Aims

There is a lack of published evidence relating to the rate of nonunion seen in occult scaphoid fractures, diagnosed only after MRI. This study reports the rate of delayed union and nonunion in a cohort of patients with MRI-detected acute scaphoid fractures.

This study is a mid-term follow up of an original series of 51 babies treated with a modified Ponseti technique for idiopathic congenital talipes equinovarus using below-knee Softcast (easier to remove and hygienic)¹ to determine whether this method is as effective as traditional above-knee plastering.

Background: The best treatment for displaced distal radius fracture is still debated. The aim of our study is to use the PRWE and Euroqol questionnaires to look at patients function at a minimum of 1 year following distal radius fracture.

Method: 32 consecutive patients with a Colles-type fracture were treated surgically. 16 were treated with K wires and 16 underwent an open reduction and internal fixation. At a minimum of one year the PRWE and Euroqol questionnaires were filled in.

Results: Intra articular and extra articular fractures were equally distributed between the 2 groups. The Euroqol the EQVAS and PRWE scores showed no statistical difference between the 2 groups (respectively p=0.7 CI 95% -0.23 to 0.17; p=0.05 CI -30 to 0.6 and p=0.5 CI 95% -18 to 9.4).

Conclusion: Using PRWE and Euroqol, there is no short term functional difference between patients treated with closed reduction and percutaneous wire fixation or open reduction and internal fixation following a distal radius fracture.

Purpose of study: The UMEX frame was developed from the Joshi external fixator, being first used in the UK in 2004. It corrects deformity by gradual distraction and manipulation. We report the outcomes of a two centre combined experience of the UMEX frame for the treatment of complex congenital foot deformities.

Method: The frame was used in the management of 27 complex foot disorders, the majority of which were resistant club feet. All patients had at least 18 month follow up.

Results: Good deformity correction was achieved in all cases, with a plantigrade foot immediately post-treatment. However, minor degrees of relapse have been noted when the strict postoperative regimen was not followed.

Conclusions: The application of external fixators for the correction of foot deformities can be a complex procedure for the surgeon, and cumbersome for the patient. This frame is simple to apply and manage and allows multi-planar deformity correction in one stage. Our experience and patient outcome data suggest that this technique is a useful surgical option for the Paediatric Orthopaedic surgeon dealing with a relapsed club foot and other complex foot deformities.

Aims: To establish the frequency and demographics of soft tissue sarcomas (STS) presenting in the lower limb.

Methods: Patients presenting to a tertiary referral orthopaedic oncology unit over a 10-year period were prospectively entered into a computerised database. The site of primary STS and demographic details were also recorded.

Results: 1519 STS in all body regions were treated. 1067 (70.2%) within the lower limb. 57.0% thigh, 13.0% calf, 8.2% foot and ankle, 7.7% buttock, 5.7% knee, 4.6% pelvis and 3.8% in the groin. There was a male predominance (56.2%). M:F ratio was 2.5:1 for the groin and 1.3:1 for the thigh with the other body regions approximately equal.

Conclusion: The majority of STS are found in the lower limb. In this large series there was a male predominance most marked in groin presentations.

Aims: Soft tissue sarcomas (STS) of the foot and ankle are rare tumours. The aims of this study were to examine the presenting features and highlight those associated with a delay in diagnosis.

Methods: Patients presenting during a 10-year period were identified using a computerised database within the Orthopaedic Oncology Unit at the Royal Orthopaedic Hospital, Birmingham, UK. Additional information was obtained from a systematic case note review.

Results: 1519 patients were treated for STS of which 87 (8.2%) had tumours sited in the foot and ankle. Of these, 75 (86.2%) had presented with a discrete lump (42 (56%) of them having an inadvertent “whoops” excision biopsy), 3 (3.4%) with ulceration and the remaining 9 (10.3%) with symptoms more commonly associated with other benign foot and ankle pathology. Within the group of 9 patients they had previously been treated as plantar fasciitis (3), tarsal tunnel syndrome (2), Morton’s neuroma (1) and none specific hind foot pain (3). Median delay from onset of symptoms to diagnosis as STS was 26 months for this group (mean 50; range 6–180 months) compared to 12 months (mean 32; range 3–240) for the “whoops” biopsy group and 10 months (mean 16; range 2–60 months) for the unbiopsied discrete lump group.

Conclusion: Soft tissue sarcoma in the foot and ankle may present insidiously and with symptoms of other benign pathologies. Failure to respond to initial treatment of suspected common benign pathology should be promptly investigated with further imaging e.g. MRI scan or high resolution ultrasound, or with specialist consultation.

Aim: The pelvis is a rare location for osteochondromas and differentiation from chondrosarcomas can be difficult. We aim to aid this differentiation using tends and demographics of treated cases.

Methods and Results: Patients referred to a supra-regional bone tumour centre with pelvic tumours, consequently diagnosed as osteochondromas were studied to determine the clinico-pathological features that differentiate them from chondrosarcoma. Treatment outcome was also reviewed.

30 patients were studied with a mean follow-up of 32 months. The mean age at diagnosis was 34yrs (range 19–79). The male to female ratio was 1:1. The most common location was the ilium (19 patients), with the pubis and ischium accounting for a third of patients. Only 1 patient had an acetabular osteochondroma. Median duration of symptoms prior to referral was 6 months (1–79). Pain without a lump was the main presenting symptom (16 patients), followed by lump with pain (6), and lump alone (6). Two patients presented with obstructive labour requiring emergency procedures. The lesions were solitary in 24 and associated with hereditary multiple exostosis (HME) in 6 patients. 1 patient had a radiation induced lesion.

The lesions showed increased uptake on bone scans and the cartilage cap was less than 10mm in all but 2 patients. Treatment was surgical excision in 21 patients and observation with serial radiographs in 9. Histological examination confirmed osteochondroma in all patients, however 1 patient with HME had areas of Grade I malignancy. Significant surgical complications occurred in 1 patient who developed pulmonary embolism.

Conclusion: We conclude that symptoms from osteochondromas of the pelvis are similar to those with chondrosarcomas and increased uptake on bone scans is seen in both. However, a tumour with a cartilage cap larger than 10mm or arising from the acetabulum is unlikely to be an osteochondroma.

Aims Soft tissue sarcomas (STS) of the foot and ankle are rare tumours. The aims of this study were to examine the presenting features and highlight those associated with a delay in diagnosis.

Methods Patients presenting during a 10-year period were identified using a computerised database within the Orthopaedic Oncology Unit at the Royal Orthopaedic Hospital, Birmingham, UK. Additional information was obtained from a systematic case note review.

Results 1519 patients were treated for STS of which 87 (8.2%) had tumours sited in the foot and ankle. Of these, 75 (86.2%) had presented with a discrete lump (56% of them having an inadvertent whoops excision biopsy), 3 (3.4%) with ulceration and the remaining 9 (10.3%) with symptoms more commonly associated with other benign foot and ankle pathology. The 9 had previously been treated as plantar fasciitis (3), tarsal tunnel (2), Morton’s neuroma (1) and none specific hind foot pain (3). Median delay from onset of symptoms to diagnosis as STS was 26 months for this group (mean 50; range 6–180 months) compared to 12 months (mean 32; range 3–240) for the “whoops biopsy group and 10 months (mean16; range 2–60 months) for the unbiopsied discrete lump group.

Conclusion Soft tissue sarcoma in the foot and ankle may present insidiously and with symptoms of other benign pathologies. Failure to respond to initial treatment of suspected common benign pathology should be promptly investigated further with an MRI scan.