The surgical care of extra-articular distal tibial fractures remains controversial. This study looks at the radiological outcomes of distal tibial fractures treated with either a direct medial or anterolateral plate, with or without plating of the fibula, to assess the outcome and complications associated with these 2 approaches.

This is a retrospective review of 80 patients with distal tibial extra-articular fractures, treated with an open reduction and plating, between 2008 and 2019 at Glasgow Royal Infirmary. Case notes and x-rays were reviewed.

Of those tibial fractures fixed with only a medial plate, 78% united (28/36), 5% (2/36) had a non-union and 17% (6/36) a malunion. In the group treated with a combination of medial tibial and fibular plating, the figures were; 71% (15/21), 19% (4/21) and 10% (2/21). However, in the group treated with anterolateral plating of the tibia alone, only 53% (8/15) united, with a 20% (3/15) non-union and 13% (2/15) malunion rate. Additionally in this group, there were 2 patients (13%) with loss of fracture reduction within the first two months of fracture fixation, requiring revision surgery. Interestingly, of the 8 patients treated with anterolateral tibial and fibular plating, 88% (7/8) showed full union and only one (12%) had a non-union, with no malunions is this group.

It would appear that medial tibial and a combination of medial tibial and fibular plating, have superior outcomes compared to anterolateral plating. Results suggest, if anterolateral plating is done, this should be augmented by fixation of the fibular fracture as well.

In recent years there has been growing interest in enhanced recovery regimes in lower limb arthroplasty due to potential clinical benefits of early mobilisation along with cost-savings. Following adoption of this regime in a district general hospital, it was observed that traditional dressings were a potential barrier to its success with ongoing wound problems in patients otherwise fit for discharge. The aim of this audit was to assess current wound care practice, implement a potentially improved regime and re-evaluate practice.

A prospective clinical audit was performed over a three month period involving 100 patients undergoing hip or knee arthroplasty. Fifty patients with traditional dressings were evaluated prior to change in practice to a modern dressing (Aquacel™ Surgical). Fifty patients were then evaluated with the new dressing to complete the audit cycle. Clinical outcome measures included wear time, number of changes, blister rate and length of stay. Statistical comparisons were performed using Mann Whitney or Fisher's Exact test (statistical significance, p<0.05).

Wear time for the traditional dressing (2 days) was significantly shorter than the modern dressing (7 days), p<0.001, and required more changes (0 vs. 3 days), p<0.001. 20% of patients developed blisters with the traditional dressing compared with 4% with the modern dressing (p=0.028). Length of stay was the same for the modern dressing (4 days) compared with the traditional dressing (4 days). However, in the modern group 75% of patients were discharged by day 4 whereas in the traditional group this took until day 6.

This audit highlights the problems associated with traditional dressings with frequent early dressing changes, blistering and delayed discharge. These adverse outcomes can be minimised with a modern dressing specifically designed for the demands of lower limb arthroplasty. Units planning to implement enhanced recovery regimes should consider adopting this dressing to avoid compromising patient discharge.

Osteoid osteoma is a classically described benign bone tumour. Traditionally, the surgical treatment of choice was excision, but this can have significant morbidity. In recent years, percutaneous Radiofrequency Ablation (RFA) has grown in popularity as an alternative treatment. This study reports the outcomes using this technique in our regional bone tumour unit. Between May 2003 and October 2007, 14 patients (female, n=4; male, n = 10) aged 15 - 32yrs (mean age, 20.4yrs) underwent CT guided radiofrequency ablation treatment. These patients had typical radiograph, CT, MRI or isotope bone scan features of osteoid osteoma and had significant pain symptoms. The protocol for ablation in our institute is heating the tip of the electrode to 90°C for 6 minutes. All patients were subsequently offered follow up in the out-patient clinic. Outcomes were taken from the Scottish Bone Tumour Registry database.

11 patients (78.6%) patients had complete resolution of symptoms after one RF treatment. 3 (21.4%) cases were unsuccessful but 1 of these was due to technical failure. All 3 of the above patients had complete relief of symptoms after one further RF treatment. 1 (7.1%) patient initially had complete relief of symptoms, but suffered a recurrence after 9 months. This patient also had a second curative treatment. Follow up ranged from 3 – 18 months (mean 10 months). Percutaneous RFA for osteoid osteoma is an attractive treatment due to its efficacy and low morbidity. Our results showed a primary success rate of 78%, a secondary success rate of 100% (after one additional procedure) and a recurrence rate of 7.1%. These are comparable to previous reported series.

We believe our results add to the growing literature supporting radiofrequency ablation as the treatment of choice for osteoid osteoma.