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Short-term exercise in growing rodents provided lifelong benefits to bone structure, strength, and fatigue resistance. Consequently, exercise when young may reduce the risk for fractures later in life, and the old exercise adage of “use it or lose it” may not be entirely applicable to the skeleton. Introduction: The growing skeleton is most responsive to exercise, but low-trauma fractures predominantly occur in adults. This disparity has raised the question of whether exercised-induced skeletal changes during growth persist into adulthood where they may have antifracture benefits. This study investigated whether brief exercise during growth results in lifelong changes in bone quantity, structure, quality, and mechanical properties. Materials and Methods: Right forearms of 5-week-old Sprague-Dawley rats were exercised 3 days/week for 7 weeks using the forearm axial compression loading model. Left forearms were internal controls and not exercised. Bone quantity (mineral content and areal density) and structure (cortical area and minimum second moment of area [IMIN]) were assessed before and after exercise and during detraining (restriction to home cage activity). Ulnas were removed after 92 weeks of detraining (at 2 years of age) and assessed for bone quality (mineralization) and mechanical properties (ultimate force and fatigue life). Results: Exercise induced consistent bone quantity and structural adaptation. The largest effect was on IMIN, which was 25.4% (95% CI, 15.6–35.3%) greater in exercised ulnas compared with nonexercised ulnas. Bone quantity differences did not persist with detraining, whereas all of the absolute difference in bone structure between exercised and nonexercised ulnas was maintained. After detraining, exercised ulnas had 23.7% (95% CI, 13.0–34.3%) greater ultimate force, indicating enhanced bone strength. However, exercised ulnas also had lower postyield displacement (−26.4%; 95% CI, −43.6% to −9.1%), indicating increased brittleness. This resulted from greater mineralization (0.56%; 95% CI, 0.12–1.00%), but did not influence fatigue life, which was 10-fold greater in exercised ulnas. Conclusions: These data indicate that exercise when young can have lifelong benefits on bone structure and strength, and potentially, fracture risk. They suggest that the old exercise adage of “use it or lose it” may not be entirely applicable to the skeleton and that individuals undergoing skeletal growth should be encouraged to perform impact exercise.

s / International Journal of Surgery 12 (2014) S13eS117 S67 12 months. Both insertional and non-insertional tendinopathies were found to be improved after surgical treatment. Conclusions: Our series shows surgical treatment of Achilles tendinopathies can be successful in patients who fail conservative treatment. 1396: ‘TIERS OF DELAY’: WARFARIN, HIP FRACTURES AND TARGET DRIVEN CARE Will Eardley , Hannah Freeman, Kirsty MacLeod, Anne Tate. Jaems Cook University Hospital, Middlesbrough, UK. Introduction: Anticoagulation reversal causes operative delays and loss of Best Practice Tariff (BPT). We sought to establish the impact on BPT for hip fracture patients admitted on warfarin. Methods: Patients undergoing surgery for a hip fracture over a 32-month period were reviewed. Time to theatre, length of stay and mortality were subject to independent samples t-tests. Results: 83 patients on warfarin had a mean time to theatre of 49.74 hrs (1.71-121.88), a 79% breach of BPT. In the control group, 908patients tookon average 24.51 hrs (1.2-287.48), a 28% breach of BPT (p 50degrees) demonstrateda significant improvement in correction with the CoCr constructs (0.81 vs 0.69, P1⁄40.02). Sagittal balancewas improved in both (CoCr 27.8, Ti 28.0) without significant difference (p1⁄40.84). Preoperative kyphosiswas normal in 49% and 43% of the CoCr and Ti Groups respectively (p1⁄40.63). 12 Ti patients moved from normal kyphosis to abnormal. 9 moved from abnormal to normal (p1⁄40.66). 10 CoCr patients were normalised with only 2 becoming abnormal (p1⁄40.04). Conclusions: Stiffer CoCr rods improve coronal correction for patients with large curves and normalise hypokyphotic deformities more effectively. Improvements weren't seen in sagittal balance or coronal curves less than 40 degrees.

PURPOSE: To evaluate the efficacy and utility of SPECT/CT as a diagnostic modality and preoperative planning tool in patients undergoing fusion surgery for low back pain and/or leg pain. STUDY DESIGN/SETTING: A prospective cohort study (n525) performed over a 2-year period. PATIENT SAMPLE: All consecutive patients requiring lumbar spondylodesis for back pain and/or leg pain included. OUTCOME MEASURES: Clinical outcome measures included EQ-5D, EQ-5D VAS, ODI and VAS Pain Scores. METHODS: SPECT/CT fusion imaging was performed in conjunction with standard CT and MRI preoperatively to guide patient selection and surgical planning. Clinical outcome measures were collected preoperatively and at 6 weeks, 6 months and 1 year postoperatively. RESULTS: SPECT/CT fusion imaging demonstrated increased sensitivity for facet degeneration when compared to MRI. No difference was identified when comparing SPECT/CT to standard CT to assess disc degeneration. There was a significant improvement in all clinical outcome measures assessed preoperatively and followed out to 1-year postoperatively. Mean ODI score improved from 58.92 to 12.0; VAS back pain score improved from 7.46 preoperatively to 1.0; VAS leg pain score improved from 4.15 to 0.25. CONCLUSIONS: SPECT/CT fusion imaging is an excellent adjunct to existing imaging modalities, facilitating accurate level selection in patients undergoing lumbar fusion surgery for low back pain and/or leg pain. Lumbar fusion surgery guided by SPECT/CT fusion imaging was associated with excellent postoperative health related quality of life (HRQOL) outcome measures. CONFLICTS OF INTEREST: None. FUNDING SOURCES: None.