This study reports the results of open reduction and internal fixation of 26 unstable, intra-articular, dorsally displaced fractures of the distal radius using a bio absorbable dorsal distal radius (Reunite) plate and calcium phosphate (Biobon) bone substitute. The bio absorbable plate has the advantages of being low profile, easily contourable due to temporary malleability and is angularly stable. It retains its strength for 6 to 8 weeks and undergoes complete mass loss within one year, thereby allowing gradual load transfer to the healing bone. In the majority of cases, this plate produces functional results comparable with metal plates.

The Gartland and Werley score was excellent or good in 21 patients. The most important advantage over metal plates is in eliminating the need to remove the plate and hence the need for a second operation if implant related extensor tenosynovitis occurs. Inflammatory tissue reaction to the degradation products of the plate is a potential concern, although the co-polymer ratio used in this plate appears to have reduced the severity of this reaction, which was seen in two patients in this series. The reduction was lost in five patients with severe dorsal comminution. For such fractures, the plate did not retain its strength for long enough to allow adequate healing for satisfactory load transfer.

Following this experience, we do not recommend this plating system for fractures with a metaphyseal gap of greater than 7 mm following reduction. For fractures that cannot be treated by closed means but where the metaphyseal gap following reduction is less than 7 mm, this plate provides all the theoretical advantages. Further developments allowing the plate to retain its strength for longer while maintaining the low incidence of inflammatory reactions will make it more universally applicable for the treatment of a greater spectrum of unstable distal radius fractures.

Background

A randomised prospective study has already demonstrated that at 1-year follow-up, palmaris longus interposition or flexor carpi radialis (FCR) ligament reconstruction and tendon interposition do not improve the outcome of trapeziectomy for the treatment of painful osteoarthritis of the trapeziometacarpal joint. This study consisted of 183 thumbs in 162 women.

Pyogenic haematogenous spinal infection in the elderly, described as spondylodiscitis, vertebral osteomyelitis and epidural abscess is considered a rare but life threatening condition. Our objective was to test the hypothesis that low index of suspicion leads to delayed diagnosis and referral for definitive treatment resulting in increased and perhaps avoidable medical morbidity, social drift including early mortality and to analyse pathological entities, complications and optimum treatment options.

We performed a retrospective review of medical records over 10-year period. Post-operative infections and patients under 65 years old excluded. Initial presentation, investigations and differential diagnosis, time to diagnosis, date and day of referral, mode of definitive treatment, pathologic entities, complications and outcomes were noted. Patient outcomes were measured as duration of treatment, length of hospital stay, complications, ambulatory status, complications, discharge destination and death. Outcomes were correlated with delayed diagnosis and referral.

46 elderly (age> 65) patients with a mean age of 71 years (range=65–91). 62% referral from physicians. Fever with malaise associated with chronic LBP was the commonest presenting complaint. There were 31 patients with discitis, 12 epidural abscess and 3 osteomyelitis. Lumbar spine was affected in 63% patients. Time to diagnosis ranged from 2–17 days with mean of 8 days. Mean referral time was 9 days with 39% referrals on Friday. Staphylococcus aureus (47%) was the commonest organism isolated. Duration of hospitalisation ranged from two to twelve weeks. 46% required surgical decompression with four cases of related mortality during acute hospital stay.

Time duration to spinal referral had direct correlation with increase in morbidity, social drift and mortality. The incidence of haematogenous spinal infection in the elderly has increased over the years in our series, contrary to popular belief. A high index of suspicion in elderly patients with PUO promotes early diagnosis and optimises outcome.

Background: Pyogenic haematogenous spinal infection in the elderly, described as spondylodiscitis, vertebral osteomyelitis and epidural abscess is still considered a rare but life threatening condition.

Objective: To test our hypothesis that low index of suspicion leads to delayed diagnosis.

Late referral for definitive treatment may result in increased and perhaps avoidable medical morbidity, social and psychological drift, including early mortality.

Method: Retrospective review of medical records over 10-year period.

Patient pool obtained from theatre records, radiology and coding departments.

Results: Single largest series [n=46] of elderly [age> 65] patients with pyogenic spinal infections to our knowledge.

Age ranged from 65–91 with mean of 71.

Conclusions: Time duration to Spinal referral had direct correlation with increase in morbidity, social and psychological drift, and mortality.

The incidence of haematogenous spinal infection in the elderly has increased over the years in our series, contrary to popular belief.

A high index of suspicion in elderly patients with PUO promotes early diagnosis and optimises outcome.

Introduction: The mini C-arm is a compact, user-friendly device with the advantage of reducing exposure to ionising radiation compared to the conventional C-arm. Optimising radiation exposure is not only desirable, but also a legal requirement and protocols should be in place to achieve this. The purpose of this paper is to review our use of the mini C-arm for elective foot surgery and to suggest guidelines for optimising its use.

Materials and Methods: Between 2004 and 2006, all elective foot surgery requiring intraoperative imaging were performed using the mini C-arm unit. Procedures performed included ankle, midfoot and hindfoot arthrodeses and joint injections or aspirations. Screening times and radiation doses were recorded for each procedure.

Results: Following an initial learning curve, the screening times stabilised around the median value for the individual procedures. For a subtalar or triple arthrodesis this was less than 60 seconds, for ankle arthrodesis, less than 90 seconds and for hindfoot arthrodesis using a nail, less than 100 seconds. Other single joint arthrodeses had a screening time under 30 seconds and injections or aspirations, under 12 seconds.

Discussion: As screening time is the main variable that can be controlled by the surgeon, assuming that all other precautions are followed, screening time can be used as a useful audit tool to measure optimum use of the mini C-arm. A protocol is presented which includes completion of an audit form for every operation where the mini C-arm is used. The above times can be used as a guide to enable hospital trusts to formulate their own protocols to regulate radiation exposure.

Conclusion: The mini C-arm is well suited for foot and ankle surgery. Having a protocol in place and periodic audit is essential to optimise its use. Apart from being good clinical practice, this is now a legal requirement.

Results: In males CA was significantly larger in all regions of the foot than in females. There were no significant between sex differences in PP, CT and PTI. FTI was significantly greater in males than females for most regions in the foot. IPP was earlier in females. MaxF was also significantly higher in males in all the regions except the 2nd toe. MeanF was also higher in males.

Conclusion: There were no PP differences; however the plantar surface area of the male foot was larger than females.