Optimising post-operative joint function is challenging when treating periarticular soft tissue sarcoma (STS). Radiotherapy reduces local recurrence rates but periarticular fibrosis may adversely affect joint function. Neo-adjuvant radiotherapy requires lower doses and smaller treatment volumes and therefore has potential benefits for the management of periarticular STS, but may lead to an increased risk of post-operative wound complications. This study assesses initial outcome and complications after treatment with neo-adjuvant radiotherapy and surgery for patients with periarticular STS.

17 patients treated with neo-adjuvant radiotherapy and surgery were identified. 3D conformal radiotherapy was delivered at a single centre with a dose of 50Gy in 25 fractions over 5 weeks. Patients were assessed weekly for adverse effects. Resection was planned 4–6 weeks after radiotherapy.

Median follow-up was 13 months (range 5–44 months). No patients had significant adverse effects during radiotherapy. One patient had surgery delayed due to local skin reaction. Minor complications in five patients (three superficial infections, one seroma, one neuropraxia). One patient required further surgery due to incomplete margins. TESS scores for upper and lower limb patients were 86.1 and 78.1 respectively. No cases of local recurrence have occurred to date. Two patients have developed distant metastatic disease.

The early results for periarticular STS managed with neo-adjuvant radiotherapy and surgery are excellent. There does not appear to be a significant increase in post-operative complication rates. With neo-adjuvant radiotherapy. Long term follow-up is required to demonstrate final functional outcome and local control rates.

A retrospective review of 51 consecutive patients undergoing fixation of Scaphoid fractures by two surgeons in a single institution was conducted. Twenty-four patients were treated with a Herbert screw and twenty-seven with an Acutrak screw. This included six patients who underwent acute fixation, three in each group. The remaining cases were for the treatment of non-union and delayed union.

There were no significant differences between the two groups in terms of age, side of injury, and mechanism of injury. Fractures were classified as proximal, middle and distal thirds of the Scaphoid and there was no significant difference between the groups regarding the types of fractures treated. The only significant difference between the groups was the time from injury to fixation when considering the cases of delayed union and non union which was greater in the Herbert screw group (7.5 months vs 4 months p=<0.05).

There was no significant difference in outcome between the two methods of fixation. Union rates for all cases were 79% for Herbert screws and 81% for Acutrak screws and 82% and 83% respectively when only considering the delayed union/non-union procedures. There was no difference in terms of time to union, further surgery or clinical outcome between the two groups. The Acutrak screw required removal in five patients and the Herbert screw in two due to symptoms from screw prominence. This was not statistically significant.

In conclusion there is no significant difference in surgical outcome between these two methods of fixation for Scaphoid fractures. The authors feel that this supports the view that biological factors are more important than the method of fixation in obtaining union of Scaphoid fractures.