In a prospective, consecutive study we reviewed the results of 32 supracondylar femoral fractures treated by Smith & Nephew intramedullary supracondylar nailing between January 1996 and October 2002. The mean age of 23 women and nine men was 67 (58 to 89). All fractures were closed. Two patients had associated upper limb fractures. In four cases, fractures occurred around total knee prostheses. Four patients had previously undergone ipsilateral total hip replacement or had had a sliding hip screw. On the AO classification the majority of fractures were type-33A1 and A2; seven fractures were classified as C1 and C2. The patients were placed in the supine position on a radiolucent operating table with the knee in 30° of flexion.

Postoperatively a hinged knee brace was applied and worn until union. Supported, progressive knee movement was introduced from day one. Partial weight-bearing was permitted as soon as pain subsided and continued until there were radiological signs of union. Within three to six months all but two fractures united. These united after prolonged bracing. There was no sepsis or fixation failure. A functional range of knee movement was observed in all patients.

Retrograde intramedullary nailing is a safe and successful method of management of supracondylar femoral fractures in the elderly and offers a minimally invasive alternative.

The goals of this study were to determine the outcome of surgical iliotibial band release in long-distance runners with iliotibial band friction syndrome (ITBFS).

A retrospective study of 66 patients (94 ITBFS) treated between 1995 and 1999 was performed. The diagnosis was made clinically by the presence of a positive Noble test. All other pathology was excluded. All patients had failed a trial of conservative therapy consisting of rest, physiotherapy, activity modification and corticosteroid injections.

Surgery was performed on an outpatient basis and patients were monitored postoperatively for at least two years. The outcome was assessed according to patient satisfaction, the time it took to return to running, level of activity and surgical complications.

Most patients were able to start running again within six weeks of surgery. Complications included three superficial infections and two cases of prolonged pain. The procedure was unsuccessful in three patients. Ninety-six percent of patients said that they would have this procedure again.

ITBFS is common in long-distance runners in this country. This is a safe, simple and effective surgical alternative for patients who do not respond to conservative treatment.

Purposes of the study and background: This study tests the hypothesis that it is possible to visualise the cervical spine musculature using ultrasound. The use of diagnostic ultrasound is well established for assessing other anatomical regions; whereas the cervical spine has received little attention. Other available imaging procedures can be resource intensive with recognized risks and do not give an indication of structural detail. Ultrasound has the potential to resolve these inadequacies and would therefore be appealing.

Summary of the methods and the results: 10 healthy volunteers (age range: 21–36 years, 6 females, 4 males) were evaluated using a 8-16MHz linear array transducer (Diasus Dynamic Imaging, UK) and a 16MHz CL15-7 linear array scanhead transducer (Phillips ATL HDI 5000 SonoCT, Netherlands). Subjects were seated with their neck in a neutral position. The transducer was orientated transversely, and initially placed on the thyroid cartilage. Successive images were taken as the transducer was moved laterally across the anterior triangle, over the sternocleidomastoid, into the posterior triangle, ending in the posterior midline. Landmarks, with characteristic ultrasonic appearances, were identified to aid orientation e.g. carotid artery. Both machines produced images that clearly displayed the musculature of the cervical spine. Composite images were obtained of the anterior and posterior aspects of the neck (Figure 1) to provide information regarding the spatial orientation and relationship between the muscles.

Conclusion: This study concludes that modern ultrasound equipment provides cervical spine soft tissue images of a quality suitable for diagnostic applications. It also has the advantages of being a risk free, economic and portable procedure.

Purposes of the study and background: Diagnostic interventional procedures are often performed on patients who suffer from cervical facet joint pain and discogenic pain emanating from the cervical region. These procedures require radiographic imaging to confirm placement of instruments e.g. needles. However, these techniques are unable to provide real-time images hence prolonging the intervention. It would be of benefit to have an imaging tool that is capable of visualising needle insertion in real-time whilst preventing side effects. The purpose of this study was to determine the ultrasonic appearance of cervical facet joints in vivo and describe a standardized transducer position to visualise intervertebral discs and facet joints.

Summary of the methods and the results: 10 healthy volunteers (age range: 21–36 years, 6 females, 4 males) were evaluated using an 8-16MHz linear array transducer (Diasus Dynamic Imaging). Subjects were scanned in a prone, lateral position. The transducer was placed in the posterior triangle orientated longitudinally, initially along the posterior border of sternocleidomastoid and then moved in a cranial-caudal direction. By adjusting the angle (in the antero-posterior direction) of the transducer about a fixed position; facet joints and discs were located. The characteristic V shaped appearance of the facet joint emanates from the hyperechoic signal of the closely spaced transverse processes of adjacent vertebra (Figure1). Disc regions appeared as areas of high signal penetration into the spine with low amplitude signals returning from the disc.

Conclusion: The detail of facet joint and disc anatomy captured using ultrasound reveal it to be a viable imaging tool for interventional procedures. Noteworthy advantages of ultrasound include: its ability to provide real-time images economically, the option of portability and no known side effects.

In a retrospective study of 100 cases treated between 1995 and 1999, we evaluated the outcome of surgical iliotibial band release in long-distance runners with ilio-tibial band friction syndrome (ITBFS).

All patients had a positive Noble test. All other pathology was excluded. Conservative therapy comprising rest, physiotherapy, activity modification and corticosteroid injection had proved ineffective.

Surgery was performed as an outpatient procedure and patients were followed up for at least two years postoperatively. The outcome was assessed by the time to return to running, the level of activity, patient satisfaction and the surgical technique.

Iliotibial band release offers an effective surgical alternative to patients with ITBFS who do not respond to conservative treatment.