith lower limb arthroplasty has reducedover the last three decades. However,little is known about the impact of thisapproach on patients, their experienceof being rehabilitated at home. Focusingon an Early Discharge Scheme, the aimwas to investigate patient andpractitioner experiences. A mixedmethods approach was used. Thechallenges faced at a both physical andemotional level is still underestimated.Patients with high anxiety anddepression scores struggle both inhospital and when sent home early.There is a double whammy effect whensuch patients also live alone at home.

953 10:34

Enhanced RecoveryProgramme in Primary Hipand Knee Arthroplasty –Does it work in a DistrictGeneral Hospital?A Avasthi, BM Rao, T Tandon, C Moore, C Eitel, R HillSt. Richard’s Hospital, Chichester

Introduction: Patients received astandardised ERP protocol fromadmission to discharge as compared todiffering peri-operative regimespreviously. Objectives: Assess theoutcomes of 217 pre-ERP and 305 post-ERP patients. Results: A statisticallysignificant reduction in average length ofstay from 5.86 to 4.34 days. Transfusionrates dropped from 12.03% to 2.95%,catheterisation reduced from 44.4% to13.44%. Post-operative hypotension,nausea and vomiting rates reducedsignificantly and more patients mobilisedearlier. Conclusion: Multidisciplinaryapproach of a cost neutral ERP allowedearlier mobilisation, shortened hospitalstay and as per SHA data a predicted

saving of nearly £900,000 in bed daycosts.

836 10:38

An enhanced recoveryprogramme forunicompartmental kneereplacement-patientsatisfactionM Faimali, A NakhlaBasildon & Thurrock University Hospitals NHSFoundation Trust, Basildon

The enhanced recovery programme wasdesigned to optimise patient care. In thisretrospective study we identified 18patients whom between July andNovember 2012 underwent Oxfordunicompartmental knee arthroplastyunder the enhanced recoveryprogramme. The outcomes assessed inthe medium term were patientsatisfaction and functional activities ofdaily living (ADL’s) scores. At follow-upthe functional ADL’s knee score was 82%(range 54-98%) with 11 out of 18patients rating their overall satisfactionas either excellent or very good. In ourexperience unicompartmental kneereplacement on the enhanced recoveryprogramme results in very goodfunctional outcomes with high patientsatisfaction.

224 10:42

A Dedicated Trauma DaySurgery Unit: a necessaryresource foruncompromised patientcare and cost efficiency inthe NHSJ Bhamra, M Oliver, C DaviesWilliam Harvey Hospital, Ashford

We conducted a retrospective review of105 patients. A sub-cohort of 33 patients(group A) and 38 patients (group B)admitted as an in-patient, but suitablefor DSU, were further analysed to enablea cost comparison. 88% of patients weredischarged on the day of surgery. The

surplus revenue generated in Group Awas £21516 compared to £50214 forGroup B. However, Group A saved 75bed days (equating to £18750). Eventhough a higher tariff is associated withemergency procedures as an in-patient,the cost per patient is less using the 23hour trauma pathway and increaseselective capacity.

911 10:46

The impact of dedicatedupper limb trauma lists ina district general hospitalD Makki, HM Alnajjar, N SawPrincess Alexandra Hospital, Harlow

Purpose: To assess the efficacy ofdedicated upper limb trauma lists in adistrict general hospital. Methods: Wefirstly audited 52 patients with upperlimb injuries treated on routine traumalists. Accordingly, we introduced a newpathway, whereby, patients were bookedfor surgery on a dedicated list. The auditloop was closed by reviewing 78 patientstreated using this pathway. Hospital stayand patients’ satisfaction were assessed.Results: The new pathway hassignificantly reduced hospital stay andled to a better patients’ satisfaction(p<0.05). Conclusion: The new pathwayreduced hospital stay without affectingpatients’ care and improved patients’satisfaction.

DISCUSSION 10:50

793 10:55

The impact of NICEguidance (2011) on themanagement of hipfractures in a busy DistrictGeneral HospitalW Norton, C Gray, H Divecha, S MannionBlackpool Victoria Hospital, Blackpool

In 2011, NICE updated their guidance onthe management of hip fractures. Wereviewed the compliance with new NICEguidance in relation to the surgicalmanagement of intracapsular fractures.Of 192 hemiarthroplasties performed,

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the majority did not receive a provenfemoral stem and of 38 displacedintracapsular fractures meeting the NICEcriteria for THR, only 4 received thisoperation. The NICE (2011) criteria arenot being met. There is a preference forthe use of the Thompsonhemiarthroplasty, and a reluctance toperform thrs on suitable patients.Reasons for this include insufficienttrauma theatre time and availability oftrained surgeons.

52 10:59

Total hip replacement vs.Hemiarthroplasty for intra-capsular fracture neck offemur; a cost analysisstudy to review financialimpact of implementationof recent NICE guideline(CG124) in NHSorganisationsS Horriat, PD Hamilton, AH SottEpsom and St Helier University Hospitals NHSTrust, London

We reviewed the financial aspects ofimplementation of recent NICEguidelines for neck of femur fracture(CG124) which suggests offering total hipreplacement instead of hemiarthroplastyfor intra-capsular fractures. Review ofour database suggested that accordingto the guideline, 17% of all neck of femurfractures would potentially be eligible forTHR rather than hemiathroplasty.Although performing cemented THR wasthe more expensive procedure, ourcalculation shows that despite increasedcost of performing the operation, Trustscan increase their net income by £300-600 (depending on their market forcefactor) per patient using correct HRGcoding and relevant National Tariffs.

933 11:03

An audit of adherence toBritish OrthopaedicAssociation Standards forTrauma (BOAST) guidelinesfor pelvic and acetabularfracture managementundertaken in a traumacentreN Dziadulewicz, G Roberts, A EvansCardiff University, Cardiff

An audit of adherence to BOA standardsfor trauma guidelines regarding pelvicand acetabular fracture managementwas undertaken in Morriston Hospital, alarge hospital in Swansea, South Wales.The audit looked at a period of two anda half years and covered forty ninepatients with pelvic and/or acetabularfractures. The guidelines stipulate elevencriteria that were suitable for audit inthis group of patients. In general theguidelines were well followed. The onlyconcerns highlighted weredocumentation of post-operativeneurovascular status and to possiblyreview the type of traction preferred bythe hospital.

525 11:07

What do Scottish patientsexpect from their total hipand knee arthroplasties?V-L Soon, S Sapare, A Boyd, J mcallister, AH Deakin, M Sarungi Golden Jubilee National Hospital, Clydebank

100% THR and 96% TKR patients had 10or more expectations of their operation.All expected pain relief. Otherimprovements expected were: walkingfor 100% THA and 99% TKA patients;daily activities for 100% thas and 96%tkas; recreational activities for 96% thasand 93% tkas; sexual activity for 66%thas and 59% tkas; psychological well-being for 98% thas and 91% tkas.Patients expect far more than pain reliefand improved mobility from theiroperation. It is important to discuss and

manage expectations with patients priorto surgery.

623 11:11

Pembrokeshire emergencyadmissions: effect ofseason, sun and rainB Marson, D Arvinte, N Deshmukh, M YaqoobWithybush Hospital, Haverfordwest

It is an assumed fact that there are moreorthopaedic admissions whenholidaymakers are out enjoying goodweather. This study aims to establish ifthere are seasonal and meteorologicalinfluences on admission rates. Admissiondata and weather measurements werecollected from 1/3/2011 to 31/8/2012.There was an increase in admissionsduring summer months (p=0.02) and acorrelation with maximum temperature(p=0.01). Daily rainfall did not correlatewith admission rates (p>0.05). Thoughcausation cannot be proved, ourpopulation are more likely to beadmitted when it is warm and summer.Rainfall does not seem to deter themfrom injuring themselves.

DISCUSSION 11:15

Paediatrics134 14:15

‘At risk’ screening ofbreech presentation andstrong family history inDDH: A 15 yearprospective longitudinalobservational studyC Talbot, R PatonEast Lancashire NHS Hospital Trust, Blackburn

A 15 year prospective, observationalcohort study was undertaken to assess

14:15 – 15:45Hall 11A

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selective screening of DDH in males andfemales referred with risk factors only.Individuals born breech or with evidenceof a strong family history for DDH werethe ‘risk factors’ studied. All wereclinically examined and sonographicallyscreened by one Consultant PaediatricOrthopaedic surgeon. There was asignificant difference in the number offemale individuals sonographicallydiagnosed as having ‘pathological’ DDHcompared to males (p<0.001). Ourfindings question the current UKscreening policy for ultrasoundexamination of males with risk factors inthe absence of clinical instability.

547 14:19

Does Back Carrying InfantsDecrease the Incidence ofDevelopment HipDysplasia?SM Graham, J Manara, L Chokotho, WJ HarrisonCountess of Chester Hospital, Chester; BEIT CUREInternational Hospital, Blantyre, Malawi

Aim: Determine the incidence ofsymptomatic DDH in Malawi and discussthe role of back-carrying as a potentialinfluence on the incidence. Methods: Weretrospectively reviewed themanagement of all infants seen at theBEIT CURE International Hospital,Malawi, over ten-years (2002-2012).Results: 40,683 children were managedat our institute, of which 9,842underwent surgery. No infant presentedwith, or underwent surgical interventionfor symptomatic DDH. Discussion:Almost all mothers in Malawi back-carrytheir infants, in a position similar to thatof the Pavlik harness. We believe this tobe the prime reason for the lowincidence of DDH.

149 14:23

A mutli-center analysis ofthe accuracy of clinicalexamination in thecommunity in diagnosingDevelopmental Dysplasiaof the HipL McLoughlin, P Groarke, B Curtin, P KellyOur Lady’s Children’s Hospital, Crumlin, Dublin;Galway University Hospital, Galway

Aim: To evaluate the accuracy of clinicalexamination in the community indiagnosing DDH, using the acetabularindex angle (AIA) as the reference test.An AIA of >30° is significant for DDH.Results: 420 hips in 210 patients werereviewed. 14% had an AIA >30°.Asymmetric skin folds was the mostfrequent indication for referral (53%).Conclusion: The clinical signs mostfrequently associated with a diagnosis ofDDH in the community are asymmetricskin folds and hip click. Both of thesesigns have a relatively low sensitivity andPPV for detecting DDH.

780 14:27

An analysis of the failurerates of Pavlik harnesstreatment fordevelopmental dysplasiaof the hip.A Elfaki, W Harrison, A De Gheldere, P HenmanNewcastle upon Tyne Hospitals, Newcastle

This retrospective study aims todetermine the local failure rates ofPavlik´s Harness and the prognosticvalue of the age of presentation andseverity. In the Newcastle Hospitals, 73babies were treated between 2003 and2008. Failure was defined as the inabilityto achieve stable reduction byclinical/ultrasound examination andrequired open/closed reduction. 5 out of97 (5.15%) hips failed. All failures werefemales presenting with Graf 3 or 4. 1patient presented within 1 month and 4presented beyond 3 months. Our lowfailure rates may be due to early

recognition, fortnightly follow-up and adedicated DDH clinic.

DISCUSSION 14:31

903 14:38

The Impact of MajorTrauma Centres onPaediatric OrthopaedicTrauma Service DeliveryA Farooq, R Visagan, Y Jabbar, R Bhattacharya, S Tennant, D HuntHeatherwood and Wexham Park Hospitals NHSFoundation Trust, SloughAbstract not provided

777 14:42

Birth Fractures: a 21stCentury PerspectiveP Promod, A RehmCambridge University Hospitals NHS Trust,Cambridge

Methods: 67,392 deliveries performedfrom 2000 to 2012 were reviewed forfractures from birth to the age of 1 year,looking at incidence, bones fractured,birth weight, multiple births, gestationalage, type of delivery andinstrumentation. Results: 242 fractureswere identified of which 39 were birthfractures (26 clavicle, 9 humeral, 2femoral and 2 parietal bone fractures).Conclusion: The incidence of birthfractures was 0.58 per 1000 deliveries.There was a significant associationbetween birth fractures and high birthweight but no association with any ofthe other factors evaluated.

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167 14:46

Improving outcomes forpaediatric supracondylarfractures: Completing thecycleA Malhas, I Kanya, E Murphy, D CampbellNinewells Hospital, Dundee

There is controversy regarding the timingof treatment of supracondylar fractures.A local audit (A) (2004-2010)demonstrated open reduction (OR) ratesof 31% (36/115 cases). After aneducational programme and delayinguncompromised injuries until a routinetrauma list, a re-audit was performed(RA)(2011-2012). The OR rate wassignificantly reduced to 8% (4/48) in RA(p=0.001). In those with noneurovascular deficit, fewer operationswere undertaken out-of-hours (from 17%to 7%). There were no increases inadverse outcomes. If no neurovasculardeficit is found, delaying operativeintervention until routine hours has alower OR rate with no increase incomplications.

570 14:50

Complications andrefractures after removalof forearm fixation inpaediatric patientsD Makki, A Kheiran, R Gadiyar, D RickettsRoyal Sussex County Hospital, Brighton

Introduction: Metalwork removal frompaediatric forearms remains debatable.Methods: We reviewed thecomplications following removal of 112plates and 38 intramedullary nails.Results: Following plate removal, 10 re-fractures occurred (8.9%). Children ≥11years were at risk if removal < 6 months,p=0.03 and those ≥13 years if removalbetween 6-12 months, p=0.02. Followingnail removal, 5 re-fractures occurred(13%). Children ≥ 7 years were at risk ifremoval < 3 months, p=0.01 and in those≥ 12 years if removal between 3-6months, p=0.05. Conclusion: Metalworkremoval should not be undertaken

before 12 months for plates and 6months for nails.

390 14:54

Abstract withdrawn.

DISCUSSION 14:58

248 15:05

Guided growth with theeight-Plate for gradualcorrection of deformity inpatients with SkeletalDysplasiasMTR Gaden, S DharNottingham University Hospitals, Nottingham

Eight plating is a versatile technique forcorrecting angular deformity around theknee of the growing child. We analysedthe outcomes of 28 patients (45 limbs)of whom 14 (25 limbs) had deformitysecondary to skeletal dysplasia. Over theperiod of the study full correction ofdeformity was achieved in 15 patients, 6in the dysplasia group. Overall the rate ofcorrection was (0.74 degrees/month inthe dysplasia group as compared with0.52 degrees/month in the non-dysplasiagroup. Average time to full correction of12.5 months was observed in thedysplasia group compared with 16.6months. Few complications wererecorded.

929 15:09

A modified imhauserosteotomy – Anassessment of the additionof an open femoral neckosteoplastyN Bali, J Harrison, E BacheBirmingham Children’s Hospital, Birmingham

An intertrochanteric osteotomy(Imhauser) can be used to realign thefemoral head and neck following a SUFEbut does not eliminate the problem ofthe metaphyseal ‘bump’ or ‘cam’. 19patients had an imhauser osteotomyover a 10 year period, 13 with an open

osteoplasty,. The average follow up was53 months. The average Non ArthriticHips score in those without anosteoplasty was 50.2, and with anosteoplasty 67.5. Native hip survival was83% without osteoplasty, and 100% withosteoplasty. Femoral neck osteoplastydoes not increase the complication rate,and may improve functional outcomeand prolong native hip survival.

15:09

213 15:13

Distal femoral deformity inBlount disease.R Dimitriou, R Hill, C Bradish, D EastwoodGreat Ormond Street Hospital, London

We retrospectively reviewed twenty-eight patients (43 tibiae) withuntreated-infantile, relapsed-infantile oradolescent Blount, aiming to evaluatethe distal femoral alignment dependingon time of onset and occurrence ofrelapse of the disease. We calculated thedistal lateral femoral angle (DLFA) andassessed the medial proximal tibialgrowth plate. Overall, a substantialangular distal femoral deformity has notbeen observed. However, the majority ofpatients with late-onset Blount seem tohave some degree of distal femoralvarus; whereas those with relapsedinfantile Blount seem to have acompensatory valgus. In 54% of casesthe medial proximal tibial growth plateshowed radiological evidence ofpremature closure.

368 15:17

Delayed consolidation ofregenerate requiring bonegrafting in children withlower limb deformity beingtreated with an externalfixatorJ Fagg, B Kurien, M Ahmad, J Fernandes, S JonesSheffield Teaching Hospitals NHS Trust, Sheffield

Out of 150 paediatric patients treatedwith external fixators to correct lower

British Orthopaedic AssociationCaring for Patients; Supporting Surgeons106

Notes

limb deformities in our institution(excluding feet, acute fractures andpseudarthrosis of the tibia), weidentified 11 patients who had poorregenerate formation treated with bonegrafting. Mean average age was 9 years 9months (range 2 years 5 months – 17years 5 months). Three patients weremale and eight female. The deficientregenerate was in the tibia in ninepatients and the femur in two patients.The mean time to regenerate bonegrafting was 7 months, and time tohealing following bone grafting was 2.5months.

DISCUSSION 15:21

894 15:28

Obtaining consent forchildren in care. Are theybeing treated like secondclass citizens?S Johal, R Nadler, A RehmAddenbrooke’s Hospital, Cambridge

In England there are over 67,000children in care. Their parentalresponsibility lies with over 150 localauthorities. We investigated the issuessurrounding the consenting process forsurgical procedures, with regards tothese children. Every local authority wascontacted by telephone / questionnaire.Heads of department / service managerswere responsible for signing the consentform, but in no case did this personcome to clinic to discuss the procedurewith the surgeon or have direct contactwith the child. We propose that currentpractice does not represent the needs ofchildren in care, and must be addressed.

282 15:32

Functional improvement incomplex congenital footdeformities using UMEX®mini-external fixatorsS Aranganathan, CE Carpenter, DP Thomas, S Hemmadi, D O’DohertyUniversity Hospital of Wales, Cardiff; YsbytyGwynedd, Bangor

We report our experience of UMEX®frames for children with complexcongenital foot deformities between2004 and 2011. Conditions includedresistant/recurrent Congenital TalipesEquino Varus (CTEV), cavo-varusdeformity secondary to Charcot-Marie-Tooth disease, arthrogryposis, fibularhemimelia etc. Thirty-two children weretreated. Good functional outcomes werenoted in 19 of the 23 patients (24 feet) inthe fifth postoperative year. Furtheroperations were needed in 10 patients.Complications occurred in 10 patients,predominantly pin-site infections, bonyovergrowth at pin-site and proximaltibio-fibular diastasis. This is a simplefixator system, well tolerated by childrenand achieved good functional outcomewith low-complication rates.

862 15:36

Ponseti treatment: Achillestenotomy under general orlocal anaesthetic in clinic.M Ahmad, K Saldahna, M Flowers, J Fernandes,N Garg, S JonesAlder Hey Children’s Hospital, Alder Hey;Sheffield Children’s Hospital, Sheffield

Perspective review of children withidiopathic CTEV treated by the ponsetiregime. We compared the treatmentpracticalities, parent’s perspective andfinancial implications of undertakingAchilles tenotomy under general or usinglocal anaesthetic in clinic. We confirmedour clinical experience of a satisfactoryoutcome when tenotomy is performedunder GA or LA. There is a wide range ofincome generated with up to a x15 foldincrease in extra funding whenperforming a tenotomy in theatre underGA. Income generated is affected by

factors such as secondary diagnosis andcan attract a complex/co-morbidity anda specialised children’s top up payment.

DISCUSSION 15:40

Computer AssistedSurgery, Audit &Management298 14:15

Patient perceptions ofComputer Assisted SurgeryMJ Gandhi, AR Patel, R Fawdington, E DavisRussell Hall Hospital, Dudley

Introduction: This study assessespatients’ perceptions of CAS. Method:Patients completed a questionnaire inorthopaedic clinics. Results: 122completed questionnaires. Utilisation:59.3% thought over 50% of operationswas CAS. 94.9% would support moreCAS. Complications: 66.1% felt short-term complications would decrease,3.4% felt it would increase. Outcomes:81.4% felt CAS operations would farebetter. No respondents felt long-termoutcomes would be worse. 100%support the surgeons’ decision in eventof a conflict with CAS recommendations.Conclusion: The vast majority of patientswelcome the use of CAS and felt it hadboth short-term and long-termadvantages on patient outcome.

14:15 – 15:45Hall 6

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801 14:19

Comparison of the lateralparapatellar and themedial parapatellarapproaches for total kneearthroplasty in severevalgus kneesB Sankar, R Venkataraman, M Changulani, S Sapare, A Deakin, K Deep, F PicardGolden Jubilee National Hospital, Glasgow

This study compared outcomes followingTKA performed through a medialparapatellar approach with thoseperformed through a lateral parapatellarapproach in severe valgus knees. Nostatically significant difference betweengroups at one year follow up formaximum flexion (p=0.42), fixed flexiondeformity (p=0.31) or Oxford score(p=0.49). Statistically significantdifference in mean radiographic post-operative alignment (Medial 1.8° valgusvs. Lateral 0.3° valgus, p=0.02). Nowound breakdown or patellar avascularnecrosis noted in either of the groups.The lateral parapatellar approach is asafe and reliable alternative to themedial parapatellar approach forcorrection of severe valgus deformity inTKA.

869 14:23

Assessment of precisionand accuracy of computernavigation in total hiparthroplastyMS KHAN, S Goudie, K DeepGolden Jubilee National Hospital, Clydebank

This largest single surgeon studyanalyses 259 total hip replacementsperformed with imageless computernavigation system. Mean cup abductionand anteversion was 40.35° (SD5.81) and18.46° (SD6.79) in postop radiographscompared to 41° (SD5.03) and 14.76°(SD6.11) for navigation measurements.Intraoperative navigation measurementshad high precision (>95%) and specificity(>90%) for cup abduction andanteversion. Radiographs and navigation

had a mean difference of 1.01mm(SD2.83) for offset and a difference of1.05mm (SD4.37) for postop limb lengthmeasurements, the differencestatistically not significant for both (pvalue>0.2). Computer navigation canserve as an excellent tool for appropriateplacement of implants and restoringlimb length and offset.

DISCUSSION 14:27

348 14:32

Low incidence ofcomplications in ComputerAssisted Total KneeArthroplasty – aretrospective review of1596 cases.RS Khakha, M Norris, A Kheiran, S ChauhanRoyal Sussex County Hospital, Brighton

Introduction: Computer Assisted TotalKnee Arthroplasty (CATKA) has provenbenefits of achieving reproducible andaccurate component alignment. Method:We collected data of all patientsundergoing CATKA for the last 8 years.Results: 1596 cases were performed bythe senior author. Intraoperatively, therewere 8 episodes of software failure ofwhich 6 were successfully retrieved and2 required a change to conventional jigbased TKR. 2 episodes of intraoperativemalalignment. Post-operatively therewere 17 episodes of superficial pin siteinfections. Conclusion: Our experience ofComputer Assissted Total KneeArthroplasty demonstrates acomplication rate of 1.5% related to thetibial tracker device

750 14:36

A single surgeonexperience in using PSItechnique for kneereplacements.S Aranganathan, S Thati, M GanapathiYsbyty Gwynedd, Bangor

Patient Specific Instruments (PSI ®) havebeen suggested to improve patient

outcome and theatre efficiency. Ourstudy evaluates the adequacy of MRI-based moulds and theatre efficiencyusing Zimmer PSI®. There was no mouldmismatch in a series of 100 consecutivetkrs. 99% of the component sizes werepredicted accurately. Streamlining theoperating technique with PSI® reducedskin-to-skin operating time to 40.65minutes compared with hospital averageof 92.5 minutes, allowing up to 6 tkrs tobe done in all day list. Reducedinventory, reduced bone resection timeand ability to predict component sizesare important factors in improvingtheatre efficiency.

984 14:40

Robotic-assistance enablesinexperienced surgeons toperformunicompartmental kneearthroplasty “right firsttime”M Karia, B Andrews, M Masjedi, Z Jaffry, J CobbImperial College London, London

The aim of this study was to determinewhether robotic technology enablesinexperienced surgeons to performaccurate ukas. Sixteen traineesperformed three medial ukas (CorinUniglide) on dry-bones by robotic(Sculptor RGA) or conventionaltechniques. Implant positions werecompared to a 3D-CT based plan. At allattempts robotic mukas were moreaccurate in translational and rotationalaligments with maximal rotational errorsfor the tibial component reaching 9° withthe robot vs 18° conventionally. Robotictechnology could allow medial ukas tobe performed with accuracy on their firstattempt providing new consultants withconfidence to offer ukas to theirpatients.

