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It has not yet been well established whether femoral shaft fracture malunion and malalignment lead to the development of knee osteoarthritis.This study has assessed a cohort of 62 patients after femoral shaft fracture at a median follow-up of 22 years (range 18–28). The mean age of the patients at time of follow-up was 42 years (33–80). Each patient was clinically examined for signs and symptoms of osteoarthritis, radiographs were taken to assess malalignment and radiographic osteoarthritic changes, and WOMAC and SF-36 (physical and mental) scores were measured.Radiographic changes consistent with osteoarthritis were present in only 5 (8%) ipsilateral and 3 (5%)contralateral knees. Clinical signs and symptoms of osteoarthritis were present in only two (3%)ipsilateral knees. However, 16 patients (26%) exhibited mild pain or stiffness in the ipsilateral knee,while only 4 patients (6%) had such findings in their ipsilateral knee (OR 4; p = 0.004).The median WOMAC score for knee pain was 3 (range 1–15; max 20), knee stiffness was 1 (0–8; max 8) and disability was 6 (0–55; max 68). The median SF-36 score for physical function was 85 (range 0–100; max 100).The mean coronal plane malunion was 58 (range 198 to 88). There was no significant association between any measures of malunion and the WOMAC scores, or the presence of either clinical or radiological osteoarthritis.It is concluded that femoral shaft malunion and malalignment does not cause an excess of knee arthritis at 22-year follow-up. However, a significant number of this cohort has developed mild symptoms of ipsilateral knee pain or stiffness at a median age of 42 years; the long-term significance of this is not known., (2010 Elsevier Ltd. All rights reserved.)

The results of a consecutive series of bone-grafting procedures for non-union of scaphoid fractures were assessed in order to investigate whether the patient's age or the delay between acute fracture and bone-graft surgery influenced the outcome. One hundred and thirty-four patients with a mean follow up of 2.6 years from bone-graft surgery for scaphoid fracture non-union were assessed for post-operative pain and radiographic evidence of union. No association was found between the union rate following surgery and either the patients' ages or the interval between the original injury and subsequent non-union surgery.

A retrospective study was undertaken to compare the costs of treating tibial diaphyseal fractures non-operatively in a cast or operatively with locked intramedullary nailing. In total 39 patients with isolated closed or grade I open, two-part, displaced tibial diaphyseal fractures were studied. Of these, 18 were treated by manipulation under anaesthesia and cast immobilization, and 21 by closed, reamed, locked intramedullary nailing. A detailed analysis of the cost of treatment of each patient was performed and analysed in terms of the in-hospital costs and the overall costs, taking into account time off work. The mean hospital costs were 2226 pounds for plaster treatment and 3727 pounds for intramedullary nailing (significantly different, p < 0.05). The mean time off work was 9 weeks longer in the plaster group and when the cost of lost production through time off work was added to the hospital costs, the overall costs of plaster treatment and intramedullary nailing were 6810 Pounds and 6592 Pounds (difference not significant). This study suggests that the cost to the hospital of treating these fractures is less with plaster treatment but that the overall cost to the community is no different.

The results of 46 extensor tendon repairs performed by junior accident and emergency doctors were assessed, with a minimum follow up of 6 months. Based on Miller's assessment, 80 per cent of the proximal injuries achieved excellent or good results. Only 18 per cent of distal injuries achieved excellent or good results. Neither grip or fingertip pinch strength were significantly reduced. Sixty-seven per cent of patients complained of no residual pain and only 7 per cent complained of the injured digit getting in the way.

The effect of the timing of operative treatment on the mortality and morbidity of a consecutive series of 230 patients with intertrochanteric fractures of the femur has been studied. It was found that the mortality rate was not influenced by the timing of surgical treatment. Loss of mobility and the frequency of pressure sores and chest infections were also not influenced by the timing of surgery. Those patients who underwent early operative treatment had a lower rate of urinary tract infection, but this was partially due to the better general health of these patients. It is concluded that the timing of operative treatment of these fractures is not an important determinant of outcome.

This prospective randomized study has compared the use of the Küntscher-Y nail and a sliding hip screw in the treatment of intertrochanteric fractures of the femur. For patients whose general health was good, the use of the sliding hip screw was associated with a significantly lower 1-year mortality rate. The use of the sliding screw also resulted in a higher proportion of 1-year survivors regaining their prefracture level of mobility. There was no difference in the rates of cutting-out of the two implants but use of the Küntscher-Y nail was associated with a greater incidence of shortening.

A controlled prospective trial of early exercise of slightly displaced fractures of the distal radial metaphysis has been performed. Twenty-eight fractures were enclosed in a tubigrip support 7-13 days after injury and 28 fractures were splinted in below-elbow plaster for 4 weeks. It was found that early movement of the wrist produced a superior functional result at 5 and 7 weeks (P less than 0.05) and allowed an earlier recovery of domestic skills (P less than 0.05). Early exercise did not improve recovery of strength of grip and did not produce a higher incidence of malunion. Patients treated in tubigrip experienced no more pain in weeks 4 and 6 and apart from one failure, no patient actively disliked this form of treatment and 22 were totally satisfied.