Purpose of the study: Determining bone age at the wrist is not an easy task and can be a source of error. We elaborated a method for determining bone age at the elbow using an analysis of bone maturation at this localization.

Material and methods: The method finetunes the Sauvegrain method and is based on more than ten years of data for the analysis of more than 3600 x-rays. Bone maturation evolves from 0% at birth to 100% marking the end of growth. We propose a digital system for drawing the growth curve from 50% to 100% bone maturation as a function of chronological age. This curve gives the distribution of bone age around the median for each gender. Fifty percent maturation corresponds to onset of adolescence and can be used to define onset of puberty before any other clinical sign; 100% bone maturation corresponds to maximal growth or stature. Specific bone landmarks are used and the method for calculating bone age is presented.

Results: It is interesting that a shift of one year or more between bone age calculated at the elbow and that calculated from the wrist. This observation was frequent and suggests that bone age determined at the elbow gives a better reflection of limb maturation. In addition, regular use of this method in daily practice confirmed its usefulness, reliability, and inter- and intra-observer reproducibility.

Conclusion: This is a reliable simple method for determining bone maturation. It is easier to use than the wrist method and probably better reflects bone maturation of the limbs.

Purpose: This prospective study focused on an interhospital collaboration for foot and ankle surgery. Collaboration was organised between the referring surgeon and four regional foot and ankle specialists. We evaluated concordance and discordance between expert opinions.

Material and methods: Patients for whom an opinion was requested were selected by the requesting surgeon based on problems involving diagnosis or therapeutic indications. Opinions were requested by email. Individual protocols were established for the clinical report and x-ray file of each type of condition. The final therapeutic decision was made by the requesting surgeon.

Results: Among the 450 patients seen for foot and ankle disorders, opinions were requested from experts for 30. The conditions involved: the forefoot (46%), the middle foot (16%), the hindfoot (7%) and the ankle (31%). Mean time for the response was eleven days (1–60). Experts responded to all requests (120 responses) but in four cases (3%) could not provide an opinion. The index of diagnostic agreement among the experts was 3.2/4. The index for therapeutic indications showed agreement at 2.6/4. Agreement between the therapy proposed to the patient and that proposed by the experts was 2.6/3.

Discussion: We analysed the advantages for the patient, the responsibility of the requesting and responding surgeon, and the problems related to remuneration of this type of counselling. Compared with other technologies, email was found to be simple, reliable, and low-cost with good quality images. This work showed that there was concordance between the opinions and that electronic expertise counselling is certainly very useful for foot disorders. Requests addressed to several experts increases precision and provides complementary information for difficult cases. It is important that the different participants know each other.

Conclusion: This work is the first step towards the development of a care network for foot and ankle disease enabling graduated patient management.