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616 14:44

Minimum 5-year follow upof 253 consecutiveComputer AssistedUnicondylar KneeReplacementRS Khakha, M Norris, A Kheiran, S ChauhanRoyal Sussex County Hospital, Brighton

Introduction: There is little published onthe outcomes of navigated UKR surgery.Methods: 253 UKR’s were performed bya single surgeon using computer-navigation were followed-up. Results:Pre-op mean KSS scores was 54 (24-62)and post-op scores were 89 (75-100).92% percent of femoral componentswere aligned at 90+/- 4 degrees fromneutral in the coronal plane whilst eightynine percent of tibial components werealigned at 90+/- 4 degrees from neutralin the coronal plane. Mean tourniquet-time was 53 minutes. Conclusion: Oursingle surgeon series of ComputerAssisted UKR demonstrates favourableoutcomes in the medium term with 98%survival at 5-years.

HKOA 14:48

A randomized controlledtrial comparing patientspecific instrument withconventional instrumentand computer navigationin total knee arthroplastyYan CH, KY Chiu, Ng FY, Chan PK, Fang CXThe University of Hong Kong, Queen MaryHospital, Hong Kong

Ninety knees in 78 patients wererecruited. The average age was 68.1±8.0years. They were randomized in 1:1:1ratio into CON, NAV and PSI groups toreceive TKA. Post-operative standinglong films of the entire lower limbs weretaken. The tourniquet and operativetimes of CON and PSI were significantlyshorter than NAV; the differencebetween CON and PSI was insignificant.The number of outliers in postoperativelower limb alignment in 3 groups

showed no difference. The NAV groupshad significantly less outliers in thefemoral and tibial componentspositioning in the sagittal plane.

DISCUSSION 14:52

654 14:58

The choice of implants inorthopaedics: who reallydecides?J Bhamra, E Gillott, S Ngmansun, P Gikas, T BriggsRoyal National Orthopaedic Hospital, Stanmore

We conducted a National survey ofOrthopaedic Clinical Directors todetermine the principal factors thatdrive implant selection. 156 HospitalTrusts covering 260 hospitals werecontacted in 2012. Questionnaireresponses were obtained by telephone,post and e-mail. We received 91completed responses (58%). TheMajority of trusts had at least 2 brandsof hip (32%) and knee prostheses (41%)available. Our results are reassuring anddemonstrate that 72% of OrthopaedicDirectors stated that their choice ofstock implant was decided bydepartmental consensus with perceivedimproved clinical record being the majorinfluencing factor (74%).

516 15:02

Routine telephone reviewof orthopaedic patients –an acceptable and efficientsystemF Dean, D Wallace, A MuirheadUniversity Hospital, Ayr

We use telephone reviews to reduceclinic visits. This study utilised astructured telephone questionnaire toassess the efficacy and acceptability ofthis approach. 50 of 55 patients who hadreceived a telephone review over a fourmonth period were contacted, and allwere satisfied with the telephoneconsultation. 8 would have preferred aclinic appointment; 32 did not require afurther clinic appointment for the same

problem; all were very satisfied orsatisfied with the overall follow-upprocess. Using telephone review follow-up for selected patients is effective atreducing the number of clinic visits, andis acceptable to patients.

658 15:06

Do patients really wantcopies of their clinicconsultation letters? Acost-analysis andreadability studyS Robati, W El-Alami, A Gulihar, P HousdenWilliam Harvey Hospital, Ashford

Many centres currently send patientscopies of their clinic letters withsignificant financial and resourcingimplications. Posters were strategicallyplaced in orthopaedic outpatients withinthe Trust over six weeks informingpatients of their entitlement to a copy oftheir letter. Of the 2453 patients whomattended clinic, only 10 (0.4 %)requested copies of their letter.Readability scores of the letterscorresponded to the reading age of 15-16 year olds (UK average = 9). Significantcost benefits (~ £15 million per annum)can be made from not sending them outroutinely, but only to patients whomspecifically request them.

877 15:10

Streamling Total Hip &Knee Replacementinstrument sets: Functional& cost-effective?A Aframian, J Preston, G Green, KS Khor, F Ashouri, P Vinayakam, PJS JeerQEQM, Margate

Sterilisation of surgical equipment,although necessary, is a costly process.Instruments may be sterilised in batcheson trays; or as individual instruments athigher cost. Prior to July2011, 2instrument trays and 4 individually-packaged instruments were opened foreach TKR. After this time the sets werestreamlined so only 2 trays were

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required to be opened per procedure(saving £18.08 per procedure). Due tothe success of this, the same principle isnow being applied to THR sets (saving£28.84 per procedure). Streamlined setsare functional and provide an excellentmoney saving opportunity, withoutcompromising the quality of patientcare.

446 15:14

How Primary Care Trust(PCT) New Referral andTreatment Criteria Goingto Affect SymptomaticHallux Valgus PatientsReferred to Specialist ClinicC Yeoh, A Patel, J RitchieMaidstone and Tunbridge Wells Hospital NHSTrust, Tunbridge Wells

Introduction: With the new local PCTcriteria based on intermetatarsal angle(IMA), only selected patients sufferingfrom forefoot problem would be eligiblefor specialist clinic referral. Methods: Weidentified and measured IMA for 118patients referred with painful halluxvalgus over 12 months and categorisedthem into operative and non-operativegroups. Results: 58% patients will missout the specialist referral with the newcriteria, increased to 92% if restrictionextended to diabetes, rheumatoid or“foot-at-risk” patients. Conclusion: IMAis acceptable measurement for halluxvalgus deformity. Symptomatic patientswithout major hallux deformity will missout on surgical opportunity and sufferunnecessarily.

DISCUSSION 15:18

724 15:23

A prospective audit on theassessment andmanagement of pain inpatients with neck offemur fractures on theintegrated care pathway:from the EmergencyDepartment to the TraumaUnit.J Palan, H Courtney, V Indrakumar, M Wiese,A AbrahamUniversity Hospitals Leicester, Leicester

This was a prospective audit of 100patients undertaken to evaluate howpain is assessed and managed in patientswith a neck of femur fracture. In theEmergency Department, 70% of patientshad a pain score recorded upon arrivalwith only 4% of patients having areassessment of their pain score afteranalgesia. On the Trauma Unit, only 8%of patients had a pain score recordedwith only 4% having a pain scorerecorded following analgesia. The type ofanalgesia provided is quite varied. Inconclusion, pain assessment andmanagement in patients with neck offemur fractures remains poor.

70 15:27

Local anaesthetic use: Arewe practising safely?L Osagie, M Mughal, J Read, PS MathewRoyal National Orthopaedic Hospital, London

Increasing use of regional anaesthesiaraises the risk of local anaestheticsystemic toxicity (LAST); intravenous lipidemulsion (ILE) is a known LASTresuscitation adjunct. We audited 100general and plastics surgeons,orthopaedists, emergency doctors andanaesthetists-investigating dosing, LASTand ILE use across two teachinghospitals. 48% questioned were unableto identify maximum doses-sprsperformed best across surgicalspecialities. 38% of orthopaedistsanswered correctly compared to 68% of

general surgeons. No surgeon was awareof ILE and 40% of orthopaedist could notname one LAST sign. The auditdemonstrated a need for re-education toimprove patient safety and awarenessacross grades.

954 15:31

Does preop bacteriuriaincrease the risk of deepjoint sepsis after jointarthroplasty?M Changulani, W Manning, K Mcroy, R DharmarajanCumberland Infirmary, Carlisle

Within our unit no consensus exists as tothe management of preoperative MSUbacteruria, this reflects the literaturewith no strong evidence to supportdepartmental guidelines. MSU screeningand its subsequent effect on patientmanagement, surgical timing andarthroplasty infection rates wereevaluated in a single-centreretrospective review of 290 patients.20% of patients had a positive growth onMSU. (M:F Ratio 1:5). Of this group halfreceived antibiotics and 33% had surgerydelayed. At 1-year review, 3% of patientswith positive MSU preoperativelydeveloped superficial infection. Furtherprospective studies with sufficientstatistical power are required todetermine any causality.

132 15:35

False-negative rate ofGram-stain microscopy fordiagnosis of septicarthritis: suggestions forimprovementP Stirling, R Faroug, M Armstrong, P Sharma, A QamruddinUniversity of Manchester, Manchester

Objectives: To quantify the false-negativerate of Gram-stain microscopy fordiagnosis of septic arthritis. Methods:Retrospective study of synovial fluidanalyses between December 2003 andMarch 2012. Synovial fluid cultures

Notes


positive for coagulase-negativeStaphylococci, Diphtheroids, alpha-haemolytic Streptococci or fungi wereexcluded. Results: 111 false-negativeresults from a cohort size of 143 positivecultures, giving a false-negative rate of78%. Conclusions: False-negative rate of78% is higher than previously reported1-3. Clinicians should avoid thisinvestigation until a significant data setconfirms its efficacy. The investigation’svalue could be improved by usingLithium Heparin containers to collecthomogenous synovial fluid samples.

DISCUSSION 15:39

General116 16:15

Reduced medium termmortality followingprimary total hip and kneearthroplasty with anenhanced recoveryprogram: A study of 4500consecutive procedures.T Savaridas, I Serrano-Pedraza, S Khan, K Martin,A Malviya, M ReedNorthern Deanery, Newcastle

An enhanced recovery (ER) protocol ledto earlier discharge, reduction incomplications and mortality at 90-dayspost hip and knee arthroplasty. Here weevaluate survival benefits at 2 years.4500 consecutive hip and kneereplacements were evaluated; 3000traditional protocol (TRAD), 1500enhanced recovery (ER) protocol. At 2

16:15 – 17:45Hall 9

years death rate was reduced [TRAD vsER, 3.8% vs 2.7%, (p=0.05)]. Survivalprobability at 3.7 years post surgery wasbetter in the ER group. This prospectiveseries shows reduced mortality with theimplementation of an ER protocol. Thissupports the routine use of multimodaltechniques for hip and knee arthroplasty.

441 16:19

Does the timing of pre-operative joint schoolaffect post-operativelength of stay inarthroplasty patients?HK Ribee, T Moody, JD Edwards, J Kozdryk, T ClareRussell Hall Hospital, Dudley

We recorded the time between jointschool and admission, and postoperative length of stay, for 255 patientsadmitted for arthroplasty surgery. Therange of time between joint school andadmission was 0 to 118 days, mean23.96 days. Length of post operativeadmission was analysed in relation totime between joint school and admissionusing ANOVA. No significant differencewas found in length of stay in thedifferent groups (p=0.0604). It is difficultto predict if this work applies equally toall types of pre-operative education usedfor arthroplasty patients.

567 16:23

What do patients knowabout their jointreplacement implants?Z Abual-rub, M Husaini, C GerrandFreeman Hospital, Newcastle Upon Tyne

Early failure of some types of jointreplacement and the associated intensemedia interest has caused concernamongst patients with any kind ofimplant. A survey was distributed to asample of patients attending anarthroplasty follow up clinic. A minorityof patients recognized the name of theirimplant model or the material theimplant and bearing surfaces were made

of, while most respondents expressed aninterest in knowing more about theirimplant. In addition to preoperativeeducation programmes which focus onthe procedure itself, arthroplastypatients might benefit from morepostoperative education about livingwith their joint replacement.

61 16:27

Total joint replacement inthe over 90s age group.B Youssef, P Fenton, K Ford, D BakerThe Royal Orthopaedic Hospital, Birmingham

Our aim was to examine the outcome ofjoint replacement in the over 90s in ourtertiary referral unit. 49 patients whohad undergone a primary total knee orhip replacement aged 90 or older fromJuly 2007 to August 2011. The mean ageat time of surgery was 90.8 years. Therewere no deaths at 90 days postoperation, at 12 months, 3 patients(6.25%) had died. Our 90 day and 12month mortality compares favourablywith the published data. Old age doesnot appear to be a contraindication tojoint replacement surgery.

892 16:31

The increased costsassociated with performinghip and knee arthroplastyin obese patients in theNational Health ServiceB Bradley, S Grffiths, K Stewart, G Higgins, M Hockings, D IsaacSouth Devon Hospitals NHS Trust, Torquay

The financial cost associated withperforming hip and knee replacements iscontroversial and has not beenquantified in the NHS. 589 consecutivepatients undergoing lower limbarthroplasty were reviewed. The effectof BMI on operative duration and lengthof stay (LOS) was analysed. Wedemonstrate that for a 1 point increasein BMI we expect LOS to increase by afactor of 2.9% (p<0.0001) and meantheatre time to increase by 1.46 minutes(p< 0.0001). Financial costs associated

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have been calculated. If obese patientshave the correct OPCS code they canattract additional reimbursement whichmay partly offset treatment costs.

DISCUSSION 16:35

799 16:39

VTE Prophylaxis in PrimaryHip and Knee Arthroplasty– Comparison ofRivaroxaban Versus LMWHat Limited and StandardLengthThromboprophylaxisB Rao, A Avasthi, M MossSt. Richard’s Hospital, Chichester

Study comparing the efficacy ofRivaroxaban and LMWHthromboprophylaxis in patientsundergoing hip and knee arthroplastyadministered at different length ofperiods. In Group ‘A’, Tinzaparin 4500IU/day (average for 7.6 days), Group ‘B’Rivaroxaban in (tkrs, 2 weeks, thrs 4weeks) and Group ´C´ Deltaparin (tkrs, 2weeks, THR, weeks) was used. There wasno difference in rates of VTE betweengroup ‘B’ and ‘C’ but was significantwhen compared to Group ‘A’. There waslittle statistical difference betweenRivaroxaban and LMWH whenadministered according to NICEguidelines but higher rates of VTE areseen when period ofthromboprophylaxis is suboptimal.

713 16:43

Comparative study ofDabigatran versusRivaroxaban for venousthromboembolismprophylaxis following hipand knee arthroplastysurgeriesWY Leong, R Finley, C Ng, N DonnachieWirral University Teaching Hospital NHS Trust,Wirral

Prophylactic therapy for prevention of

venous thromboembolism (VTE) is nowstandard practice following arthroplastysurgery in the UK. We ran a prospectivedirect comparative study usingRivaroxaban followed by Dabigatran for12 months duration each. Primaryoutcome measure was specified as anyVTE event. Secondary outcomemeasures being drug complications.There were 841 and 877 patients with arate of DVT/PE of 2.1%/1.1% and2.2%/0.8% in Rivaroxaban andDabigatran group respectively. The ratesof drug discontinuation were between 4-5%. There was a slight increase in woundproblem in Rivaroxaban group albeitwith no statistical significance but withcomparable VTE rate.

531 16:47

Warfarin – an expensivecause of delay in dischargeof elective arthroplastypatientsR Venkataraman, F PicardGolden Jubilee National Hospital, Clydebank

Post operative warfarinisation of electivearthroplasty patients delays theirdischarge. This study aimed to quantifythe cost of this event. Over a six monthperiod a total of 76 patients werewarfarinised post operation (37 THR and33 TKR). The mean extra days stayed was3.1 (0-9). Random loading dose insteadof the recommended 5 mg of warfarinresulted in prolonged stay, 4.5 dayscompared to 3 days. The mean cost was£1500 per patient, extrapolating to£228,000 a year. Substantial financialand resource savings can be made ifwarfarinisation is undertaken at thecommunity level.

326 16:51

Medication requirementsone year after total jointreplacementIKT Cunningham, FA mcconaghie, J Erdocia, AH Deakin, F PicardGolden Jubilee National Hospital, Clydebank

This study examined the analgesic

requirements of 78 patients prior to totaljoint arthroplasty and at one year post-operatively. At one year 75 patientsreported a decrease in pain and 3reported an increase. 33 patientsrequired no analgesia, compared with 9pre-operatively. 44 patients requiredopioids pre-operatively, with 33 patientscontinuing these at one year. Of these 33patients 25 had a co-morbid condition, 2required them for the joint operated and6 had no indications. Not all patientswho reported decreased pain reducedtheir analgesic usage. Staff shouldreinforce the need foradjusting/discontinuing pain medicationpost-operatively.

DISCUSSION 16:55

827 16:58

A prospective audit of 954consecutive orthopaedicpatients with plaster-in-situ in order to evaluateplaster related issuesD Wallace, I Johnston, H SharmaUniversity of Glasgow, Glasgow; DerrifordHospital, Plymouth

This audit examines 954 consecutivepatients treated with plaster castfollowing trauma. All patients receivingplaster casts were recorded for threemonth. All presentations with plasterproblems over this time were analysed.56 patients (6% of casts) presented tothe plaster room. Attendance peaked inthe first week. Almost half ofattendances (24) were due to swelling,and its resolution – loose or tight casts. Athird (18) had compliance issues, withwet or removed casts. Only a smallnumber had problems caused by thecast. We believe most cast problems canbe prevented by re-iteration of patientsinstructions.

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632 17:02

Applications of Bone GraftSubstitutes in Trauma andOrthopaedics Indicationsand Evidence for theirClinical Use. Should weUse Them?T Kurien, R Pearson, B ScammellUniversity of Nottingham, Nottingham

A Systematic review of bone graftsubstitutes currently available in the UKwas conducted to assess the currentclinical literature for their use. 59 bonegraft substitutes were identified on salebut only 22 products (37%) from 12manufacturers had published peer-reviewed clinical literature. Only fourproducts, Alpha-BSM® (Depuy),Cortoss™ (Orthovita), Norian SRS®(Synthes) and Vitoss™ (Orthovita) haveLevel I published data that are equal toor superior to autograft. Further rcts andclinical trials are essential to assess theclinical efficacy of bone graft substitutesand improved medical regulation ofthese products based on clinicalevidence must be sought.

625 17:06

What should be done forWhoops! Procedures forbone sarcomas?CL Gaston, T Nakamura, K Reddy, A Abudu, S Carter, L Jeys, R Tillman, R GrimerRoyal Orthopaedic Hospital, Birmingham

Bone sarcomas are rare cancers thatorthopaedic surgeons come acrossinfrequently, sometimes only during thetime of inappropriate surgery. Weinvestigated 95 patients referred afterWhoops! Procedures for bone sarcomas(44 intralesional excisions, 35 fracturefixations, 16 joint replacements). Limb-salvage in this group of patients isassociated with higher rates ofinadequate margin surgery andconsequently higher local recurrencerates than amputation but should still beattempted whenever possible becauselocal control is not a significant

determinant of survival. Delay in referralby the previous treating team is animportant modifiable factor that affectssurvival.

519 17:10

Audit of Fragility FractureManagement at a DistrictGeneral HospitalN Patel, D Wilson, P Patel, E Dhillon, C Li, M Solan Royal Surrey County Hospital, Guildford

We performed a retrospective analysis ofpatients presenting to fracture clinic fora one-month period before and after thecommencement of a dedicated fractureliaison service (FLS) since poorrecognition and organisation ofosteoporosis services increases fracturerisk. Results: Pre-FLS: Of 78/258 patientsidentified with fragility fractures only 2were considered for fracture riskassessment and bone protection. Post-FLS: Of 92/311 patients identified, allpatients were appropriately identified bythe FLS for consideration of boneprotection and further investigations.Discussion: Implementation of a FLSimproved identification andmanagement of fragility fractures. Thishas both patient and economic benefits.

526 17:14

Projected demands forprimary and revision lowerlimb arthroplasty inScotland from 2010 to2035V-L Soon, AH Deakin, M Sarungi, DA McDonald Golden Jubilee National Hospital, Clydebank

This study aimed to predict the demandsfor lower limb arthroplasty in Scotlandfrom 2010-2035. Modelling primary TKAshowed demand increasing between31% and 110% (8,650 and 17,270procedures) by 2035, with revision TKAmodels predicting between 670 and2,000 procedures. Modelling primaryTHA showed demand increasingbetween 60% and 110% (11,000 and

14,500 procedures) by 2035 withrevision THA models predicting between1,300 and 2,100 procedures. Theseprojections show large increases inarthroplasty demands over the next twodecades. They highlight that currentresources may be insufficient or theselection criteria for surgery may need tobe revisited.

DISCUSSION 17:18

256 17:22

Nine Years of IncreasingOrthopaedic Litigation inthe NHS: A Cause forConcernJT Machin, H Krishnan, S Sarker, J Bhamra, E Gillott, TWR BriggsRoyal National Orthopaedic Hospital, London;University College London, London

From April 2003 to April 2012 9049claims were brought against‘Orthopaedic-Surgery’ with 74.23%increase in yearly claim volume. Thecommon causes in 2011-12 were‘unsatisfactory outcome of surgery’ 798(54.14%), ‘judgement/timing’ 659(44.71%) ‘tissue damage’ 599 (40.64%),‘mobility’ 481 (32.63%) and‘Interpretation of results/clinical picture’463 (31.41%). The 2011-12 claims areestimated at £187million, equivalent toover 35,000 joint replacements. Thecurrent trend is unsustainable. Claimvolume could be reduced by education,increasing the number of cases intraining, improving continuity of careand implementing regional networks toensure the right patient is seen at theright time by the right specialist.

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75 17:26

A prospective studylooking at the use ofthyroid shield and dose ofradiation per trauma case,in trauma theatres in alocal district generalhospitalM Shahid, H Watkin, R Tansey, S Malik, U Ahmed, S RoyCity and Sandwell NHS Trust, Birmingham

Introduction: The thyroid is highlyradiosensitive with malignancy occurringat doses as low as 10 cgy(centigray)=100msv. We looked at thecompliance of wearing the thyroid shieldduring fluoroscopy. Methods: Aprospective study over a fortnight. Werecorded the radiation dosage,procedure length and the number ofstaff wearing thyroid shields. Results: Ofthe 281 staff in the theatres only 10wore thyroid shields Conclusion:Compliance with the thyroid shield ispoor. We highlight the need to addressthe risk of radiation in theatres andmaking surgical staff aware of currentprotocols.

630 17:30

Can the mini C-arm reduceradiation exposure inupper limb surgery?O Berber, R Bawale, T Yousofi, B SinghMedway Maritime Hospital, Gillingham

The objective of this study was todetermine a difference in radiationexposure levels between a standardfluoroscope and a mini C-arm in routineupper limb surgery to assess forpotential cost saving and improvementsin theatre efficiency. We compared 75cases each in the mini C arm & standardfluoroscopy. The average dose areaproduct for the cases performed withthe standard fluoroscope was 13.48 vs5.22 for the mini C-arm. There was nosignificant difference in duration ofsurgery. A calculated annual savingestimation of £6200 can be achieved

with use of the mini C-arm.

35 17:34

Value of the skin knife inorthopaedic surgeryO Schindler, R Spencer, M SmithSt Mary’s Hospital, Bristol Arthritis & SportsInjury Clinic, Bristol

Skin, inside and control blades wereobtained following 203 electiveprocedures. Bacterial-growth wasobserved on 31-skin (15.3%), 22-inside(10.8%), and 13-control blades (6.4%).Three (9.7%) of 31 contaminated skinblades grew identical organisms foundon the corresponding inside blade.Contamination of deeper layers in theremaining 90% may have beenprevented by changing the knifefollowing the skin incision. Coagulase-negative staphylococci andproprionibacterium species were mostcommonly observed; both are linkedwith peri-prosthetic infections. The useof separate skin and inside knives shouldbe maintained since cost implicationsassociated with deep infections areconsiderable in both human andfinancial terms.

637 17:38

Correlation of overactivebladder symptoms andfalls with injuries in theelderlyO Berber, R Bawale, B SinghMedway Maritime Hospital, Gillingham

Overactive bladder (OAB) symptoms andfalls in the elderly is a growing concernand is a modifiable risk factor. Theobjective of this study was to assess theproportion of patients presenting with afall related injury and suffering fromoveractive bladder symptoms. A falls riskassessment & OAB questionnaire wasused to collect prospective data in 100patients > 65 yrs. The male to femaleratio was 1:3.8 and the average age was82 years. All patients sustained afracture, 66% of which was a hip fracturerequired surgical treatment. Overactive

bladder symptoms were present in 16patients.

