Two Air Assault Surgical Groups (AASGs) from 16 Close Support Medical Regiment deployed to Kuwait on Operation Telic in February 2003. Each AASG was comprised of a four-table resuscitation facility, a two table FST and a twin-bedded ITU facility. An A+E Consultant and nurse, an experienced radiographer and laboratory technician with two further RGNs and CMTs provided resuscitation support. Each FST had an orthopaedic and a general surgeon, two anaesthetists and eight operating department practitioners. Further equipment consisted of a Polymobil 111 x-ray unit, a Sonosite 180 ultrasound scanner and an ISTAT gas, haematocrit and electrolyte analyser. 100 units of mixed blood were carried by each AASG. Fifty-one surgical procedures were performed on thirty-one patients. Twenty-one of these patients were Iraqi prisoners of war or civilians. Seventeen wound debridements, five amputations, five laparotomies, four insertions of Denham pins with Thomas splintage for femoral fracture, three external fiations and one axillary artery repair formed the basis of the major cases undertaken. The first field use of activated factor 7 by the British Army was successful in the resuscitation of a patient with exsanguinating haemorrhage after an open-book (APC-III) pelvic fracture and a ruptured intrapelvic haematoma. The other cases included eleven manipulations under anaesthetic/application of plaster and four finger terminalisations. Forward military surgery has a continued role to play on the modern fast moving battlefield. 16 Close Support Medical Regiment normally supports 16 Air Assault Brigade with its remit for out-of-area operations and SF support. Its experience on Op Telic should influence planning for future deployments.
A 36 year old gentleman presented to the Metabolic Bone Disease Clinic with a progressive history of thoracic and lower limb pain. He had originally been seen by the podiatrists with worsening foot pain for which no cause had been found. Initial investigation revealed a hypophosphataemic osteomalacia and a bone scan demonstrated multiple abnormalities suggesting old fractures. Investigations were performed to establish the cause of the osteomalacia and we discuss the differential diagnosis and the progression towards a diagnosis based on the results of these tests. The most useful investigation in this case was an octreotide scan which indicated the presence of an endocrine tumour in the medial femoral condyle of the right knee. Plain x-rays revealed no clear bony abnormality in the area of increased uptake on the octreotide scan. The lesion was therefore localised with an MRI scan. This subsequently demonstrated the exact location of the lesion and in image guided biopsy was performed in theatre. This confirmed the presence of a benign Phosphaturic Mesenchymal tumour. This rare tumour is usually found in soft tissues and this case is atypical given that the lesion was wholly within the femoral condyle. Despite the benign appearance of the tumour cells there were some areas of locally invasive growth and excision rather than curettage of the tumour was recommended. It was possible to preserve both the bulk of the femoral condyle and the articular surface although the knee was protected with a hinged brace for six weeks following surgery. Follow up biochemistry results demonstrate that the serum phosphate and alkaline phosphatase are returning to normal. Symptomatically the patient is much improved.
