Background Locking titanium plates revolutionized the treatment of osteoporotic and metaphyseal fractures of long bones. However as with any innovation, with time new complications are identified.

Patella fractures are relatively common injuries. Tension band wiring is commonly used to treat displaced patella fractures. The goal of this study was to assess the outcome and implant removal rate following surgical stabilization of patella fracture. A consecutive series of 67 patients over a 6-year period was reviewed. Minimum follow-up to fracture healing (3 months) was available in 63 patients. Forty-three men and 24 women with a mean age of 49 years (range, 14-90 years) underwent surgical stabilization of patella fracture. Three open fractures and associated injuries were noted in 22 patients. Surgical treatment methods used were: tension band wiring in 44, tension band wiring with cerclage wire in 13, tension band wiring with screws in 4, and screw fixation in 6. All fractures united. Two superficial infections responded to oral antibiotics. One patient had revision surgery at 6 weeks. Twenty-two patients required implant removal for implant-related symptoms. Mean follow-up in asymptomatic patients was 8 months (range, 3-18 months) and in patients with implant-related problems was 17 months (range, 10-36 months). Four patients were lost to follow-up. Surgical stabilization of patella fractures by current techniques demonstrated satisfactory fracture union. However, 1 in 3 required surgery for implant-related symptoms. In the younger than 60 years group, the implant removal rate was 40%. This high rate of implant removal must be discussed with the patient prior to surgery. Newer techniques to avoid skin irritation should be considered.

Open carpal tunnel release is one of the commonest performed procedures in hand surgery. We performed a prospective randomised control trial to compare the efficacy and patient satisfaction of the traditional arm tourniquet versus infiltration of adrenaline and local anaesthetic solution to achieve haemostasis during the procedure. Using a combination of objective and subjective measures we concluded that infiltration of local anaesthetic and adrenaline not only provided adequate haemostasis but also provided a significantly more tolerable experience for the patient during the procedure.

A significant proportion of patients had access to the Internet to find health information. The widespread availability and increased usage of medical websites by patients raises important issues regarding the need for quality control and impacts on the doctor-patient relationship.

This prospective study assessed the results of a custom-made thermoplastic splint for treatment of mallet finger deformity. From April 1999 to April 2000, 42 patients with mallet finger deformity were recruited. All patients were seen within 1 week and treated with a thermoplastic splint custom-made by the hand therapy department. The splint was simple to make, easy to fit and suitable for all finger shapes and sizes. It improved the deformity in 30 out of 34 cases, and caused no skin irritation.