The lack of a universal, consistent protocol for the subjective, objective and radiographic evaluation of these injuries has hampered the comparison of results. Methods. 45 patients with complex fractures of the calcaneus were included in this prospective study, which was undertaken from July 2003 to December 2005. The fracture classification of Essex-Lopresti was used. We also observed the extent of secondary fracture lines extending from the primary shear line (on axial and external oblique plain radiographs) to establish comminution. The external oblique view for subtalar joint was performed with the patient supine, the knee at about 60 degree of flexion and the limb rotated externally 45 degree with a vertical X ray beam. All of these patients were managed by an external fixator using the principle of ligamentotaxis. Patients were evaluated by AOFAS. Results. We identified two broad patterns of secondary lines on plain X-rays:. with anterior secondary fracture lines and. with posterior secondary fracture lines. There were 20 cases of tongue type and 25 of joint depression type fracture pattern by the Essex-Lopresti classification. Forty two (93.4%) patients had fractures with posterior secondary fracture line and 3 (6.7%) patients had anterior secondary lines. The calcaneo-cuboid type of anterior secondary line pattern was present in 2 (4.5%) cases, and the plantar type in only 1 (2.5%) case. We observed posterior secondary line Type A pattern in 2 (4.5%) cases, depression / central depression type B in 20 (44.5%) cases, tongue shaped Type C pattern in 16 (36.5%) cases and Type D severely comminuted fracture line pattern in 4 (8.7%) cases. Conclusion. Comminution was significantly associated with prognosis and final outcome. Evaluation of secondary fracture lines corresponds with comminution of fractures of the calcaneus and the final outcome of these fractures. NO DISCLOSURES

Aims

Chronic osteomyelitis (COM) of the lower limb in adults can be surgically managed by either limb reconstruction or amputation. This scoping review aims to map the outcomes used in studies surgically managing COM in order to aid future development of a core outcome set.

Rugby union is the second commonest cause of sporting fracture in the UK. Yet little is known about patient outcome following such fractures. All rugby union fractures sustained during 2007–2008 in the Lothian were prospectively recorded. Patients were contacted by telephone in February 2012 to ascertain their progress in returning to rugby. There were 145 fractures in 143 patients, including 122 upper limb and 25 lower limb fractures. 117 fractures (81%) were followed at mean 50 months (range 44–56 months). 87% returned to rugby post injury, with 85% returning to rugby at the same level or higher. 77% returned by three months and 91% by six months. In upper limb fractures 86% returned by six months and 94% by six months. In lower limb fractures 42% returned by three months and 79% by six months. 32% had ongoing fracture related problems. 9% had impaired rugby ability secondary to fractures. Most patients sustaining a fracture playing rugby union will return to rugby at a similar level. While one third of them will have persisting symptoms post-injury, for the majority this will not impair their rugby ability