There is a high complication rate associated with axial pattern flaps but these are usually easily managed and long term outcome is excellent, in either species.

The use of fluoroscopy is of great importance for operative fixation of fractures. Previous studies have shown an increased fluoroscopy time for intramedullary nails and with junior surgeons in comparison with more experienced surgeons. We examined the impact of operation length on fluoroscopy dose, cumulative fluoroscopy time between consultant and registrar surgeons and cumulative fluoroscopy time between dynamic hip screw and intramedullary nailing. We performed a retrospective cohort study of all patients admitted to our centre over the period of 1 year. Patients who underwent dynamic hip screw (DHS) or intramedullary (IM) nailing were identified from our in-hospital hip fracture database. Intraoperative fluoroscopy images were then accessed through our hospital's medical imaging software. A total of 137 patients were identified. Fluoroscopy reports were not available for 49 patients, resulting in a final total of 88 patients. Patients whose operation lasted longer than 1 h received a statistically significant higher dose of radiation (183.83 cGYM2 vs. 368.22 cGYM2; p value 0.0002). Operations performed by a consultant resulted in less cumulative fluoroscopy time in comparison with those performed by a registrar or specialist registrar although this was not statistically significant (00:00:53 vs. 00:00:45; p vaue 0.38). Cumulative fluoroscopy time was less in dynamic hip screw compared to long intramedullary nails (00:00:39 vs. 00:01:29; p value <0.001) and short intramedullary nails (00:00:39 vs. 00:01:52; p value 0.387). Studies, which had a cumulative fluoroscopy time exceeding 50 secs, delivered a higher radiation dose (434.34cGYM2 vs. 150.51cGYM2; p value <0.001). We concluded that there is no significant impact in cumulative fluoroscopy time in operations performed by either a registrar or consultant. Dynamic hip screws have a lower fluoroscopy time in comparison with long intramedullary nails.

Aims: To determine the outcome at 10 years of a cohort of ASR XL total hip arthroplasties (THAs) and reasons for revision. Methods: Between November 2005 and May 2007, 122 ASR XL THAs were implanted. All patients had a routine review at 6 weeks and 1 year, followed by a review in 2009 because of clinical concern and thereafter annual review up to 10 years with MRI. Review also included functional scores, radiographs, pain scores and blood metal ions. Results: 67 (54.9%) ASR XLs had been revised by 11.1 years. Reasons for revision included pain (89.6%), high levels of cobalt and chromium ions (50.7%) and radiographic or MRI changes (80.6%). All 3 factors were present in 23 (34.3%). Pain at 1 year did not predict revision, but pain at the 2009 review did. At 10 years the revised patients had an average Oxford Hip Score (OHS) of 25.38 (12–42) and the non-revised 23.61 (2–21), the difference was not significant ( p  = 0.48). 3 patients (4.5%) have had a further revision; 2 for a previously unrevised stem and the other for instability. Conclusions: Our arthroplasty care practitioner service allowed us to identify increased pain and stop using the ASR XL over 3 years before the implant was recalled. The revised patients had similar functional outcome to those unrevised. Poorly performing implants need to be identified earlier.

A Becker’s naevus is a rare, pigmented, cutaneous hamartoma, which when associated with other cutaneous or musculoskeletal anomalies is termed Becker naevus syndrome. Female patients commonly seek medical attention for breast hypoplasia. Here, we describe our experience in the surgical management of unilateral breast hypoplasia in a patient with Becker naevus syndrome, using high-volume autologous fat grafting. This is, to our knowledge, the second report in the literature describing the aforementioned management technique in this patient cohort.

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