Background

The R3 cementless acetabular system (Smith & Nephew, Memphis, Tennessee, United States) is a modular titanium shell with an asymmetric porous titanium powder coating. It supports cross-linked polyethylene, metal and ceramic liners with several options for the femoral head component. The R3 cup was first marketed in Australia and Europe in 2007. Two recent papers have shown high failure rates of the MoM R3 system with up to 24% (Dramis et al 2014, Hothi et al 2015). There are currently no medium term clinical papers on the R3 acetabular cup.

Background

Fractures of the metatarsal bones are the most frequent fracture of the foot. Up to 70% involve the fifth metatarsal bone, of which approximately eighty percent are located proximally. Low-intensity pulsed ultrasound (LIPUS) has been shown to be a useful adjunct in the treatment of delayed fractures and non unions. However, there is no study looking at the success rate of LIPUS in fifth metatarsal fracture delayed unions.

Introduction: Langerhans Cell Histiocytosis (LCH) is a tumour-like condition that runs a variable clinical course. Recent series1,2 have suggested that skeletally immature patients with a solitary bony focus (eosinophilic granuloma) have an especially good prognosis.

Aim: To compare recurrence/progression rates for Scottish patients with solitary eosinophilic granulomas, according to skeletal maturity.

Methods: Retrospective case note review of patients identified from the Scottish Bone Tumour Registry.

Results: We identified 70 cases of biopsy-proven non-spinal eosinophilic granuloma of bone. Of these, 39 were skeletally immature (< 16 years) and 31 were skeletally mature (> 16 years). Follow-up (mean 8.25 years) was either continuing or to discharge/death. On the basis of initial screening (skeletal survey/bone scan), 9 cases (13 %; 4 and 5 patients, from the paediatric and adult groups respectively) were found to have multi-focal disease. Considering those with unifocal disease:

in the immature group, 6 patients (ex 35; 17%) developed a further manifestation of the condition (2 had recurrences at same site; 2 developed a distinct focus in bone; 1 developed a distinct soft tissue lesion causing spinal cord compression; 1 developed diabetes insipidus),

Conclusions: For this population, these data show that the prognosis for paediatric patients with isolated eosinophilic granuloma of bone must be more guarded than that suggested by other series1,2.