Introduction: Distal radius locking plates are increasingly being used to treat distal radius fractures.

The purpose of our study was to determine the medium term clinical and radiological outcome of comminuted, displaced fractures of the distal radius. We present our experience in using the Aculoc (Acumed) volar fixed angle plate to treat 100 consecutive fractures of the distal radius.

Methods: All one hundred patients were prospectively (clinically and radiologically) assessed between 2003 –2007, with a minimum follow up of one year. Fractures were radiologically classified using the Frykman classification Clinical outcome was measured using the Mayo score, DASH questionnaire, SF36 and Range of Wrist Movement and pinch and grasp power. The post operative x rays were assessed for fracture union, alignment and displacement.

Conclusion: Our study demonstrates that volar fixation of distal radius fractures, using a fixed angle, locking accumed plate provides satisfactory treatment for fractures of the distal radius. Angular stability of the implant provides mechanical stability and aids early rehabilitation which results in good functional outcomes.

Whereas avascular necrosis of the scaphoid after a fracture is well-documented, idiopathic avascular necrosis of the scaphoid (Preiser’s disease) is rare. Little is known of the aetiology of the condition and even less about the best course of management. We describe a rare case of bilateral Preiser’s disease. Possible aetiological factors and a summary of the current concepts of management are discussed.

Panton-Valentine leukocidin secreted by Staphylococcus aureus is known to cause severe skin, soft tissue and lung infections. However, until recently it has not been described as causing life-threatening musculoskeletal infection. We present four patients suffering from osteomyelitis, septic arthritis, widespread intravascular thrombosis and overwhelming sepsis from proven Panton-Valentine leukocidin-secreting Staphylococcus aureus. Aggressive, early and repeated surgical intervention is required in the treatment of these patients.

The Panton-Valentine leukocidin toxin not only destroys host neutrophils, immunocompromising the patient, but also increases the risk of intravascular coagulopathy. This combination leads to widespread involvement of bone with glutinous pus which is difficult to drain, and makes the delivery of antibiotics and eradication of infection very difficult without surgical intervention.