ObjectivesTo document the transition to a totally one-stop (patient seen and treated in one appointment) wide-awake (local anaesthesia only) hand surgery service.DesignRetrospective review of 10 year service with detailed analysis of last 1000 cases including process and cost-effectiveness and efficiency analysis.SettingPurpose-built CQC-certified day-case surgical facility where we have pioneered the UK's first totally one-stop wide-awake orthopaedic service.ParticipantsApproximately five thousand orthopaedic patients treated in the last ten years.Main outcome measuresSurgical outcomes, patient satisfaction and cost-effectiveness and efficiency.ResultsThe OSWA model is safe, efficient and effective; with a low complication rate, extremely high patient satisfaction; and cost-savings to the NHS of 50–75% of the national tariff. The service saved the NHS approximately £750,000 for the 1000 cases presented; and over £2 million since the inception of the service.ConclusionsA totally one-stop wide-awake hand surgery service is a practicable and feasible alternative to the conventional treatment pathway with benefits in terms of efficiency and cost-effectiveness.

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ObjectivesTo document any consistent clinical findings in a large cohort of patients with whiplash associated disorder.DesignFour-year observational study.SettingLarge orthopaedic medicolegal practice in the UK.Participants1025 consecutive cases of chronic whiplash associated disorder.Main outcome measuresObservational study of the clinical features of whiplash associated disorder: detailed examinationResultsThree consistent clinical features: neck pain; reduced cervical spine range of motion; and myofascial-entheseal dysfunction. With regards to the myofascial-entheseal dysfunction there were trigger points in the upper, middle or lower trapezius; with or without enthesopathy in the lower or middle trapezius.ConclusionsOn the basis of this large observational experience we propose a clinically-based definition of chronic whiplash associated disorder: a painful syndrome following acceleration-deceleration injury with neck stiffness; and myofascial-entheseal dysfunction.

ObjectivesTo detail the transition to a totally one-stop wide-awake (OSWA) Dupuytren's contracture surgical service.DesignRetrospective review of Dupuytren's component of last 1000 OSWA cases.SettingThe UK's first totally one-stop wide-awake orthopaedic service.Participants270 patients with Dupuytren's contracture out of the last 1000 OSWA cases.Main outcome measuresSurgical outcomes, patient satisfaction and cost-effectiveness and efficiency.ResultsThe OSWA Dupuytren's model is safe, efficient and effective; with a low complication rate, extremely high patient satisfaction; and cost-savings to the nhs of £2500 per case treated. The service saved the NHS approximately £675,000 for the 270 cases presented.ConclusionsA totally one-stop wide-awake Dupuytren's Contracture service is practicable and feasible alternative to the conventional treatment pathway, with benefits in terms of efficiency and cost-effectiveness.

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