The pre-operative differentiation between enchondroma, low-grade chondrosarcoma and high-grade chondrosarcoma remains a diagnostic challenge. We reviewed the accuracy and safety of the radiological grading of cartilaginous tumours through the assessment of, first, pre-operative radiological and post-operative histological agreement, and second the rate of recurrence in lesions confirmed as high-grade on histology. We performed a retrospective review of major long bone cartilaginous tumours managed by curettage as low grade between 2001 and 2012. A total of 53 patients with a mean age of 47.6 years (8 to 71) were included. There were 23 men and 30 women. The tumours involved the femur (n = 20), humerus (n = 18), tibia (n = 9), fibula (n = 3), radius (n = 2) and ulna (n = 1). Pre-operative diagnoses resulted from multidisciplinary consensus following radiological review alone for 35 tumours, or with the addition of pre-operative image guided needle biopsy for 18. The histologically confirmed diagnosis was enchondroma for two (3.7%), low-grade chondrosarcoma for 49 (92.6%) and high-grade chondrosarcoma for two (3.7%). Three patients with a low-grade tumour developed a local recurrence at a mean of 15 months (12 to 17) post-operatively. A single high-grade recurrence (grade II) was treated with tibial diaphyseal replacement. The overall recurrence rate was 7.5% at a mean follow-up of 4.7 years (1.2 to 12.3). Cartilaginous tumours identified as low-grade on pre-operative imaging with or without additional image-guided needle biopsy can safely be managed as low-grade without pre-operative histological diagnosis. A few tumours may demonstrate high-grade features histologically, but the rates of recurrence are not affected.

Cite this article: Bone Joint J 2014; 96-B:1098–105.

Purpose: Lower extremity articular fracture treatment requires acccurate diagnosis and anatomic reduction and fixation. As articular injuries, posterior malleolus (PM) fractures are still poorly defined: for example the incidence of associated PM marginal impaction and of free articular fragments is unknown. The purposes of this study were:

to define the articular injuries of PM fractures into clincially relevant groups, as complex articular injuries could require specific surgical steps;

Method: Our prospectively-collected orthopaedic trauma database (OTDB) query identified 796 ankle fractures treated operatively between 2003–2007. Of these 147 cases involved the posterior malleolus. Four were misclassified leaving 143 cases. We obtained demographic and injury data from the OTDB, and validated the OTDB coded mechanisms of injury by an individual chart review. We reviewed all radiographs to describe the PM injuries (fracture patterns and dimensions) and to identify the associated injuries.

Results: Of the 143 cases: Mean age was 50 years (sd=19), 68.5% were female, 51% were right sided injuries, and the median ISS=4 (in fact, 97.5% had ISS=4, most therefore being isolated trauma). The mean post malleolus AP size=11mm (sd=5). We identified recurrent patterns and classified the PM fracture as SIMPLE or COMPLEX (to include marginal impaction or free comminuted fragment, which should be anatomically reduced), 42% of cases (60/143) were COMPLEX (18 were impaction, 42 were free fragment). To help clinicians identify which cases could be COMPLEX we correlated (Chi-sq) the presence of a COMPLEX PM fracture to common clinical and radiographic variables. COMPLEX PM were statistically significantly associated with (p values)

an axial loading injury mechanism (.000),

For example, axial loading would result in a complex fracture in > 85% of cases. In contrast, there was a statistically significant association between a Weber C fracture and older age and the presence of a SIMPLE PM fracture. These factors being potentially “protective” from joint comminution.

Conclusion: We have defined and quantified the PM articular lesions which require anatomic reduction and fixation, beyond what has been published. We have defined clinical and radiographic criteria which, because higly associated with COMPLEX lesions, could

prompt surgeons to order further imaging (CT) to better delineate the lesion, and

Aims

Due to the recent rapid expansion of scooter sharing companies, there has been a dramatic increase in the number of electric scooter (e-scooter) injuries. Our purpose was to conduct a systematic review to characterize the demographic characteristics, most common injuries, and management of patients injured from electric scooters.