DISCUSSION 17:42

BORS/BOTA Prize16:15

Increased interfacial bonecontact using titaniumcoated nano-patternedimplants on rabbit tibiaeAS Brydone, L Prodanov, E Lamers, N Gadegaard,JA Jansen, XF WalboomersBiomedical Engineering Research Division,University of Glasgow, Glasgow; RadboudUniversity Nijmegen Medical Centre,Netherlands

Osseointegration of titanium implantscan be improved by surfacemodification. This project comparesosseointegration of conventional grit-blasted acid etched (GAE) titanium withtwo types of nano-patterned titaniumcoated implants featuring a square (SQ)and random (RAND) array of nano-pits.GAE, SQ and RAND discs were platedbilaterally onto a flattened area of thetibiae of 12 rabbits and the bone-implantcontact was assessed histologically at 4and 8 weeks. At 8 weeks the BIC ratiowas significantly increased in the twonano-patterned implants (80% for SQand 72% for RAND) compared to the GAEtitanium (55%) (P < 0.05).

DISCUSSION 16:23

16:15 – 17:00Hall 8

Notes


16:27

Non-invasive in vivocollection of biochemicalinformation fromosteogenesis imperfectahuman bone; developingmethodology for a clinicalinvestigationJG Kerns, K Buckley, P Gikas, HL Birch, AW Parker,P Matousek, R Keen, AE GoodshipInstitute of Orthopaedics and MusculoskeletalScience, University College London; Central LaserFacility, Oxfordshire; Royal National OrthopaedicHospital, Stanmore

Osteogenesis imperfect (OI) is a geneticcondition caused by a collagen type Idefect and characterised by multiplefractures. The oim mouse is a model forhuman type III OI, exhibiting reducedbone mineral crystallinity. The studytests the hypothesis: Raman spectralsignatures of human OI bone (n=10;controls n=10) will have reduced mineralcrystallinity. No difference in mineralcrystallinity was found between cohorts:the oim mice are poor models for ourpatients, with less severe geneticmutations. We demonstrate Ramanspectroscopy has the capability ofextracting biochemical signatures frombone, transcutaneously in vivo, providingan important tool to explore bonedisorders.

DISCUSSION 16:35

16:39

Collagenase injection forthe treatment of moderateDupuytren’s disease – aprospective studyJ mcfarlane, AM Syed, T Chester, D Powers, TF Sibly, A Talbot-SmithHereford County Hospital, Hereford

Our study included 43 patients with asingle cord affecting the MCPJ only witha contracture angle of 30 to 60 degrees.Each patient was given one injection ofCHC into the cord in clinic withmanipulation the next day. The meancontracture angle was -2.42 at 1 month

follow up (n=43), 0.00 at 6 months(n=15) and 0.75 at 12 months (n=4)compared to 43.0 degrees pre-injection.Mean Unité Rhumatologique desAffections de la Main (URAM) scoreswere 2.7 at 1 month, 0.3 at 6 monthsand 0.5 at 12 months compared with apre-injection score of 19.1. This studydemonstrates the clinical efficacy, safetyand cost-effectiveness of CHC injectionsin moderate Dupuytren’s diseaseinvolving the MCPJ.

DISCUSSION 16:47

Research245 16:15

Towards a core outcomeset for hip fracture trials: Aconsensus statementXL Griffin, KL Haywood, J Achten, ML CostaUniversity of Warwick, Warwick Medical School,Coventry

We aimed to reach consensus for a coreoutcome set to be used in clinical trialsinvolving patients with hip fracture.Stakeholder groups in the UK wereidentified and approached to berepresented on the panel. Source dataand questionnaires were summarised atthe subsequent consensus meetingfollowed by discussion of candidatedomains and potential outcomemeasures. Participants were able toreach consensus on those domains thatwere important in this population and anappropriate corresponding core outcomeset. The chosen set must now be widelyadvertised and distributed to thecommunity in order to achieve trueconsensus through consultation.

16:15 – 17:00Hall 8

397 16:19

The influence of pre-operative anaemia onshort-term outcomes afterprimary hip and kneearthroplasty under anEnhanced RecoveryprogrammeS Khan, S Jameson, W Fishley, T Petheram, P Partington, M ReedNorthumbria Healthcare NHS Trust, Ashington

This retrospective study investigates theeffect of pre-operative anaemia in aconsecutive series of 2940 ‘EnhancedRecovery’ lower limb arthroplasties. Inunadjusted analyses, anaemic patients(n=388, 13%) had more bloodtransfusions and critical care admissions(p<0.0001) and longer hospital stays(p<0.05), but reduced deep infections(p=0.03) compared to non-anaemicpatients. They also had higher mortalityat one year (p=0.0004). There were nosignificant differences in the incidence ofmedical complications. In multivariableregression analyses, the odds of anaemicpatients receiving transfusion and criticalcare admission remained significant, butthey were still less likely to suffer deepinfections.

431 16:23

Finite element analysis ofcement shear stresses inaugmented total kneereplacementG Brigstocke, Y Agarwal, B Freehill, N Bradley, A CrocombeRoyal Surrey County Hospital NHS Trust,Guildford; Department of Engineering, Universityof Surrey, Guildford

A three-dimensional FE model of theproximal tibia was constructed usingSIMPLEWARE v3.2 image processingsoftware. The tibial component of a TKRwas implanted with either a block or awedge-shaped metal augment in-situ.The FE model demonstrated reducedcement shear stresses with a wedge-shped rather than block-shaped

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augment. However, both values ofmaximal recorded shear stresses werebelow the fatigue limit of the cement.Therefore, either a wedge or block-shaped augment can be used and thechoice of augment may be determinedby the shape of the defect and thequality of the underlying bone.

490 16:27

Patterns of femoral headwear in end stageosteoarthritisO Diamond, JC Hill, A McCann, C McGrath, JF Orr, DE BeverlandMusgrave Park Hospital, Belfast; QueensUniversity Belfast, Belfast

The aim of this study was to assesspatterns of cartilage wear in end stageosteoarthritis. Two studies wereperformed examining the location andarea of full thickness wear on femoralheads removed at the time of total hiparthroplasty. Findings suggested thatanterosuperior is the most commonlocation of full thickness wear. Theposterior surface has a statistically lowerpercentage full thickness cartilage losscompared to the anterior or superiorsurfaces. This finding may be ofrelevance for forms intraoperativetemplating and navigation in total hiparthroplasty, when considering theoriginal position of femoral head centre.

951 16:32

Collateral laxity in normalknees and variation withsex and positionK DeepGolden Jubilee National Hospital, Glasgow

This multicentre study on 155 male and112 female normal knees of personsaged between 18-35 with acomputerised infrared navigation systemmeasured medial and lateral laxity usinga validated method. Femoro tibialmechanical angle (FTMA) was measuredwith and without 10 newtonmeter stressin valgus and varus. Mean nonstressFTMA was a varus 1.2° (SD4.0) in full

extension and 1.2° (SD4.4) in 15° flexion.On varus stress these changed by3.1°varus (SD2.0) and 6.9° varus (SD2.6)respectively. On valgus stress thesechanged by valgus 4.6° (SD2.2) and 7.9°(SD3.4) respectively. Statisticallysignificant variations were seen betweenmales and females. Laxity in individualsneeds quantification for personalisedsurgery.

DISCUSSION 16:36

Audit &Management98 17:00

Do the European WorkingTime Directive and the‘Four Hour Target’ impactupon surgical trainingopportunities?J Widnall, N Peterson, S PlattArrowe Park Hospital, Wirral

Introduction: Since the introduction ofMMC and EWTD there have beenconcerns regarding surgical training.Methods: This study uses data collectedvia an online questionnaire to assess thecurrent training opportunities for coresurgical trainees. Results: 48.9hours/week were worked on average.41.7% of these were spent away fromthe trainees’ team. Trainees missed45.5% of clinics and 46.4% of theatrelists. Only 24.6% of trainees felt ready totake a registrar post if awarded onefollowing basic training. Conclusion: Thissurvey provides a snapshot of theexperience of a cohort of current coresurgical trainees in the UK.

17:00 – 17:45Hall 8

131 17:04

Training the orthopaedicsurgeons of the future:development of astructured, stratifiedorthopaedic simulationcurriculum: introducing the“Imperial ladder ofsimulation”CM Gupte, K Akhtar, K Sugand, J CobbImperial College London; St Mary’s Hospital;Charing Cross Hospital, London

With reduced training hours and focuson patient safety, the role of simulationin orthopaedic training is graduallyincreasing. However, at present there is alack of a coherent strategy thataddresses the conflicts between the costof each simulation scenario, its fidelilty(or degree of “reality”), and the level oftrainee each simulation should be aimedat. We have developed a logical stepwiseapproach to designing a simulationcurriculum that involves a “ladder ofprogression”. Whilst all simulationmodels require further validation, thiscould serve as a template for developinga national orthopaedic simulationcurriculum.

485 17:08

An audit of the accuracy ofdata reported to thenational hip fracturedatabaseS Sawalha, M Grant, A Acharya Warrington Hospital, Warrington

We assess the accuracy of data collectedon types of hip fractures and operationsperformed by non-clinical staff andreported to NHFD. There were 299patients. Data on type of fracture wasincorrect in 71 patients (23.8%). Themost common error was ‘displacedintracapsular fracture’ reported as‘undisplaced’ (n=46). Data on type ofoperation performed was incorrect in 78patients (27%). The most common errorwas ‘unipolar hemiarthroplasty’

Notes


reported as ‘bipolar hemiarthroplasty’(n=32). Overall, 55.1% of patients(158/287) had correct data on bothindicators. Orthopaedic surgeons shouldbe involved in data collection to ensureaccurate data is reported to NHFD.

509 17:12

A Quality Audit of theNational Hip FractureDatabaseAP Swayamprakasam, S Taqvi, S HossainRoyal Oldham Hospital, Oldham

The NHFD has the potential to be apowerful research tool. However thequality of data in it is unknown. It is thisthat was audited here. Proximal femurfractures treated at our centre over a 4month period were included. The hipfracture type data was used as a markerfor overall data quality. 100 patientswere included in this audit. Only in 50%cases was hip fracture type datarecorded in the NHFD accurate. Thisaudit has raised concerns over thequality of the data in the NHFD.Strategies to improve the quality of thedata are presented.

377 17:16

Fifth metatarsal fractures –how a change in protocolhas influenced our serviceK Ferguson, J McGlynn, CS Kumar, J Madeley, L RymaszewskiGlasgow Royal Infirmary, Glasgow

Fifth metatarsal fractures are commonand the majority unite regardless oftreatment. In 2011 a standardisedprotocol was introduced to promoteweight-bearing as pain allowed. Weretrospectively reviewed all patientswith a 5th metatarsal fracture beforeand after this change. Our study of 618patients did not demonstrate any addedvalue for routine outpatient follow-up of5th metatarsal fractures. At presentationpatients can be safely allowed to weightbear and discharged, if they are providedwith appropriate information and accessto a “help line” run by experienced

fracture clinic staff. The result is a moreefficient, patient- centred service.

DISCUSSION 17:20

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Friday 4th October

General669 08:00

A comparison of surgicalapproaches for primary hipreplacement – A study ofpatient reported outcomemeasures and earlyrevision using linkednational databasesS Jameson, P Baker, J Mason, P Gregg, D Deehan,I McMurtry, M ReedDurham University, Durham

NJR-PROMs linked data were analysed toascertain whether the posteriorapproach offers benefit over the directlateral. Specific componentcombinations of the commonest brandswere analysed. There were 18,600patients in total, of which 3420 hadlinked data. Adjusted OHS change wassignificantly higher with the posteriorapproach (OHS: 20.6 versus 19.2,p<0.001, EQ5D index: 0.416 versus0.383, p=0.003). There were nosignificant differences in patientreported complication rates and earlyrevision between the two approaches.Significantly greater improvements inoutcome scores were found with aposterior approach, with no increasedrisk of complications or early revision.

101 08:04

Poor survivorship of theSpectron EF stem at aminimum of 10 yearsfollow-upBJ Burston, JH Wood, GH Prosser, DJ Wood, PJ YatesRobert Jones and Agnes Hunt OrthopaedicHospital, Oswestry; Perth Orthopaedic Institute;Fremantle and Kaleeya Hospital, Perth, Australia

We prospectively followed 112 hips,

08:00 – 08:45Hall 10

undergoing THR with a Spectron EFstem. At mean follow-up of 11.2 years,21 patients had died. We obtainedradiological follow-up in 99% and clinicalfollow-up in 100% of the surviving 91hips. 54% demonstrated osteolysis in atleast one Gruen zone. 22 hips requiredrevision with a further 5 stemsradiologically loose. With endpoint beingstem revision for aseptic loosening orradiological failure, survivorship at 11years was 0.783. We believe the additionof a rougher surface finish hascontributed to high levels of osteolysisand stem failure seen with the SpectronEF.

898 08:08

MARS MRI Scanning formetal on metal hiparthroplastySS Mahmoud, R Gwyn, K Lyons, M Maheson, A John, S JonesUniversity Hospital of Wales, Cardiff

Cross-sectional imaging is a keyinvestigation in the assessment ofpatients with a MoM hip arthroplasty.We present our extensive experiencewith MARS MRI. The key aim is toprovide longitudinal data that cancontribute to an understanding of thenatural history and progression of softtissue damage as a result of AdverseReactions to Metallic Debris. Our studygroup comprised a total cohort of 450serial scans relating to 216 that wereclassified by a MSK radiologist. Timeintervals for progression betweendifferent types were considered. Aquarter of the hips scanned remainednormal with interval scanning.

408 08:12

Effect of increasedfrictional torque on thefretting corrosionbehaviour of the largediameter femoral heads:An in vitro study.BJRF Bolland, A Panagiotidou, JM Latham, G BlunnSouthampton Orthopaedics: Centre forArthroplasty & Revision Surgery, (SOCARS),Southampton; Institute of Orthopaedics andMusculo-Skeletal Science, University CollegeLondon; Royal National Orthopaedic Hospital,London

This study investigated the relationshipbetween increasing frictional torque andfretting corrosion for large diametermetal femoral heads. 36mm CoCr headswere coupled with CoCr or Titaniumstems with 12/14 tapers. Increasingperpendicular horizontal offset createdincremental increases in torque.Electrochemical tests (potentiostatic,potentiodynamic) were performed.There was a linear significant increase inmean (R=0.992, p=0.008) and frettingcurrent (R=0.929, p=0.071) with time forboth CoCr/CoCr and CoCr/Ti materialcombinations. Increasing torque lead toincreased susceptibility to frettingcorrosion at the modular head-necktaper interface of total hip replacementsfor both head stem materialcombinations.

828 08:16

Infection rates in revisionhip surgery: does the useof allograft make adifference? an analysis of2776 procedures.D Cohen, A Shah, H Nagai, B Purbach, M Wroblewski, P KayWrightington Hospital, Lancashire

Introduction: Does the use of allograftincrease the rate of infection followingrevision hip surgery? Method: Ourprospective database was examined tocalculate the incidence of infectionfollowing single stage revision for aseptic

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loosening. Results: 2,776 revisionprocedures took place between 1966and 2012. 1,344 with allograft: 22 hipsinfected, 1.64%. 1,432 without allograft:31 hips, 2.16%. Discussion: We presentthe largest series of revision hip workfrom a single hospital looking at infectionrates with and without allograft. Ourresults suggest that there is no increasedrisk of infection when using allograft inaseptic hip revision surgery.

DISCUSSION 08:20

477 08:25

Use of prophylactic inferiorvena cava filters in majortrauma patients – are weusing them and should webe?O Nzeako, M Khalfaoui, O Berber, T Hardwick, A TavakkolizadehKing’s College Hospital, London

Introduction: Prophylactic use of IVCfilters remains controversial. Objectives:Assess local practice in a level 1 major-trauma center and create localguidelines. Methods: Data was collectedretrospectively. EAST guidelines from theUS were used as the standard.Results: 72 patients were included withan average age of 42 years. 21%underwent insertion of an IVC filter. 11%suffered a non-fatal VTE. 2 patients withfilters had their removal delayed due tothe presence of thrombus within thefilter. No other significant complicationswere observed. Discussion: This is avaluable resource; however, we mustidentify patients where benefitsoutweigh the risks.

854 08:29

Fascia iliaca blocks; analternative painmanagement tool in neckof femur pathway?H Williams, V Paringe, P Michael, S Shrisha, B RameshGlan Clwyd Hospital, Rhyl

Since their first description, FICB have

been indicated but not widely used inthe NOF pathway. We investigated theirimpact on pain management. Fortyblocks were performed. Efficacy wasassessed using a 10 point visualanalogue score (VAS) taken pre-block, 15minutes, 2 and 8 hours post block instatic and dynamic positions. VAS scoreswere reduced in patients at rest andmovement up to 8 hours. There was areduction in the amount of additionalopioid analgesia given and the incidenceof opioid overdose. FICB provides a goodalternative form of analgesia in thepathway for NOF fractures.

806 08:33

Biomechanical evaluationof a novel technique ofpatella fracture fixationwith comparison toconventional techniquesA Hughes, M Jackson, S EvansUniversity Hospitals Bristol Foundation Trust,Bristol

Fractures of the patella represent asignificant biomechanical surgicalchallenge and fixation methods are ofinterest. Bovine patellae were fractured,fixed and tensile tested. Biomechanicalparameters were used to compare thestability of three different fixationmethods: two conventional methods anda novel technique using headlesscompression screws with a longitudinalanterior tension band (HCS method). This study showed significantbiomechanical advantages of both theHCS method and cannulated screwmethod when compared to a traditionaltension band wire. This study does notsupport the use of headless compressionscrews due to lack of biomechanicaladvantages and increased cost.

DISCUSSION 08:37

Sports Trauma andFoot & Ankle579 08:00

ACL and MPFL concurrentrupture rate: An MRI studyA Aframian, O Jindasa, KS Khor, P Vinayakam, S Spencer, PJS JeerEKHT, Kent

The Medial Patello-Femoral Ligament(MPFL) is the largest component of themedial parapatellar ligamentouscomplex. Literature search revealed nopublished concurrent ACL-MPFL injuryrates. Magnetic Resonance Imaging(MRI) scans of fifty consecutive ACLreconstruction patients retrospectivelyreviewed by two independentradiologists, looking for evidence ofMPFL injury. 29% showed evidence ofinjury, scored as low-grade sprain (10%),high-grade sprain (12%), or rupture (6%).With almost a third of ACL ruptureshaving evidence of MPFL injury, wesuggest that it always be considered andpropose scoring as described. Scans withfat-suppressed sequences had betterdiagnostic value and should be includedas standard.

174 08:04

Transmedial “All-Inside”Posterior CruciateLigament Reconstructionusing a fibertape®Reinforced graftlink® in aTibial Inlay PositionT Nancoo, B Lord, S Yasen, A Wilson, HampshireKnee Study GroupBasingstoke and North Hampshire Hospital NHSFoundation Trust, Basingstoke

Posterior cruciate ligamentreconstruction (PCLR) is technicallychallenging. We present a novel “all-

08:00 – 09:30Hall 7

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inside”, tibial-inlay technique thatsimplifies the difficult steps. InTransMedial PCLR, socket preparation isvia the medial arthroscopic portals usingspecially contoured and calibratedinstruments. A single semitendinosishamstring-tendon is quadrupled to forma Graftlink® that can be reinforced withFiberTape® or modified for double-bundle PCLR. Outside-to-in drilling isused to create bone-preserving retro-sockets. Fixation is achieved with corticalsuspensory buttons. Knotless anchorsprovide supplementary tibial fixation.The graft is placed in an anatomicposition, which better approximatesnative knee biomechanics, avoids the‘’killer-turn’’ and prevents graft laxity.

205 08:08

Use of fibertape® toreinforce tendon grafts inknee ligamentreconstructionT Nancoo, S Yasen, B Lord, M Risebury, A Wilson,Hampshire Knee Study GroupBasingstoke and North Hampshire Hopsital NHSFoundation Trust, Basingstoke

FiberTape® is an ultra-high strengthpolyethylene tape not previouslydescribed in knee-ligamentreconstruction. We designed a newtechnique for reinforcing grafts bysandwiching the FiberTape® betweenlooped tendon grafts so the tape iscompletely surrounded by graft tissue.This technique confers strength andinitial stability to otherwise inadequategrafts and improves biocompatibility.Since March 2011, 36 patients (meanage= 36.1yrs) received reinforcedautogenous hamstring-tendon graftsand/or tendo Achilles allograft. At lastfollow-up, Lysholm and KOOS scoresimproved from 59.2 to 84.1 and 57.5 to82 respectively. There was one earlyfailure (2.7%) due to deep infection butno other complications.

622 08:12

Posterior cruciate ligamentand posterior lateralcorner reconstructionusing the lars ligamentB Anand, A Anand, H Krishnan, A Patel, D Houlihan-BurneHillingdon & Mount Vernon Hospitals, London

Aims: To evaluate clinical and functionaloutcomes of PCL & PLC reconstructionusing the LARS ligament. Methods:Prospective, single surgeon seriesassessing 25 adult patients. Mean age32. Mean follow-up 26 months. Patientswith multi-ligament injuries involving thePLC or PCL ruptures were reconstructedusing the LARS, and autologoushamstring tendons for the ACL.Outcomes were assessed using the IKDC,Tegner Activity and Lysholm score.Results: Statistically significantimprovement in subjective stability,function and patient satisfaction. Nopatients lost to follow. 2 minorcomplications. Conclusions: LARSligament appears to be a suitablealternative to autografts for PLC & PCLreconstruction.

DISCUSSION 08:16

918 08:20

Non-operative treatmentof Achilles rupture byfunctional mobilisation:Audit of two differenttreatment regimesA Kumar, S Srinivasan, P Ganapathy, M BhatiaUniversity Hospitals Leicester, Leicester

Between 2010-12, there were a total of118 patients treated consecutively withthe VACOped functional boot (group 1=59, group 2 = 59) for Achilles tendonruptures. The total number of re-ruptures was 6 (group 1 =2, group 2 = 4).The combined ATRS scores was 70(group 1 = 75, group 2 = 65). Total post-injury follow up was average 2 years.Complications included 6 episodes ofvenous thrombo-embolism (3 pergroup). We conclude that use of the

VACOped functional orthosis is a safeoption in ruptured Achilles tendon withlow re-rupture rate (5%) and good ATRSscore.

696 08:24

Reconstruction of theneglected Achilles tendonrupture: a new techniqueV Asopa, J Clayton Sportsmed.SA, Adelaide, Australia

A free-flap modification of the Lindholmtechnique is described for neglectedachilles tendon ruptures. Through aposteromedial approach, the rupturedends are debrided and the fasciaoverlying the flexor hallucis longusmuscle belly is released. A 10cm by 2cmarea is marked out on the gastrocnemiusfascia and resected as a free graft. This isinterposed between the ruptured endsof the Achilles tendon and sutured with1-vicryl using the Adelaide techniquewhilst keeping the foot plantigrade.Weight bearing is allowed in a CAMboot. This technique eliminates thebulky repair and demonstrates goodpreliminary results.

419 08:28

Short-term outcomefollowing peroneus brevistransfer and hamstringaugmentation for themanagement of chronicAchilles tendon ruptureS Ahmad, C Heaver, M CarmontPrincess Royal Hospital, Telford

Introduction: Following delayedpresentation of Achilles tendon rupture,musculotendinous function may berestored by using local peroneus brevistransfer or free autograft hamstringaugmentation. Methods: Outcomes of15 patents who had reconstructiveprocedures of the Achilles tendonperformed were assessed using theAchilles tendon Total Rupture Score(ATRS). Results: The mean post-operativeATRS at 12 months for the peroneus

Notes


brevis group was 72.9 and for thehamstring group was 71.0. There was nostatistically significant differencebetween the two groups. Conclusion:The management of chronic Achillestendon ruptures with peroneus brevistransfer or hamstring augmentationgives good short-term results.

861 08:32

Mid to long-termoutcomes of lateralligamentous complex ankleinjuries treated bymodified brostrom’sreconstruction techniqueafter traumaS Hassan, T Sian, A Goyal, P KothariEast Midlands Deanery (North), Nottingham

Purpose: We report outcomes forpatients treated for lateral ligamentcomplex injuries by Modified Brostrom’sTechnique(MBT).Method: Patients had minimum of 6months follow-up.Over 5 year period(2007-2012). 27 patients (meanage=33.9years;F/u=36.9months) weretreated. Retrospective data wascollected. 88.5 percent completed anAmerican Orthopaedic Foot & AnkleScore (AOFAS) questionnaire. Results:The mean post-op AOFAS was 85. 88percent of patients were satisfied. Meantime-lag between injury and surgery was47.9 months. 1 patient underwentrevision surgery.There were no deepinfections or nerve damage. Conclusion:Despite delayed presentation,the MBT isvery effective in treating ankle jointinstability secondary to trauma.

