Introduction: Tutobone is a solvent-preserved cancellous bovine bone substitute. There is little published about its use in humans. We have been using it as a wedge graft to correct deformity in hindfoot fusion surgery.

Aim: To review the outcome following the use of Tutobone in hindfoot fusion and compare it with a control group without Tutobone.

Method: We performed a retrospective review of all hindfoot fusion performed by the senior author (AG) from 1 Sep 2004 to 31 Jan 2008. We excluded all revision procedures for non-union or malunion. A CT or MRI scan was performed to assess union and graft incorporation in the Tutobone patients at more than six months postoperatively. In the control group fusion was assessed with plain radiographs. The difference in proportion of fusion with complete fusion by six months post-operatively was assessed with a Fisher’s exact test

Results: There were eleven patients in the Tutobone group (1 ankle, 7 subtalar and 3 triple fusions) and 35 in the control group (15 ankle, 11 subtalar, 3 pantalar and 6 triple fusions). All Tutobone patients had partial union on CT/MRI scans. The Tutobone graft had not incorporated at a mean time interval of 14 months post surgery. 30 out of 35 control patients had fused by six months and 33 out of 35 controls were fused by 12 months. The rate of complete fusion between the two groups at six months was statistically significant (p< 0.0001). Two Tutobone patients developed an inflammatory reaction at more than six months post fusion. This reaction is not infective and appears to be a reaction to the Tutobone.

Conclusion: Tutobone should not be used in hindfoot fusion surgery.

Introduction: The Literature is divisive in regards to the superiority of Core versus Incision biopsy in the diagnosis of Soft Tissue Tumour. The Aim of the study is to compare the accuracy of Trucut biopsy and open Incision Biopsy.

Methods: This was a retrospective review of case notes and pathology records. Between January 2006 and June 2007, 34 Trucut biopsies were performed without imaging guidance in an outpatient setting and 57 incision biopsies were performed as an inpatient on patients referred with a soft tissue mass to our service. In each case the accuracy of biopsy in providing a diagnostic sample, in determining the tumour type and the histological grade of tumour were calculated. For each biopsy method we compared the diagnosis after biopsy with the final diagnosis after excision. The proportion of diagnostic biopsies was calculated, as were the sensitivity and specificity of each technique in providing a diagnosis. Fisher’s exact test was used to test for differences in the techniques.

Results: In this series there were 41 soft tissue sarcomas, 8 metastatic adenocarcinoma soft tissue deposits, 7 lymphomas, 1 non soft tissue sarcoma, 32 benign soft tissue tumours and 1 infection. 33/34 Trucut biopsies and 55/57 open biopsies provided the final histological diagnosis (p=1). There was no statistical difference between the techniques in the accuracy of identifying the type and grade of soft tissue sarcoma

Discussion: Trucut biopsy is equivalent to incision biopsy in its accuracy of diagnosing soft tissue tumours. Biopsy in an outpatient setting for appropriate tumours is cost effective and likely shortens the time to diagnosis. Our results are comparable to published data from other centres.

Locking after total knee replacement is uncommon and is generally caused by the formation of fibrous tissue around the patella. We report an unusual cause of locking resulting from intermittent occlusion of the popliteal artery, which was tethered to cement at the posterior aspect of the tibial component.