Introduction

Scaphoid fracture is the most common undiagnosed fracture. Occult scaphoid fractures occur in 20-25 percent of cases where the initial X-rays are negative. Currently, there is no consensus as to the most appropriate investigation to diagnose these occult frctures. At our institution MRI has been used for this purpose for over 3 years. We report on our experience and discuss the results.

Introduction: Arthrodesis of 1st MTPJ is performed using various fixation techniques including lag screws, dorsal plate and screws, K-wiring. We evaluated the strength of fixation using two staples placed at right angles.

Methods: Ten pairs of cadaveric feet were dissected to harvest the hallux MTPJ. Planar cut of articular surfaces using a micro-saggital saw. The bony ends were then approximated with an intervening blade and fixed using 2 staples placed at right angles. The specimen was supported on either ends and subjected to 3 point loading using a materials testing machine (Instron). The load at which the joint opened up sufficiently to let the blade fall was recorded. The load at which the construct failed was then recorded

Results: The joint opened up at an average of 41 Newtons. The load to failure was 130 Newtons. The corresponding average values in kilograms were 4.19 kilograms for the opening of the joint and 12.61 kilograms for the failure of the construct. On full weight bearing using the heel weight bearing shoes that we normally use post-operatively, the forces going through the forefoot were 0 newtons/kilograms, calculated using a TEK SCAN (measures the foot pressure on walking)

Conclusion: It is safe to walk patients using a heel weight bearing shoe (Benefoot post op wedge shoe) following 1st MTPJ fusion using staples (uniclip-NewDeal). This is a major advantage compared to other methods of fixation that require plaster cast immobilisation thus reducing inconvenience, plaster expenses and possible complications like DVT.

Introduction: In 1979 Linburg and Comstock described anomalous tendon slips between flexor pollicus longus and the flexor digitorum profundus in 31% of individuals (Linburg, Comstock; J Hand surg 1997, Jan). The purpose of this study is to find out the incidence of Linburg-Comstock Syndrome in the British population.

Methods: A clinical examination of the hands of healthy volunteers, including office workers and medical professionals was carried out. It was determined if flexion of the thumb causes concomitant flexion of index or/and middle finger. Additionally, pain on passive extension of the fingers was also documented.

Summary of Results: 70 volunteers were included, the test for Linburg-Comstock syndrome was positive in 55% of people who had concomitant flexion of the fingers with the thumb and pain in the wrist with passive extension. In 70% of people just concomitant finger flexion was seen. In 10 cadaveric dissections no connecting tendon slips were found but one fibrinous connection between FPL and FDP was noted.

Conclusion: Our study shows that the incidence of Linburg –Comstock Syndrome is much higher than previously thought based on the clinical examination. However cadaveric dissections did not confirm a distinct structural connection except in one case where there was a fibrinous connection. It is likely that at least in some cases it is a acquired anomaly in response to repeated use/overuse of thumb and index fingers.

The study was designed to determine the incidence and to quantify the risk factors of permanently decreased bone mineral density (BMD) of the Lumbar spine and Femoral neck following tibial shaft fractures.

42 consecutive adults treated for isolated tibial shaft fractures at our institution between January 1984 and June 1985 formed the subjects of this study. Mechanism and type of injury, method of treatment, length of immobilisation and weight bearing status and healing time were determined from the patient records. A questionnaire including history of smoking, alcohol consumption, medications, other fractures, medical conditions like thyroid/parathyroid disorders, convulsions, and renal disorders was administered. Bone mineral density of lumbar 1–4 vertebrae and both hips was assessed using DEXA scanning. T and Z scores were generated. Statistical analysis was performed using the Chi square test to test the significance of association of osteopenia/osteoporosis (Z score < -1) with a previous tibial shaft fracture and calculating the odds ratio (OR) and 95% confidence interval (CI) to quantify the suspected risk factors.

The incidence of significant loss of BMD of the ipsilateral femur and/or lumbar spine was found to be 33%. A statistically significant association (p< 0.001) between a history of tibial shaft fracture and permanent loss of BMD was noted. The following risk factors were found to be statistically significant; Smoking (OR 22, 95% CI=4–> 40, p< 0.001), Alcohol more than 20 units/week (OR 11, 95% CI 2.2–54,p< 0.005), Open fracture (OR 17, 95% CI=2.9–> 40, p< 0.001), Non-weight bearing more than 12 weeks (OR 15, 95% CI 2.9–> 40, p< 0.005), and delayed union defined as healing time more than 6 months (OR 15, 95% CI 1.54–> 40, p < 0.05).

Permanent regional osteopaenia/osteoporosis occurs in a significant proportion of tibial shaft fracture patients. Modern fracture management should include identifying ‘at risk’ patients and appropriate management to prevent fragility fractures.