The migration patterns of two versions of the Furlong cementless femoral stem: a randomised, controlled trial using radiostereometric analysis.

We have evaluated the difference in the migration patterns over two years of two cementless stems in a randomised, controlled trial using radiostereophotogrammetric analysis (RSA). The implants studied were the Furlong HAC stem, which has good long-term results and the Furlong Active stem, which is a modified version of the former designed to minimise stress concentrations between the implant and bone, and thus to improve fixation. A total of 23 Furlong HAC and 20 Furlong Active stems were implanted in 43 patients. RSA examinations were carried out immediately post-operatively and at six, 12 and 24 months post-operatively. The subsidence during the first year in the Furlong HAC stem, was approximately one-third that of the Furlong Active stem, the measured mean subsidence of the femoral head at six months being 0.27 mm (95% confidence interval (CI) 0.03 to 0.51) and 0.99 mm (95% CI 0.38 to 1.60), respectively (p = 0.03). One Active stem continued to subside during the second year. All hips, regardless of the type of stem were clinically successful as judged by the Oxford hip score and a derived pain score without any distinction between the two types of stem. The initial stability of the Furlong Active stem was not as good as the established stem which might compromise osseo-integration to the detriment of long-term success. The changes in the geometry of the stem, to minimise stress have affected the attainment of initial stability.

Uk Armed Forces unintentional firearm injuries.

OBJECTIVES: To report on the incidence of unintentional firearm discharge and injury across the UK Armed Forces and present several cases of this wounding phenomenon. METHOD: Munitions Incidents and Defects (MID) Cell data on UK Military Negligent Discharges and unintentional firearm injuries from 01 Jan 03 to 31 Dec 07 was categorised according to cause of injury, wound, service affiliation, incident context and weapon type. The injuries of three patients are described. RESULTS: Over the 5 year period there were 1158 Unintentional firearm discharges, forty three (4%) of which resulted in injury. Fifty five military personnel sustained unintentional firearm injuries during the review period, more than half of which were gunshot wounds and this included one fatality. The Regular Army suffers an average of 7.7 unintentional firearm injuries per 100 000 Regular Army person years. CONCLUSION: Unintentional firearm injury is well recognised across the civilian and police sectors worldwide. Despite the recent tempo of high grade training and operations that currently engage UK Armed Forces this form of injury remains uncommon. We hope to facilitate discussion with the chain of command to manage the risk of these injuries.

The natural history of hooked forefoot.

This paper reports on a prospective study undertaken to determine the natural history of untreated idiopathic hooked forefoot. The progress of 130 affected feet in eighty-three children was followed for an average of seven years. At review 86% of the feet were normal or only mildly deformed and all were fully mobile; 10% were still moderately deformed but were asymptomatic; 4% remained deformed and stiff. It was not possible to detect these resistant cases before the age of three years, but the low failure rate would seem to justify a policy of expectant treatment.