In January 2000 we introduced identical guidelines for the more rapid rehabilitation of Achilles tendon ruptures, whether treated operatively or non-operatively. A relaxed equinus cast was used to four weeks, then a CAM walker to eight weeks with supervised mobilisation. The aims of this study were to compare the outcomes of the operative and non-operative groups treated with the same rehabilitation program and audit the effectiveness of these guidelines.

The audit was retrospective from January 2000 till January 2008. The patients were identified from the Emergency Department admissions database, the hospital clinical coding system, the department’s surgical audit data and the hospital physiotherapy appointment system. The audit system was used to identify patients that had complications of their operative treatment, re-ruptures or readmissions. This study focused on the end points of re-rupture, readmission, complications including wound complications and infection.

Five hundred and eighty seven presentations were recorded as Achilles tendon injuries. One hundred and eighty patients were treated operatively and 407 patients were treated conservatively. Seventy five patients (42%) treated operatively and 126 patients (30%) of the non-operative group were rehabilitated in our hospital physiotherapy department. The remaining 386 patients (65.7% of all patients) received physiotherapy elsewhere or did not attend for further treatment. In the operative group there were two re-ruptures (1.1%) both treated in our hospital physiotherapy department. There were 2 wound complications (1.1%), one requiring re-operation. In the non operative group there were 15 re-ruptures (3.7%). Of these three had attended the hospital physiotherapy department (rerupture rate of 2.4%) In the non-operative group treated elsewhere there were 12 re-ruptures from 281 patients (4.2%).

Comparable results were found between operative and non-operative treatment when combined with close physiotherapy guidance. Non-operatively treated patients treated in the community may have higher re-rupture rates. The results are comparable to those in the literature suggesting that the guidelines are effective.

To evaluate the medium term results of the Lautenbach procedures for the treatment of chronic osteomyelitis [COM] in long bones.

Cohort of 17 patients (18 segments) prospectively treated. Mean age 37 years. High-energy trauma effecting 8 tibia (6 open) & 9 femora (5 open). Duration of COM was mean 12. 5 years (1–31 years). Discharging sinus present in all. Lautenbach procedure comprises intramedullary reaming/debridement to 13 mm and establishment of local antibiotic delivery system, cavity analysis for volume and culture. The end point is 3 clear culture results of the irrigate, improvement in blood indices and reduction of cavity volume.

Mean treatment time 27 days (14–48). Mean hospital stay 38 days. Two needed revision of Lautenbach procedure and one local debridement for recurrence of infection. 7 non-unions needed further fixation. 2 needed Papineau grafting and 3 had further limb lengthening procedures. Mean follow-up is 3. 3 years. 4 patients have been discharged, 1 awaiting THR.

This procedure permits precise control over the osteomyelitis cavity until objective assessment suggests that infection has been cleared and cavity obliterated.