Purpose: Traumatic knee dislocations are complex injuries. A thorough knowledge of the pattern of ligament damage is essential to plan for definitive treatment. Injuries to the structures of the posteromedial corner (posterior oblique ligament, the semi-membranosus tendon and its expansions, the meniscofemoral and meniscotibial ligaments, posterior horn of the medial meniscus and posterior reflections of the deep and superficial medial collateral ligament) can contribute to rotational laxity and have not been previously described in the setting of knee dislocations. We set out to evaluate the injury patterns of the posteromedial corner in a series of traumatic knee dislocations.

Method: A radiographic (MRI) study was conducted on 22 multi-ligament knee injuries in 22 patients, managed at a level one trauma centre by a single surgeon between July 2006 and May 2008.

Results: There were 14 male and 6 female patients with an average age of 29. The mechanism of injury was high velocity in 10 cases, and low velocity in 12 cases. One case (ACL/PCL/posterolateral corner injury) was associated with a vascular injury. While the incidence of MCL injury was 59%, injury specific to the PMC was evident on MRI in 81.8% (18/22) of cases. The deep and superficial MCL were involved in 13/18 and 12/18 PMC injuries, respectively. The posterior oblique ligament was injured in 11/18 cases and the semi-membranosus and its expansions were injured in 10/18 cases (all distal). Injuries to the posterior horn of the medial meniscus (9/18 cases) were associated with a tear of the menisco-femoral/meniscotibial ligaments in all cases.

Conclusion: Injury to the PMC was common with high-grade multi-ligament knee injuries in this series. PMC injuries were more common than MCL injuries alone. Injury to the posterior horn of the medial meniscus was predictive of more extensive PMC injury in all cases. The posteromedial corner of the knee is an under recognized area where important injuries can occur in the setting of a dislocatable knee. Future research will involve the correlation of the injury patterns described in this series to clinical measures of knee instability and laxity.

Malunion following displaced fractures of clavicle most commonly occurs with shortening and anterior rotation of the distal fragment. This results in scapular malalignment, which has been documented clinically as scapular winging. However, to our knowledge, this scapular malalignment has never been quantified radiographically. The purpose of our study was to quantify the radiographic parameters in patients with symptomatic midshaft clavicle malunions demonstrating scapular winging.

Fourteen patients with symptomatic midshaft clavicle malunions demonstrating scapular winging of the affected shoulder were identified. Each patient underwent CT scanning of both clavicles and scapulae. A standardised CT protocol was used for each patient. Multiple measurements were used to document the clavicle malunion and scapular malalignment including clavicular length, the distance from the tip of the scapula to the chest wall and to the nearest adjacent spinous process, and the relative height of each scapula on the chest wall. Statistical analysis using the Student t-test was performed.

The mean time from fracture was twenty-nine months. There were eleven males and three females with a mean age of 33.1 years. The mean clavicular shortening was 17mm (P> 0.001). The mean anterior-rotation through the malunion was nine degrees, and showed a trend toward significance (P=0.1). The distal fragment was anteriorly translated 13.5mm (P> 0.001) relative to the opposite normal shoulder. The scapula was displaced laterally 10.3mm (P> 0.001) from the nearest spinous process, superiorly 16.3mm and 12.2mm (P> 0.001) off the chest wall on average compared to the opposite normal shoulder.

Patients with symptomatic clavicle malunions often complain of periscapular pain, and winging of the scapula has been noted in such individuals. Ours is the first study to document and quantify scapular malalignment in this clinical setting. Since most shoulder musculature is scapular based, identification and quantification of scapular malalignment may have important ramifications in decision-making regarding treatment of clavicle fractures and malunions.

CT scans of thirty pes planus and eighteen normal feet were obtained in a simulated weight-bearing mode at 50% of body weight. The navicular skin distance was 22% less (1.9vs2.5cm) in the pes planus feet and forefoot supination was only 50% of normal (8.9vs18.6 degrees). Subtalar subluxation was observed in only the most severe pes planus feet. Navicular skin distance relates to medial arch collapse; loss of forefoot supination reflects the rigidity of the forefoot compensation to hindfoot valgus. Severe pes planus results in subtalar subluxation. The radiological indices described have not previously been reported in the literature.

To compare the inter-tarsal relationships of the pes planus foot to the normal foot in the weight-bearing state.

Weight-bearing CT scan of the feet is a practical examination with rapid set-up and minimal patient discomfort. Preliminary results demonstrate differences in the inter-tarsal relationships of pes planus feet compared to normal feet. Better understanding of pes planus deformity will advance clinical evaluation and treatment strategies.

Radiological indices described have not previously been reported in the literature.

Thirty pes planus and eighteen normal feet were imaged. All patients were able to tolerate the six- minute exam at 50% of body weight. Total study time averaged fifteen minutes. The navicular skin distance was 22% less (1.9vs2.5 cm) in pes planus feet compared to normal feet. Pes planus feet had only 50% of the normal forefoot supination (8.9vs18.6 degrees). Lastly, subtalar joint subluxation was observed in only the most severe pes planus feet. Values ranged from 0.2 to 1.1cm.

Axial CT images of 1mm thickness with 0.5mm overlap were obtained at a weight-bearing load of 50% of body weight using the weight-bearing CT device. Coronal and Sagital images were then reconstructed.

Radiological indices obtained can be related to the clinical picture of the pes planus foot. The navicular skin distance reflects medial arch collapse, where as the lack of forefoot supination reflects the rigidity of the forefoot compensation to hindfoot valgus. Severe hindfoot valgus in pes planus results in subtalar sub-luxation.

812 consecutive patients with soft tissue sarcoma of the extremity were studied to compare the characteristics and outcome of patients who had primary amputations and limb preserving surgery.

Patients with primary amputations were more likely to have metastases at presentation, high-grade tumours, larger tumours and were older.

The most frequent indications for primary amputation were tumour excision which would result in inadequate function and large extracompartmental tumours with composite tissue involvement including major vessels, nerves and bone.

The requirement for primary amputation was a poor prognostic factor independent of tumour grade, tumour size and patients’ age.