Patients awaiting resolution of swelling and oedema prior to ankle surgery can represent a significant burden on hospital beds. Our study assessed whether external pneumatic intermittent compression (EPIC) can reduce delays to surgery.

Our prospective randomised controlled trial (n= 20) compared outcomes of patients treated with EPIC vs control group managed with ice and elevation. Included were patients aged <18 years with isolated closed ankle fractures admitted for management of swelling prior to surgery. Excluded were open fractures, injuries to contralateral leg, diabetes, absent pulses, peripheral vascular disease, inability to consent, no requirement for admission. Eligible patients were randomised to active or control arms. All patients were managed initially with reduction and back slab application. Patients in active arm fitted with EPIC (Hydroven 3000) device over the back slab. Assessment by treating team determined the time at which patient is assessed ready for surgery.

Patients in the treatment arm were assessed as ready for surgery sooner, (123 hrs vs 168hrs, T score = 1.925, P 0.035) and had a shorter time to surgery (167 hrs vs 216 hrs, T score = 1.748, P 0.047) Length of stay was reduced bud did not reach statistical significance. (259 hrs vs 269 hrs, T score 0.229, P 0.41)

Our results showed a statistically and clinically significant reduction in time that patients were assessed ready for surgery and time to surgery in the treatment cohort. We conclude that although further data is needed to achieve an adequately powered study and assess the safety profile of the EPIC, incorporation of EPIC into routine clinical practice has the potential for significant cost savings.

Stabilisation of the ankle syndesmosis remains a topic of debate regarding the best method of fixation; the most recent development is the ankle tightrope - a tensionable fibrewire suture. Despite over thirty thousand successful surgeries(1) reported, evidence supporting its use remains extremely limited. The aim of our study was to identify complications arising after insertion of this device for syndesmotic instability.

All patients undergoing tightrope stabilisation of the ankle syndesmosis in Aberdeen Royal Infirmary between January 2006 and February 2009 inclusive were incorporated in our study. Patient identifier data was collated at the time of operation by a research nurse with case records collected and analysed by the authors at the end of the study period. Nineteen cases were identified with one subsequently excluded due to death. Of the remaining patients thirteen were male and five female. Age ranged from sixteen to fifty-eight years. Five patients required tightrope fixation alone, the remainder necessitating bony fixation according to AO recommendations. Time in cast immobilisation ranged from five to eight weeks, time to full weight bearing six to ten weeks and time to discharge eight weeks to fifteen months.

In this series, 22% of tightropes were removed secondary to wound breakdown or knot prominence. Other complications included syndesmotic widening(11%), knot prominence without removal(5.5%) and synostosis(5.5%).

Incontrast to previously published literature (2,3,4,5,6) this, the second largest series to date, demonstrates a high complication rate(44%) - perhaps the tightrope is not as advantageous as initially thought.

The detection and treatment of acute compartment syndrome following trauma is critical if contractures, delayed fracture healing and possible amputations are to be avoided. The current standard for monitoring relies on invasive compartment pressure measurements. These require an additional procedure and cause discomfort to the patient. This prospective clinical study investigates the relationship between the intra-compartmental pressure and soft tissue oxygenation (%StO₂) measured non-invasively by near-infrared spectroscopy (NIRS) in patients at risk of acute compartment syndrome.

Adults with acute tibial or radial diaphyseal fractures were recruited on admission to the orthopaedic trauma unit. Non-invasive and invasive monitoring over anterior tibial or volar forearm compartments was carried out from admission and continued post-operatively. The differential pressure (ΔDP) was calculated as the compartment pressure subtracted from the diastolic blood pressure. The threshold for fasciotomy was a ΔDP < 30mmHg. StO₂ values were simultaneously recorded from the contralateral (uninjured) limb at the same site. All patients had the difference between the StO₂ value on the injured and uninjured sides calculated (‘StO₂ difference’).

Sixty patients with tibial fractures and 5 patients with forearm fractures were recruited. The mean age was 39 years (S.D.18 years). Fourteen patients underwent a four-compartment lower leg fasciotomy determined by a ΔDP < 30mmHg.

We have observed that the difference in StO₂ between limbs (measured non-invasively) was significantly lower in patients undergoing a fasciotomy. This suggests that NIRS is able to detect a change in oxygenation of the soft tissues in trauma patients developing an acute compartment syndrome. We are optimistic that near-infrared spectroscopy (NIRS) will be a reliable new non-invasive technique for detection of an acute compartment syndrome.