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Between 2000 and 2004, 42 fresh midshaft clavicular fractures in adults with initial shortening of >20 mm were treated with primary internal fixation. In this retrospective study, the results of plating the fractured clavicle on its anterior surface were compared with placing the plate on the superior surface. The plates were placed anteriorly in 16 patients and 26 patients had them superiorly. The placement of the plate anteriorly or superiorly was based on the preference of the surgeon operating. There were 31 men and 11 women. The average age was 34.23 years (range 14-61). The follow up varied from 4 months to 3.5 years. The results were analysed by a physiotherapist as a neutral observer with a Biodex machine and were assessed for shoulder function. The patients were also assessed with regards to their return to occupation, satisfaction with the operation and scar cosmesis. The functional results between the two groups with respect to the above mentioned parameters were similar. Overall 97% were satisfied with the outcome. The plates were on the superior surface of the clavicle in both patients who had implant failure. They were replated anteriorly and the patients recovered well. Deep infection occurred in one patient in whom the plate was incidentally superior and was replated once the infection settled. Out of the seven patients in whom the plates were removed, five were superiorly placed plates and had to be removed due to prominent metal work and soft tissue irritation. In our study, the incidence of implant failure and implant removal was higher in patients in whom the plates were placed superiorly compared to the group in whom it was anterior.

sterile drapes is difficult, disrupts surgery and can prolong the duration of anaesthesia. A simple and cheap solution is to use an inflated latex glove and position the patient's hand with interlocking fingers around it as shown in Figure 1, thus maintaining dorsiflexion of the patient's wrist and so preventing arterial line kinking. When performing contaminated abdominal surgery, one of the problems that all surgeons will have experienced is the nasty 'smell' left on their hands after the procedure, even when double-gloving. Surgeons at our institution have found that by using a pair of sterile co-polymer overgloves as undergloves (e.g. Bodyguards ® ; Medisavers, E: sales@medisavers.co.uk) instead of a pair of latex gloves results in no 'smell' being transmitted to the hands. One of the major problems reported by surgeons when using two pairs of gloves is loss of tactile sensitivity. 1 We have found that these gloves do not significantly affect tactile sensitivity. During proximal locking of a retrograde femoral intramedullary nail, retraction can be difficult when using traditional radio-opaque retractors. A 50-ml syringe, such as BD Plastipak™ (BD, The Danby Building, Edmund Halley Road, Oxford Science Park, Oxford, UK), with the catheter tip cut off, either with scissors or a saw, can be placed directly onto bone via the skin incision. This easily retracts the tissues allowing access to the proximal femur with the added benefit of being radiolucent. This allows the surgeon to interpret the fluoroscopy findings accurately and position the proximal locking screw precisely. Furthermore, the surgical assistant is protected from erroneous exposure to radiation whilst screening.A loop transverse colostomy can be performed as an effective method of relieving acute colonic obstruction. In the setting of disseminated intra-abdominal malignancy and resultant abnormal anatomy, the procedure is frequently underestimated. By securing a coin in the right upper quadrant and obtaining a plain film of the abdomen, the location of the proposed colostomy relative to the transverse colon can be estimated pre-operatively. This facilitates less dissection of the peritoneal attachments in order to mobilise the colon to the desired site.

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