Introduction and Aims: Kinematic and morphologic suggests the scaphoid may be moved differently between individuals. This study therefore aims to determine to what extent the morphology and ligamentous support of the scaphoid supports the suggestion of variable scaphoid motion. The influence of scaphoid motion on the remainder of the carpus will be considered.

Method: Embalmed specimens were either dissected (n=50) using 3x loupes, sectioned histologically (n=30) or sectioned macroscopically (n=20).

Results: Two distinct morphological patterns were observed. Some scaphoids had a shallow capitate facet and were supported by a series of ligaments that may prevent flexion/extension, but allow/facilitate rotation about the longitudinal axis of the scaphoid. Others had deeply concave capitate facets and were supported by ligaments that may prevent rotation but allow flexion/ extension. These patterns may be continuous throughout the proximal row of the carpus.

Conclusion: Two morphological patterns may dictate the mechanical pattern of the carpus. A flexing and extending scaphoid is restricted by the capitate to its radial position, while a rotating scaphoid may be allowed to translate along the proximoulnar aspect of the capitate.

Introduction In this institution a structured program of conservative management of Achilles tendon rupture has been developed combining a conservative and orthotic treatment regime with a view to adding the advantages of a removable orthosis to traditional non-operative therapy. This study compares the results of this protocol to published surgical results. This is the largest detailed study of conservative management of Achilles tendon rupture in the literature to date.

Methods We assessed 140 subjects who had a complete rupture of their Achilles tendon treated with our combined conservative and orthotic regime between 1992 and 1998. Subjective assessments of symptoms and objective measurements of ankle range of motion, calf circumference and isokinetic measurements of ankle plantar flexion and dorsi flexion were recorded. Patients also completed a functional heel-rise test. Our results have been compared to published series.

Results Our overall results showed 56% had excellent, 30% good, 12% fair and two percent poor results. The overall complication rate was four percent, with three tendon reruptures. When compared with published results for operative repair, our combined conservative and orthotic treatment produces better results overall. Patients are subjectively happier, they have better strength results and have fewer complications.

In relation to the conduct of this study, one or more of the authors is in receipt of a research grant from a non-commercial source.