DISCUSSION 08:36

142 08:40

The prognosis of acuteankle and foot injuriesusing ultrasonography.MD Franklin, MJ Callaghan, S CarleyDerriford Hospital, Plymouth; Manchester RoyalInfirmary, Manchester

Introduction: 22% of Ottawa Foot andAnkle Rules positive injuries haveradiological fractures. Materials &Methods: This diagnostic cohort studyexamined if ultrasound could detectacute non-bony injuries in Ottawa rulespositive patients and predict prognosis.The Foot and Ankle Outcome Score(FAOS), was also used. Results: 110subjects participated. At 6 weeks asignificant difference persisted betweenFAOS scores for ‘Pain’, ‘Sport’ and‘Quality of Life (QOL)’ compared withbaseline. Initial Anterior TalofibularLigament (ATFL) scan findings weresignificantly predictive of FAOS‘Symptoms’, ‘Sport’ and ‘QOL’ results.Conclusion: Initial ATFL findings predictpatient perceived sporting competenceat 6 weeks.

588 08:44

Treatment with Bracing –Stable ankle fracturesJ Yates, D Melling, M Hawkesford, E WoodCountess of Chester Hospital, Chester

Introduction: This study adds weight tothe evidence that the treatment ofstable ankle fractures in functionalbracing gives good results and is safe.Methods: This two stage auditconducted over sixteen months lookedat treatment of stable ankle fracturesbefore and after a change in practice wasimplemented. Results: Our resultsdemonstrated that through the use of abrace a cost saving of £131.99 perpatient was made and reduction ofcomplications was achieved. Conclusion:Treatment of patients with stable anklefractures in functional bracing is aclinically and financially sound treatmentoption.

437 08:48

Aircast walking boot andbelow-knee walking castfor avulsion fractures ofthe base of the fifthmetatarsal: A comparativecohort study.MK Shahid, S Robati, S Punwar, C Boulind, G BannisterYeovil District Hospital, Yeovil

Introduction: There has been nocomparison of the outcome of treatmentof the avulsion fracture of the base ofthe fifth metatarsal with short-leg cast ora walking boot. Methods: Twenty-threepatients received a short-leg cast andsixteen were treated with a walkingboot. The Visual-Analogue-Scale Footand Ankle score was used to assessfunctional outcome and pain. Results:The mean time for patients to return totheir re-injury level of pain and functionwas approximately 9 weeks in thewalking boot group and 12 weeks in theshort-leg cast group. Conclusion:Patients treated with walking bootreported better outcomes for pain andfunction.

DISCUSSION 08:52

411 08:55

Pectoralis major tendonrepair: a biomechanicalstudy of suture buttonversus transosseous suturetechniquesW Thomas, S Gheduzzi, I PackhamAvon Orthopaedic Centre, Bristol; University ofBath, Bath

In a biomechanical study of pectoralismajor tendon avulsions, we testedtransosseous sutures (TOS) againstsuture button (SB) repairs (PecButton,FibreWire, Arthrex). In the static loadexperiment, designed to replicatecatastrophic failure there was asignificant difference in median failureload, favouring TOS(p=0.009) andmedian extension at failure, favouring SB

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(p=0.009). In the cyclic load experiment,2/3TOS and 0/3SB failed prematurely.The difference in mean cycles completedwas non-significant. The meanextensions were: SB6.66mm,TOS11.73mm. SB has shown at leastparity with TOS. The difference inextension is more clinically relevant thanload at failure. We cannot support anaccelerated rehabilitation model.

470 08:59

Functional results andoutcomes in bilateralproximal hamstring tearsN Atwal, R Pennington, D WoodNorth Sydney Orthopaedic and Sports MedicineCentre, Sydney, Australia

Twelve patients with bilateral proximalhamstring tears were identified from aprospectively collected database andcompleted the modified Perth HamstringScore (MPHS – maximum 100). Therewere 8 men and 4 women, with anaverage age of 51.39 years (range 40 –64.25). The mean follow-up was 38.25months (6-96 months). Of the 24hamstrings repaired, 9 were acute (< 6weeks after injury) and 15 were chronic(> 6 weeks). The mean MPHS was 84.125(55 to 100.) 7 out of 12 patients (58.3%)had returned to their pre-injuryactivities, and all patients would havesurgery again.

DISCUSSION 09:03

981 09:05

Comparison of posteriortibial slope in ACL-injuredand control subjects usingCTC Mcgarvey, J BirdLewisham University Hospital, London

Introduction: ACL rupture has beenrelated to lateral posterior tibial slope(PTS). Previous MRI based in-vivo studiesshow wide variation and none have usedCT. Method: 64 non-contact ACL-injuredpatients and 41 non-injured controlswere compared. Medial and lateral PTS

were calculated using Hashemi’smethod. Results: Mean medial PTS was5.3o(SD+/-2.6) in the ACL-injured groupand 5.0 o (SD+/-2.8) in the control group(p=0.6). Mean lateral PTS was 6.3 o(SD+/-3.1) in the ACL-injured group and5.1 o (SD+/-2.9) in the control group(p=0.19). Conclusion: ACL-injuredsubjects had greater absolute lateral PTSand greater difference between lateraland medial PTS though the differenceswere not statistically significant.

29 09:09

Low velocity anteromedialknee dislocation with anintact ACL reconstruction.H Edwards, S Lidder, P Mestha, A ArmitageEastbounre District General Hospital, Eastbourne

A 20-year-old male presented with ananteromedial dislocation of the rightknee. Three years previously he hadundergone an ACL reconstruction of theipsilateral knee. Whilst in his garden, hetwisted and dislocated his right knee.Following emergent treatment, he had aposterolateral corner reconstruction andthe common peroneal nerve which washeavily contused with only a singlefascicle in continuity was grafted at atertiary centre. He has since shownsignificant improvement. We believe thatthis is the first documented case of anintact ACL graft following anteromedialknee dislocation. Even with minimalforce knee dislocation can occur.

959 09:13

Skills decay in arthroscopicsurgeryK Akhtar, A Wijendra, S Bayona, J Cobb, C GupteImperial College, London

Training in Virtual Reality (VR) kneearthroscopy can significantly improvesimulator performance but it is notknown whether these skills decay ifsubjects stop performing arthroscopy.16subjects had previously undergonetraining on a simulator with significantimprovements in performance. Thesesubjects were recalled after a mean

period of 17 months and were retested.It was seen that performance on a VRknee arthroscopy simulator deterioratesover time as skills decay occurs if thesubject does not undertake arthroscopyregularly. Simulation may provide a safeand effective way of preventing skillsdecay if trainees are unable to undertakeregular arthroscopy.

288 09:17

The case for a nationalcode for mountain bikeinjuriesJA Gillespie, RD FerdinandDumfries & Galloway Royal Infirmary, Dumfries

Aim: To quantify the impact of mountainbiking injuries. Methods: Using ourhospital coding system we identifiedpotential “cycling” injuries over a 1 yearperiod. Results: We confirmed mountainbike related injuries in 29 inpatientsresulting in occupation of 91 bed days,19 operations and 1130 minutes theatretime. Conclusion: Mountain-biking isextremely popular in our area. Weanticipate that our result is anunderestimate and suggest a new code iscreated to specifically identify mountainbike injuries for inpatient care and A&E.This would allow more accurateassessment of the impact on allhealthcare providers in the country.

624 09:21

Injury characteristics at theIronman Wales triathlonB Marson, N Deshmukh, H Iljas, M YaqoobWithybush Hospital, Haverfordwest

The Ironman Wales is an extremetriathlon event. In 2012, 1,320 athletesentered the event. Following a review ofattendances to the EmergencyDepartment, we present the injuryprofile of those who attended thehospital during or following the race. 3athletes presented to the emergencydepartment. All were injured during thecycling phase of the race. 2 had scapulafractures and 1 had a chest wall injury.We conclude that the Ironman Wales is a

Notes


relatively safe event, but eventorganisers and local hospitals should beaware of the potential for relativelyunusual upper limb injuries.

DISCUSSION 09:25

ARUK YoungInvestigator’sAward & PosterPrize181

Pain mechanisms inrotator cuff tendinopathyB Dean, S Franklin, K Wheway, W Bridget, C Cooper, R Murphy, A CarrOxford University, NDORMS, Oxford

Introduction: Shoulder pain is the thirdmost frequent cause of chronicmusculoskeletal pain in the communityand is usually caused by rotator cufftendinopathy (RCT). Methods: Rotatorcuff tendon specimens were obtainedfrom 64 patients undergoing the surgicalrepair, and were analysed usinghistological techniques andImmunohistochemistry. Results: TheGlutaminergic system was significantlyup-regulated with an increase inGlutamate and changes in severalrelated receptors in disease versuscontrol (p< 0.01). Conclusions: Thesefindings are novel and further ourunderstanding of the disease process inRCT, and these targets could be used inthe development of novel therapeutics.

10:00 – 11:30Hall 11A

00

The incidence of pre-operative asymptomaticDVT among patientsawaiting total kneearthroplasty or total hiparthroplastyG Sisodia, WS Fernando, C Melton, V Algar, A Elsayed, T BaggaDiana, Princess of Wales Hospital, Grimsby, HullYork Medical School, York

A prospective study of 107 consecutivepatients awaiting primary total knee ortotal hip arthroplasty was undertaken,with the aim of determining the pre-operative incidence of asymptomaticDVT. All patients underwent bilateralpre-operative Doppler ultrasounds scans.Those found to have positivesonographic evidence of DVT went on tohave a D-dimer blood test. Resultsshowed that 22.4% of patients hadpositive Doppler ultrasound evidence ofpre-operative asymptomatic DVT and9.3% had both positive sonographic andD-dimer evidence. This study, therefore,raises important questions regarding theappropriateness of post-operative DVTprevention, investigation and treatmentin the context of arthroplasty surgery.

796

Twelve to twenty yearoutcomes of 1515consecutive tibial shaftfracturesCL Connelly, V Bucknall, C Court-Brown, MM McQueen, LC Biant University of Edinburgh, Edinburg; The RoyalInfirmary of Edinburgh, Edinburgh

Prospective study assessing pain andfunction of 1515 consecutive tibial shaftfractures at 12-22 years following injury.1515 tibial shaft fractures in 1459consecutive adult patients. 1034 weremale and mean age was 40 years.Function was assessed at 12 to 22 yearspost-injury using standardisedquestionnaires. 87% of fractures united.11.5% patients underwent fasciotomy

which did not correlate with poorerfunction. One-year mortality in theelderly was 30%. 44.7% of patients haveanterior knee pain and 29.6% anklediscomfort after IM nailing. This is thelargest and longest study assessingfunctional and economic outcomes oftibial shaft fracture.

628

High dose, doubleantibiotic-impregnatedcement reduces surgicalsite infection (ssi) in hiphemiarthroplasty – arandomised controlled trialof 848 patients withintracapsular neck offemur FracturesC Jensen, A Sprowson, S Chambers, D Inman, S Jones, NM Aradhyula, M ReedNorthumbria Healthcare NHS Trust, Ashington

We aimed to investigate the effect on SSIrates of doubling the gentamicin doseand adding a second antibiotic(clindamycin) to the bone cement in hiphemiarthroplasty after NOF fracture. 848patients were randomized to receivestandard single antibiotic-impregnatedcement (Palacos®) or high dose, doubleantibiotic-impregnated cement (Copal®.)We calculated the SSI rate for each groupat 30 days post-surgery. The two groupswere demographically and medicallycomparable. Using high dose doubleantibiotic-impregnated cement ratherthan standard low dose antibiotic-impregnated cement significantlyreduced the SSI rate after hiphemiarthroplasty for fractured neck offemur; 1.7%(6/344) vs 5%(20/394)(p=0.01).

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Hip Surgery121

Limb preservation systemfor salvage of failedrevision total hiparthroplastyA Nisar, A Marsh, S Patil, RMD Meek [Glasgow]

We present our experience of LimbPreservation System for salvage of failedrevision hip arthroplasties. Seventeenpatients (13 female and 4 male) had amean age of 64.5 years. Primarydiagnoses were DDH (7), Primary OA (5),RA (2), proximal femur fracture (2) andphocomelia (1). There were 13 proximaland 4 total femur replacements. Five(n=5) patients had 9 complications (2infections and 7 dislocations). Meanfollow up was 7 years (range 5-9 years).WOMAC, Oxford and Harris hip scoresshowed significant improvementpostoperatively. No stems have beenrevised due to aseptic loosening at 5-9years.

151

Risks of false positive CTPAin the early post-operativearthroplasty populationD Dowen, P Partington [Northumberland]

Despite a higher pick up rate for PE dueto improved imaging modalities, themortality rate has remained stable. Wepresent 3 post op arthroplasty patientswho were all started on therapeutictinzaparin by medical teams within 72hours of joint replacement for equivocalCTPA findings and minimal physical signs.All patients subsequently developedhaematomas and subsequent deepinfection requiring further surgery. Nonehad DVT diagnosed, or had subsequentthromboembolism.Recent publications suggest thatasymptomatic post operativearthroplasty patients can show signssimilar to PE on CTPA. We suggest careful

discussion between physicians andorthopaedic surgeons prior toanticoagulation.

196

Patient positioning fortotal hip arthroplasty: canthis affect leg lengthdiscrepancy?G Phillips, P Lee, T Owen [Llantrisant]

Hypothesis: Supine positioning ofpatients will square the pelvis more akinto that of the anatomical positionallowing for more accurate equalisationof leg-length.Method: Leg-length was measuredradiographically by drawing a near-horizontal through the acetabulae. Fromthis line a perpendicular line is drawn tothe lesser trochanter.A comparison was then made betweenthe lateral decubitus and supine groups.Results: For the lateral position pre-opdifference in leg-length was 7.2mm(SD5.78) and post-op 10.1mm(SD 7.24). p-value 0.03. For the supine group pre-opdifference was 9.6mm(SD 6.85) and post-op 6.0mm(SD4.55). p-value 0.05.Conclusions: Statistically significantdifference to support the hypothesis.

236

Metal ion levels andrevision rates in metal onmetal hip resurfacingarthroplasty: acomparative studyPG Robinson, AJ Wilkinson, RMD Meek[Glasgow]

Metal on metal bearings in hip surgerymay result in increased blood levels ofmetal ions and earlier hip failure.We compared three equal cohorts ofresurfacing patients, Birmingham HipResurfacing ≥50mm and Duromresurfacing ≥50mm and < 50mm.Median cobalt levels for the BHR was8nmol/L higher than the small Durom

(P< 0.005). The small Durom cobaltlevels were 8.5nmol/L higher than thelarge Durom (P=0.0004). Large BHR andlarge Durom revision rates were both3.3%. The small Durom´s revision ratewas 8.3%.Our results suggest ion levels do notabsolutely predict the rate of HRAfailure.

241

Does a ‘safe-zone’ foracetabular componentposition exist in metal-on-metal total hiparthroplasty?AR Pearce, TW Briant-Evans, KS Conn, RJ Harker,GJ Stranks, JM Britton [Basingstoke]

A ‘safe-zone’ for acetabular componentposition in hip resurfacing to minimiseARMD risk has been proposed (35-55oinclination; 10-30o anteversion). Weanalysed 1097 radiographs from oursingle centre series of 1197 38mm M2aMetal-on-Metal THA, looking atacetabular component position andrevisions secondary to ARMD.611 had components within the ‘safezone’, 486 outside. Revisions for ARMD(including pending) were 50(8%) in the‘Safe’ group and 65(13%) in the ‘non-safe’ group(p = 0.0053, relative risk 1.6,95% CI 1.2-2.3). High Inclinationincreases relative risk to 2.2(p=0.0005 CI1.4-3.4). Although a ‘Safe-Zone’ exists,component position alone does notexplain our findings.

Poster Abstracts

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269

The ice-cream coneprosthesis: a novel methodfor acetabularreconstruction using anextended posteriorapproachR Mehdian, G Matharu, D Sethi, L Jeys[Birmingham]

This study describes the surgicaltechnique for a novel implant used foracetabular reconstruction. Between2009-2012, 17 patients (10 tumour / 7arthroplasty) received the ‘ice-cream´cone prosthesis for complex acetabularreconstructions. An extended posteriorhip approach was used to expose theacetabulum. The stem of the prosthesiswas inserted in the ileum and guidedtowards the posterior superior iliac spineand secured with cement. Meanoperative time was 153 minutes. Duringfollow-up one patient required revisionfor cone migration. The ice-cream coneprosthesis is useful for acetabularreconstruction and can be insertedthrough an approach familiar toarthroplasty surgeons.

272

Baseline bone mineraldensity and boneresorption markersamongst preoperative hipand knee arthroplastypatients: a prospectivestudyS James, S Mirza, D Culliford, P Taylor, N Arden,COASt Study Group [Southampton]

Bone quality may prove to be asignificant factor influencing theoutcome of arthroplasty surgery. Thisprospective cohort study of 234 patientsawaiting hip or knee arthroplasty,measured baseline bone mineral densityusing DEXA scans, and bone resorptionactivity using urinary deoxypyridinoline

(DPD). Prevalence of hip osteoporosisamongst arthroplasty patients was foundto be low (2.9%), but may be up to 8.3%when allowing for those already onbisphosphonate therapy. Mean total hipT-score (-0.22, sd 1.31) was withinnormal limits. Median urinarydeoxpyridoline/creatinine was raised inmales 7.0 (IQ Range 5.7-9.1), but normalin females 6.8 (IQ Range 5.2-9.2).

456

Influence of bone cementcontamination on thesurface roughness of highlycross-linked polyethylenebearing surfaceP Lee, E Brousseau, P Alderman, P Roberts[Cardiff; Newport]

The tribological behaviour of the bearingsurface in hip arthroplasty is greatlyinfluenced by its surface roughness. Theeffect of bone cement polymerizationand its thermal effects on a highly cross-linked polyethylene bearing surface cansignificantly increase its surfaceroughness (p=0.01)and alter its surfacetopography. The mean surface roughness(Ra) of pre-contamination was 190 nmwhile post-contamination was 230 nm.This effect is likely to affect the tribologyof the bearing surface and even its long-term performance outcome. Surgeonsshould be aware of this potential seriouseffect and be cautious intra-operativelyto minimise bone cementcontamination.

501

Limb length discrepancythe under reportedcomplicationC Dannana, M El Sayad, M Yaqoob[Haverfordwest]

Limb length discrepancy(LLD) is a knowncomplication of total hip replacements(THR).The reported incidence of LLDfrom previous studies is between 6 & 32%. Our aim was to assess (LLD) in

patients who had undergone a THR inour department and compare our resultswith previous studies. 96 patients hadtheir LLD assessed radiologically by theWoolson method postoperatively. Theresults showed that 68(70.83 %) patientslimbs were lengthened, 14 wereshortened (14.58%),14 were equal(14.58%). and in total 27(28.1%) patientsrequired a shoe raise. Our results showthat limb length discrepancy is a morecommon complication than reported.

505

Economic implications ofperiprosthetic femoralfracturesV Paringe, T Williams, S White [Cardiff]

Periprosthetic Femoral Fractures [PFF]account for 8-9% of the THR revisionburden with significant financial elementto it. In our 6 year retrospective analysisin 66 patients with mean age on 75years, Vancouver´s B was the mostcommon injury with a total surgical tariffof £30,020-£40010. The Type B2 PFF´sresulted in the lower overall cost due toimproved weight bearing statusfollowing revision THR as compared toORIF for the other groups. From ourfinancial analysis of the cohort, it wasnoted that the total cost was in excess ofthe tariff price reimbursed from HRGPayments.

557

Eleven years results ofelastic, uncementedacetabular cup: 1194consecutive implants froma non-designer centreI Malek, L Green, A Westwood, M Mullins, D Woodnutt [Swansea]

An elastic, hemispheric, uncemented, HAcoated hemi-spherical titaniumacetabular implant was introduced in1987 with perceived advantages ofbetter primary and secondary implant

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stability, low fracture rate at the time ofimpaction, better polyethylene insertstability and wear characteristics withlow incidence of osteolysis. Aprospective review of 1194 consecutiveprocedures performed in 1075 patients.Twenty five implants have been revisedfor various reasons. The Kaplan MeierSurvivorship analysis showed survivalrate of 93% at 11 years (97% CI: 87-99%).The risk of implant revision was 2.4% at11 years. We conclude that, thisacetabular component has excellentmid-term results.

718

Early direct-exchangerevision for acutelyinfected cementless totalhip replacementS Alazzawi, M Sukeik, F Haddad [London]

We report our experience of using single- stage revision arthroplasty in treatingpatients who had an acute postoperativeinfection (within 6 weeks) aftercementless primary or revision total hipreplacement. There were 19 patients (13primary and 6 revision THRs), averageage was 64 years (39 - 85), male: femaleratio was 11:8. Average time from theindex operation to the development ofinfection was 18 days (4 - 41). Fifteenpatients (78.9%) treated successfullywith no evidence of re-infection at 64.3(32 - 89) months follow up. Four patients(21.1%) developed re-infection whichrequired a two stage-revision procedure.

808

Management ofrecalcitrant osteomyelitisof the native hip and pelviswith a two-stagedebridement and a rectusfemoris pedicledinterposition graft: a casereport of four operationsD Giotikas, S Daivajna, M Kaminaris, A Norrish[Cambridge]

We report our experience with a twostage debridement and rectus femorisgraft technique in three patients, fourhips, with chronic severe native hipinfection.The first stage comprised wounddebridement, washout, gentamycin-bead application and vacuum assistedwound coverage. At the second stage,the rectus femoris muscle was elevatedon its pedicle, rolled and transposed intothe acetabulum. All patients received a 6week course of intravenous antibiotics.No loss of flap occurred. At the finalexamination all the wounds were healed.The described technique may be usefulfor the treatment of complex persistentosteomyelitis of the hip and groin.

830

Estimating the truefemoral offset fromanteroposteriorradiographicmeasurements using‘lesser trochanter index’K Boddu, M Siebachmeyer, S Lakkol, V Kavarthapu, PLS Li [London]

We developed a method to predict theunderestimation of femoral offset in theAP radiographs using the ‘lessertrochanter index’ (LTI). Computedtomographs of forty normal hips wereincluded. Simulated radiographs werereconstructed at hip rotations of 10°increments from 30 ° internal rotation to

40 ° external rotation. A radiograph withan LTI value above 35 is 94% (95% CI,89% to 97%) likely to underestimate thefemoral offset by more than 5%. Allradiographs with an LTI between 0 and30 demonstrated femoral offset within5% of the true offset (predictive value100%, CI 89% to 100%).

901

Characterisation of in vivorelease of gentamicin fromALAC using a novel methodH Gbejuade, J Webb, A Lovering, R Spencer[Bristol]

Antibiotic loaded acrylic cement (ALAC)is commonly used for managingprosthetic joint infection. Publishedstudies on antibiotic elution are largelyin vitro. We investigated urinary in vivoelution kinetics of gentamicin fromALAC. Postoperative urine samples werecollected from 35 patients whounderwent cemented primary total hiparthroplasty patients (using 0.5ggentamicin ALAC) and analysed forgentamicin concentrations. Meanduration of urinary gentamicin release inall cases was 43 (13-49) days. 20% stillhad detectable gentamicin even at finalcollection. Our study demonstrates thebiphasic gentamicin elution, as well asrobust release for up to six months usinga non-invasive technique.

967

Evaluation of magneticresonance arthrography(MRA) versus hiparthroscopy inidentification of labraltears and associatedarticular pathologyC Mcgarvey, T Hardwick, D Elias, S Vijayanathan,V Kavatharpu [London]

In FAI, MRA performance in identifyingintra-articular pathology other thanlabral tears is not commonly

Notes


documented. Of 102 consecutive hiparthroscopies, 67/75 MRA reports werecompared to intra-operativedocumentation of: CAM lesion; labraltears; and articular cartilage changes. Atarthroscopy labral tears were found in57/67 patients (MRA sensitivity 78%,specificity 80%, NPV 42%). Atarthroscopy, articular cartilage lesionswere found in 50/67 patients (MRAsensitivity 55%, specificity 93%, NPV40%). Among 22 false-negatives forarticular cartilage lesions, six had GradeIII-IV wear. MRA detected labral tears inline with published series, but did notexclude advanced (Grade III-IV) wear.

