We present the case of a previously well 18 year old female who presented with an acute onset swollen painful right ankle with an overlying non-blanching purpuric rash. There were no associated systemic features. Ankle joint aspirate grew Neisseria Meningitides. She was treated with intravenous third generation cephalosporin's and surgical washout of the joint with improvement. Primary meningococcal arthritis (PMA) is rare and mostly associated with the knee joint. Presentation of meningococcal disease in this manner is easily missed or misdiagnosed as gonococcal disease or overlying cellulitis.

Primary meningococcal arthritis is a rare form of septic arthritis. It can be misdiagnosed as an overlying cellulitis or as a gonococcal rash. Physicians should be aware of the possibility of this microorganism presenting as a septic arthritis, and understand the importance of joint aspiration at the centre of diagnosis.

Introducition Early splinting of long bone fractures reduces pain, facilitates patient transport and helps prevent further soft tissue injury. Experience suggests that the rate of splinting is low. This study aims to quantify this rate and determine whether it could be improved with a simple educational intervention.

Methods Radiographs ordered in the Emergency Department over an eight week control period were examined for fractures and presence of splints. The junior doctors responsible for these patients completed a questionnaire to assess how highly they rated early splinting. At the beginning of the next emergency term, new junior doctors were given the same questionnaire followed by an information sheet relating to fracture splinting. The questionnaire was repeated after reading the information sheet to confirm comprehension. Radiographs performed over the following eight weeks were examined.

Results Ninety-six long bone fractures amenable to splinting were x-rayed in the control period, and of these 15 were splinted (16%). After the intervention this rose to 28 out of 98 fractures (29%, p< 0.05). The intervention group prior to reading the information sheet ranked splinting in a similar manner to the control group (p> 0.20). Splinting ranked significantly more highly after reading the information sheet (p< 0.01).

Conclusions We have shown that a simple and concise teaching session to junior doctors in the Emergency Department significantly improves the rate of splinting in the early management of fractures. We suggest that similar training should be applied to all emergency staff.

Introduction Kirschner wire (K-wire) pinning is a widely accepted technique for fixation of distal radius fractures. Potential exists for injury to the soft tissues. This cadaveric study evaluates the safety of percutaneous pinning of distal radius fractures using a technique of intrafocal placement of K-wires.

Methods Three K-wires (1.6 mm diameter) were inserted percutaneously into 18 cadaveric wrists 18 mm proximal to the radial styloid. A radial wire was placed between the first and second extensor compartments. A dorso-radial wire was placed proximal to Lister’s tubercle. A dorsoulnar wire was placed between the fourth and fifth compartments. The wrists were dissected along the wires to the bone.

Results The superficial radial nerve (SRN) was pierced twice (11%), the abductor pollicis longus six times (33%), the extensor pollicis brevis and the extensor carpiradialis brevis once (6%). Extensor pollicis longus (EPL) was entered five times (28%), the fourth compartment four times (22%) and the fifth compartment once (6%). Only four wrists (22%) escaped injury to any important structure.

Conclusions The incidence of SRN injury by percutaneous insertion of K-wires is similar to that reported for the mini-open approach of around 12%. Rupture of EPL has been reported at around two percent. Aetiology of rupture is unclear and a K-wire that is subsequently removed may not increase the risk of rupture.