In a prospective randomized trial, we divided a group of patients with a clinically suspicious, although radiographically normal, acute fracture of the scaphoid into 2 groups, 1 treated with a cast (group I), the other with a splint (group II). There were 14 patients in group I, and 18 in group II. Patients were reviewed at 2,6, and 12 weeks for range of movement, grip strength, pain and satisfaction rating. Work disability costs were also calculated for both groups. Patients in group II had better range of movement and grip strength at 2 weeks, although complained of more pain. There was no difference in range of movement, grip strength, or pain at 6 or 12 weeks. Group II was more satisfied at 2 weeks, although not at 6 or 12 weeks. Group I required more time off work, and disability costs were significantly higher [€15,209 per person compared to €3,317 per person]. We recommend that all patients, with only a clinical suspicion of a fractured scaphoid, should have a short period of splint immobilization until symptoms resolve, or until further investigations reveal a fracture which can be appropriately treated. This policy is cost efficient and improves the short term outcome.

This study reviewed the subjective, clinical, and radiological outcome of 24 patients (31 feet) treated by basal metatarsal osteotomy with a modified McBride procedure for severe (intermetatarsal angle > 150) hallux valgus, carried out at our institution with an average follow-up time of 29 months.

At the time of follow-up, 40% of the patients were very satisfied, 45% were satisfied, and 15% were not satisfied. The mean Hallux – Metatarsophalangeal – Interphalangeal scale score raised significantly from 39 points (17 – 64) pre-operatively, to 82 (39 – 96) points at follow-up (p < 0.001). The Lesser - Metatarsophalangeal – Interphalangeal scale score raised significantly from 46 points (26 – 69) pre-operatively, to 84 (33 – 97) points at follow-up (p < 0.001). The radiological angles, including M1-M2, M1-P1, M1-M5, and DMAA improved significantly (p < 0.001). 12 of these cases had a M1-M2 angle post correction > 15°. Among the 9 complications recorded, 7 were minor and 2 required an additional procedure.

The basal metatarsal osteotomy coupled with a modified McBride procedure resulted in an overall high satisfaction rate, as well as significant clinical and radiological improvements in our series. Nevertheless, the range of motion of the first MTP joint remained low: 30 – 75° in 67% and < 30° in 6%. Furthermore, the failure to correct the M1-M2 angle to < 15° in 12 cases was probably due to the severe nature of the M1-M2 angle in these patients pre-operatively (21–33°).

Basal metatarsal osteotomy with a modified McBride procedure remains a safe procedure with excellent results, both subjectively and objectively, in patients with severe hallux valgus

This study was carried out to determine the incidence of shoulder injuries in the ipsilateral shoulder of patients who attended our unit with fractures of the humeral diaphysis.

This was a prospective study. 22 patients with fractures of the humeral diaphysis had an early (within 10 days of injury) MRI scan of the shoulder. The contralateral shoulder was also scanned as an internal control. There were 10 male and 12 female patients. The average age was 45 years. 20 were treated non-operatively, and 2 had retrograde intra-medullary nailing of the humerus. 6 patients in our study had a symmetrical MRI scan. The remaining 16 patients had some acute abnormality evident in the ipsilateral shoulder. 11 patients had a significant subacromial bursitis. 2 of these patients had a tear of the supraspinatus tendon. 1 patient had an undisplaced fracture of the coracoid process. The remaining 4 patients had significant AC joint inflammation, 3 being acute, the 4th being acute-on-chronic.

This study shows a high incidence of asymmetrical MRI scans, indicating a definite shoulder injury sustained at the time of the fracture of the humeral diaphysis. We therefore surmise that shoulder pain and dysfunction post antegrade intra-medullary nailing of the humerus may not be due to iatrogenic causes, but may in fact result from concomitant ipsilateral shoulder injury. To our knowledge, this is the first study demonstrating such an association.

Background: We have noticed while performing total hip arthroplasty, that during skin closure, the anterior edge of the wound tends to migrate proximally in relation to the posterior edge. This result is an inaccurate approximation of the wound, the so-called ‘dogs ear’. The aims of the study were to assess and quantify the degree of migration of the anterior edge relative to the posterior one using an invisible marker and to see whether marking the incision site prior to surgery improved skin closure.

Material and methods: We included forty patients undergoing primary hip arthroplasty in the study. Prior to surgery, the skin was marked with five lines perpendicular to the incision line with an invisible skin marker using the greater trochanter as reference point. The skin was then routinely prepared with betadine and a proprietary adhesive incision drape (Ioban 2) was applied to the incision site. The surgeon performed the operation routinely and intra-operatively, the subcutaneous fat content was measured at three set points and averaged. After the wound had been closed, an ultraviolet light source was used to highlight the invisible lines. The gap between the anterior and posterior edge was measured for each line. One set of patients had their incision site marked with a visible marker on the incision drape while the other set did not.

Results: There was a persistent proximal migration of the anterior edge in relation to the posterior edge. The proximal part of the incision site had a more marked skin migration compared to the distal wound. In the unmarked group, the proximal part of the anterior edge tended to migrate on average by 9.5 mm (from 30 mm to 5 mm) in respect to the posterior edge. In the marked group, this migration was reduced to an average of 1.6 mm (from 2 mm to 0 mm) and there was a statistical difference between the 2 groups with p< 0.0001 using the independent t-test as illustrated by the table. Of note, the degree of migration did not vary with the thickness of the fat content. Also, all the wounds healed with no signs of infection.

Conclusion: From this study, we have been able to quantify objectively the extent of migration of the anterior edge of the wound in a hip incision in relation to the posterior edge. Improved hip closure following total hip replacement was achieved after marking the skin prior to surgery. We therefore recommend marking the skin pre-operatively prior to hip incision in order to achieve accurate skin closure as part of the general principle of proper wound closure.