1009

High survivorship ofimpaction grafting ofcontained acetabulardefects with a biphasicporous ceramic bone graftsubstitute in 43consecutive patients at amean follow up of 51monthsW Michael, P Dacombe, J Webb, A Blom [Bristol]

Background: Bonesave is used inconjunction with allograft for impactiongrafting of the acetabulum, in this serieswe look at its use alone. Methods:retrospective review of 43 patientsundergoing impaction grafting ofcontained acetabular defects. Patientswere assessed radiologically, withPROMS and Kaplan-Meier survivalanalysis. Results: survivorship ofacetabular component was 97.7% at 85months. Median OHS was 36, SF12 PCSwas 36 and SF12 MCS was 50. Graftmaterial incorporated in all three zonesof the acetabulum in 33 of 37.Interpretation: medium-term resultsshow that Bonesave alone is a reliablematerial for impaction grafting of theacetabulum.

Knee Surgery

102

Long term survivorshipfollowing Scorpio totalknee replacementC Quah, G Syme, A Martin, N Segaren, S Pickering [Nottingham]

The primary aim of our study is to assessthe survivorship of the Scorpio totalknee replacement (TKR) after 10 years.This study consisted of 456 consecutivepatients who underwent a primary TKRbetween 1998-2003 in a singleinstitution. At an average of 12.5 years,196 patients were available for review;124 (27.2%) were lost to follow up and136 (29.8%) patients died of unrelatedcauses. The cumulative survival for theprosthesis was 99.5% for any cause at 5years and 97.4% at 14 years. In ourseries, the Scorpio TKR showed goodlong term survivorship and functionaloutcomes.

177

Autologous osteochondralmosaicplasty or Trufit™plugs for cartilage repair; aretrospective non-randomized comparisonP Hindle, J Hendry, J Keating, L Biant [Edinburgh]

The outcome of autologousosteochondral mosaicplasty andTruFitTM Bone Graft Substitute werecompared using the EQ-5D, KOOS andModified Cincinnati scores at follow-upof 1-5 years. There was no significantdifference in the requirement for re-operation (p=0.254). Patients undergoingautologous mosaicplasty had a higherrate of returning to sport (p=0.006),lower EQ-5D pain scores (p=0.048),higher KOOS activities of daily living(p=0.029) scores. This studydemonstrated significantly betteroutcomes using two validated outcome

scores (KOOS, EQ-5D) and an ability toreturn to sport in those undergoingautologous mosaicplasty compared tothose receiving TruFit plugs.

253

Pre-tibial reaction to bio-interference screw inanterior cruciate ligamentreconstructionV Ramsingh, N Prasad, M Lewis [Newport]

We report a case series that presentedas pre-tibial reaction following ACLreconstruction using bioabsorbablefixation devices for tibia. 273 ACLreconstructions using quadrupledhamstring autograft were performedover 3 years. Thirteen patients (5%)presented at a mean post-operativeperiod of 26 months with pre-tibial painand swelling. All patients had normalinflammatory markers. All underwentsurgical debridement. There was noevidence of infection in cultures.Histopathology revealed reactiveappearance. All patients had completerecovery at mean follow up of 12months. We report an incidence of 5% ofpre-tibial reaction. This may be relatedto foreign body reaction.

467

Cementation in TKR -warm versus cold salineA Mehra, Z Morrison, R Power, E Schemitsch[Toronto, Canada; Leicester]

Better cement penetration reducesmicro-motion in TKR. We compared theeffect of warm versus cold saline washon cement penetration in porcine tibia.Ten paired porcine tibiae wereharvested. Cancellous bone surface waswashed with 500mls of saline. The leftside bones were washed with cold saline(room temperature) and right with warmsaline (40 degree). Polyethylene blockwas implanted using simplex P cementand Cement penetration measured.Paired t-test was used to assess

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statistical significance. The difference inthe sagittal plane was statisticallysignificant (p=0.003). Cementpenetration is better and more uniformwith warm saline.

468

Improving the accuracy ofunicompartmental kneearthroplasties: robots vs.patient specificinstrumentationZ Jaffry, M Masjedi, S Clarke, S Harris, M Karia, B Andrews, J Cobb [London]

The accuracy with whichUnicompartmental Knee Arthroplasties(UKAs) are carried out using a semiactive robot, Patient SpecificInstrumentation (PSI) and theconventional technique was compared.A total of 36 UKAs were done onidentical knee models, 12 with eachmethod, and implant placement wasjudged against that in a pre-operativeplan. Overall, the robot produced themost accurate UKAs but there was nosignificant difference between this andthe PSI group in femoral componentplacement. The robot also took asignificantly longer surgical time than theother two techniques so with furtherdevelopment PSI could be the mostefficient.

493

Unpredictable outcomesfollowing FPVpatellofemoralunicompartmental kneereplacementA Davies [Swansea]

52 consecutive FPV PatellofemoralUnicompartmental Knee Replacementswere studied prospectively using OxfordKnee Score and American Knee SocietyScores. Oxford Knee Scores improvedfrom 30 points pre-operatively (36.6%)to 19 points (60%) at one-year. American

Knee Society Knee scores improved from51 points pre-operatively to 81 points atone-year. Function scores improved from42 points pre-operatively to 70 points atone-year. 13 (25%) patients had anexcellent outcome however 11 (21%)patients gained very little improvement.Seven cases have been revised to a totalknee replacement. The patellar buttonwas very poorly fixed in all cases thatwere revised.

534

Quantitative measurementof mechanical alignmentand coronal laxity duringearly knee flexionDF Russell, AH Deakin, QA Fogg, F Picard[Clydebank]

We report repeatability and agreementof a non-invasive image-free navigationbased system assessing lower limbmechanical alignment (MA) with acommercially available invasivenavigation system. 12 cadaveric lowerlimbs were tested. MA was measuredwith no stress, then 15Nm ofvarus/valgus moment from extension to90˚. Repeatability coefficient of < 3˚ wasacceptable. The non-invasive system wasprecise from extension to 60˚.Agreement between invasive and non-invasive was satisfactory from extensionto 40˚ with no stress, and extension to30˚ with varus/valgus stress.The non-invasive system providesreliable MA and laxity in the rangerelevant to arthroplasty planning.

543

Centre and surgeonvolume influence revisionrate following unicondylarknee replacement: ananalysis of 23,400 medialcemented unicondylarknee replacementsP Baker, S Jameson, R Critchley, M Reed, P Gregg,D Deehan [Middlesbrough]

Aim: to determine how surgeon andcentre operative volume influencefailure rates for unicondylar kneereplacements (UKR). Methods: Registrybased cohort study of 23,400 medialcemented Oxford UKR. Results: thelowest volume centres/surgeons hadsignificantly higher rates of revision thanthe highest volume centres/surgeons (allp< 0.001). Compared to the highervolume centre/surgeons (>13cases/year) the hazard of revision for thelower volume centre/surgeons (< 13cases/year) was 1.87 (95%CI:1.58-2.22),p< 0.001). Conclusion: high volumecentres and surgeons demonstratedsuperior results. These results suggestsurgeons should undertake a minimumof 13 procedures/year to achieve resultscomparable to higher volume operators.

589

To hinge or not to hinge?Analysis of 108 cases ofrotating hinge TKR´s inrevision knee arthroplastyB Rao, T Tandon, A Avasthi, M Moss, L Taylor[Chichester]

In the study of 108 patients with meanage of 76 years, we evaluated theoutcomes of a newer generationRotating Hinge Knee (RHK) in revisionsfor major bone loss and ligamentousinstability. We used 30 Tibial and 4Femoral trabecular metal cones in type2/3 AORI defects to address bone lossalong with RHK´s. At average follow-upof 54 months, mean OKS improved from

Notes


21 to 32 and AKS scores improved from32 to 76. With advent of modern RHK´s,there appears to be a place for them inrevision knees especially with majorbone loss and ligamentous instability.

592

The oblique lateralligament (Ligamentumobliquum laterale)-description of a ´new´ kneeligamentA Dodds, A Williams, C Gupte, A Amis [London]

We have sought to clarify anatomy andfunction of the anterolateral kneestructures by dissecting 40 fresh frozencadaveric knees and performingbiomechanical tests. A consistentstructure was observed clearly in 33knees, which has been termed theoblique lateral ligament. It passedantero-distally from proximal andposterior to the lateral collateralligament (LCL) femoral attachment to thelateral tibial plateau margin, midwaybetween Gerdy’s tubercle and the fibularhead. It passed superficial to the LCL,and was separate from the capsule.Biomechanical testing revealed it wasnot isometric, and was lengthened byimposing a tibial internal rotationtorque.

607

A novel patellofemoralinlay resurfacingarthroplasty for isolatedpatellofemoral arthritis:independent assessmentand functional outcomesA Patel, A Anand, D Spicer [London]

Aim: to prospectively evaluate functionaloutcomes and complications for patientsundergoing novel inlay resurfacingarthroplasty for isolated patellofemoralarthrosis. Methods: from 2009-2012, weundertook 12 procedures. Outcome

measures included range of movement,functional scores (Oxford knee, KOOS,SF-36), and complications. Results: 6men and 6 women were evaluated, withaverage age 63.1 years and averagefollow-up 24.1 months. There wassignificant improvement in range ofmovement and all functional scores (p<0.0001). One patient underwent revisionfor infection. No other complications.Conclusion: our results demonstrate theHemicap Wave resurfacing prosthesishas good early results with lowcomplication rates.

681

Cost of adverse events inknee arthroplasty - areview of the nationalhealth service litigationauthority databaseA Chen, Y Khan, K Akhtar, JP Cobb, CM Gupte[London]

Aims: to determine costs of adverseevents occurring from knee arthroplasty.Methods: The NHSLA database wasanalysed for case-mix and total payout.Results: 515 cases involved knee surgery.298 cases involved knee replacements.Total payout was £10.45 million. 11 casesinvolved unicondylar knee replacements.Highest payouts were amputation - £2132,097, poor outcome and furthersurgery - £1,453,880, wrong prosthesisor prosthesis size - £1 465,595. Toplitigation success rates were- drain left inknee, wrong prosthesis/size, pooroutcome/ further surgery. Estimatedfuture payout - £3.382 million.Conclusions: litigation success rates werehigher involving technical errors. Thenumber of wrong prosthesis claims isconcerning.

842

Range of motion as adischarge criterionfollowing kneearthroplasty: can it besafely ignored in anenhanced recoverysetting?K Akhtar, N Hadjipavlou, N Aresti, D Houlihan-Burne [London]

Range of motion is traditionally used as akey discharge criterion following totaland unicompartmental kneereplacement, with 90° of flexiondesirable at discharge. 126 consecutivepatients undergoing knee arthroplastywithin an enhanced recoveryprogramme (ERP) were followedprospectively. Significant improvementswere seen in both flexion and extensionbetween the time of discharge and at 6weeks. Range of knee motion atdischarge does not predict the range ofmotion at 6 weeks following surgerywithin an ERP and may be safely ignoredas a discharge criterion.

880

Alignment profile ofnormal knees and itsvariations with posture,sex, side and geographyK Deep [Glasgow]

This multicentre study (6 Centres) on267 normal knees of persons agedbetween 18-35 with a computerisedinfrared navigation system measuredfemoro tibial mechanical angle (FTMA)with a validated method. Mean supinenon weight bearing FTMA was a varus1.2°(SD4.0) in full extension and1.2°(SD4.4) in 15° flexion. It changed by amean varus 2.2°(SD3.6) in bipedal and3.4°(SD3.8) in monopedal stance. Onstanding, the knee extension increasedby 5.6°(SD6.8) in bipedal stance and by5.5°(SD 7.7) in monopedal stance. There

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were statistically significant variationswith sex, side and north vs south. Theneutral alignment may not be the bestfor all.

973

Survival, risk factors forfailure and functionaloutcome of autologoushamstring anatomicanterior cruciate ligamentreconstructionC Robb, H Standell, P Thompson, J Soh, D Lin, T Spalding [Coventry]

A prospective database for patientsundergoing a standardised anatomic ACLreconstruction was analysed. A pooroutcome was defined as patientinstability symptoms, an abnormal pivotshift, MRI or arthroscopy showing ACLgraft rupture. Kaplan Meier survivalanalysis was calculated. The Coxproportional hazard model was used toinvestigate which covariates influencedgraft survival. At 2 year follow up survivalanalysis showed a good outcome in81.5% (95%CI 73.6 to 90.3). Risk factorsfor a poor outcome were medial(p=0.015) and lateral (p = 0.03) meniscaldeficiency. Conclusion: Surgeons shouldendeavour to repair all meniscal tearsassociated with ACL reconstruction.

991

Clinical outcome of TKAperformed with patientspecific instrumenttechnology (PSI) -minimum 1 year follow-upA Porteous, M Hassaballa, J Robinson, J Murray[Bristol]

Assessing clinical and radiologicaloutcome of TKA done with PSI. Method:Over 100 cases of TKA using PSI.Radiographic and clinical outcome wereanalysed. Pre-and 1 year postoperativedata, including Oxford, Womac and AKSscores, AP, Lateral and long-leg

alignment films collected. Op-notesreviewed for additional bone cuts done.Results: 1 revision for acute infection. In10 cases an additional 2mm of distalfemur was resected, all with >15 degreesFFD. Alpha = 96.2, Beta= 88.1. Nooutliers beyond +/- 3 degrees of neutralmechanical alignment. Conclusion:Performing TKA using PSI is safe andprovides good radiological alignment andclinical outcome.

999

The FPV patellofemoralreplacement: minimum 5year results from anindependent centreMN Joseph, C Downham, M Costa, P Thompson,U Prakash, P Foguet, N Parsons [Warwick;Coventry; London]

This study reports minimum 5-yearfollow-up of the FPV patellofemoral jointreplacement from an independentcentre. We retrospectively assess thefunctional and radiological outcomesand survivorship of this prosthesis. Intotal 55 FPV replacements wereperformed. The mean follow-up was 6years. The cumulative survival at 5 yearswas 90% with revision as endpoint. Thefunctional scores were good. Theradiological outcomes used showed highinter- and intraobserver reliability. TheCaton-Deschamp ratio and patellar tiltimproved significantly (P < 0.05). Ourfindings suggest the FPV providessatisfactory mid-term results howeverthe survivorship may not be comparablewith the Avon.

Trauma

13

Are plain radiographsuseful in accuratelyclassifying distal radiusfractures?S Evans, A Taithongchai, M David, B Machani[Birmingham]Aim: does assessment of plain filmsalone accurately depict the fracturepattern found

intra-operatively? Methods: closed,adult distal radius fractures included.Preoperative fracture radiographsclassified (Frykman and AO methods).The same systems were used to classifythe fracture pattern intra-operatively.Results: 24 wrists; 16 female. Mean age51.0 years. There were 3 patients whosepre- and intraoperative classificationsmatched. There was a mean discordanceof 3 grades in the fracture classificationpre- and intra- operatively when usingboth the Frykman and AO methods. Thisstudy shows that plain wrist radiographsdo not accurately classify distal radiusfractures.

69

Functional outcomefollowing tibio-talar-calcaneal nailing forunstable osteoporoticankle fracturesS Jonas, A Young, C Curwen, P Mccann[Gloucester]

Fragility fractures of the ankle areincreasing in incidence. Such fracturestypically occur from low energy injuriesbut lead to disproportionately high levelsof morbidity. Both conservative andoperative modalities have shown highrates of failure. Optimal treatmentremains controversial. Our retrospectivereview of 31 patients managed withTibio-talar-calcaneal Nail (TTC) showed a

Notes


high mortality at follow up 9/31 and 3had periprosthetic fractures. 2 infectionsoccurred but 29/31 returned to theirprevious level of mobility postoperatively. Complications rates are highin patients regardless of management.The TCC nail allows immediate fullweight-bearing with an acceptablecomplication rate.

125

Results of non union ofhumerus treated withretrograde humeral nailH Bhatt, S Halder [Huddersfield]

We report outcome of 51 cases of non-union of humerus treated RetrogradeHalder Humeral Nail. Mean age ofpatient was 54 years with mean durationof non-union of 8 months. Of 51patients, 48 had union at mean of 10months. 1 patient was lost to follow up.18 patients out of 51 needed bonegrafting to aid union. The mean ConstantScore at last follow up was 83 and MayoScore for elbow was 80. There were noreported cases of infection. 3 patientsdeveloped radial nerve palsy which fullyrecovered at 3 months.

217

Impact of time to surgeryon POSSUM physiologyscores and predictedoutcome in patients withneck of femur fracturesR Afinowi, C Mount, I Chambers [Scunthorpe]

Introduction: we determine the effect oftime to theatre on POSSUM scores.Method: observational study. Timedependent changes in physiology scoreswere analysed in 3 subgroups. Results:we found no significant change in scoreswhere time to theatre was within 36hours or longer for logistic reasons.Those delayed for medical reasons, hadon average higher scores with noimprovement. Conclusion: our findings

suggest that in relatively unwell patientswith neck of femur fractures, there is anearly window of opportunity for limitedresuscitation and optimisation, beyondwhich there appears to be no benefit indelaying surgery.

266

Targon Femoral Neck HipScrew versus cannulatedscrews for internal fixationof intracapsular fracturesof the proximal femur: asingle centre, parallelgroup, participant blinded,randomised controlled trialXL Griffin, N Parsons, J Achten, ML Costa[Coventry]

The aim of this study was to quantify theclinical effectiveness of the TargonFemoral Neck Hip Screw in themanagement of a typical osteoporoticfracture of the hip. Patients aged 65years and over with any type ofintracapsular fracture of the proximalfemur were eligible. The primaryoutcome was the risk of revision surgerywithin one year of index fixation. Theabsolute reduction in risk of revision was4.7% (95% CI -14.2 to 22.5%) in favour ofthe Targon Femoral Neck Hip Screw.Although there was no significant effect,we cannot definitively exclude a clinicallymeaningful difference.

270

The management of openlower limb fractures at alevel 1 major traumacentre: how orthoplasticshas changed the approachH Colaco, M Khan, S Anwar, A O’Rourke-Potocki,C Cox, N Cavale, S Phillips, AM Phillips [London]

Aim: audit performance of Level 1 MTCin managing open lower limb fracturesagainst the BOA-BAPRAS/BOAST4guidelines (2009). Method: audit all

lower limb fractures admitted with off-site Plastics (Jan-Dec 2011), and afterappointment of Orthoplastics Consultant(Jan-Sep 2012). Results: in 2011,26/47(55%) Gustillo III. CombinedOrthoplastics plan documented:0/47(0%). 13/47(28%) required softtissue cover by Plastics 8.16days(av.)(58%< 7days). In 2012, 20/34(59%)documented Gustillo III. CombinedOrthoplastics plan documented:56/56(100%). 24/56(43%) required softtissue cover by Plastics6.18days(av.)(83%< 7days). Conclusion:performance has improved whenmeasured against the BOA-BAPRAS/BOAST4 guidelines. Furtherstudy is required to assess patientoutcomes.

277

The post-operativemanagement of anklefractures: a systematicreview, meta-analysis andevidenced based protocolC Atherton, G Cheung [Liverpool]

Data from 24 studies assessing theeffects of early weight bearing andmobilisation in the post-operativeperiod, was combined for the outcomes:ankle score, range of motion (ROM),time until return to work andcomplications. Weight-bearing and anklemobilisation early in the post-operativeperiod improved scores, ROM andhastened return to work, withoutcompromising fracture healing. Wesuggest a post-op protocol of belowknee cast at 48 hours with full weight-bearing, converting to a removable bootonce the wound has healed, allowingmobilisation. This allows earlier return toa higher level of function, shorterinpatient stays, reducedthromboembolism and stiffness.

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293

Surgical and conservativemanagement of displacedradius and ulna shaftfractures in children- avoidusing flexible nail forradius alone!K Wronka, S Richards [Poole; Carmarthen]

Methods: retrospective review ofchildren who had intervention(MUA/fixation) for fracture shaft ofradius AND ulna. Results: 56 childrenwith closed, displaced fractures wereidentified. 26 had fixation, 30-MUA. 27%from MUA group required furtherintervention. 13% of fractures healedangulated 25-30degree. Of 4 patientswho had single nail to ulna, despiteinitial reduction, 3 suffered angulation toradius (25-40 degree). None of fracturestreated with 2 nails re-displaced. Therewere no growth problems. Discussion:internal fixation of forearm bones inchildren is safe. Authors recommendfixation of both bones rather than ulnaalone due to risk of re-displacement.

355

Outcome of traumaticshoulder dislocation inpaediatric populationA Bidwai, J Chan, C Bruce [Warrington]

Purpose: shoulder dislocation isinfrequent in the paediatric population.The aim of this study is to determine ifour standard management ofphysiotherapy supervised mobilisation isappropriate. Method: Retrospectiveanalysis of patients identified fromhospital records database. Results: 8from 10 patients were contactable. Allpatients had symptoms of instability,four male patients required surgery atanother institution. Conclusion: a highincidence of recurrent instability in thissmall cohort has led to a change inpractice. Patients with traumaticshoulder dislocation are referred to adult

centres, where patients can beinvestigated and managed by adultshoulder surgeons.

367

Severe open tibialfractures treated with the´flap and frame´ techniqueJ Fagg, E Mills, S Royston [Sheffield]

We retrospectively reviewed the casenotes and radiographs of sixtyconsecutive cases of severe (Gustillo-Anderson Grade III) open fractures of thetibia treated in our tertiary referral unitwith the ‘Flap and Frame’ technique.Mean age was 43.3 years (16 - 89). 25%were IIIA and 75% were IIIB fractures.Half of the fractures had significant boneloss following debridement, with a meanaverage loss of 28.1mm (range 5 - 125).Mean follow up was 10.3 months. Thedeep sepsis rate was 1.7 percent with a 5percent non-union rate. Mean averageframe time was 182 days (range 71 -525).

413

Locking plate fixation forcomplex peri-articularfractures of the tibia. Asingle centre study of themanagement of 73patientsA Leonidou, G Erturan, A Brooks, S Deo[Swindon]

The purpose of this study is to presentour experience with the use of thelocking plate for the management ofcomplex peri-articular tibial fractures. 73patients with complex peri-articulartibial fractures were managed in ourinstitution. 34 fractures involved theproximal tibia, 35 the distal tibia and 4the shaft. The applied systems were theAxSOS Plate and the LCP or LISS systems.Mean time from injury to fixation was6.5 days. 7 patients had superficialinfection and 4 deep. 4 patients had non-

union and one delayed union. Lockingplate fixation is technically demandingand achieves good results.

415

The Dudley grid: Anevidenced-basedaudit/research tool toinvestigate mortalitywithin 1-year following adisplaced intracapsular hipfractureMJ Gandhi, S Bhasin, S Quraishi [Dudley]

Introduction: we present a tool to aidmanagement plans taking into accountpatients’ mortality risk and mobility.Methods: Factors analysed in patientssustaining displaced intracapsular hipfractures: Nottingham Hip Fracture Score(NHFS), age, gender, admissionhaemoglobin and pre-admission walkingability. Analysis: Cox proportional hazardmodel. Results: N=562. All factorssignificantly influenced mortality risk.Walking ability gives an indication of hipuse. Conclusion: multiple factorsinfluence mortality risk. Walking abilitycan be displayed alongside the NHFS in agrid format. The Dudley Grid can displayincidence and mortality data and hencethe basis of a more objectivemanagement strategy.

433

Patient reported outcomesmeasures (PROMs)following internal fixationof distal radius fracturesR Jeavons, H Thirkettle, J Auyeung [Durham]

We retrospectively reviewed all distalradius fractures treated with APTUSDistal Radius Plating System (MedartisAG, Basel. Switzerland) over 6 years. Wecollected demographics, classifiedfractures and sent two postal PROMs,Patient Related Wrist Evaluation (PRWE)and Quick DASH to patients. Of 93

Notes


patients 10 were excluded. Mean age54.61 years; length of Follow up 2.35years; Mean time to theatre 3.82 days.62.7% responded to questionnaires;mean Quick DASH 32.69 and PRWE score34.12. No difference in PROMs wasfound between those with or withoutulnar styloid fractures or different plateconstructs. The APTUS plating systemoffers satisfactory PROMs.

