We sought to validate a method of measuring the range of motion of knees on radiographs as part of a new system of “Virtual Knee Clinics”.

The range of motion of 52 knees in 45 patients were first obtained clinically with goniometers and compared to radiographs of these patients' knees in full active flexion and extension. Four methods of plotting the range of motion on the radiographs were compared.

The intra-class correlation coefficient (ICC) for inter-rater reliability using the goniometer was very high; ICC=0.90 in extension and 0.85 in flexion. The best ICC for radiographic measurement in extension was 0.86 indicating substantial agreement and best ICC in flexion was 0.95 (method 4). ICC for intra-rater reliability was 0.98 for extension and 0.99 for flexion on radiographic measurements.

Measuring range of motion of the knee has never previously been validated in the literature. This study has allowed us to set up a “Virtual Knee Clinic,” combining postal questionnaires and radiographic measurements as a surrogate for knee function. We aim to maintain high quality patient surveillance following knee arthroplasty, reduce our new to follow-up ratios in line with Department of Health guidelines and improve patient satisfaction through reduced travel to hospital outpatients.

Introduction: Adult acquired flat foot deformity is recognised as a spectrum of pathology related to tibialis posterior dysfunction (TPD) and plantar ligament insufficiency. Cobb has described a method of reconstruction in pure Johnson and Strom type II TPD using a split Tibialis Anterior musculo-tendinous graft.

Methods: We describe a prospective study of 32 patients treated by the Cobb technique and a medial displacement translational os calcis osteotomy for Johnson and Strom type II TPD. There were 28 females and four males (age range 44–66, average 54) each with unilateral disease. The average follow up was 5.1 years, range 3 to 7.2 years. Each patient had failed conservative management and the staging was confirmed clinically and radiologically (ultrasound scanning and MRI). The surgery was performed as described by Cobb but with a bone tunnel in the navicular rather than the medial cuneiform. Postoperative immobilisation in plaster was for eight weeks followed by orthotics and physiotherapy.

Results: All the os calcis osteotomies healed uneventfully. 29 of the 32 patients were able to perform a single heel rise test (none prior to surgery) at twelve months follow-up. These patients had grade 5 power of the tibialis posterior tendon. The others had grade 4 power and were also happy with the result. The mean American orthopaedic foot and ankle society (AOFAS) hindfoot score was 82. There was one superficial wound infection successfully treated by antibiotics and a temporary dysaesthesia in the medial plantar nerve in another.

Discussion: This prospective study confirms that the Cobb technique is an excellent method of treating pure Johnson and Strom type II TPD after failed conservative management. The procedure is performed with a medial displacement os calcis osteotomy but in selected cases may be combined with spring ligament repair and lateral column lengthening. An updated classification will be presented designed to facilitate the decision making process in this difficult condition.

Aims: Necrosis of fingers secondary to the use of digital tourniquet has been reported. Harmful effects of tourniquet are due to the high pressures generated beneath the tourniquet.

The aim of this study is to compare the pressures beneath the three different types of digital tourniquet namely rolled rubber glove, commercially available band and urinary catheter on human volunteers using a standardised device which directly measures the pressure and to assess pain score using visual analogue scale. Methods: Twenty healthy volunteers with eighty fingers in total were blinded and the pressures were measured for the three different types of tourniquet in a random fashion. Standard technique of tourniquet application was used. Result and Conclusion: The variation in pressures for each finger and between three different types of tourniquet was examined using the standard analysis of variance. This showed that there was no statistically significant variation between the fingers (F=1.87, 3,234 df) for one type of tourniquet. However the pressures in the catheter tourniquet group was significantly higher (F=53.59, 2,237 df). Analysis of pain perception showed that the catheter tourniquet led to substantially higher pain. We conclude that the catheter tourniquet generates high pressures and thereby increasing the potential risk of neurovascular complications.