Ann R Coll Surg Engl 2010; 92: 665-667 665A major determinant of patient satisfaction following surgery to the upper limb is an acceptable cosmetic result. 1 Both absorbable and non-absorbable suture materials are available for wound closure. Absorbable sutures do not require removal and may, therefore, save clinic time and reduce patient anxiety postoperatively. Non-absorbable sutures may be less likely to elicit an inflammatory response or break prematurely. The aim of this study was to evaluate prospectively aesthetic outcomes in a group of randomised patients undergoing elective day-case hand and wrist surgery using either absorbable or non-absorbable sutures. Patients and MethodsOne hundred adult patients presenting to our unit for daycase hand and wrist surgery were included in the study. Patients on steroids or those who had medical problems affecting wound healing (such as diabetes mellitus) were excluded as were those undergoing revision procedures. All patients were under the care of a single consultant hand surgeon who routinely utilised both absorbable and nonabsorbable wound closure for upper limb surgery. Following informed consent, patients were randomised using a sealed envelope technique to receive either absorbable (3/0 Vicryl rapide™, Ethicon, UK) or nonabsorbable sutures (3/0 nylon) for their wound closure. Wound closure was performed using interrupted skin sutures in each case. No subcutaneous sutures were used. Fifty patients were included in each group. The demographics of each group along with the procedures performed are summarised in Table 1 We prospectively evaluated aesthetic outcomes in a group of randomised patients who underwent elective daycase hand and wrist surgery using either absorbable or non-absorbable sutures. PATIENTS AND METHODS A cohort of 100 adult patients were randomised using sealed envelopes to receive either absorbable or non-absorbable sutures for their wound closure. Clinical review was carried out at 6 weeks. A postal questionnaire was sent to all patients 3 months following surgery comprising a visual analogue scale (VAS) for wound satisfaction, a validated 6-point patient scar assessment tool and the shortened version of the disabilities of the arm, shoulder and hand questionnaire (QuickDASH). RESULTS From the postal questionnaire, 70 responses were received. There was no statistically significant difference between the two groups in terms of VAS, patient scar assessment tool and quick DASH. CONCLUSIONS For elective day-case hand and wrist surgery, either suture material can be used confidently with respect to overall aesthetic appearance in such patients.

The aim of this study was to assess sporting and physical activities in patients who had undergone hip resurfacing. Our study included 117 patients who underwent hip resurfacing between

The management of osteoarthritis of the hip in young active patients is challenging. We compared the functional outcomes and activity levels following hip resurfacing and uncemented THA in young active patients matched for age, gender and activity levels. Mean follow-up period was five years (4-7 years). Within each group there was a statistically significant improvement in the mean University of California at Los Angeles (UCLA) and Oxford Hip Score (OHS) scores following surgery. This study found no statistically significant difference in the levels of function (p= 0.82) or activity pursued (p= 0.60) after surgery between uncemented THA and hip resurfacing. The potential complications unique to hip resurfacing may be avoided by the use of uncemented THA which in itself has longer follow-up compared to resurfacing.

We report a specific pattern of osteolysis around bone tunnels on the lateral cortex of the greater trochanter following abductor reattachment using a polyester suture. Radiographs of 395 patients who underwent cemented THA during a four year period between 1999 and 2003 were reviewed. 27 patients had abductor reattachment using number 5 Ethibond suture through bone tunnels. These patients displayed a predominantly osteolytic pattern of bone reaction around the greater trochanter bone tunnels. All patients were subsequently reviewed in clinic at 4-7 years following surgery. Three patterns of response were observed around the bone tunnels. Recognition of this unique osteolysis pattern may be important in the investigation of complications following cemented THA.

INTRODUCTION The Lachman test is commonly performed as part of the routine assessment of patients with suspected anterior cruciate ligament (ACL) deficiency. A major drawback is its reliance on the clinician's subjective judgement of movement. The aim of this study was to quantify Lachman movement using a magnetic tracking device thereby providing a more accurate objective measure of movement.PATIENTS AND METHODS Ten patients aged 21-51 years were assessed as having unilateral ACL deficiency with conventional clinical tests. These patients were then re-assessed using a Polhemus Fastrak™ magnetic tracking device. RESULTS The mean anterior tibial displacement was 5.6 mm (SD = 2.5) for the normal knees and 10.2 mm (SD = 4.2) for the ACL-deficient knees. This gave an 82% increase in anterior tibial displacement for the ACL deficient knees. This was shown to be highly significant with P = 0.005.CONCLUSIONS The magnetic tracking system offers an objective quantification of displacements during the Lachman test. It is convenient, non-invasive and comfortable for the patient and is, therefore, ideally suited for use as an investigative tool.