BackgroundRecent reforms to the training grades have provoked debate about both quality and quantity of training. The bulk of previous research into this area has been qualitative, and little is known about the quantity of training opportunities. This study aimed to determine if the number of elective operations available to trainees was stable.MethodsThe number of elective procedures carried out in each surgical specialty (General & Vascular Surgery, Urology, Orthopaedics, ENT) in a large district general hospital was analysed in 6 month periods and adjusted for the number of basic surgical trainees in each specialty. In order to allow comparison between specialties, results for each 6 month period were calculated as a percentage of those for the first period.ResultsThe number of elective operations available per trainee fell in 3 of the 4 specialties, with a rise in Orthopaedics. Overall, the number of operations available to each trainee was 56% of that less than a decade ago.ConclusionThe number of operations available in a conventional hospital setting is decreasing. Introduction of the Modernising Medical Careers reforms must take account of this if they are to succeed in improving the quality of surgical training.

Madelung's deformity is the most recognizable clinical manifestation of dyschondrosteosis. The natural history of the painful wrist in this condition has not been well documented and a study of nineteen patients is reported, with a review of the literature on the surgical treatment.

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Chronic contained rupture of an abdominal aortic aneurysm is rare. These aneurysms are small and affected patients are usually normotensive. The resultant pseudoaneurysmal sac may cause extensive vertebral erosion. Diagnosis is often delayed as the condition may present with symptoms referable to the lumbar spine. This report is of two cases where the initial diagnosis was infective spondylitis.

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