484

Factors affecting 30 daycomplications anddischarge in patientsundergoing total hipreplacement for fracturedneck of femurS Dorman, V Gedela, R Thonse [Chester]

We reviewed the post-operativeoutcome of 42 total hip replacements(THR) done for fractured neck of femur(NOF) over a 20-month period to identifyspecific risk factors for complications andany further surgical intervention. 12/42patients experienced complications.Complications included catheterassociated urinary tract infection (5),pneumonia (2), superficial woundinfection (3), Myocardial Infarction (1)and dislocation (1). Length of stay andcomplication rates were higher inpatients treated on trauma wardscompared with elective wards. Wepropose that THR for fractured NOF bemanaged on a dedicated ward, urinarycatheters avoided and fascia iliaca blocksused for analgesia to facilitate toiletingand mobilisation.

491

The outcome of operativemanagement of extra-capsular proximal femoralfractures in the youngadult (< 50 years)DN Ramoutar, P Kodumuri, S Olewicz, JN Rodrigues, DP Forward [Nottingham]

Patient details were obtained from aprospective database (n= 88). Mean agewas 38.5 years. The commonest fracturetypes were basicervical (38.6%) and 2-part trochanteric (33%). The majoritywere treated with DHS fixation (84.1%)with few complications (5.7%). Meanlength of stay was 13.5 days. 17 patientshad died (19.3%) at a mean time fromoperation of 40 months. The one yearmortality was 4.5%. All deaths were fromother injuries or comorbidities. Patientshad returned to near normal function(assessed by SF-36 and EuroQol 5D), butstill had reduced function in the hip(Oxford Hip Score mean 38.4).

500

Training in a traumacentre: a United KingdomexperienceW Kieffer, K Gallagher, A Dean, R Crawley, I McFadyen, C Mills [Brighton]

Introduction: the UK Trauma Networkhas changed workload and thereforetraining/caseload across Hospitals.Objectives: we aimed to quantify thischange in a Teaching Hospital before andafter Trauma Centre designation.Methods: all TARN eligible patients andoperations April to August 2011 (Pre-designation) and April to August 2012(Post-designation) were studied. Theoperations performed and surgeon gradewere primary outcomes. Results: therewas no statistically significant differenceindex or trainee caseload. Conclusions:the impact of the trauma centre onsurrounding DGHs has not been studied.We propose continued monitoring toensure maximal trainee exposure andtrauma experience is maintained.

559

Patient factors associatedwith survival period andmortality within 30-days,90-days and 1-yearfollowing a displacedintracapsular neck offemur fractureM Gandhi, S Quraishi, S Bhasin [Dudley]

Introduction: this study investigatesfactors that influence mortality followinga displaced intracapsular hip fracture.Methods: factors analysed: NottinghamHip Fracture Score (NHFS), age, gender,admission haemoglobin, pre-admissionwalking ability and fracture side. Results:maximum eligible n=555. Across all timeframes, significantly lower mortalityrates observed in patients with lowerNHFS groups, who were younger, hadhigher admission haemoglobin andbetter outdoor mobilisers. Conclusions:the NHFS predicts mortality risk acrossall time frames. Admitting teams shouldclarify the patient’s outdoor pre-admission mobility as poorpre-admission outdoor walking abilityidentifies higher risk patients andpredicts the patient’s hip use.

575

Proximal femoral nail anti-rotation (PFNA) - quality ofreduction & fixation: adistrict general hospitalexperienceG Green, J Stanton, A Aframian, KS Khor, P Vinayakam, PJS Jeer [Margate]

Introduction: PFNA is used to achieveanatomical fixation insubtrochanteric/pertrochantericfractures. Tip-apex distance as apredictor of metalwork cut-out inintramedullary devices is poorlydocumented. Aims: outcomes followingPFNA. Methods: All PFNA sinceJanuary2011. Tip-apex distance andalignment measured radiologically.

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Fragment apposition graded. Results: 36follow-up. 12/36 united, 7/36 failed,11/36 callus no fixation loss, 6 no callus.Alignment: 23/55 “good”; bonyapposition: “excellent” 23/55, “verypoor” 12/55. Average tip-apex distancefailed PFNA: 36mm

Conclusions: quality of reduction relatedto failure but not cut-out. Tip-apex cut-out distance similar to DHS.Recommendations: aim tip-apexdistance < 25mm. Avoid varus.Anatomical reduction.

582

Prophylaxis for venousthromboembolism in neckof femur fracture: a re-auditA Aframian, KS Khor, G Green, P Vinayakam, PJS Jeer [Margate]Following Department of Health (DoH)efforts to reduce venousthromboembolism (VTE), we conductedtrust wide audits in VTE prophylaxis forpatients with neck of femur fracture(NOF), who are at high risk. DoH, NICEand Trust guidelines recommendthromboprophylaxis 28-dayspostoperatively.The Trust specialist-NOF wards wereaudited over a four month period.Results revealed lack of awareness andpoor compliance (< 10%) to guidelines.Findings were disseminated, teamseducated and change implemented. Re-audit revealed >90% compliance, in linewith the CQUIN targets with nosignificant drop-off during junior doctorchange-over. Simple and cost-effectiveeducation should be the first target forimprovement.

605

Importance of templatingof X-Rays and pre-operative planning beforeExeter Trauma Stemhemiarthroplasty of hipK Wronka, P Cnudde, B Sangar [Poole;Carmarthen]

Background: Exeter Trauma Stem(Stryker) hemiarthroplasty is prosthesissimilar to Exeter Hip Replacement.During femoral preparation sometimesfemoral canal is too narrow and surgeonmust use different prosthesis. Methods:retrospective review of patients listed forETS-Hemiarthoplasty.

Results: 380 patients were listed for ETS-hemiarthroplasty. In 34 cases-9%femoral shaft was too narrow andsurgeon was forced to changeprosthesis. 4 of those patients (12%)suffered early dislocation. Discussion: wenoticed significant conversion rate fromETS hemiarthroplasty to other prosthesisdue to narrow femoral canal. Thisresulted in high complication rates,disturbed theatre work, increased cost.We recommend careful pre-operativeplanning to avoid this.

671

The severely injuredelderly trauma patient: animpending flood?A Das, M Petrie, C G Moran, B Ollivere[Nottingham]

Aim: we aimed to establish the clinicalcourse for elderly patients with severetraumatic injuries. Methods: Wereviewed TARN data from our traumacentre between 2008-2012. Results: ourstudy included all patients aged over 65with an ISS>9 (n=724, mean age 79.7,mean ISS 16.3). 17% of patients wereadmitted to ITU. Hospital stay was amean of 17.7 days. 24-hour mortalitywas 3.2% and 14.5% at 30 days. 1 yearsurvivorship was 78%. Head injury and C-spine fractures were strong predictors of

mortality (p=0.0001, p=0.045).Conclusion: we observe significant earlymortality and prolonged hospital stays inthis expanding demographic of thepopulation.

809

Handling extremity injuriesin 26yrs counter-terroristwar: a Sri Lankan civil warexperienceC Karunathilaka, N Pinto [Colombo, Sri Lanka]

In the Sri Lankan civil war humancasualties started with cut injuries, blunttrauma, shot gun injuries and developedinto a stage of extensive soft tissue andbone injuries. Objective: identify theextremity injury pattern. Evaluate theprinciples of management of extremityinjuries. Results: non ballistic injuriesreduced over the years and ballisticinjuries increased. 70% had extremityinjuries - remarkably high compared toworld figures. In the immediate post warEra, the extremity injury patterns weredue to inappropriate treatments.Conclusion: management of war injuriesis a real challenge between evidencebased orthopaedics and experiencebased orthopaedics.

873

Validation of a virtualreality trauma simulatorK Akhtar, K Sugand, A Chen, J Cobb, C Gupte[London]

28 participants (7 each in 4 cohorts ofdiffering experience) performed fixationof a femoral neck fracture on a VR DHSsimulator and completed Likert-scalequestionnaires before and after. Thesimulator was seen to have good faceand content validity and wasunanimously accepted as a usefullearning tool, particularly by juniorsurgical trainees. There is a desireamongst junior trainees for simulationbased training to give them theconfidence and skills to transfer to theoperating theatre, but there is a need for

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heightened fidelity to make this anappropriate training tool forincorporation into the orthopaediccurriculum.

905

The role of iliaco-fascialblocks for pre-operativepain relief in patients withneck of femur fractures P Buddhdev, A Ghatahora, A Kalraiya [London]

Iliaco-fascial Blocks are a noveltechnique using local anaesthetic forpain relief in hip fracture patients. It is aneasier, cheaper and safer method, withpain control found to be significantlybetter compared to opioids. Weprospectively studied 80 patients withneck of femur fractures; Group 1received regular oral analgesia andoramorph, Group 2 received an iliaco-fascial block and the same regular andPRN analgesia. There was a statisticallysignificant improvement in the visualanalogue pain scores in the groupreceiving the blocks and an 80% averagereduction of PRN oramorphconsumption, improving patientsatisfaction and reducing complications.

1012

Use of the Dall-Miles platefor periprosthetic femoralfractures: 27 cases and areview of the literatureD Dargan, M Jenkinson, D Acton [Londonderry]

A cable plate is an established treatmentmethod for Vancouver type B and Cperiprosthetic femoral fractures. The useof the Dall-Miles (Stryker) broad boneplate in a district general hospital wasevaluated over a 2 year, 10 monthperiod. Twenty-seven fractures werefixed using a Dall-Miles plate during thistime. Two plates fractured and twofurther fixations loosened, developingvarus malunion. All four events occurredwithin six months of plate fixation. The

increasing population age andprevalence of hip arthroplastyprostheses will likely increase theincidence of periprosthetic femoralfractures. This will lead to a greaterunderstanding of their outcomes.

Foot & AnkleSurgery

238

Rheumatoid forefootreconstruction: outcome of1st metatarsophalangealjoint fusion and theStainsby procedure in thelesser toesE Bass, S Sirikonda [Liverpool]

12 patients underwent 13 novelcombinations of 1stmetatarsophalangeal joint fusions andStainsby procedures between 02/2009and 11/2012. AOFAS scoring wasperformed preoperatively and again sixand 12 months post-surgery. Halluxvalgus (HVA) and intermetatarsal angles(IMA) were measured preoperatively andsix weeks and six monthspostoperatively. The mean AOFAS scoreincreased from 45.67 to 73.58 12months postoperatively. The mean HVAreduced from 47.76 degreespreoperatively to 14.35 degrees sixmonths postoperatively. The IMAdecreased from 14.86 degrees to 9.65degrees six months postoperatively. Thisnovel approach is an effective procedurethat reduces forefoot deformity andpain.

297

Treatment of Freiberg’sdisease with modifiedWeil’s osteotomy ‘a caseseries’K David-West [Kilmarnock]

The initial treatment of choice forFreiberg’s diseases is non-operativeconservative management, whenconservative treatment has failed. Thereare various surgical procedures. Thisreport is one of the large series ofmodified-Weil’s osteotomies in 12-feetwith Freiberg’s diseases of stage-2 andabove. Mean-follow of four-and-halfyears. Mean-age 30.7 years. Nine-feet-75% had Freiberg’s diseases affecting thesecond metatarsal and three-feet-25%had Freiberg’s disease in the thirdmetatarsal head. AOFAS pre-operative-score was 48.1 and post-operative-scorewas 88.9. Mean improvement was 40.8.Modified-Weil’s osteotomy is aneffective procedure for the treatment ofFreiberg’s disease and few complications.No patients had transfer metatarsalgia.

466

The value of rapid surgicaldebridement in infecteddiabetic forefoot ulcersE Izadi, M Edmonds, V Kavarthapu [London]

Background: the role of rapid surgicaldebridement in management of diabeticfoot ulcers is unclear. Methods: 23patients received conservativemanagement for forefoot ulcer becameinfected. 70% neuropathy and 40%Charcot’s. Average age 54.2.Male/Female 3/1. 82% type 2 Diabetes.Result: 85% surgery within 24 hours;56% amputation and 12% plastic referral.78% positive specimens, 33%Staphylococcus Aureus. Time intervalbetween ulcer development and surgerywas 17.5 months. Healing occurred in 19patients (83%),an average time of 7.6months; 4 patients (17%) remainedunhealed. 61% had improved mobility.

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Conclusion: high value of rapid surgicaldebridement in infected diabetic footulcers.

733

Hindfoot fusion inhaemophiliac arthropathyM Brkljac, S Shah [Manchester]

We looked at the outcomes of varioustechniques of hindfoot fusion usinginternal fixation for the treatment ofhaemophiliac arthropathy of thehindfoot. 28 patients underwent 42procedures. 35 ankle fusions; sevenwere arthroscopically fused, six by aminimal access approach, the rest byopen approach. Two isolated subtalarfusions, two combined ankle andsubtalar fusions; one included atalonavicular fusion and also an isolatedtriple ankle fusion. The non-union ratewas 9.5%; all cases were followingtibiotalar fusion. One deep infection(2.8%) occurred in an arthroscopicallyfused ankle.Hindfoot arthrodesis is successful withcomparable outcomes to non-haemophiliacs.

847

Pathogenesis of avulsionfracture of the base of thefifth metatarsal bone: acadaveric studyMA Mussa, J Salim, PE Allen, G Hussain, B Luo[Hull; Leicester]

The anatomy of the structures attachedto the proximal portion of the 5thmetatarsal bone was studied toinvestigate the potential pathogenesis ofavulsion fracture in this region. 32human cadaveric feet were dissected.The pathogenesis of avulsion fracturesproximal to the tuberosity seems to berelated to the violent pull of the strongand extensive structure formed by theconverging fibres of lateral cord ofplantar aponeurosis and the Peroneusbrevis tendon. The current consensus

that this fracture is caused by theavulsion force of Peroneus brevis tendonalone seems unlikely to be true.

902

Gait analysis of the effectof postoperativerehabilitation shoesS Javed, R Rachha, F Alvi, A Lui, Z Hakim, A Shoaib [Stockport]

Introduction: this study aims to establishthe effect of post-operative shoes onother joints using gait analysis. Methods:11 healthy volunteers were studied withgait analysis equipment and the jointmotion assessed with commercialsoftware. Results: there was a reductionin knee flexion and extension comparedto the contralateral leg in all phases ofthe gait cycle. This was the case withboth heel wedge shoes and inflatable airboots. Conclusion: patients are at risk ofinitiation or exacerbation of low backpain or lower limb joint pain from theuse of postoperative shoes.

Elbow andShoulders Surgery

46

Coronal stabilization andbracing of displacedcapitellum fractures: asimple Kirchner wirestapling techniqueS Sonanis [Aberystwyth]A study was done using J shapedKirschner(K) wires to internally fixdisplaced capitellum fractures.

Since 1989 total 17 patients, Type I:(Hans Steinthal #)12, Type II: (KocherLorez #)1, and Type III: (Broberg andMorrey #)4 were treated. Averagefollowup was 31.7months and capitellumfractures healed in all the patients. Mayo

elbow performance score was excellentin 12, good in 4, and fair in 1 patient.Average elbow ROM was 5 to 132degrees, pronation 84.5 degrees andsupination 88 degrees. Complicationsseen were wire pain, loosening. Wefound K wires stapling technique to bevery easy and stable.

234

Analgesic provision forpatients undergoing daycase arthroscopic shouldersurgery in a district generalhospitalA Hayward, D Wallace, O Bailey, A Winter, E MacDonald, K Cheng [Glasgow]Post-operative pain is well recognisedafter shoulder arthroscopy. The majorityare day case procedures, under generalanaesthetic using a nerve block or localanaesthetic infiltration.The aim of our audit was to investigatethe adequacy of analgesia. Fifty patients,who underwent arthroscopic shouldersurgery, were contacted to assess painscores and analgesic requirements.

Patients who received a block werefound to have a significantly longerduration of pain relief and also had atrend for less pain performing their usualactivities. Our audit has confirmed thatnerve blocks provide longer pain relief,supporting the use of them if resourcesallow.

364

Complications related totension band wiring ofolecranon fracturesAAH Parkar, S Adesina, M Barry [London]

The records and X rays of 84 patientsoperated on between November 2006and February 2012 were reviewedretrospectively. Symptomatic metalworkprominence was noted in 53.6% (45/84)of cases. In 19.0% (16/84) theintramedullary wire was noted to have

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backed out and this was more likely tohave occurred when the wire was intra-medullary (68.7%, 11/16) compared toan anterior cortex penetration (31.2%,5/16). 56.2% (9/16) of the wires thatbacked out were symptomatic. Otherpost-operative complications includedsuperficial wound infection in 6.0%(5/84), failure of fixation in 3.6% (3/84)and non-union in one patient needingrevision with plate.

483

Clinical and radiologicaloutcome following 4thgeneration total shoulderreplacement - early resultsD Thyagarajan, V Kumar, J Blacknall, J Geoghegan, P Manning, WA Wallace[Nottingham]

We report our early experience of a 4thgeneration Vaios shoulder arthroplastysystem. Aim: to assess outcome ofpatients treated with the Vaios totalshoulder replacement system. Methods:We performed 216 total shoulderreplacements (Vaios, JRI). Results of theinitial 87 patients are reviewed with anaverage follow up 32 months (24 - 41months). Results: the mean Oxfordscores improved from 16.5 to 35.5following primary anatomic replacementand from 17 to 29.7 following inversereplacement. Conclusion: the earlyresults are promising and good outcomewas observed but it is important tomonitor the medium and long termoutcomes.

487

Night time shoulder pain isnot a positive indicator forrotator cuff tearsS Hassan, C Blundell, E Burgess, CP Charalambous [Blackpool]

Introduction: in patients with shoulderpain of sub-acromial origin, night painhas traditionally thought to be predictiveof Rotator Cuff Tears (RCTs). Objective: to

determine if night pain was indicative tothe presence of a RCT. Methods: datawas collected prospectively byConsultant, trainees and specialistphysiotherapists using a pre-designedproforma. Results: using logisticregression the degree of associationbetween RCTs and Eight Variables (Age>60, Gender, Trauma, Impingement, Cuffweakness, Painful Arc and Night pain andif Night pain>day) were investigated. Theonly variable that was significantlyassociated with RCT was age(p< 0.01).Conclusion: this study showed nightshoulder pain in isolation is not a helpfultool for predicting RCTs(p=0.47).

514

Clinical outcome ofrevision surgery for failedBristow-Latarjet procedureV Beckles, O Uri, S Lambert [Stanmore]

Medical records of 15 patients withfailed Bristow-Latarjet procedure whowere referred to our hospital werereviewed. The reason for failure waspainful anterior instability in 9 patients,secondary glenohumeral arthritis in 4patients and painful stiffness in 2patients. Seven of the patients who hadrecurrent instability underwent revisionanterior stabilization with iliac crest boneblock and were followed-up for a meanof 15 months. At the latest post-revisionfollow-up all the shoulders remainedstable. Oxford shoulder instability scoreimproved from 55±4 to 42±9 (p< 0.01)and pain level decreased from 9.4±0.8 to5.6±3.5 (p=0.01).

754

Isolated greater tuberosityfracture stability andassociation withdislocationR Dolan, T Harding, S Hannah, I Anthony, R Halifax, J Wells, A Brooksbank [Glasgow]

A retrospective analysis of isolatedgreater tuberosity fractures. The primary

outcome measure is further fracturedisplacement following conservativemanagement. Secondary outcomemeasures being the number of follow upx-rays, the time between follow up,associated dislocation and measurementof inter-observer variability. 22% (n8) offractures displaced less than 5mm atpresentation further displaced to greaterthan 5mm at follow-up, with 88% (n7) ofthese associated with concurrentdislocation. This demonstrates thatisolated greater tuberosity fracturesdisplaced less than 5mm at presentation,which are not associated withdislocation, are stable. Therefore there isscope to reduce follow-up in this patientgroup.

864

Ulnar nerve compressionneuropathy: what is therole of electromyographybefore surgery?E Lindisfarne, O Templeton-Ward, E Smee, J Granville-Chapman, A Hearnden, P Magnussen[Guildford]

Electromyography (EMG) of the ulnarnerve may be normal when tested inpatients despite a history and clinicalsymptoms of Ulnar Neuropathy at theElbow. Our aim was to determine ifpatients with normal electrophysiologyhad symptomatic improvement afteroperative treatment. 36 patients withhistory and symptoms of cubital tunnelsyndrome had operative decompression.Pre-operative EMG was abnormal for 22and normal for 14 patients. Symptomaticimprovement at follow up was noted in17 (77%) and 11 (79%) patientsrespectively. Patients with normal EMGmay still benefit from operativedecompression. Success of surgery is notpredicted by positive EMG results.

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Children’sOrthopaedics

178

Ultrasonographic findingsafter Achilles tenotomyduring Ponseti treatmentfor club feet. Is ultrasounda reliable tool to assesstendon healing?P Nasr, L Berman, A Rehm [Cambridge]

We monitored the post tenotomyhealing process in 20 tendons using highfrequency ultrasound. We studied 9normal controls and 11 tendons that hadundergone an achilles tenotomy upto 7years previously. Our primary studygroup were followed up with scans for aminimum of 6 months.We encountered pitfalls in the use ofultrasound to define stages of healingthat were not described in previousstudies raising doubts regarding accuracyof this method. We discuss the principlesof anisotropy and partial volumingeffects that can give spurious imagesfrom which it is difficult to draw any firmconclusions.

357

Biomechanical analysis ofposterior intrafocal pinfixation for the paediatricsupracondylar humeralfractureD Marsland, S Belkoff [Baltimore, United States]

We aimed to assess the stiffnessprovided by a recently describedposterior intrafocal pin fixationcompared with standard fixationmethods for supracondylar humeralfractures. In 15 pairs of cadavers,Gartland type 3 supracondylar fractureswere created and stabilized using theposterior pin method, crossed pins or

divergent lateral pins. Specimens werethen subjected to internal rotation. Thetrend showed that the greatest stiffnessand peak torque were provided bycrossed pins followed by lateral pins andthen the posterior pin (differences notstatistically significant). Our resultssuggest that posterior intrafocal pinfixation provides equivalent torsionalstiffness to standard fixations.

907

Patient reported outcomemeasures in the non-operative management ofpaediatric claviclefracturesR Morrell, R Jeavons, J Kent, A Gower[Newcastle]

Optimal management of paediatricclavicle fractures remains debatable: weanalysed Patient Reported OutcomeMeasures (PROMs) retrospectively in 83paediatric clavicle fractures treated non-operatively. Fractures were classifiedusing Craig Modified AllmanClassification. Patients over 16years atstudy commencement received OxfordShoulder Scores(OSS) and Quick DASHScores, the remaining patients receivedPain Scale Scores. Mean age was8years.Response rate was 76%.58 Type I,5 Type II fractures. Adult questionnaires:mean OSS 59.3 and 59.7 in Type I/IIfractures respectively, mean QDASH was3.100% reported OSS reflecting excellentoutcomes. Paediatric questionnaires:84.4% no residual pain. PROMs/PainScale data suggests non-operativelytreated paediatric clavicle fractures haveexcellent outcomes.

935

Treatment of clubfoot withthe Ponseti method- theLeicester experience-results & analysisA Ghosh, A Furlong, A Abraham [Leicester]

Treatment of clubfoot at our institutionis by the method described by Ponseti.We present our results and analysis oftreatment of all patients treated fromJanuary 2009 (61 feet).

970

Management of bothbones forearm fractures:“To nail or not to nail”?O Akilapa, C Petrides, M Roper, E Bache[Birmingham]

The management of complete bothbones forearm diaphyseal fractures ischallenging as these fractures areinherently unstable with equivocalevidence about the best treatmentoptionsWe compared the functional outcomesof sixty nine consecutive AO Type 22-A3fractures treated by CRC (28) and ESIN(41) between 2006 and 2010. The resultsshowed comparable complication ratesin both groups (7 malunions in CRCversus superficial radial nerveneurapraxia (3), iatrogenic extensorpollicis brevis damage (1), prematureremoval of a prominent nail (3), cellulitis(1) and malunion (1) in the ESIN group.ESIN is a viable but not “minimallyinvasive” treatment option.

977

Management of GartlandIII supracondylar fractures;time is not of the essenceO Akilapa, C Petrides, M Roper, E Bache[Birmingham]

The timing of treatment of displacedpaediatric supracondylar humerus

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fractures is a very important practicaldilemma. The clinical and radiologicalrecords of eighty nine consecutivepatients were reviewed retrospectivelyto compare the outcomes of early (< 12hours) versus delayed surgical treatment(>12 hours). The early and delayedgroups were similar in regard to gender,age and length of follow-up. There wasno statistically significant differencebetween with respect to peri-operativecomplications regardless of the timing oftreatment. The suitability ofurgent/emergent treatment can bebalanced against the availability of asurgeon, access to theatre, and safeanaesthesia.

