Allograft bone, in the form of fresh-frozen human femoral head, gives clinical results at least as good as autograft bone in instrumented posterolateral lumbar spinal fusion and completely avoids any donor site complications.

Background. Previous studies have shown Graf ligament stabilisation procedure to give mixed results in the short to medium term. The aim of this study was to correlate the pre-operative state of the disc, multifidus muscles, age of the patient, levels operated and the clinical outcome after a mean follow-up of 47 months. Methods. Graf ligament stabilisationprocedure was carried out in 38 patients between 1996 and1999. Their post-operative status was assessed using MacNab criteria. The postoperative follow-up was by postal questionnaires and review of the clinical notes. Disc morphology and multifidus muscle wasting was graded blindly and independently. The intra-and interobserver reliability was measured with kappa score and classified using the kappa classification of Landis and Koch. Correlation was measured with the help of Spearman correlation coefficient. Results. Thirty-eight patients (100%)returned the questionnaires. Mean follow-up time was 47.55 months. Fifty-nine levels were operated on. Mean age was 39.68 years. The overall re-operation rate was 15.8%. The intra-and interobserver reliability was graded as good to substantial. Twenty-two patients (57.89%) were satisfied with the procedure. There was no statistically significant correlation between disc morphology, multifidus muscle wasting, sex, age, number of levels operated, the levels operated, and the satisfaction rate.Conclusions. The indications of Graf ligament stabilisation procedure are not clear. Further work is necessary to clearly identify the indication for the procedure.

The establishment of diagnostic reference levels (DRLs) for all typical radiological examinations became mandatory following the implementation of the Ionising Radiations (Medical Exposure) Regulations Act 2000. At present, there are no national dosage guidelines in the UK regarding use of fluoroscopy in orthopaedic trauma. The increasing popularity of the mini C-arm image intensifier amongst surgeons has led to concerns regarding use of ionizing radiation by personnel who have not been trained in radiation protection. It is therefore essential to have formal protocols for use of the mini C-arm to comply with the law and to maintain safe clinical practice. It is attempted to provide dose data for wrist fracture manipulations that may be used as a basis for setting a DRL for this procedure. Screening times were recorded for 80 wrist manipulations in a fracture clinic setting using a mini C-arm image intensifier. A DRL was set using the third quartile value for screening time. The median screening time for wrist fractures was 20 s with a range from 1 to 177 s. The third quartile value for screening time was 34 s. This value can be used as a provisional DRL for wrist fracture manipulations. The DRL is a quantitative guide for the optimisation of radiological protection. IR(ME)R 2000 states that if it is consistently exceeded by an individual operator or a piece of equipment, investigation and remedial action must be taken. We recommend that trauma units establish their own local DRLs for common procedures as made mandatory by legislation.

Displaced distal radius fractures are common injuries and present regularly to most orthopaedic surgeons. Several documented treatment modalities for these fractures have been described with a recent trend for internal fixation with volar plating. However, the literature suggests that there is still no consensus as to the best treatment of these injuries. We set out to find the current consensus amongst orthopaedic surgeons in the Northwest and Northeast of England with respect to treatment of displaced distal radius fractures. A questionnaire was sent out to all consultant orthopaedic surgeons practicing in these regions. Antero-posterior and lateral radiographic images of two cases of displaced distal radius fractures (one extraarticular and the other intraarticular) were provided along with a short history. A list of the common modalities of treatment was given. Each surgeon was asked to indicate their ideal method of management of each of these cases. Two hundred and forty-four questionnaires were sent out and a completed form was received from 166 (69%) of surgeons. The results again indicated a wide variety of opinion as to the best way to manage these two cases. The most popular methods of treatment were MUA + Kwiring, volar plating and application of an external fixator. In the extraarticular fracture, 82 (49%) surgeons favoured MUA + K-wiring, 47 (28%) favoured volar plating and 14 (8%) an external fixator. In the intraarticular case, 28 (17%) surgeons favoured MUA + K-wiring, 53 (32%) advocated volar plating and 33 (20%) an external fixator. Upper limb surgeons were more likely to treat these with volar plating (63% in each case) than non upper limb surgeons (18% and 23% for each case). A randomised clinical trial would help elucidate which treatment is best for these common injuries Introduction: The establishment of diagnostic reference levels (DRLs) for all typical radiological examinations became a mandatory requirement following the implementation of the Ionising Radiations Medical Exposure Regulations Act (IRMER) 2000. At present there are no guidelines from the Health Protection Agency (formerly the National Radiation Protection Board) regarding use of fluoroscopy in orthopaedic trauma. The mini C-arm image intensifier allows surgeons to perform fluoroscopy in the out-patient setting in the absence of trained radiographers. Its increasing popularity amongst surgeons has led to concerns regarding use of ionizing radiation by personnel who have not been trained in radiation protection. It is therefore essential to have formal protocols for use of the mini C-arm in order to comply with the law and to maintain safe clinical practice.Objective: To provide data on dosage for wrist fracture manipulations in order to establish a DRL for this procedure.Methods: Screening times were recorded for 80 wrist manipulations in a fracture clinic setting using a mini C-arm image intensifier. The entrance skin doses (ESD) for the procedures were calculated and a diagnostic reference level was set using the third qu...

SUMMARYA right hand dominant man in his 60s was moving his wheelie bin when he tripped and landed still holding on to the handle. His hand was trapped between the handle and the ground. He sustained lacerations at the level of the proximal interphalangeal joints of all the fingers of his right hand. The index and middle fingers had damage to the proximal phalangeal articular cartilage and central slip. The central slip loss in the middle finger required reconstruction. The wounds healed without complication by 4 weeks, at which point the patient's fingers were mobilised; he regained almost full range of movement by 3 months. BACKGROUND