Aneurysmal bone cyst is a rare tumour-like lesion which develops during growth. Our aim was to determine the efficacy of the administration of percutaneous intralesional 3% polidocanol (hydroxypolyaethoxydodecan) as sclerotherapy.

Between July 1997 and December 2004 we treated 72 patients (46 males, 26 females) with a histologically-proven diagnosis of aneurysmal bone cyst, at various skeletal sites using this method. The sclerotherapy was performed under fluoroscopic guidance and general anaesthesia or sedation and local anaesthesia. The mean follow-up period was 34 months (26.5 to 80). The patients were evaluated using the Enneking system for functional assessment and all the lesions were radiologically quantified into four grades.

The mean age of patients was 15.6 years (3 to 38) and the mean number of injections was three (1 to 5). Ten patients were cured by a single injection. The mean reduction in size of the lesion (radiological healing) was found to be 76.6% (61.9% to 93.2%) with a mean clinical response of 84.5% (73.4% to 100%). Recurrence was seen in two patients (2.8%) within two years of treatment and both were treated successfully by further sclerotherapy.

Percutaneous sclerotherapy with polidocanol is a safe alternative to conventional surgery for the treatment of an aneurysmal bone cyst. It can be used at surgically-inaccessible sites and treatment can be performed on an out-patient basis.

In 44 patients with tuberculosis of the foot we identified five radiological patterns of lesions; cystic, rheumatoid, subperiosteal, kissing and spina ventosa. Cystic destruction had the best outcome and rheumatoid the poorest. All the patients were cured after antituberculous treatment for 18 months, and none required surgery.

A medical and engineering study was made of 1074 car accidents involving 2520 vehicle occupants. The injuries they sustained were correlated with details of the crash and with contact points inside the cars. Where possible the forces which were generated in the crash were estimated and related to the injuries. In all, 39 car occupants suffered femoral shaft fracture, with an incidence of 1.7% and 0.8% for front and rear seat occupants respectively. Of these, 31 had associated injuries to other regions of the body; these were the cause of 13 of the 14 deaths in this group. Associated injuries were more severe in car occupants who were not wearing seat belts but the incidence of femoral fracture was not significantly different. The mean velocity change (delta-V) causing femoral fracture was 26 mph (42 km/h) and there was a higher incidence of femoral shaft fracture when delta-V was over 30 mph. Estimates of forces needed to cause fracture were higher than those found in cadaver studies. The time to union of femoral fractures did not correlate with the severity of the crash but was longer (mean 19 weeks) than the average for other femoral fractures.