ObjectivesTo ascertain whether the use of oral glucosamine influences symptoms or functional outcomes in patients with chronic low back pain (LBP) thought to be related to spinal osteoarthritis (OA).DesignSystematic review of randomised control trials. Searches were performed up to March 2011 on Medline, AMED, CINHAL, Cochrane and EMBASE with subsequent reference screening of retrieved studies. In addition, the grey literature was searched via opensigle. Included studies were required to incorporate at least one of the Cochrane Back Pain Review Group's outcome measures as part of their design. Trials with participants over 18 years with a minimum of 12 weeks of back pain, in combination with radiographic changes of OA in the spine, were included. Studies were rated for risk-of-bias and graded for quality.Results148 studies were identified after screening and meeting eligibility requirements, and three randomised controlled trials (n=309) were included in the quantitative synthesis. The review found that there was low quality but generally no evidence of an effect from glucosamine on function, with no change in the Roland-Morris Disability Questionnaire score in all studies. Conflicting evidence was demonstrated with pain scores with two studies showing no difference and one study with a high risk-of-bias showing both a statistically and clinically significant improvement from taking glucosamine.ConclusionsOn the basis of the current research, any clinical benefit of oral glucosamine for patients with chronic LBP and radiographic changes of spinal OA can neither be demonstrated nor excluded based on insufficient data and the low quality of existing studies.

Given the choice, most patients would choose intraoperative diagnosis, though a minority would explicitly not, due to the adverse psychological effect thereof. Despite a good understanding of the procedure, the majority of patients overestimate the sensitivity of intraoperative diagnosis of sentinel nodes, which may heighten disappointment when a false negative diagnosis occurs. Intraoperative diagnosis should not be the automatic choice and patients should be actively involved in this decision making process.

Abstracts / Injury Extra 42 (2011) 95-169 163 the primary THR was anterolateral (15 cases), posterior (53) and tran-trochanteric (6). Mechanism of dislocation included traumatic (25) and non-traumatic causes (49) cases. Dislocations after primary THR were 9 within the first month of surgery, 26 between 1 and 12 month, 24 after the first year. After revision THR there were 8 dislocations between 1 and 12 months. Revision procedures were performed on 31 patients. After the first dislocation, the risk of a further dislocation was 28.4%. Risk factors for dislocations included rheumatoid arthritis (8 cases), dementia (3), extensive hip muscle/tissue damage (2), trochanteric non-union (8). The mean acetabular inclination was 44 • (27-72). The mean number of days of hospitalisation was 8.37 days. The cost of hospitalisation excluding cost of medical or surgical intervention was £900,000 GBP.Conclusion: The incidence of THR dislocation was 2.4%. The risk of subsequent dislocation after the first one was 28.4%. The requirement for revision THR was 42%.Aim: To evaluate whether the use of a consultant-led triaging service for acute referrals to fracture clinic improves the management of patients who require urgent early intervention.Methods: An audit of prospectively collected data from the Patient Administrative System (PAS) was carried over the period of 1 month, which assessed the waiting time to fracture clinic appointments and the subsequent late admission rate. We defined the late admission rate as the proportion of patients admitted after their first fracture clinic appointment who had a delay of ≥5 days from their initial referral.A consultant-led triaging service was subsequently implemented. X-rays (on PACS) and A&E notes of patients were assessed and the referrals assigned to one of three categories: 1. Admit/or Call Back Patient for Urgent Review. 2. Discharge Patient. 3. Keep Current Appointment. The subsequent waiting time for fracture clinic and late admission rate were re-audited.Results: A total of 367 new A&E referrals were seen in fracture clinic during the audit period. The median waiting time to be seen in fracture clinic was 10 days (range of 1-29 days). 14 patients (3.8%) were admitted for further management from their first fracture clinic appointment after having waited ≥5 days from their initial referral. On re-audit, the median fracture clinic wait time was 9 days (range of 0-28 days). The late admission rate from clinic fell to 0.9%.Conclusion: Fracture healing occurs within a limited time frame, therefore a delayed clinic appointment for an injury that requires urgent intervention not only has an impact on clinical care but can lead to serious medico-legal consequences. We have shown that the use of a simple consultant-led triaging service reduces the late admission rate from fracture clinic and subsequently improves the clinical management of our patients.

Spinal metastases may present in a myriad of ways, most commonly back pain with or without neurology. We report an unusual presentation of isolated atypical chest pain preceding metastatic cord compression, secondary to penile carcinoma. Spinal metastasis from penile carcinoma is rare with few cases reported. This unusual presentation highlights the need for a heightened level of clinical suspicion for spinal metastases as a possible cause for chest pain in any patients with a history of carcinoma. The case is discussed with reference to the literature.