Gastrocnemius Release in the Treatment of Achilles Tendinopathy: A Systematic Review.

Background: The aim of this study is to evaluate the use of isolated gastrocnemius release in the treatment of Achilles tendinopathy. The primary outcome is the change in patient-reported pain outcomes. Secondary outcomes include the change in patient-reported foot and ankle function, ankle range of motion and strength, patient satisfaction and rate of surgical complications.

Safety of early weightbearing after ankle fracture fixation.

Purpose: Patients with surgically treated ankle fractures are traditionally kept non-weightbearing for at least six weeks post-operatively; however, recent literature suggests numerous benefits of early weightbearing (EWB) before six weeks without significantly impacting long-term outcomes. This study aims to review the safety of early vs late weightbearing following ankle fracture fixation by assessing the complication rate.

Methods: This was a single-centre retrospective study.

Identifying at risk populations amongst breast cancer survivors and their common symptoms and concerns.

Purpose: The survival rate amongst breast cancer survivors (BCS) have been increasing, with a 5-year survival rate of almost 90%. These women face many quality of life (QOL) issues either due to either cancer itself or the complex treatment regimen. Our retrospective analysis aims to identify at risk populations among the BCS and their most common concerns.

An elevated creatine kinase in the context of influenza A infection and sickle cell trait.

We describe the case of a 37-year-old normally fit and well man who presented to hospital with fever, lethargy and myalgia. He was found to have a creatine kinase level of over 1 million IU.l.

Minimally invasive distal metaphyseal metatarsal osteotomy (DMMO) for symptomatic forefoot pathology - Short to medium term outcomes from a retrospective case series.

Background: Minimally invasive distal metaphyseal metatarsal osteotomy (DMMO) may be used to treat metatarsalgia and forefoot pathology. Few large series report its results or examine the degree of metatarsal shortening with this technique. The clinical and radiographic results of a cohort of patients treated with DMMOs at our unit are reported.

Is It Possible to Overcompress the Syndesmosis?

The case we present suggests that it might be possible to overcompress the syndesmosis, causing subluxation of the talus within the ankle mortise. A 26-year-old female patient had had a Weber Type C ankle fracture internally fixed with a lateral plate and syndesmosis screws. Despite the fibula appearing well reduced and computed tomography imaging showing a well-aligned fibula within the fibular notch, anteromedial subluxation of the talus was present in the ankle mortise.

Immediate Remote Ischemic Postconditioning Reduces Brain Nitrotyrosine Formation in a Piglet Asphyxia Model.

Remote ischemic postconditioning (RIPostC) is a promising therapeutic intervention that could be administered as an alternative to cooling in cases of perinatal hypoxia-ischemia (HI). In the current study we hypothesized that RIPostC in the piglet model of birth asphyxia confers protection by reducing nitrosative stress and subsequent nitrotyrosine formation, as well as having an effect on glial immunoreactivity. Postnatal day 1 (P1) piglets underwent HI brain injury and were randomised to HI (control) or HI + RIPostC.

Talar Neck Fracture after United Tibiotalar Fusion.

Tibiotalar arthrodesis is a well-established treatment for tibiotalar arthritis, for example, in younger high demand patients. Talar neck fractures are less common though well-recognised sequelae of foot ankle trauma. Here we present the clinical case of a 69-year-old male who presented to our institution with a nonunion of a talar neck fracture, having undergone a left tibiotalar fusion 24 years previously.

Stress fractures of the foot and ankle.

Stress fractures occur as a result of microscopic injuries sustained when bone is subjected to repeated submaximal stresses. Overtime, with repeated cycles of loading, accumulation of such injuries can lead to macro-structural failure and frank fracture. There are numerous stress fractures about the foot and ankle of which a trauma and orthopaedic surgeon should be aware.

A case of check-rein deformities of the great and lesser toes treated through exploration at the midfoot.

We present the case of a twenty-two year old man who presented to the orthopaedic clinic complaining of clawing of his great toe. Further examination revealed clawing of the lesser toes and surgical scarring to the fibula and tibia. A history of previous operative fixation for lower limb trauma was described.

Lisfranc injuries.

Lisfranc injuries are commonly asked about in FRCS Orthopaedic trauma vivas. The term "Lisfranc injury" strictly refers to an injury where one or more of the metatarsals are displaced from the tarsus. The term is more commonly used to describe an injury to the midfoot centred on the 2nd tarsometatarsal joint.

A rare Lisfranc-type injury involving dorsal dislocation of the intermediate cuneiform.

Lisfranc injuries occur at the tarsometatarsal joint resulting from direct or indirect force to the midfoot. They account for only 0.2% of all fractures, with diagnoses easily missed on presentation.

The reliability and variation of measurements of the os calcis angles in children.

The databases of the Picture Archiving and Communication Systems of two hospitals were searched and all children who had a lateral radiograph of the ankle during their attendance at the emergency department were identified. In 227 radiographs, Bohler's and Gissane's angles were measured on two separate occasions and by two separate authors to allow calculation of inter- and intra-observer variation. Intraclass correlation coefficients were used to assess the reliability of the measurements.

Deaths on the table: proposal for an international convention on the investigation and prevention of anaesthetic mortality.

National and international variations in clinical practice, study methodologies, and data collection make the estimation of patient deaths attributable in some measure to anaesthesia a difficult task. Such rates have undoubtedly significantly declined, a tribute, in large part, to the work of groups such as the International Committee for the Prevention of Anaesthetic Mortality and Morbidity, the Anesthesia Patient Safety Foundation and the Australian Patient Safety Foundation. There is, however, internationally, still a significant risk of mortality associated with anaesthesia which is distinct from that related to any relevant surgery or intercurrent disease.

Decision-making in anaesthesia.

Anaesthetists work as part of a process and deal with complex situations in their daily work. Considerable effort is put into training anaesthetists, but little has been done either in research or improving awareness of the intangible components of the anaesthesia system that affect safety, such as decision-making. The purpose of this article is to apply the principles of decision-making to anaesthesia practice.

Discriminators between neurotics who die and neurotics who live.

An increased death rate has been found in patients treated in hospital for neurosis but the reasons for this are not known. A case note study is described in which 37 patients who were treated in hospital for neurosis and subsequently died are compared with a cross-matched sample of treated neurotics who were alive at follow-up. Measures believed to indicate greater severity of neurosis were found to be significantly higher in the experimental (dead) group than in the control (living) group.