Spinal Surgery

304

We count but should wescrutinize? An unreportedcomplication in spinalsurgeryHB Abdul-Jabar, M Smith, M Kotrba [Croydon]

Complications following spinal surgerycan range from simple wound infectionto complete paralysis. Intraoperativechecks have been introduced to accountfor all the instruments and materialsused and help minimize surgeon relatedcomplications. We report a case of abroken osteotome tip within the spinalcanal following a routine posteriordecompression of the lumbar spine.

562

Is there seasonal variationin presentation of caudaequina syndrome (CES)?M Venkatesan, S Balasubramanian, C Uzoigwe,J Braybrooke, M Newey [Leicester]

Seasonality in ischaemic coronary arterydisease and other vascular territories iswell documented with a winter/summervariation the commonest pattern. Wesought to discover whether there is a

seasonal variation in the presentation ofcauda equina syndrome. We collecteddata on 40 consecutive patientsundergoing emergency lumbardiscectomy for MRI proven CES. Monthof presentation was noted. There is noseasonal variation in the presentation ofCES (Winter p=0.3, Spring p=0.9,Summer p=0.8, Autumn p=0.1).Therewas no gender difference in seasonalpresentation (p=0.86).However, weobserved monthly variation ofpresentation clusters. Vast majoritypresented in September and Octobermonths (14/40). This was statisticallysignificant (p=0.0077).

563

Is there a genderdifference in lumbarsubcutaneous fatdistribution?M Venkatesan, D Mahadevan, C Uzoigwe, J Braybrooke, M Newey [Leicester]

Fat distribution plays important role inhealth. Different fat distribution occursin women and men in well recognizedbeing gynoid and android patternsrespectively. We sought to determine ifthere exists a gender difference inlumbar subcutaneous fat distribution.Two observers reviewed MRI images of88 consecutive patients who underwentlumbar discectomy to measure thicknessof subcutaneous fat (measured at L4level) respectively. There were 47women and 41 men with a mean age of43.5 years. Mean BMI of men andwomen was 28.3 and 27.9 respectively.Although women tend to have slightlyhigher subcutaneous fat distribution, thisdifference was not statistically significant(p=0.2).

868

The invaluable role ofSPECT imaging inidentifyingpseudoarthrosis followingprevious lumbar spinalinstrumented fusionG Prasad, SK Tucker [Stanmore]

We present a case of persistent low backpain in a male patient who had L4/5 andL5/S1 posterior lumbar inter-bodyfusion. CT scan suggested pseudo-arthrosis at L4/5 level but fusion atL5/S1. SPECT scan howeverdemonstrated non-fusion at both levels,further evident intra-operatively. Heunderwent revision fusion surgery ofboth levels and improved dramatically.SPECT imaging has the advantage ofcombining benefits of both bone scanand CT, therefore more specific inassessing fusion. Moreover, its resultsare not affected by metal artefact.Perhaps SPECT should be the firstinvestigation modality, particularlywhere multiple levels might beimplicated as cause of on-goingsymptoms.

989

Neck pain and stroke:should it be ignored?Beware of neck pain insuspected stroke. Cervicalepidural abscess can mimicstroke. Report of two casesKV Sigamoney, H Gakhar [Newcastle]

Introduction: we would like to highlighttwo cases provisionally diagnosed asCVA, in which neck pain was initiallyignored. Both turned out to be cervicalepidural abscesses. The delay indiagnosis and treatment led tosuboptimal outcome in both cases.Discussion: late recognition often leadsto permanent weakness/ paralysis. Itcauses severe neurological deficit by

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compression of the abscess onto thespinal cord or nerve roots or by causingischaemia secondary to vascularthrombosis. Conclusions: we suggestperforming an MRI spine particularly inthe presence of inflammatory markers inpatients with suspected CVA and neckpain with negative CT brain scans.

Hand Surgery

159

Effect of sex and ethnicityon range of movement ofhand and wrist joints innormal subjectsM Shahid, S Mahroof, K Bourne, F Wu, C Simpson, M Lawson-Smith, R Jose, G Titley[Birmingham]

Many existing hand rehabilitationprotocols were based on data fromCaucasian patients. There is a perceptionthat patients of Asian origin haveincreased joint mobility and this maylead to better postoperative outcomes.We compared the range of handmovements in healthy Caucasian andAsian participants. Subjects were dividedinto: Asian males, Asian females,Caucasian males and Caucasian females.In the small finger joints Asians hadgreater movements compared toCaucasiansNormative data for different ethnicgroups is important for hand therapy asthey can guide rehabilitation protocols.We demonstrate a difference in handflexibility between both groups.

161

Immediate mobilisationversus immobilisationfollowing excision of thetrapeziumF Wu, M Shahid, S Deshmukh [Birmingham]

Introduction: this retrospective studyreviews the outcomes of 30 patientswho underwent trapeziectomy and

ligament reconstruction between 2005and 2010 with two rehabilitationregimes. Methods: Fifteen patients wereimmobilised for six weeks post-operatively in a plaster-of-Paris castbefore commencing hand therapy.Fifteen patients were mobilisedimmediately post-operatively.Assessments included subjectivesatisfaction, pain measurement, range ofmovement, grip and pinch strengths,DASH and PEM scores. Result: therewere no significant differences inoutcome between the two rehabilitationregimes. Conclusion: cast immobilisationfollowing trapeziectomy and ligamentreconstruction confers no additionalfunctional benefit over immediatemobilisation.

LimbReconstruction

789

Robot-assisted, custom-made, unicompartmentalknee arthroplasty formassive, traumatic,osteoarticular lossB Andrews, S Shunmugam, S Clarke, D Floyd, A Aqil, J Cobb, MSk Lab, Imperial College London[London]

In a novel solution for massiveosteoarticular bone loss of the kneefollowing trauma, robot-assisted surgeryand patient-specific implantmanufacture were integrated. Theprocedure has been performed in twosoldiers on the medial compartment,and in one soldier the lateral. Patient-specific titanium unicompartmentalprostheses were designed to fillosteoarticular defects. The bone wasprepared using a haptic robot, to matchthe curved implants. At 6 months, allpatients are pain-free and walkingunaided. Radiographs are satisfactory. 2patients developed deep post-opinfections, which have been treated

successfully. The combined technologiesoffer a highly conservativereconstruction option.

Tumours

157

Outcomes after surgicaltreatments forperiacetabular metastaticlesionsM Shahid, T Saunders, A Kotecha, L Jeys, RGrimer [Birmingham]

Background: to develop a treatmentalgorithm for the surgical managementof symptomatic periacetabularmetastases. Methods: eighty-onepatients were identified. The diagnosis,size of lesion, performance status,survival, pain, mobility andcomplications were recorded. Results:the most common diagnoses weremetastatic breast carcinoma. Five yearsurvival was 5%. Most patients receiveda Harrington Reconstruction(32)followed by a Total Hip Replacementwith cementoplasty (32) then an icecream cone hemipelvic replacement(11).Pain scores improved postoperatively.Conclusions: we recommend an icecream cone for pelvic discontinuity andHarrington rod reconstruction for severebone loss. Smaller defects can bemanaged with standard revision hiptechniques.

386

Deep fibromatosis – areview of current practice,long term recurrence ratesand survivalN Eastley, R Aujla, C Richards, C Esler, R Ashford[Leicester]

Introduction: there are no publisheddiagnostic algorithms for suspectedcases of deep Desmoid Fibromatosis. Weoutline such a pathway centred onadequate imaging, appropriate tissue

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biopsy and early soft tissue tumour MDTinvolvement (prior to definitivetreatment). Methods: we performed an8 year retrospective review analysingmodes of diagnosis, managementstrategies, oncologic outcomes,recurrence rates and the effects of ourproposed pathway. Results: we analysed47 cases. Variance was seen in theimaging modalities and biopsytechniques used and MDT involvement.Conclusions: adherence to our proposedstrategy may increase successful excisionrates (82% vs. 42%) without significantlyworsening oncological outcome.

546

Outcomes of surgicalmanagement of long bonesarcomas in children agedfive or under at diagnosisK Reddy, L Gaston, R Nandra, K Ozkan, R Grimer[Birmingham]

We report surgical outcomes in 42children with primary long bonesarcoma, aged five years or under atdiagnosis. Thirty patients with Ewing´sSarcoma and twelve with Osteosarcomawere included. Five patients weretreated with a primary amputation, 37patients underwent excisions, of which,4 were excisions alone; 18 underwentbiological reconstruction and 15 withEndoprosthesis. The cumulative survivalat five & ten years was 75% & 71%. Thesurvivorship of the originalreconstruction without major surgerywas 54% and 37.8% at five & ten years.This study shows young children (age< 5)can have successful limb salvage intoadulthood.

569

The use of neo-adjuvantradiotherapy in themanagement of peri-articular soft tissuesarcomaC Green, N Nguyen, J Wylie, A Choudhury, J Gregory [Manchester]

17 patients were treated between 2009-2012 for periarticular soft tissue sarcomawith a standardised protocol involvingneo-adjuvant radiotherapy. Limb salvagesurgery took place six weeks aftercompletion of radiotherapy for 16patients, one patient had delayedsurgery due to erythema. 16 patientshad negative margins on resection, onepatient required further surgery. After amean follow-up of 21.4 months no localrecurrences have been found, twopatients developed metastatic disease.Wound complication rate was 17.6% (3patients). TESS scores were 86.1 and78.1 for upper and lower limb tumours.Neo-adjuvant radiotherapy may benefitpatients despite lower doses ofradiation.

652

Two week referrals forbone and soft tissuetumoursCR Varrall, S Murray [Newcastle-upon-Tyne]

Introduction: NICE guidelines forsarcoma referral. Studies showincreasing referrals without increasingdiagnoses. Method: Prospective reviewof Northern Bone and Soft TissueTumour Service referrals over threemonths looking at guideline compliance.Results: 32 referrals under 2 week rule. 6malignancies - all met criteria. 26 benigndiagnoses - five did not meet criteria. 9delays for investigations. No consistentreferral form. 61 MDT pathwaysreviewed. Discussion: Compared with2007, increasing referrals with a similarmalignancy rate. Enhanced referral

pathway required with GP education. Wehave new referral form, updated websitewww.newcastlesarcoma.org.uk, andwork with Cancer Network on GPawareness.

820

Skeletal chondromyxoidfibroma: proposal of aprotocol for managementof these rare tumoursJ Bhamra, H Al-Khateeb, B Dhinsa, P Gikas, M Brown, W Aston, R Pollock, J Skinner,S Cannon, T Briggs [Stanmore]

Chondromyxoid Fibroma (CMF) is a rarebenign bone tumour, accounting for <1% of all bone tumours. Varioustreatment strategies have beendescribed, all with varying outcomes. Weassessed functional outcomes postintralesional curettage in 22 patientsusing the Musculoskeletal TumourSociety scoring system. All patients wereinvestigated using our standard protocol.There were 9 males and 16 females witha mean age of 36.5 years. Mean follow-up was 4.3 years. The average MSTSscore achieved post-operatively was96.7%. Local recurrence occurred in 2patients (9%). We conclude thatintralesional curettage is an effectivetreatment strategy for skeletal CMF.

834

Local recurrence in ewingssarcoma: the enigma ortreatment?L Jeys, J Kozdryk, R Grimer, A Price [Birmingham]


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Research

235

The equivalence of remoteelectronic and papercollection of patientreported outcomemeasures (PROMs): acrossover trialW Griffiths-Jones, D Williams, M Norton, D Fern[Truro]

The collection of Patient ReportedOutcome Measures (PROMs) isincreasingly being used in everydayclinical practice. Online remotecollection provides a platform to collectscores at regular intervals. The aim ofthis study was to assess the equivalenceof this to traditional collection methods.Patients were allocated to one of twogroups as part of a randomised crossoverstudy. Group 1 completed online scores,followed by the paper equivalents oneweek later. Group 2 visa versa.The Intraclass Correlation Coefficient(ICC) for the scores ranged from 0.95-0.99, demonstrating excellentequivalence between electronic andpaper collection using this website.

401

The effect of the MediShoeon knee gait kinetics: apreliminary clinical studyK Ghosh, S Robati, A Shaheen [Cardiff; Guildford]

Background literature suggests rigidsoled shoes may increase the kneeadduction moment during gait. Gait wasanalysed with/without a specificpostoperative shoe during gait. Theangle at which the ground reaction forceacted to the ground in the coronal planeas well as the tibiofemoral angle werealso calculated with/without the shoe.Two-tailed paired t-tests (95% C.I)showed no significant differencebetween the two groups in estimated

knee adduction moment (p=0.238),tibiofemoral angle (p=0.4952) and angleof the ground reaction force to theground (p=0.059). This shoe appears notto have a significant effect on kneekinematics in healthy individuals.

452

Gait assessment duringfast and incline walkingdistinguishes between wellfunctioning hiparthroplastiesA Aqil, R Drabu, J Bergmann, M Masjedi, B Andrews, S Muirhead-Allwood, J Cobb[London]

Introduction: we assessed whether aninstrumented treadmill revealedbetween-leg gait differences in bilateralhip replacement subjects. Methods: thisethically approved, blinded study used 9subjects who were compared to amatched control group. Results: at thefastest speeds, differences in weightacceptance reached significance(1208Nv1279N, p=0.03). There werepositive correlations between increasingspeed and between leg differences in:weight acceptance (r=0.9, p=0.000),push-off (r=0.79, p=0.002) and Impulse(r=0.75, p=0.005). At steepest inclinesthere were differences in push off forces(1120Nv1177N, p=0.01). Control grouplegs were symmetrical. Conclusion: gaitassessment at challenging speeds andslopes can identify high-performingarthroplasties.

489

A study of femoral headshape in patients withosteoarthritisO Diamond, JC Hill, A Smyth, K De Sousa, M Bowes, DE Beverland [Belfast; Manchester]

The aim of this study was to measure thesphericity of the femoral head andassess the fitting error to a sphere of theanterior, posterior and superior surfaceson pre-operative CT scans in a

consecutive group of patients going forTHA. Results showed that the fittingerror and 95% confidence intervals forthe overall population was 0.58mm(CI0.52-0.64). Fitting error for very severelydiseased hips was 0.74mm(CI 0.66-0.82).The posterior surface appears lessaffected by osteoarthritis than thesuperior or anterior surfaces in severedisease.

698

Can the healing potentialof juvenile cartilagefollowing trauma beextended to the adult?V Asopa, J Saklatvala [London]

Cartilage injuries commonly occur duringsporting activities and defects may betreated by microfracture, osteochondralgraft or chondrocyte implantation,however, the outcome of surgicaltreatment is variable. Poor qualitycartilage is often produced consisting ofType I collagen rather than Type IIcollagen of healthy articular cartilage. Asystematic study of adult and juvenileporcine articular cartilage is presented.Juvenile cartilage produces significantamounts of type II collagen and Sox9unlike in the adult. Understanding thisprocess will enable better treatments toaugment current surgical practice.

726

An MRI based assessmentof various axes todetermine femoralrotation during total kneereplacementP Mohanlal, R Prasad, A Vijapur, S Jain[Medway]

A prospective study was performed on205 MRI scans of knee to analyse variousaxes used to determine femoral rotationduring total knee replacement. Thetransepicondylar, posterior condylar,posterior femoral cortical, anterior

Notes


femoral cortical and tibial antero-posterior axes were measured. Themean relation between the posteriorcondylar and transepicondylar axes was4.04 (SD-2.27), posterior condylar andposterior femoral cortical axes was 5.05(SD-2.81), posterior condylar andanterior cortical axis was 6.03 (SD-3.37),and posterior condylar and tibial antero-posterior axes was 89.3 (SD-5.48). Thisstudy confirms transepicondylar axis tobe the most consistent amongst thelandmarks used to determine femoralrotation.

768

Bone and joint physiologyduring activity:intraosseous pressure re-explored and jointpathology explainedM Beverly [Southall]

Small areas of local bone circulation andphysiology can be studied at the tip of aneedle in cancellous bone. By usingalternate proximal arterial and venousocclusion we see that subchondral boneis a compressible perfused sponge with a‘pumped’ microcirculation.Very highpressures arise in subchondral boneduring ordinary walking. There areanatomical adaptations to cope withthese pressures. Failure of subchondralcirculation causes arthritis which ismainly a ‘vasculo-mechanical’ disease.This work explains the spectrum ofarthritis, osteonecrosis and other jointpathology.

972

Perceptions of simulationbased training in trauma &orthopaedicsK Akhtar, K Sugand, A Chen, J Cobb, C Gupte[London]

18 participants (3 each in 6 cohorts ofvarying levels of experience) performedVirtual Reality (VR) DHS fixation of a

femoral neck fracture. A pre- and post-study Likert scale questionnaire wascompleted. Significant positive changeswere seen in the perception of VRtrauma simulation in orthopaedictraining after using a simulator. Using thesimulator provides an insight into theknowledge, skills and attitudes that canbe gained through vicarious training andthere is a significant consensus thatsimulation has a role to play in trainingthe orthopaedic surgeons of the future.

992

Extensor mechanismefficiency followingpatellofemoralreplacement and totalknee replacement: acadaveric biomechanicalstudyMN Joseph, M Carmont, H Tailor, A Amis[Warwick]

The study aim was to determine whethergeometrical differences between TKRand PFR resulted in dissimilar extensormoment efficiencies (EME). Eightcadaveric knees were tested under fourconditions: native knee, PFR, CR-TKR andPS-TKR. PFR produced the greatest EME(p < 0.008) at 30° and 40° knee flexioncompared with native, CR- and PS-TKR.This suggests that PFR may be moreefficient during the more functionalrange of motion. All the prostheses hadsignificantly higher peak pressurescompared with native. Significantreduction in PFR peak pressurecorresponded with increased contactarea. The claimed benefits of PS-TKRwere not detected.

Audit &Management

111

Lower limb revisionsurgery: can the districtgeneral hospital afford it?R Chana, P Smitham, A Malik, B Mann, G Biring,D Johnstone [London]

Financial analysis of revision lower limbarthroplasty was performed in a districtgeneral hospital.Data on consecutive revisions werecollected between February 2011 andFebruary 2012. Of 81, 70 underwentsingle stage revision, 11 underwent two-stage revision (infection). Total implantcost: £309,365. LoS costs: £315,980,miscellaneous costs totalled £157,022.The HRG4 tariff returned £982,756. Theservice was £200,389 in surplus. Codingwas 70% accurate for primary procedure,90% accurate for co-morbidities.Inaccuracies resulted in £47,000 notbeing paid to the trust.The results support the continuedservice provision of revision hip andknee arthroplasty within the districtgeneral setting.

239

A prospective databasecan be successfully set upto monitor complicationsin total joint arthroplasty:our 8 year experience in adistrict general hospitalS Jonas, P Bosanquet, I Lowdon, J Ivory[Swindon]

National Joint Registries providemonitoring on survivorship and otherlong-term variables; however they maybe slow to react to local complications.Our unit has instituted a local reviewprocess as part of our department’sclinical governance programme to

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address this issue. Data has beencollected for the past 8 years regardingfirst year re-operations in lower limbarthroplasties and input using a simpleMicrosoft Access© database. It has ledto change of local practices of oralanticoagulants in arthroplasty DVTprophylaxis (Gill et al 2011). Local auditof arthroplasty complications isimportant in identifying problems notquickly identified in NJRs.

257

The WHO Checklist: can itbe used as an accurateaudit tool to identifytheatre inefficiency?A Vaughan, M Tulbure, C Cheesman, J Mutimer[Cheltenham]

Objective: We propose that the WHOchecklist, as well as maintaining patientsafety, can be used as an audit tool toidentify reasons for theatre delay orcancellation. Method: A retrospectivereview of 1166 orthopaedic patientWHO forms was performed at twoDistrict General Hospitals in 2012.Results and discussions: Theatre issues,staffing levels, and patient relatedproblems were identified as problematic.65.7% of theatre related delays wereattributable to equipment or sterilizationerror. Conclusions: This studydemonstrates that WHO checklists canadditionally be used an accurate audittool for identifying causes for patientdelay in our orthopaedic departments.

307

Patient safety. The WHOsurgical check listV Patel, J Auld, S West [Leicester; Northampton]

Patient safety. The WHO surgical checklist. Despite the introduction of the WHOsurgical safety our trust had 5 neverevents between 2010 -2012. Ananonymous questionnaire was sentamongst theatre staff to ascertain valuesand compliance relating to the WHO

check-list. Results concluded the clearneed for leadership ideally fromsurgeons to ensure WHO check-list isalways done properly. Although most(69%) staff thought WHO check-list wasimportant for patient safety, 52% felt amajor obstacle was due to lack ofenthusiasm. There is tendency to viewthe check-list as a ´tick box´ exerciserather than an integral tool.

405

Fracture clinic patientsatisfactionT Antonios, C Huber [London]

We aimed to measure patientsatisfactions with services offered at abusy district hospital fracture clinicagainst the NHS patient survey by theQuality Care Commission. Nearly 80% ofparticipants stated that “the reason oftheir visits dealt with to theirsatisfaction” which equals the nationalaverage. Moreover, 92% were satisfiedwith the care they received compare to95% of those surveyed nationally.Current patient satisfaction is similar tothe national average. The survey findingshave played a great part in shelving theplanned financial cuts to the departmentwhich would inevitably have affectedpatients´ satisfaction with the fractureclinic.

425

Improving communicationbetween orthopaedics andprimary care: a completed,closed loop audit cycleF Shivji, C Bailey, D Ramoutar, J Hunter[Nottingham]

Aims: this audit assessed the content ofdischarge summaries from theorthopaedic department in a teachinghospital. Methods: a randomised,prospective audit of sixty orthopaedicdischarge summaries was conducted.One-to-one teaching sessions with JuniorDoctors were given after the initial audit.

Results: initially, 90% of dischargesummaries had a correct diagnosis,whilst 91% had accurate medical co-morbidities, improving to 100% and 97%respectively post intervention. 72% hadan allergy status and follow updocumented, increasing to 95% and100% respectively. Conclusions: Groupteaching followed by short, non-labourintensive, one-to-one sessions for JuniorDoctors improved our communicationwith primary care.

495

An audit into transfusionpractice following hip jointreplacement surgery:improving standardsMY Khalfaoui, R Thalava [London; Manchester]

Introduction: blood transfusionrecommendations are largely based onguidance published in the British journalof haematology (BJH) in 2001. Methods:we conducted a retrospective audit oftransfusion practice in patientsundergoing hip-joint arthroplasty.Following an initial audit, doctors wereprovided with newly developed flow-chart protocols based on the agreedthresholds according to BJH guidelines.Practice was re-audited the followingyear. Results: the transfusion rate fromthe re-audit was 12.12% demonstratinga 43.6% reduction in the transfusion ratefrom the previous year (21.5%).Conclusion: this audit demonstrates theimportance of transfusion guidelines inensuring only necessary transfusions aregiven to patients.

601

The cost of repeatingradiographs inosteoarthritis of the kneeK Aggarwal, J Balogun-Lynch, A Chen, K Akhtar, K O’Neill, C Gupte [London]

Background: radiographs are oftenrepeated in patients with kneeosteoarthritis as weight-bearing

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radiographs were not performed onimaging ordered by GPs. Method:patients >40 referred for kneeradiographs between 01/01/2011-31/12/2011 were included. Radiographswere identified as WB/non-WB.Subsequent WB repeats weredocumented. 35 other London hospitalswere surveyed. Results: 97.7%(n=1923)had non-WB initial radiographs. 56 hadrepeat WB radiographs, costing £1232.54% of hospitals routinely performedWB radiographs. Conclusion: fewpatients referred by GPs have WB films.Many hospitals in London don´troutinely perform WB radiographs. Thecost of repeat imaging may represent asignificant financial cost to the NHS.

604

Importance of fractureliaison service in secondaryosteoporosis prophylaxis inelderly patients admittedwith fragility fracture totrauma wardK Wronka, C Topliss [Swansea; Carmarthen]

Background: NICE and BOA stress theimportance of secondary prevention ofosteoporosisMethods: we conducted audit andretrospective reviewed data of allinpatients who had fragility fracture inJuly 2011. After presentation of results,part-time fracture liaison service wasintroduced. We conducted re-audit inApril 2012 using same methodology.Results: initially only 14% of patientswith fracture different than NOF wereassessed for osteoporosis. Re-auditshowed that 48% of patients with non-NOF fracture were managed well. Allwere assessed by fracture liaison nurse.Discussion: we postulate, that with a fulltime fracture liaison nurse specialist, thepractice can be improved further.

