The purpose of this study was to assess the impact of Ilizarov frame fixation and total contact casting on the complications of Charcot arthropathy.

The diabetic charcot foot or ankle is a potentially limb threatening disorder. This progressive disorder is characterised by osteopenia, bone fragmentation and joint subluxation. The risk of significant deformity and osteomyelitis lead to high rates of amputation in these patients.

We analysed patients with acute charcot arthropathy attending the Rowley Bristow Unit between 2008 and 2012. We assessed 48 patients with a mean age of 59 years. Mean follow up was 24 months. 12 patients were managed with Ilizarov frame fixation and 36 using total contact casting. The duration of management was determined using serial infrared temperature monitoring to ensure the temperature of the limb normalised before patients were deemed safe to remove their immobilisation. The mean duration of Iliazarov frame fixation was 6.2 months and 5.3 months duration for total contact casting. In the Ilizarov group pin site infections were common and treated with a short course of antibiotics. In total one patient required below knee amputation following Ilizarov frame fixation. No patients suffered with osteomyelitis.

We feel that prompt management of acute charcot arthropathy with either total contact casting where appropriate or Ilizarov frame fixation can reduce serious complications of this disorder.

Background

Morton's neuroma (MN) is a common cause of metatarsalgia. Whilst there are a many treatment modalities available, studies looking at the long term effectiveness of most forms of treatment are scarce. The injection of MN with alcohol has gained popularity over the past ten years with widespread media coverage. Many surgeons have anecdotally questioned the long-term effectiveness. Sixty patients underwent alcohol injection for the treatment of MN by Radiologists at our institution. These results were originally published showing 92% (92/100) success rates and only 3% (3/100) requiring surgical excision at a mean follow up of 10.5 mths. The authors concluded that alcohol injection was comparable to results for surgical excision.

Background

Most patients with Achilles tendinopathy (AT) are treated successfully with physiotherapy ie eccentric calf training. In some patients gastrocnemius contracture persists. Three other publications have reported improvement in AT following gastrocnemius release, but this is the first series of patients to have proximal medial gastrocnemius release (PMGR) for AT. The purpose of this study was to review patients with refractory non-insertional and insertional AT treated by PMGR with a minimum followup of 18 months.

Recent changes in health care policy relating to pre hospital triage and closure of acute services in district general hospitals have placed unanticipated strains on financially challenged larger trusts in London. The financial implications for the presumed ‘designated’ regional trauma centre have previously not been scrutinised. Our study investigates how these changes and the resultant ‘out of area’ trauma has impacted on workload at our London teaching hospital and looks at the financial implications for the Trauma and Orthopaedics department.

A retrospective analysis of all attendances to the A& E department over a four month period (July – October) in 2006 was compared to a similar period in 2005. All admitted, major orthopaedic trauma cases bought in by ambulance or HEMS services were included. Review of case notes and phone interviews were used to ascertain how many of the incidents had occurred outside our region of referral.

An 83% increase in major trauma admissions was observed (32 cases in 2005, 53 cases in 2006; P value = 0.03). Of these cases, 27/32 and 46/53 could be assessed. Two patients in 2005 (7%) and twelve patients in 2006 (26%) were out of area (P value = 0.07). As these patients were bought in as ‘local’ cases, and not as regional referrals for treatment, the Trust was not reimbursed appropriately. Fiscal analysis of the out of area trauma cases was carried out to ascertain the shortfall incurred by the department.

Aim: To describe a new radiological sign after rupture of the thumb ulnar collateral ligament.

Introduction: Rupture of the thumb ulnar collateral ligament is a commonly missed injury, with delayed diagnosis leading to considerable morbidity. Stress radiographs and MRI scans have been used to diagnose chronic (gamekeepers thumb) or acute (skiers thumb) injuries to this ligament. The former often causes discomfort and the latter are often not readily available. We describe a new radiological sign seen on the lateral radiographs of the thumb, which has previously not been described in the literature. The ‘sag sign’ is volar subluxation of the proximal phalanx in relation to the metacarpal at the metacarpal phalangeal joint

Method: Between 2001–2006, radiographs of nineteen patients who had undergone repair of thumb ulnar collateral ligaments were retrospectively reviewed. There were 12 male and 7 female patients with an average age of 44. These were compared to a control group of normal thumb radiographs. The ‘sag sign’ was present on all the lateral radiographs of thumbs with ulnar collateral ligament tears. Once the ligament was repaired, the metacarpophalangeal joint alignment returned to normal. The sign was validated by senior house officers and registrars in orthopaedics training.

Conclusion: The sag sign is a reliable indicator of an underlying injury to the thumb ulnar collateral ligament. Many studies have looked at the radiological diagnosis of this commonly missed injury. Stress radiography and ultrasound require straining an injured thumb which can extend the lesion and cause discomfort. MRI and MR arthrography are both sensitive and specific, but are costly and time consuming. Our sign is evident on plain film, is easily available, and does not require additional apparatus.