We have carried out a retrospective review of 20 patients with segmental fractures of the tibia who had been treated by circular external fixation. We describe the heterogeneity of these fractures, their association with multiple injuries and the need for multilevel stability with the least compromise of the biology of the fracture segments. The assessment of outcome included union, complications, the measurement of the functional IOWA knee and ankle scores and the general health status (Short-form 36).

The mean time to union was 21.7 weeks (12.8 to 31), with no difference being observed between proximal and distal levels of fracture. Complications were encountered in four patients. Two had nonunion at the distal level, one a wire-related infection which required further surgery and another shortening of 15 mm with 8° of valgus which was clinically insignificant. The functional scores for the knee and ankle were good to excellent, but the physical component score of the short-form 36 was lower than the population norm. This may be explained by the presence of multiple injuries affecting the overall score.

Aims: To assess the reliability of ultrasound guided (USG) tru-cut needle biopsy technique in the management of soft tissue tumours.

Methods: Pathology reports of patients who underwent USG needle biopsy and surgical resection of the tumour between 1994 and 2002 were reviewed. 141 biopsies (142 patients; 59 females and 82 males; mean age 52.5 years [range 16 to 96]) were included. Exclusions were those who did not undergo both procedures, had recurrent disease, had previous biopsy of same site, inadequate or damaged biopsy materials.

Results: Final histology showed 74 malignant and 68 benign tumours compared with 72 and 70, respectively, on biopsy reports, with 94.6% sensitivity, 97.1% specificity, 97.2% positive predictive value (PPV) and 94.3% negative predictive value (NPV). The histological grade was commented on in 48 cases. Final histology reported 18 high grades versus 30 low or medium grades compared to 17 and 31, respectively, on biopsy reports, giving 88.9% sensitivity, 96.7% specificity, 94.1% PPV and 93.5% NPV. Overall accuracy is 95.8% for malignant/benign reporting and 93.8% for grading. One patient developed superficial haematoma that underwent spontaneous uneventful resolution.

Conclusions: This technique is as reliable as open biopsy, yet avoids the need for general anaesthesia and inpatient admission. Tumour visualisation improves sampling while the larger needle gives greater volume than fine needle aspiration.