Purpose: Core needle biopsy is increasingly accepted for the diagnosis of bone and soft-tissue tumours. Advantages over open biopsy include reduced morbidity, time and cost; however diagnostic accuracy remains a concern. Our objective was to assess and compare the diagnostic accuracy of core needle, open, and fine needle biopsies.

Method: We reviewed 286 cases collected in a prospective database between 2004 and 2007. Of these, 229 had core needle, 32 open, and 25 fine needle biopsies. 230 had soft-tissue lesions, 56 had bone lesions. The results of these biopsies were compared to the final resection diagnosis for accuracy and, where inaccurate, any effects on management.

Results: Ninety-two percent of the core needle, 100% of the open and 72% of the fine needle biopsies had adequate tissue to make a diagnosis. Of the adequate specimens, the accuracy of core/open/fine needle biopsy was 96%, 97% and 94% for determining malignant versus benign; of the correctly identified malignant lesions 97%, 100% and 80% were accurate for histological grade; and 79%, 84%, 59% for histological subtype.

Conclusion: Core needle biopsy yields diagnostic results comparable to open biopsy for determining malignancy and grade in bone and soft-tissue tumours. Fine needle biopsy has a high inadequate sampling rate and should not be used for diagnosing bone and soft-tissue tumours. Given the reduced cost and morbidity associated with core needle biopsies we believe they should be used routinely for diagnosis where possible, and open biopsy reserved for situations where an inadequate specimen is obtained or core biopsy is not feasible.

Introduction: The Copeland Shoulder prosthesis was developed as an alternative to the more traditional prostheses. This cementless design differs in that it resurfaces, rather than replaces, the native humeral head. The obvious advantage of this design is only a minimum of bone is removed thus preserving bone stock for future revisions if needed. There exists little in the orthopaedic literature concerning the clinical results of patients with a Copeland shoulder prosthesis.

Materials and methods: Twenty-four patients receiving a Copeland hemiarthroplasty were identified at our institution between 1997 and 1999. All operations were performed by the senior author. A minimum of one-year follow-up was essential. Nineteen patients with twenty shoulders were available for follow-up at a mean of 2.2 years. Patients’ charts and operative reports were examined, and patients’ received retrospective pre-operative and prospective post-operative application of the constant score. AP and axillary lateral radiographs were examined for component position, evidence of osteolysis, and glenoid wear.

Results: The average Constant scores showed improvement in all subgroups: pain relief increased from 0.4 pre-operatively to 8.4 post-operatively; function rose from 9.3 to 14.3; and range of motion from 14.4 to 29.3. Two of twenty components required revision: one for loosening and the other for head collapse. One prosthesis showed some evidence of osteolysis, and five glenoids showed evidence of further wear.

Conclusion: Copeland hemiarthroplasty of the shoulder is effective in providing improved pain relief and function in short-term follow-up. The ability to preserve bone stock for future procedures may be ideal especially for the young, active patient. Complications are similar to those seen in more traditional hemiarthroplasties—loosening, osteolysis, and progressive glenoid wear. The 10% revision rate is slightly higher than reported in most total shoulder and hemiarthroplasty series. Longer follow-up will be essential to make any definitive conclusions.

Athletes are more prone to injury because of their prolonged training, dedication and body contact, and the injuries they sustain, with some unusual exceptions, are the same as those occurring in the general population but there is more pressure to return the athlete to their chosen sport with some times, little concern for the future. Australia, and South Australia in particular, enjoys a wonderful climate that allows year round outdoor activities with a consequent potential increase in the risk of injury.

The history and clinical examination remain the mainstay of diagnosis and coupled with the knowledge of the type and extent of injury, sport involved and level of competition, appropriate investigation can be arranged leading to a conclusive diagnosis and a positive therapeutic approach.

Injuries to the wrist and hand vary from overuse type tenosynovitis through to major carpal injuries with possible neurological and vascular compromise. and as well as helping the athlete return to sport as effectively and quickly as possible, it is also important to consider the implications for the patient in the future, once he or she has retired from competitive involvement. This aspect is further accentuated by monetary gain which may influence the athlete, coaches, etc.

As well as discussing management of selected injuries to the wrist and hand, several more unusual “sporting injuries” will be addressed.