Early failure of total hip replacements implanted at distant hospitals to reduce waiting lists.

Aim: In the years 1990-1993, in an effort to reduce waiting-list time, a small number of patients were sent from Exeter to hospitals in London to undergo elective total hip replacement. No medium- or long-term follow-up was arranged. Our aim was to audit the outcome of these hip replacements.

An aid to femoral nail removal.

We describe a novel technique to aid the removal of a proximally inserted femoral nail by using a guide wire and the starter reamer. By reaming through the scar tissue, a cylindrical track is created and the threaded top end of the nail is exposed. The soft tissue dissection is therefore limited to the absolute minimum with no further damage to the hip abductors.

Inflammatory-cell subpopulations in keloid scars.

The aim of this study was to investigate the contribution of lymphocytes and macrophages to keloid scarring by morphologically characterising inflammatory cell subpopulations in keloid scars in comparison with normal skin. We took 3mm punch biopsies from the anterior forearms of eight normal healthy volunteers. Eight keloid scars were excised using an intralesional technique.

Pathophysiology of chronic bacterial osteomyelitis. Why do antibiotics fail so often?

In this review the pathophysiology of chronic bacterial osteomyelitis is summarised, focusing on how bacteria succeed so often in overcoming both host defence mechanisms and antibiotic agents. Bacteria adhere to bone matrix and orthopaedic implants via receptors to fibronectin and to other structural proteins. They subsequently elude host defences and antibiotics by "hiding" intracellularly, by developing a slimy coat, or by acquiring a very slow metabolic rate.

Arthrodesis of the distal tibiofibular joint for a large osteochondroma in an adult.

A case of a large osteochondroma of the distal tibia with distortion of the distal tibiofibular joint is presented. This could not be managed by traditional means, as excision would have resulted in ankle and tibiofibular joint instability. The problem was overcome by performing an arthrodesis.

Blood crossmatching for burn surgery: potential for reduced wastage using a modified dye formula.

Estimating the perioperative crossmatch requirement (CMR) of burn patients is difficult, as losses are variable and hard to predict. Accuracy is important, however, as over-provision risks wasting blood. Blood ordering tariffs have increased efficiency and reduced blood wastage in other branches of surgery.

Adult hernia surgery in Wales revisited: impact of the guidelines of The Royal College of Surgeons of England.

This study investigated the impact of the guidelines of The Royal College of Surgeons of England on the practice of hernia surgery in Wales. This was assessed by means of a postal survey to all consultant general surgeons in Wales in 1996-1997. The areas covered were: awareness of the guidelines of The Royal College of Surgeons of England and the impact of such guidelines on their practice, attendance at hernia courses, operative technique, materials used for repair and skin suture, proportion of day case hernias, length of inpatient stay, thromboembolic (TE) prophylaxis and postoperative advice to patients with regard to light work, heavy work and sport.