Limited forefoot amputation in diabetic patients with osteomyelitis is frequently required. We retrospectively reviewed diabetic patients with osteomyelitis, an unhealed ulcer and blood pressure in the toe of > 45 mmHg who underwent limited amputation of the foot with primary wound closure. Between 2006 and 2012, 74 consecutive patients with a mean age of 67 years (29 to 93), and a median follow-up of 31 months, were included. All the wounds healed primarily at a median of 37 days (13 to 210; mean 48). At a median of 6 months (1.5 to 18; mean 353 days), 23 patients (31%) suffered a further ulceration. Of these, 12 patients (16% of the total) required a further amputation.

We conclude that primary wound closure following limited amputation of the foot in patients with diabetes is a safe and effective technique when associated with appropriate antibiotic treatment.

Cite this article: Bone Joint J 2013;95-B:1083–7.

Our aim was to compare displayed pressure with actual intra-articular pressure using three fluid delivery systems. The pumps used were the Arthrex, FMS and Dyonics.

We investigated thirty patients undergoing shoulder arthroscopy. Patients with a previous disruption to the joint capsule were excluded.

A standard set-up was used with the patient in a lateral position and arm in traction. The arthroscope was introduced from the posterior portal. The rotator interval was identified and the needle introduced from this point. The needle was attached to a arterial pressure transducer. The pressure transducer was coupled to the anaesthetic machine. Pressures of 30, 50 and 80 mmHg were dialled on the fluid management systems. Once the pressures stabilised on the pumps the intra-articular pressure was measured independently using the pressure transducer.

Median pressures for the FMS and Arthrex pumps were approximately twice set pressures. Median pressures for the Dyonics pump were closer to set pressures but the range of values was wider.

The three pumps were inaccurate and behaved differently to each other. They are not interchangeable. Each pump performed inconsistently.

Introduction: The use of Ilizarov frames is contraindicated in patients with psychiatric conditions, thought to be due to non compliance. We present our experience of treating five fractures with Ilizarov frame in four patients who sustained their injuries through parasuicide.

Method: Consecutive series of patients treated by a single surgeon at our institution. Five fractures in four patients, (one bilateral fracture) were treated with an Ilizarov fine wire frame. All fractures were comminuted distal tibia (pilon): one was B3.3, two C3.2 and a further two C3.3 using the AO system. Four out of five fractures were open Grade IIIA. Outcome was based on functional score (Olerud and Molander); SF 12 and radiological assessment.

Results: There were three females and the mean age was thirty-one years. Of the five fractures, three united successfully, at eight months; one achieved a malunion and one an aseptic non-union at 1 year

Discussion: Our experience suggests complex fractures can be treated favourably with circular frames in parasuicide patients. The patients were generally compliant with frame care and the outpatient monitoring was no different from any other patient with similar injuries.