Introduction: In April 2007, NICE published guidance on reducing the risk of venous thromboembolism. Immobilization of a limb in plaster was identified as a risk factor for thromboembolism. NICE recommend that all orthopaedic patients with risk factors are offered low molecular weight heparin (LMWH) whilst an inpatient. There was no cost effective evidence to continue treatment as an outpatient in foot and ankle patients. Foot and ankle surgery often requires prolonged periods of immobilization postoperatively. This study aims to provide a snapshot of current practice amongst foot and ankle surgeons in the UK, highlighting any differences between current practice and NICE guidelines.

Materials and Methods: A random sample of the 267 members of the British Foot and Ankle Surgery Society listed in the 2007 BOA Handbook was obtained. In order to have a 90% confidence level, the sample size was calculated to be 71. The specialist teams identified were contacted by telephone and questioned on their use of thromboprophylaxis for elective patients in plaster. The results were collated and compared to NICE guidelines.

Results: 94% of foot and ankle surgeons prescribe LMWH to post operative elective inpatients in plaster. 65% of specialists continue thromboprophylaxis for out-patients. The duration and agent of thromboprophylaxis varied markedly. The commonest agents were LMWH and aspirin. The length of treatment ranged from ten days to the duration of plaster immobilization.

Discussion: The results highlight a trend amongst foot and ankle surgeons to exceed current NICE guidelines for thromboprophylaxis, continuing treatment for an extended outpatient period. Although there was shown to be no cost effective evidence to continue treatment, the practice continues.

Conclusion: The vast majority of UK foot and ankle surgeons fulfill the NICE recommendations on thromboprophylaxis. There is a clear need for a policy statement from BOFAS on the extended use of thromboprophylaxis for outpatients immobilized in plaster.

The aim of this study is to assess the accuracy of clinical examination of the knee compared to MRI and Arthroscopy in diagnosing significant internal derangement.

We performed a retrospective analysis on 245 patients who underwent an MRI of the knee over a two-year period. The MRI diagnoses were compared with both clinical and arthroscopic findings. There were 169 male and 76 female patients with an average age of 33 years. A history of significant trauma was seen in 98 (40%) patients. The commonest clinical diagnosis was isolated medial meniscal tear (25%). Anterior cruciate ligament (ACL) tear was diagnosed in 8% and lateral meniscal tear in 7% of cases. No definite clinical diagnosis could be reached in 32% of patients. MRI showed no significant abnormality in 103 (42%) patients. Medial meniscal tear was noted in 47 (19%), ACL tear in 20 (8%) and lateral meniscal tear in 10 (4%) of the MRI scans. 96 patients (39%) proceeded to arthroscopy after their MRI scans. The mean time from MRI scan to arthroscopy was 181 days. The MRI and arthroscopy findings were in complete agreement in 90 (94%) patients. Of the 6 patients whose MRI findings did not correlate with arthroscopy, 4 showed meniscal tears not seen at surgery and two diagnosed ACL ruptures subsequently shown to be normal at arthroscopy. Three of the 4 meniscal tears were of the inferior surface of the posterior horn of the medial meniscus and one of the inferior surface of the lateral meniscus. The films were reviewed independently by three experienced MR radiologists all of whom confidently diagnosed a tear in each case.

Clinical examination alone is not satisfactory in the diagnosis of knee injuries. MRI is a highly sensitive tool for diagnosis. Injuries that are commonly missed at arthroscopy can be diagnosed easily with MRI.