In 2004 the Scottish Sarcoma Network (SSN) was established with the aim of optimising management of patients with sarcoma. Clinical, radiological, oncological and pathological details of all bone and soft tissue sarcomas presenting in Scotland are registered and cases discussed in a multi-centre, tele-link multidisciplinary team (MDT) forum.

The aim of this study was to establish any difference in referral patterns, time to specialist review, preoperative MRI scanning and appropriate biopsy before and after establishment of the Scottish Sarcoma Network in Grampian.

A database was established of all patients presenting with sarcomas of the trunk or extremity in Grampian between 1991 and 2010. One hundred and fifty eight patients were randomly selected, 79 (50%) presenting prior to the establishment of the Scottish Sarcoma Network.

Since the initiation of the Scottish sarcoma network we found that the median time of referral to review by the sarcoma service has improved from 19.5 days to 10 days (P=0.016). There has been an increase in the number of patients referred from other specialities while the number of general practice has remained fairly constant. This has resulted in a slight increase in the median total patient journey from 35 days to 41 days, this does not reach statistical significance.

A greater number of patients are undergoing pre biopsy MRI scan, 53 (67%) before 2004 and 68 (86%) after (P=0.009). More patients are also undergoing appropriate biopsy 45(57%) before the network and 62(79%) after.

The creation of the Scottish Sarcoma Network has had a positive impact on the care of sarcoma patients presenting in Grampian.

Introduction: The Scottish Sarcoma network was established in 2004 to optimise the management of sarcoma patients in Scotland. This maintained three units, Aberdeen, Edinburgh and Glasgow, as designated Sarcoma centres. Aberdeen takes referrals from Tayside, Grampian and the Highlands and Islands. Soft tissue tumours are managed with surgical resection +/− radiotherapy. The surgical margin is paramount and thought to predict the risk of local recurrence.

Methods: All patients presenting with a soft tissue sarcoma to the Orthopaedic department in Aberdeen between January 2001 and April 2008 were identified. A retrospective review of the hospital records and histopathology reports was performed. Our aim was to establish the number of recurrences of soft tissue sarcoma within the unit over the 7 year period and relate this to the adequacy of the initial surgical resection margin.

Results: Seventy-six patients were identified, 45 male and 31 female, with a mean age of 56 years. An average of ten patients presented annually (range 5–14). Seven patients (9.2%) presented with local recurrence, 4 with Malignant Fibrous Histiocytoma, 2 with leiomyosarcoma and 1 malignant peripheral nerve sheath tumour.

Five patients with recurrent disease were treated prior to establishment of the sarcoma network. Two patients, before the establishment of the network underwent resection and staging in another unit and the exact time to recurrence is unknown. One patient is currently under investigation for recurrence.

The average time to recurrence was 29.2 months (Range 12–48 months).

Three of the five patients with original pathology available had complete resection with mean margins of 6.25mm (range 5–7.5mm). Two had incomplete excisions carried out by other specialities, only presenting to our unit with recurrent disease.

Discussion: Our recurrence rate of 10.5% is comparable to other centres. Despite adequate resection margins and adjuvant radiotherapy some patients go on to develop recurrent disease. It is unclear why.

A long-term review of 131 children fitted with upper limb prostheses at the Ontario Crippled Children's Centre between 1965 and 1975 is reported. There were 116 children with congenital deficiencies and 15 who had had amputations. Follow-up ranged from 7 to 17 years. A total of 42 children had abandoned their prostheses, 37 of whom had congenital deformities and five were amputees. The level of deficiency was of fundamental importance in determining whether the prosthesis would be accepted; in the forearm, the longer the stump, the more likely it was that the child would discard the prosthesis. Overall, 50 per cent of children fitted over the age of two years abandoned their prostheses compared with only 22 per cent of patients who had been fitted before the age of two years. The highest drop-out rate was at the age of 13 years when the children became more conscious of their cosmetic appearance. Suggestions for reducing the high drop-out rate in the early teens are put forward.

A series of 29 patients with fractures of the tibial plateau were treated by means of a cast-brace. There were seven wedge fractures of the lateral tibial condyle, two dicondylar fractures and 20 compression fractures involving the lateral tibial plateau. The seven patients with wedge fractures were treated by skin or skeletal traction, followed as soon as possible by flexion exercises for the knee. Cast-braces were applied to all fractures as soon as possible after injury, and the patients allowed to bear weight freely. Early restoration of function of the injured limb was thereby achieved. The results of our study over a period of two and a half years indicate that cast-bracing is a very satisfactory method of treating fractures of the tibial plateau. All the fractures united, the movements and control of the knee were excellent, and valgus or varus deformity was unchanged before application and after removal of the brace.