619

Changing the consultanton call rota reduces timeto theatre for fracturedneck of femurM Kommer, K Gokaraju, S Singh [Bedford]

This study retrospectively analysedwhether changing the consultant rotafrom consultants being on call for a dayat a time to on call for a week at a timeresulted in a reduction in time to theatrefor patients presenting with hip fractureand whether it had impact on award ofbest practice tariff payments. Wecompared 2 similar 3-month periodsbefore and after the change in rota. Wefound that the average time to theatrewas reduced by 38.5% and that thenumber of cases done outside the 36hour cut off for best practice tariff washalved.

631

A solution to the problemof inadequate traumatheatre capacity -predicting the levels ofdaily trauma to plantrauma service provisionS Sarker, J Machin, H Krishnan, C Senior [London;Dorchester]

Timing of surgery is important in traumamanagement. National and regionalguidelines advocate fixation of fracturesneeding surgery, within 24 hours. Thisstudy aims to see if the level of dailytrauma admissions can be predicted,allowing planning of trauma serviceprovision. We analysed total admissions,admissions requiring surgery, admissionof patients with hip fractures andtheatre time needed and found nostatistical difference in all groupsanalysed in relation to the days of theweek.Our results show that an averagenumber of daily admissions requiringsurgery can be predicted, allowing the

planning of adequate trauma theatretime.

666

Clinical coding andpayment by results intrauma and orthopaedicsin a university hospital inthe United KingdomS Srinivasan, S Balasubramanian, M Bhatia, VRamasami [Leicester]

Health service providers rely on correctpayment for services provided topatients based on clinical coding.Inaccurate coding leads to incorrectinvoicing. Our audit demonstrates howeasily any organisation could loserevenue by poor data capture andinaccuracies in coding. While it isimportant to attract new business foradded revenue generation, it is vital toplug the holes to ensure there is nounder recovery of revenue for thebusiness episodes which have alreadyoccurred. It takes simple measures,cooperation and vigilance from all teammembers to achieve this goal.

672

Accuracy of data submittedto the NHFD from a busydistrict general hospitalC Gray, W Norton, H Divecha, S Mannion[Blackpool]

The National Hip Fracture Database(NHFD) is a key tool in monitoring andevaluating clinician and hospitalperformance against national standards.It relies on accurate submissions. Ourreview of 559 hip fractures from a busyDistrict General Hospital, andsubsequent comparison with the NHFD,showed significant discrepanciesbetween submitted and actual data.Amongst these, 94 cases (17%) had anincorrect fracture type listed on thedatabase, and 67 (12%) an incorrectoperation. This data may reflect thatfrom other units. Inaccuracies will have

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implications on annual NHFD reporting,and on research and conclusionsproduced from this data source.

721

Completion of audit cycle-medicines prescribed butnot given: are wenegligent?P Mohanlal, S Samsani, A Tolat [Medway]

After implementing allrecommendations, a prospective re-audit was done, to collect data onmissed medications on adult wards. Forease of analysis, missed medicationswere expressed as days missed out oftotal days prescribed. Of the 51 drugcharts, the number of drug charts withno missed medication improved from15% to 58.8%. The number of missedanti-coagulants reduced from 17.6% to5.2 % and number of missed anti-hypertensives reduced from 18.1% to nilfor invalid reasons. There was significantimprovement in other medications aswell. Avoiding missed medications hasgreatly improved safety and quality ofcare for our patients.

727

Does the unpredictabilityof trauma meanorthopaedic fracture clinicsare inherently inefficient?A Simpson, T Chapple, A Macleod [Reading]

Introduction: time spent in clinicalencounters and accessibility of servicesinfluence patient satisfaction. FractureClinics are notoriously overrun andfrequently result in complaints.Methods: fracture clinics in April 2012were audited with re-audit in September2012. In May 2012 a semi-automatedbooking system and staff educationprogramme were introduced and theimpact analysed. Results: clinic times,patient numbers, new to follow-upratios, staff tardiness, appointment time

duration and DNA numbersdemonstrated no significant difference(P>0.05). Conclusion: interventionsresulted in no significant difference.Orthopaedic clinicians and clinicadministrators must be flexible to thedynamic clinical demands of anunpredictable patient cohort.

744

Practice of greenorthopaedic surgery inUnited KingdomC Karunathilaka, F Chan, N Pinto [Ashton-Under-Lyne]

On average per year NHS produced 250000 tonnes of clinical waste and £73million was spent for disposal. Objective:identify the environmental effect onorthopaedic waste and how anorthopaedic surgeon can contributes foroperating theatre waste management.Methodology: observational study for 06months. Results: identified orthopaedicwaste related problems; impropersegregation of waste, excessive usage ofdisposable wrappings and instruments.Conclusion: the NHS has a carbonfootprint of around 19 million tonnes.The NHS can save £180 million byreducing its carbon emissions. Reusingand recycling programmes andredesigning the segregation of waste arerequired.

746

Dedicated neck of femurfracture theatre listsimprove time to operationat a district general traumaunitA Simpson, H Wilson, A Macleod [Reading]

Introduction: NOF fracture patientsshould receive surgery within 48 hours.To meet targets our Trauma Unitintroduced tri-weekly dedicated NOFtheatre lists in 2009. Methods: audit ofNOF fracture patients was performed in

2008 identifying failure to meet targets.Since 2009 yearly audits have beenperformed. Results: prior to NOF listintroduction 69.3% of patients receivedoperation within 48 hours. Audits havesince demonstrated targets met in89.4%, 79.2% and 86.5% of cases (p<0.002). Conclusion: s dedicated NOF listimproves time to operation at a busyTrauma Unit. Utilisation of the NOF listremains unpredictable but experienceson-going development.

872

Reconfiguration of traumaservices providesenhanced surgical trainingG Prasad, C Richards, L David, P Gibb, J Nicholl[Pembury]

We performed an audit to assesswhether the consolidation of 2 units(Maidstone and Kent&Sussex) into theTunbridge Wells Hospital at Pembury,resulted in a more consistent consultant-led service, resulting in higher qualitypatient care as well as enhanced surgicaltraining. Registrar e-logbooks wereanalysed before and after re-configuration. Reconfiguration resultedin definite consistency in consultant-ledservice due to the presence of the on-call Orthopaedic consultant on-site 13hours a day, 7 days a week. In addition toan increase in Trauma activity, 77% ofregistrar trauma operations wereconsultant supervised at the new site, animprovement of over 55%.

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925

Post-operativehyponatraemia andelective arthroplastysurgery: a review of theincidence, contributingfactors, treatment andoutcomes following totalhip arthroplasty (THA) andtotal knee arthroplasty(TKA) in a regional primaryjoint unitC Higgins, C Mullan, C O’Neill, T Mawhinney, S Derbyshire, D Beverland [Belfast]

Post-operative hyponatraemia is a wellrecognised entity with a multi-factorialaetiology. A retrospective review ofclinical data for 122 patients undergoingTHA/ TKA was performed. 18.6% of TKAsand 14.3% of THAs developedhyponatraemia. Thiazide diuretics wereassociated with development ofhyponatraemia. Mean hospital stay was3.5 days (4.5 days for patients withhyponatraemia and 3.4 days forunaffected patients). Mean admissionduration was increased by 21% for THAsand 50% TKAs following development ofhyponatraemia. Identification of patientsub-groups at risk of developing post-operative hyponatraemia may helpreduce its incidence and providesubstantial cost and resource savings.

997

Changing trends in themanagement of theCharcot neuroarthropathythrough a consultant leddiabetic foot serviceS Yousaf, A Wee, P Chong, E Bingham[Camberley]

We present our preliminary results ofmanagement of Charcotneuroarthropathy by a consultant leddiabetic foot service at a DGH .24

patients were treated presenting with orwithout ulcers over the past five years.Total contact cast, achieved gradualhealing of Charcot process in 50%patients while surgical interventionaccounted for 34% of the patients noneof which had ulcers post-operatively.Three patients (12%) had below kneeamputations. The majority of patients(84%) in this cohort were able toprogress to custom made shoes with aplanti-grade ulcer free foot at an average5.5 months with low amputation rates.

1015

Patients’ experience of theconsent processE Bagouri, KV Sigamoney, C Anderson, S Ong[Sutton in Ashfield]

Introduction: the Care QualityCommission requires the trust to haveevidence of valid consent obtained forevery procedure. Objectives: to assessthe patients’ experience of the consentprocessMethods: data was collected byquestionnaires filled on the operationday. 2 groups of patients: inpatientsconsented before day of surgery andday-case patients consented on day ofsurgery. Results: (84) patients Day-casepatients were (66%) while (34%) were in-patients. Of 42 patients answered by Yesin all their questions, (78%) were in-patients & (39%) day-case patients.Conclusion: we recommend thatconsenting be conducted in a privateenvironment before the day of surgery.

GeneralOrthopaedics

100

YouTube - an emerging toolin the development oforthopaedic examinationskillsA Fahy, J Sutherby, K Kunasingam, Z Shah[London]Abstract not provided

208

The effect of the 2010Canterbury earthquake onorthopaedic services inChristchurch, New ZealandA Rooney [London]

Introduction: on 4th September 2010 amagnitude 7.1 earthquake struck theCanterbury region of New Zealand.Objectives: in the wake of theearthquake this study looked at thenumber of orthopaedicadmissions/operations, patientdemographics, and operationsperformed. Methods: data was collectedfrom trauma logbook, Orthopaedicdepartment. Results: admissions fell inthe week following the earthquake;acute admissions and trauma operationnumbers increased; small variation inpatient demographics; no significantvariation in the operations performed.Conclusion: the relatively small impacton the department was due to thenature of the earthquake, buildingregulations.

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338

Postoperative blood usefollowing elective total hipand total knee arthroplastyJJ Murnaghan, J Gollish, Y Lin, D Murnaghan, H Razmjou [Toronto, Canada]

The purpose was to documenttransfusion rates following total hip(THA) and total knee arthroplasties(TKA). Secondary analysis ofprospectively collected data Jan-Dec2011. Univariate analysis and stepwiselogistic regression analyses. 1606patients: 989 females (62%), age 66years. TKA: Unilateral 821 (TransfusionRate (TR) 2%), Bilateral: 41 (TR 10%),Revision: 91 (TR 5%), THA: 588 (TR 4%),Bilateral: 4 (TR 50%), Revision: 60 (TR22%). Intra-operative blood loss ≥500 ml,drop in hemoglobin ≥50 g/l, beingfemale, age over 80, receiving general orepidural anesthesia, low BMI (< 18.5),and type of surgery as risk factors forblood transfusion.

395

Publications andpresentations: are theybecoming more importantin shortlisting for nationaltraining numbers intrauma and orthopaedics?P Davies, S Graham, K Razi, S Purlackee, I Braithwaite [Liverpool; Chester]

Introduction: Trauma and Orthopaedics(T+O) is a highly competitive specialty.Publications and presentations may beused to shortlist applicants. Methods: atelephone survey was undertaken toidentify how the characteristics of theT+O trainee has changed over the last 6years. Results: seventy NTN traineeswere identified. Discussion: it appearsthat trainees who obtained their NTNhalf a decade ago had similar credentialsto those from last year, by way ofpresentations and publications.Conclusions: there is no evidence that

today’s applicants require a strongerportfolio of publications andpresentations than their predecessors.

442

What effect has routineusage ofthrombopropylaxis inorthopaedics and traumahad on the proportion ofvenous thromboembolismattributable to thisspeciality?HK Ribee, JD Edwards, T Clare [Dudley]

Traditionally, between 30-45% of VTEassociated with hospital care occurred inpatients receiving orthopaedic inpatientor outpatient care. We assessed allpatients diagnosed in the trust with VTEover a six month period from September2012 to March 2012. 191 were identifiedin total. 16 patients had orthopaedicsurgery in the preceding three months.14 were diagnosed as DVT, 2 as PE. 5patients were post trauma. 11 wereelective patients. All had beenprescribed and reported compliancewith the trust guidelinerecommendation for VTE prophylaxis.This represents 8.4% of the overall VTEburden during this time period, amarked reduction.

482

Delayed or misseddiagnosis in the treatmentof knee pathology - costsfrom a review of thenational health servicelitigation authoritydatabaseY Khan, A Chen, K Akhtar, JP Cobb, CM Gupte[London]

Aims: to determine the medico-legal costof delayed or missed diagnoses.Methods: the NHSLA database was

reviewed and analysed for case-mix andtotal payout. Results: 60 cases wereidentified costing £2.90 million. Thehighest payout was for delayed diagnosisof popliteal artery transection (£520,136). 10 cases of missed ligament/meniscal damage paid out £301,790, 10cases of missed fractures paid out£307,321. 2 missed tendon ruptures -£151,237 delayed diagnosis of 4 bonetumours - £388,985, 2 deep infections -£409, 957. Conclusions: our studyhighlights the cost of missed diagnosisdespite the increased availability ofimaging technology

783

Why do UK medicalstudents chooseOrthopaedics as a career?A Vaughan, J Mutimer, S Smith [Cheltenham]

Aim: this study explores medical studentperceptions and motivational factorswhen pursuing a career in Orthopaedics.Method: a traditional London medicalschool was compared with a modernSouth West medical school, participantscompleted an online questionnaire.Results: 444 students were recruited.89% thought Orthopaedics was maledominated. Medical school experience(83%), influence of a mentor (77%), andearning potential (71%) were important.Discussion: despite efforts for genderequality, the perception remains thatOrthopaedics is male dominated.Student attachments and mentorship arestrong influences and should motivatetrainers if the speciality is to attract themost gifted students.

798

An analysis of orthopaedicinformation available forpatients on the internetA Ghosh, R Berber, R Chau [Leicester]

The use of the Internet to obtain healthrelated information is now widespread.We analyse the information available on

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the internet for 5 common Orthopaedicconditions/procedures- Rotator CuffInjury, Carpal Tunnel Syndrome, Total HipReplacement, Total Knee Replacementand Hallux Valgus. Websites wereassessed by 3 independent reviewers fortype of website, author, IS/HONcertification and content. Our studyshows the quality of informationavailable on the Internet is variable.Exceptionally good websites for patientsare available of which the clinicianshould be aware, but popular websiteswere often found to provide biased,incorrect information.

805

A prospective study of thequality of hand traumareferrals made to a tertiaryUK hand trauma centreMA Mussa, M Tare [Chelmsford]

Analyses of data from 200 referralsshowed successful documentation ofadvice given out regarding following;antibiotics in 50%, tetanus booster in49%, use of dressings in 24% andradiology in 56% of cases. Appropriateuse of antibiotics in 72%, tetanus in 81%,dressings in 66%, and radiology in 90%.We suspect that in a reasonableproportion of cases, correct advice wasgiven out but there has been a failure ofdocumentation. This makes it difficult toassess performance of referringhospitals; is it a lack of documentation, alack of advice, a lack of awareness - or allthree?

846

The role of tranexamic acidin shortening hospital stayin elective arthroplastyZ Abual-Rub, G Joseph, M Hashmi [NewcastleUpon Tyne]

Postoperative wound bleeding in electivearthroplasty is a common complicationthat is more noticeable following NICErecommendation of pharmacologic VTE

prophylaxis. We observed the effectprior and after administering intravenoustranexamic acid on induction regardingthe length of hospital stay on thepatients of a single consultant who hadstandardized criteria of care. We havenoticed that patients who receivedtranexamic acid had a shorter stay inhospital regardless of their co-morbidities. However, this effect was notconstantly significant statistically.Tranexamic acid can indirectly shortenhospital stay of patients and play a rolein achieving enhanced recovery goals.

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Safety and efficacy ofmodified protocol usingoral thromboprophylaxisagents: a complement toenhanced recoveryR Raman, C Shaw, J Marcinaik, G Johnson, A El-Khouly [Hull]

Patients in our modified protocol forthromboprophylaxis received 2 doses ofLMWH (5000iu) on the day of surgeryand 24 hours later followed byDabigatran (110mg or 220mg) orally for8 days in knee replacements and 26 daysin total hip replacements. Weprospectively reviewed 1214 consecutiveprimary total hip and knee arthroplastiesover a period of 18 months who receivedthe modified protocol. Clinical DVT wasrecorded in 69 patients and wasradiologically proven in 26 patients(2.1%). The incidence of symptomaticradiologically confirmed pulmonaryembolism was 0.5%. The modifiedprotocol is an effective balance inachieving extended thromboprophylaxis

882

Oral thromboprophylaxisin revision hip and kneearthroplasty: analysis ofefficacy and complicationsR Raman, G Johnson, C Shaw, S Gopal, S Jehan, K Sivasankaran [Hull]

We report the efficacy of Dabigatran inpreventing all thromboembolic eventsand its effect on wound complications,infections and return to theatrefollowing revision arthroplasty in 231patients. Clinical DVT was recorded in 24patients (11.5%) and was radiologicallyproven in 10 patients. The incidence ofsymptomatic radiologically confirmedpulmonary embolism was 0.5%. 10patients returned to theatre for woundrelated problems . Deep infection wasconfirmed in 3 patients and a further 3needed 2 or more washouts. The overallrate of deep infection is 0.34%. Extendedthromboprophylaxis with Dabigatran is agood oral alternative to LMWH

904

Surgical site infection inorthopaedic implantsurgeryH Kovilazhikathu Sugathan, W Pizon [SouthShields]

Aim of our study was to assess thesurgical site infection (SSI) in orthopaedicimplant surgery. We collected dataprospectively based on the Centre forDisease Control criteria and Tsukayamaclassification. We identified 32 cases ofSSI over a period of 16 months (rate-1.1%). The mean age of the group was60 years. We had 17 elective (11 jointreplacement) and 15 trauma cases. Themost common organism identified wasstaphylococcus aureus (17). We had 6deep joint infections requiring revisionsurgeries. We conclude that surveillanceof SSI in implant surgery should be anintegral part of clinical governance.

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Computer AssistedOrthopaedicSurgery

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Use of robotic technologyin cam femoroacetabularimpingement correctivesurgeryM Masjedi, A Aqil, W Tan, J Sunnar, S Harris, J Cobb [London]

Introduction: we assessed CAM surgeryaccuracy when using robotic technology.Methods: three operators used a roboton three different models. Forty-twospecimens were CT scanned and alphaangles and head neck ratios (HNR)calculated. Mann-Whitney U andCoefficient variation (CV) studiesassessed pre/post resection alpha anglesand inter/intra observer repeatability.Results: maximum alpha angles werereduced from 91°, 91° and 87° to 48°±3°,53°±5°, 47°±2° p< 0.001. The HNRs werereduced from 3.2, 3.4 and 3.1 to 3.0 ±0.1, 3.1 ± 0.1 and 3.1 ± 0.0. Inter/intra-observer repeatability was acceptable(CV< 10%). Conclusion: robots enableaccurate CAM surgery.

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Ultrasonic bone contourextraction to refineanatomic landmarkacquisition in computer-assisted measurement ofknee kinematicsDF Russell, D Graham, A Masson-Sibut, F Leitner[Clydebank]

Accurate landmark acquisition is criticalto success of navigation surgery. Wereport initial results of using newlydeveloped experimental software whichautomatically recognises the bone soft-tissue interface. Individual 2D ultrasound

images (n=651) of the anterior femoralcondyles and trochlear notch were used.Software output was compared directlyto image analysis performed by aclinician.Error was calculated using root meansquared (RMS). Median error in locatingbone soft-tissue interface was 0.67mm,(mean 0.93mm, SD 0.84mm). Medianerror for trochlear notch topography was1.01mm, (mean 1.41mm, SD 1.37mm).Bone soft-tissue interface can beaccurately defined and displayed by thissoftware.

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Five-year follow-up ofminimally invasivecomputer assisted totalknee arthroplasty(MICATKA) versusconventional computerassisted total kneearthroplasty (CATKA) - acomparative studyRS Khakha, M Norris, A Kheiran, S Chauhan[Brighton]

Introduction: minimally invasiveComputer Assisted Total KneeArthroplasty (MICATKA) has theoreticalbenefits to CATKA. Methods: 40 patientswho underwent MICATKA werecompared with 40 undergoing CATKA.Results: post-operatively mean femoralcomponent alignment was 89.7 degreesfor MICATKA and 90.2 for CATKA. Meantibial component alignment was 89.7degrees for both. Knees Society Scores inthe short term were statistically better inthe MICATKA (p< 000.1) group. Straightleg raise at day one in 93% of theMICATKA and 30% of the CATKA.Conclusions: MICATKA have significantlybetter outcomes in the immediate short-term compared to CATKA but not inmedium term.

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Outcomes of trainees’experience of computerassisted total kneereplacement withminimum follow-up of 5yearsRS Khakha, M Norris, A Kheiran, S Chauhan[Brighton]

Introduction: the benefits of thereproducible technique have beendemonstrated in literature, but there islittle evidence of benefits in trainingjunior surgeons in a clinical setting.Methods: Pre-and Post-op scores andlong-leg mechanical alignment datacollected at 5 years. Results: pre-operatively the KSS score was 45.6(24-59) and function 54 (42-65) withpost-operative scores for KSS 80.0 (55-94) and function 81 (55-100).Post-operatively the average mechanicaltibio-femoral angle for the CATKR groupwas 1.88 degrees varus, the tibialcomponent angle was 90.63 degrees andthe femoral component angle was 89.88degrees. Conclusions: trainees achievesatisfactory outcomes using computer-navigation.

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Patient reported outcomemeasures in primary totalknee replacement usingnavigation versusconventional surgicaltechnique: prospectivecomparative studyK Singisetti, K Muthumayandi, S Kumar, Z Abual-Rub, D Weir [Newcastle upon Tyne]

A comparison of patient reportedoutcome data for 351 primary TKR wasperformed. The study group (N= 113)included patients who had Triathlon TKRusing ASM (articular surface mounted)navigation technique and control group(N=238) included patients who had

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Triathlon TKR using conventional jig.No significant difference between thegroups was noted in mean WOMAC pain,function and stiffness scores at one andtwo years follow up. Significantdifference between the groups was onlyfound in the physical functioncomponent of SF36 score at one year(P=0.019) but this difference was notobserved at two year follow up.

860

Comparison of computernavigated versus nonnavigated techniques in leglength restoration in totalhip arthroplastyB Sankar, M Changulani, MS Khan, S Atiya, K Deep [Glasgow]

This study compared the accuracy ofcomputer navigated limb lengthrestoration with non navigatedtechniques in THA. 160 consecutive THAs(57 non navigated and 103 navigated)included. Analysis includedmeasurements on radiographs andcomputer generated limb lengthalteration data.The navigated group had a significantlylower mean limb length discrepancy.(p=0.04). 18% in the non-navigatedgroup and 12% in the navigated grouphad a clinically relevant limb lengthdiscrepancy (>10mm). Computerpredicted leg length alterations matchedthose measured on plain radiographs.(p=0.15). The use of Computernavigation in THA can be useful inreducing errors related to limb lengthdiscrepancy.

936

Trainees’ perception ofCAOS (computer aidedorthopaedic surgery)Y Morar, S Robati [Ashford]

CAOS is a training tool for surgeons. Anemail questionnaire sent to 110 UKorthopaedic trainees (2011) resulted in64 responses. 21% (n=13) of therespondents were from ST3 trainees,15% (n=10) from ST6 and 31% (n=20)from ST8. 76% (n=49) of trainees hadbeen exposed to or used computernavigation in surgery, but 62% (n=40)had not. 82% (n=52) thought that therewas a difference between conventionallytaught and navigated arthroplasty. 97%(n=62) thought that there was a futurefor CAOS and should be part of theorthopaedic curriculum. 56% (n=36)thought that it would enhance surgicalskills training.

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© 2013 British Orthopaedic Association (except where stated otherwise)

First published 2013All rights reserved. No part of this publication may be reproduced, stored or transmitted in any formor by any means, without the prior written permission of the publisher or, in the case of reprographicreproduction, in accordance with the terms of licenses issued by the Copyright Licensing Agency inthe UK [www.cla.co.uk]. Enquiries concerning reproduction outside the terms stated here should besent to the publisher at the UK address printed on this page.

Published by the British Orthopaedic AssociationBritish Orthopaedic Association35-43 Lincoln’s Inn FieldsLondon WC2A 3PERegistered Charity No. 1066994Company Limited by Guarantee No. 3482985

BOA Annual Congress 2013

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