Introduction: Good outcome following traumatic injuries of the thumb ray depends upon obtaining and maintaining anatomical reduction. Traditional methods using percutaneous Kirschner wires often yield poor results in complex injuries. The Stockport Serpentine Spring System, or “S” Quattro, was developed to achieve and maintain fracture reduction by ligamentotaxis. Distraction reduces fracture fragments due to the tension of ligamentous and structures surrounding the injured joint.

Methods: Ten patients with thumb fractures were treated with the “S” Quattro external-fixation device over a seven-year period from 1996–2003. The operative technique as described by Fahmy was employed. The fixation device was applied for 3 to 7 weeks.

Results: Of the 10 patients, 8 were male and 2 female, and their mean age was 28.9 (range 18–46). Injuries were sustained through sports injuries (6), falls (2) and road traffic accidents (2). Half of the patients were referrals from other orthopaedic units, three of these having failed conservative management. Injuries included 2 Rolando fractures, 5 closed, comminuted metacarpal fractures, 1 open, comminuted fracture and 1 fracture subluxation of the carpometacarpophalangeal joint. Mean interval to treatment was 8.1 days (range 2–15 days). Patients were followed for an average of 8.3 months (range 3–25 months). The mean total range of motion at discharge for the affected joint was 130 degrees. Two patients described subsequent joint pain and stiffness, one developed complex regional pain syndrome. Of note, this patient had a synchronous fracture of the distal humerus. Overall, most patients expressed high outcome satisfaction with mean DASH (Disability of the Arm, Shoulder and Hand) scores of 31.4.

Conclusion: The “S” Quattro dynamic external –fixation device proved to be effective in the management of intra-articular fractures of the first ray. The fixator achieved good functional results with an acceptably low complication rate. We propose that this device is superior in maintaining anatomical reduction of these comminuted fractures than traditional methods such as Kirschner wiring.

Introduction: Synchronous severe arthrosis of the ankle and subtalar joints is a debilitating problem that can be difficult to treat. Tibiotalocalcaneal arthrodesis remains the treatment of choice for this disabling condition. There are many techniques described for ankle arthrodesis, some of which are not applicable to patients with severe rheumatoid arthritis due to osteopenia and/or deformity. Minimally invasive procedures are preferable in this population, whose wound-healing ability is often compromised. This study aims to show the reliability and success of intra-medullary nailing for ankle arthrodesis. We also wished to assess postoperative pain relief and quality of life.

Methods: We reviewed 15 patients who had undergone tibiotalocalcaneal fusion with a retrograde intramedullary nail. Patients were assessed clinically and radiologically. Outcome measures included radiological union, ankle and foot function and quality of life, pre and postoperatively. The “ankle and foot function score” was used to assess function. Quality of life scores were obtained using the Short Form 36 (v2) pre and postoperatively. Statistical analysis was performed using the paired Student t-test.

Results: Indications for ankle arthrodesis were rheumatoid arthritis (n=11) and posttraumatic arthritis (n=4). Mean follow up was 11.2 months. Mean time to fusion was 2.9 months +/− 0.85. Solid fusion was achieved in 14 out of 15 patients (93%), one patient having a failed fusion due to persistent wound complications. There was an improvement in both the ankle and foot function scores and in the physical parameters of the SF-36 postoperatively. The mean preoperative ankle and foot function score was 26.7 +/− 13.5 versus 37 +/− 16 postoperatively (p=0.25). In assessing quality of life, the mean physical functioning score was 20.9 +/− 4 versus 29.1 +/− 10.4 postoperatively (p=0.08). Role limitations due to physical problems scored 26.3 +/− 5.3 preoperatively versus 32.7 +/− 10.9 postoperatively (p=0.09). Overall, there was a significant difference in pre and post-op mean summary physical component score: 27.5 +/− 4.9 versus 35 +/− 8.9, p=0.049.

Conclusion: This well tolerated, minimally invasive technique provides a surgical solution for a challenging clinical problem. Overall, this procedure improved both physical function and quality of life in our series and achieved a fusion rate equivalent to published series. We would advocate this procedure as a highly effective technique in the treatment of advanced rheumatoid hindfoot arthritis.

Compartment syndrome is a unique form of ischaemia of skeletal muscle which occurs despite patency of the large vessels. Decompression allows the influx of activated leucocytes which cause further injury. Vitamin C is a powerful antioxidant which concentrates preferentially in leucocytes and attenuates reperfusion-induced muscle injury. We have evaluated the use of pretreatment with oral vitamin C in the prevention of injury caused by compartment syndrome in a rat cremasteric muscle model.

Acute and delayed effects of pretreatment with vitamin C were assessed at one and 24 hours after decompression of compartment syndrome. Muscle function was assessed electrophysiologically. Vascular, cellular and tissue inflammation was assessed by staining of intercellular adhesion molecule-1 (ICAM-1) and by determination of the activity of myeloperoxidase (MPO) in neutrophils and tissue oedema.

Compartment syndrome impaired skeletal muscle function and increased the expression of ICAM-1, activity of MPO and muscle weight increased significantly. Pretreatment with vitamin C preserved muscle function and reduced the expression of ICAM-1, infiltration of the neutrophils and oedema.

Ischaemia-reperfusion injury (IRI) is caused by endothelial and subendothelial damage by neutrophil-derived oxidants. Vitamin C is an antioxidant which attenuates endothelial injury after IRI. Our aim was to evaluate the effect of oral vitamin C in the prevention of IRI in skeletal muscle. We used a model of cross-clamping (3 hours) and reperfusion (1 hour) of the cremaster muscle in rats. Muscle function was assessed electrophysiologically by electrical field stimulation. Infiltration by neutrophils was determined by the activity of tissue myeloperoxidase (MPO) and tissue oedema by the wet-to-dry ratio. Neutrophil respiratory burst activity was measured in control animals and groups pretreated with vitamin C.

IRI significantly decreased muscle function and increased muscle neutrophil MPO activity and muscle oedema. Pretreatment with vitamin C preserved muscle function and reduced tissue oedema and neutrophil infiltration. Neutrophil respiratory burst activity was reduced in the group treated with vitamin C compared with the control group.

We conclude that pretreatment with oral vitamin C protects against acute muscle IRI, possibly by attenuating neutrophil respiratory burst activity.