The posterior malleolus of the ankle is the object of increasing attention, with considerable enthusiasm for CT scanning and surgical fixation, as expressed in a recent annotation in The Bone & Joint Journal. Undoubtedly, fractures with a large posterior malleolar fragment that allow posterior talar subluxation from the mortise are served better by fixation. However, in all other situations, the existing literature does not support this widespread change in practice. The available biomechanical evidence shows that the posterior malleolus has little part to play in the stability or contact stresses of the ankle joint. Radiographic studies have not shown that CT scanning offers helpful information on pathoanatomical classification, case selection, or prognosis, or that scanning improves the likelihood of an adequate surgical reduction. Clinical studies have not shown any improvement in patient outcome after surgical fixation, and have confirmed that the inevitable consequence of increased intervention is an increased rate of complications. A careful and thoughtful evaluation of indications, risks, and benefits of this fashionable concept is required to ensure that we are deploying valuable resources with efficacy, and that we do no harm.

Cite this article: Bone Joint J 2018;100-B:566–9.

1. On the basis of radiographic studies the incidence of degenerative change in the intervertebral disc in primitive squatting populations is considerably less than that found in civilised peoples. 2. The suggestion is made that lordosis is implicated in the pathogenesis of degeneration, but further studies are required

1. The progressive radiographic changes in twenty-five patients suffering from Perthes' disease of the hip are described. 2. The prognostic value of lateral views of the hip is emphasised, and the present concepts of pathogenesis in the light of recent observations are discussed

Aims

This paper describes the methodology, validation and reliability of a new computer-assisted method which uses models of the patient’s bones and the components to measure their migration and polyethylene wear from radiographs after total hip arthroplasty (THA).

The posterior malleolus component of a fracture of the ankle is important, yet often overlooked. Pre-operative CT scans to identify and classify the pattern of the fracture are not used enough. Posterior malleolus fractures are not difficult to fix. After reduction and fixation of the posterior malleolus, the articular surface of the tibia is restored; the fibula is out to length; the syndesmosis is more stable and the patient can rehabilitate faster. There is therefore considerable merit in fixing most posterior malleolus fractures. An early post-operative CT scan to ensure that accurate reduction has been achieved should also be considered.

Cite this article: Bone Joint J 2017;99-B:1413–19.

The number of arthroplasties of the hip and knee is predicted to increase rapidly during the next 20 years. Accompanying this is the dilemma of how to follow-up these patients appropriately. Current guidelines recommend long-term follow-up to identify patients with aseptic loosening, which can occur more than a decade postoperatively. The current guidelines and practices of orthopaedic surgeons vary widely. Existing models take up much clinical time and are expensive. Pilot studies using ‘virtual’ clinics and advanced-practice physiotherapists have shown promise in decreasing the time and costs for orthopaedic surgeons and patients.

This review discusses current practices and future trends in the follow-up of patients who have an arthroplasty.

Cite this article: Bone Joint J 2018;100-B:6–10.

Aims

The outcome of total knee arthroplasty (TKA) is not always satisfactory. The purpose of this study was to identify satisfaction and biomechanical features characterising the gait of patients who had undergone TKA with either an anatomical single radius design or a medial pivot design. We hypothesised that the latter would provide superior function.

1 . Two cases of chronic progressive dislocation of the talo-navicular joints are discussed. 2. Radiographs are presented showing the development of the lesions over a period of eighteen years. 3. It is thought that the lesion is caused by laxity of ligaments and subsequent osteoarthritic changes

1. Five cases of calcified enchondroma are described. In all except one the condition was symptomless and was discovered accidentally. 2. The radiographic features are described and the differential diagnosis is discussed. 3. It is emphasised that when the diagnosis is in doubt biopsy should be undertaken

A 15-year-old girl presented with a four-year history of pain in the left ankle. There was no known trauma, only a postnatal soft tissue infection which had healed with no sequelae. Radiographs showed that the talus consisted of two large fragments and one small one

Two cases are reported in which doigt en lorgnette was associated with features of long-standing yaws. Radiographs showed an unusual bone appearance, believed to be due to superimposition of concentric atrophy with focal dissolution of the distal bones on the lesions of healed yaws osteitis

1. Attention is drawn to lesions of the inferior tibio-fibular ligaments. Two main types are described: the anterior type and the total type. 2. The clinical and radiological characteristics are described. 3. The value of strain-view radiography is stressed. 4. A plan of treatment is suggested

The new Ionising Radiation (Medical Exposure) Regulations 2000 (IR (ME)ER) were implemented in January 2001. These regulations state that “the referrer must record in the patient’s notes that a radiograph was taken and what it showed”. As a result it is now incumbent upon the orthopaedic surgeon to document formally the findings of all requested radiographs. We present a case in which a left upper bronchial carcinoma was detected initially on a radiograph of the left shoulder. It highlights the importance of careful examination of the entire radiographic image and the documenting of the findings

Aims

Periprosthetic joint infection (PJI) remains a challenging complication following total hip arthroplasty (THA). It is associated with high levels of morbidity, mortality and expense. Guidelines and protocols exist for the management of culture-positive patients. Managing culture-negative patients with a PJI poses a greater challenge to surgeons and the wider multidisciplinary team as clear guidance is lacking.

1. The radiographic appearances are no guide to prognosis or treatment of peroneal spastic flat foot. 2. Only 10 per cent of peroneal spastic flat feet are likely to cause severe persistent disability. 3. Severe symptomatic tarsal arthritis is exceptional in this condition

Two patients presented with pain in the arm and a radiographic lesion of the upper humerus which warranted surgical exploration and excision biopsy. In both cases the pathology was inflammatory and involved the insertion of pectoralis major. Tendinitis of the pectoralis major with an associated lesion of the humerus has not previously been described

The existing methods of assessing limb lengthening during total hip arthroplasty (THA) are prone to error because the measurements are not parallel to the limb lengthening axis. In order to address this, we designed a caliper to estimate limb lengthening during THA and evaluated its accuracy compared with our previous device, the straight caliper. Limb lengths were measured in 100 patients. The L-shaped caliper was used in 50 cases and the straight caliper in 50. The correlation between intra-operative and post-operative radiographic measurements was significantly improved using the L-shaped device (p < 0.0001, r = 0.934). This method was extremely accurate in predicting changes in limb length due to surgery

1. Eight cases of solitary eosinophilic granuloma of bone are described, along with two possible complications. 2. The main pathological, clinical, and radiographic features of the condition, and its treatment, are discussed. 3. The essentially benign course of the solitary lesion, even in the presence of complications, is confirmed

1. The clinical, radiographic and pathological features of aneurysmal bone cyst are described and illustrated by case reports. 2. Reasons are given for accepting the lesion as a clinical and pathological entity. 3. The cyst has a tendency to spontaneous regression and healing may occur after partial excision

We perfused 16 human femora with a 50% barium sulphate suspension and studied the intra-osseous vessels by microfocal radiography and histology. There were few anastomoses between the vessels of the greater trochanter and those of the adjacent cancellous bone of the shaft. Ischaemia of the trochanter may contribute to nonunion after trochanteric osteotomy