Treatment of acute Achilles tendon rupture is based on obtaining and maintaining apposition of the ruptured tendon ends. Surgical treatment utilises direct suture repair to produce this objective, while conservative or non-surgical management achieves the same effect of closing the tendon gap by immobilisation of the ankle joint in a plantar flexed position within a plaster cast or POP. There is still variability in the conservative treatment practices and protocols of acute Achilles tendon ruptures. The purpose of this study is to examine the current practice trends in the treatment of Achilles tendon ruptures amongst orthopaedic surgeons in the UK.

A postal questionnaire was sent to 221 orthopaedic consultants in 25 NHS hospitals in the Greater London area in June 2010. Type and duration of immobilisation were considered along with the specifics of the regime used.

Ninety questionnaires were returned giving a 41% response rate. Conservative treatment methods were used by 72% of respondents. A below knee plaster was the top choice of immobilisation (83%) within this group. The mean period of immobilisation was 9.2 weeks (Range 4-36). Weight bearing was allowed at a mean of 5.3 weeks (range 0-12)

The specific regime used by consultants was quite heterogeneous across the group, however the most used immobilisation regimen was a below knee plaster in equinus with 3 weekly serial plaster changes to a neutral position, for a total of nine weeks. A heel raise after plaster removal was favoured by 73% of respondents used for a mean period of 6.4 weeks (Range 2-36). In response to ultrasound use as a diagnostic tool, 42.4% of respondents would never use it, 7.6% would use it routinely, while 50% would use it only according to the clinical situation. Comparison of foot and ankle specialists with non-specialists did not reveal a significant difference in practice in duration of immobilisation or time to bearing weight.

Conservative management remains a widely practice option in the treatment of Achilles tendon ruptures. Although there are available a number of modern walking aids, the concept of functional brace immobilisation is not as widely used as below knee plaster cast immobilisation, which remains a popular choice amongst orthopaedic surgeons today. There is still no consensus on the ideal immobilisation regimen although a below knee plaster in equinus with serial changes for a total of nine weeks is the most frequently used choice. Further randomised controlled trials are required to establish the optimal treatment strategy for conservative management of Achilles tendon rupture.

Background: Ankle fractures in adults are an increasing part of the workload of orthopaedic surgeons today. Stable ankle fractures are usually managed conservatively and followed up in the fracture clinic to identify any later displacement which may lead to the need for surgical treatment. the guidelines for follow up varies from place to place with equally varying outcomes. the aim of this study was to look at the pattern and outcome of follow up of these fractures and also the influence, if any, of serial radiological imaging during this period.

Methods: We retrospectively reviewed the follow up of patients who were refered to the clinic as stable ankle fractures and who were treated conservatively following their first clinic attendance. the period covered was April 2002 to march 2003 and we also assessed the documentation of medial side tenderness from the casenotes.

Results: 66 patients were identified consisting of 44 Weber A, 20 Weber B and 2 Weber C fractures with an average follow up of 10weeks. 82% of cases had documented medial side tenderness. None of the Weber A fractures displaced, irrespective of weight bearing instructions and medial side tenderness. Only 2(10%) of the Weber B and 1 (50%) of the Weber C fractures required surgical intervention due to displacement detected after clinic review at week one.

Conclusion: Weber A fractures are inherently stable injuries, do not displace over time and hence do not require further clinic attendances and xrays after the first consultation. Beyond the first week, regular clinic reviews and serial xrays are not necessary in the treatment of Weber B ankle fractures. The presence of medial side tenderness was a poor indicator for joint instability in this series. with proper protocols in place, these can lead to a significant decrease in the workload of orthopaedics surgeons.

The recognition, investigation and management of osteoid osteoma has been well documented. Treatment can either be medical or surgical, studies have shown both options to have almost equal long term outcomes. However only surgical treatment involving complete excision of the lesion allows for confirmatory tissue diagnosis of osteoid osteoma especially important in cases where symptoms and signs are atypical. Several methods of surgical treatment with varying degrees of success have been described in literature. Here we describe a surgical techniques for the treatment of osteoid osteoma which enables removal of the lesion in a precise manner using a precision bone graft trephine with minimal excision of bone. This technique will be very useful in the excision of lesions in areas in which excessive excision of bone can lead to an unstable bony structure which can predispose to fracture. To our knowledge this surgical technique in the management of osteoid osteoma has not been described in the literature.