The aim of this study was to critically analyse the various outcome measures available for assessing wrist and hand function. To this end, an extensive literature search was performed on Medline, PubMed and the Science Citation Index, focusing on terms associated with the method of development of the outcome measures item generation, item reduction, validity, reliability, internal consistency and their strengths and weaknesses. The most commonly used outcome measures described in literature were the DASH score (disability of shoulder, arm and hand questionnaire), the PRWE score (patient-rated wrist evaluation questionnaire), the Brigham and Women's carpal tunnel questionnaire and the Gartland and Werley score. Our study provides very useful evidence to suggest that the PRWE score is the most responsive instrument for evaluating the outcome in patients with distal radius fractures, while the DASH score is the best instrument for evaluating patients with disorders involving multiple joints of the upper limb. The Brigham and Women's score is a disease-specific outcome instrument for carpal tunnel syndrome; it has been validated and demonstrated to show good responsiveness and reliability in evaluating outcome in patients with carpal tunnel release. The Gartland and Werley score, although the most commonly described instrument in the literature for evaluating outcome after wrist surgery, has not been validated so to date.

The aim of this study was to compare the results of the humerus intramedullary nail (IMN) and dynamic compression plate (DCP) for the management of diaphyseal fractures of the humerus. Forty-seven patients with diaphyseal fracture of the shaft of the humerus were randomised prospectively and treated by open reduction and internal fixation with IMN or DCP. The criteria for inclusion were grade 1 or 2a compound fractures, polytrauma, early failure of conservative treatment and unstable fractures. The patients with pathological fractures, grade 3 open fractures, refractures and old neglected fractures of the humerus were excluded from the study. Twenty-three patients underwent internal fixation by IMN and 24 by DCP. Reamed antegrade nailing was done in all cases. DCP was done through an anterolateral or posterior approach.

We report our initial experience of using the Ponseti method for the treatment of congenital idiopathic club foot. Between November 2002 and November 2004 we treated 100 feet in 66 children by this method. The standard protocol described by Ponseti was used except that, when necessary, percutaneous tenotomy of tendo Achillis were performed under general anaesthesia in the operating theatre and not under local anaesthesia in the out-patient department. The Pirani score was used for assessment and the mean follow-up time was 18 months (6 to 30). The results were also assessed in terms of the number of casts applied, the need for tenotomy of tendo Achillis and recurrence of the deformity. Tenotomy was required in 85 of the 100 feet. There was a failure to respond to the initial regimen in four feet which then required extensive soft-tissue release. Of the 96 feet which responded to initial casting, 31 (32%) had a recurrence, 16 of which were successfully treated by repeat casting and/or tenotomy and/or transfer of the tendon of tibialis anterior. The remaining 15 required extensive soft-tissue release. Poor compliance with the foot-abduction orthoses (Denis Browne splint) was thought to be the main cause of failure in these patients.

We audited the relationship between obesity and the age at which hip and knee replacement was undertaken at our centre. The database was analysed for age, the Oxford hip or knee score and the body mass index (BMI) at the time of surgery. In total, 1369 patients were studied, 1025 treated by hip replacement and 344 by knee replacement. The patients were divided into five groups based on their BMI (normal, overweight, moderately obese, severely obese and morbidly obese). The difference in the mean Oxford score at surgery was not statistically significant between the groups (p > 0.05). For those undergoing hip replacement, the mean age of the morbidly obese patients was ten years less than that of those with a normal BMI. For those treated by knee replacement, the difference was 13 years. The age at surgery fell significantly for those with a BMI > 35 kg/m(2) for both hip and knee replacement (p > 0.05). This association was stronger for patients treated by knee than by hip replacement.

Background The decision to recommend either reconstructive or ablative surgery to the parents of children with fibular hemimelia is difficult and debatable in the orthopaedic literature.