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This randomized prospective study compared the results of trapeziectomy alone, or combined with tendon interposition or ligament reconstruction in 76 women with basal thumb osteoarthritis. At 3 month and 1 year follow-up the results of the three procedures were indistinguishable in terms of pain relief, hand function and thumb strength. In the short term at least, tendon interposition and ligament reconstruction do not improve the results of trapeziectomy.

The findings are presented of a conference on Outcomes of Hand Surgery organized by the audit committee of British Society for Surgery of the Hand in 1993. Measures of outcome in terms of movement, power, sensibility, pain, activities of daily living, complications and patient satisfaction are considered, and an example of a patient evaluation measure given as an appendix.

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We have performed a randomized, double-blind controlled study in patients undergoing elective anterior cruciate ligament repair, to assess the effect of intra-articular morphine on postoperative pain. The morphine group (n = 11) received morphine 5 mg in saline 25 ml and the control group (n = 9), saline 25 ml intra-articularly. Patients in the morphine group had significantly smaller pain scores throughout the 24-h postoperative period compared with those in the control group (P < 0.05). There was less requirement for supplementary analgesics in the morphine group.

The in-cement technique for revision hip arthroplasty involves retaining the original cement-bone interface. This has been proven to be a biomechanically stronger method than recementing after complete removal of the original cement mantle. This study reviewed a series of 54 consecutive revision hip arthroplasty procedures, using the in-cement technique, between November 1999 and November 2003. Clinical and radiological follow-up included functional assessment. There were 54 procedures performed in 51 patients, whose mean age at surgery was 70.3 years (45 to 85). A total of 42 were available at a mean follow-up of 29.2 months (6 to 51). There was no radiological evidence of loosening. Functional assessments were available for 40 patients who had a mean Harris hip score of 85.2 (51.9 to 98.5), a mean Oxford hip score of 19.6 (12 to 41), a mean UCLA activity profile score of 5.9 (3 to 8) and a mean SF-36 score of 78.0 (31.6 to 100). The in-cement technique provides consistent, high functional outcomes and should be considered in appropriately selected cases.

Periprosthetic femoral fractures are increasingly addressed through the use of cortical onlay allografting. This study was designed to determine the effect of allograft cortical strut length, configuration, cable number, cable tension and the use of wire or cable on the fixation of periprosthetic femoral fractures. Ten cadaveric femora-strut constructs were tested using anteroposterior and axial loads to simulate the forces at the hip during gait. A transverse fracture at the level of the tip of the femoral stem was simulated. A biaxial servohydraulic testing machine was used to apply one hundred cycles of craniocau-dal load of 1.53 × bodyweight at a frequency of one Hz, along with an anteroposterior load of 0.15 × bodyweight at one half Hz. Variables for different constructs included the strut length (twelve cm, sixteen cm, or twenty cm), the number of cables (two, three, or four above and below the fracture site), cable tension, strut configurations and orientation (single strut or two struts, adjacent or opposite), and the use of wires instead of cables. Cable tension was measured using a calibrated tensioner. Movement at the fracture site was measured using a precision optoelectronic camera system. There was significantly less motion when cables were used rather than wires (p<0.05). Increasing the number of cables decreased fracture motion in some directions (p<0.05) and increasing cable tension showed a trend towards decreased fracture motion. We observed strut fractures in four cases when a single strut alone was used to stabilise the fracture. There was a significant decrease in fracture motion if two struts were used rather than one (p<0.01), but there was no significant difference between the anterior and lateral, and the medial and lateral strut configurations. Decreasing the strut length from twenty cm to twelve cm led to a significant decrease in axial rotation (p<0.05). Our data strongly favour the use of two struts, rather than a single strut alone. Cables enhance fracture stability compared to wires, presumably due to increased tension and to different surface characteristics. Increasing the cable tension gave greater stability although this may not fully translate to the clinical situation because the cable may garrotte or fracture the strut. Increased cable number and decreased strut length also enhanced fracture stability. The cortical struts essentially represent biological bone plates. If appropriately selected and prepared they can be customised to fit any femur. Our improved understanding of this technique should contribute to high rates of fracture union with an increase in bone stock and overall bone strength.