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Introduction: Mallet thumb injuries are uncommon. Traumatic avulsion injury of the extensor pollicis longus leads to significant difficulty. Case Report: A 55-year-old male patient presented with a closed hyper flexion injury to the thumb, resulting in pain and loss of active extension. Clinical examination and x-rays confirmed a soft-tissue mallet injury. The patient was treated non-operatively by immobilizing the interphalangeal joint of the thumb. The patient regained full range of motion. Conclusion: Non-operative treatment for acute closed mallet injury of the thumb provides satisfactory outcomes. It is suitable when a patient presents acutely.

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PURPOSE: The purpose of this study was to report all complications during the first consecutive 865 cases of bikini incision direct anterior approach (DAA) total hip arthroplasty (THA) performed by a single surgeon. The secondary aims of the study are to report our clinical outcomes and implant survivorship. We discuss our surgical technique to minimize complication rates during the procedure. METHODS: We undertook a retrospective analysis of our complications, clinical outcomes and implant survivorship of 865 DAA THA's over a period of 6 years (mean = 3.9yrs from 0.9 to 6.8 years). RESULTS: The complication rates identified in this study were low. Medium term survival at minimum 2-year survival and revision as the end point, was 99.53% and 99.84% for the stem and acetabular components respectively. Womac score improved from 49 (range 40-58) preoperatively to 3.5(range 0-8.8) and similarly, HHS scores improved from 53(range 40-56) to 92.5(range 63-100) at final follow-up (mean = 3.9 yrs) when compared to preoperative scores. CONCLUSIONS: These results suggest that bikini incision DAA technique can be safely utilised to perform THA.

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INTRODUCTION: There has been an increased interest in minimally invasive direct anterior approach total hip arthroplasty (THA) to provide greater patient satisfaction, improve pain relief, and reduce the duration of hospitalisation. A direct anterior approach hybrid cemented THA, utilising a bikini line incision, can be technically challenging. We aimed to undertake radiological analysis of femoral stem cementation, clinical outcomes, and component survivorship. METHODS: Over a 5-year period, 215 primary elective bikini anterior THA conducted by a single surgeon were included. All procedures were performed using a cemented collarless polished stem. The operation was performed on a standard operating table. Patients undergoing posterior approach, revision procedures, and fractured neck of femurs were excluded. Post-operative radiographs were analysed for femoral cementation quality using the Barrack grading system. Harris hip scores (HHS) were determined at 6 weeks, 12 weeks, annually thereafter and the difference in HHS was noted. RESULTS: In total, 215 anterior bikini THA (R = 101, L = 114) were performed in 199 patients (M = 89, F = 110) with a mean age of 77 and mean follow up of 2.9 years (range = 0.5-5). Radiographic analysis of femoral cementation showed 189 femoral stems (88%) were either Barrack A or B cementation grade, suggesting optimal cementation. Lucency in the cement-bone interface occurred mainly in Gruen Zone 1 (43%) and Zone 13(46.9%). At the most recent follow-up (mean 2.9 years), component survivorship was at 99.54% (stem). Significant improvement was noted in Harris hip scores at final follow-up (from 54 preoperatively to 92.7 at 2.9 years postoperatively). CONCLUSION: Our results suggest that a bikini incision direct anterior approach for total hip arthroplasty can be safely employed to perform cemented femoral stems on a standard operating table.

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PURPOSE: To describe a series of impingement lesions found on the anterior aspect of the medial femoral condyle in international cricketers. METHODS: Seven international level fast bowlers presented to our clinic with knee pain in the lead leg between 2005 and 2013. The mean age of the patients was 26.7 years (20-29 years). In all patients a careful history and examination was undertaken followed by appropriate investigations. Conservative management and arthroscopic surgery were performed on these cases. We aimed for a pain free quiet knee with resolved oedema on MRI and return to sport. RESULTS: MRI images showed oedema in the medial femoral condyle in all patients and 4 patients also had associated cartilage loss. These 4 patients underwent arthroscopic surgery whereas the other 3 were less symptomatic and were managed conservatively. All patients returned to international cricket at an average of 6 months in the non-operative group and 8 months in the operative group. CONCLUSION: Anterior impingement of the anteromedial femoral condyle can be a potentially serious lesion in the fast bowler. A strong index of suspicion regarding this lesion has to be exercised when a fast bowler attends with knee pain and effusion.

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BACKGROUND: Vastus Medialis Muscles (VMM) damage has been widely identified following patellar dislocation. Rehabilitation programmes have been suggested to strengthen the VMM and reduce clinical symptoms of pain and instability. This controlled laboratory study investigated the hypothesis that reduced Vastus Medialis Obliquus (VMO) and Vastus Medialis Longus (VML) muscle tension would alter patellar tracking, stability and PFJ contact pressures. METHODS: Nine fresh-frozen dissected cadaveric knees were mounted in a rig with the quadriceps and iliotibial band loaded to 205 N. An optical tracking system measured joint kinematics and pressure sensitive film between the patella and trochlea measured PFJ contact pressures. Measurements were repeated for three conditions: 1. With all quadriceps heads and iliotibial band (ITB) loaded; 2. as 1, but with the VMO muscle unloaded and 3. as 1, but with the VMO and VML unloaded. Measurements were also repeated for the three conditions with a 10 N lateral displacement force applied to the patella. RESULTS: Reduction of VMM tension resulted in significant increases in lateral patellar tilt (2.8°) and translation (4 mm), with elevated lateral and reduced medial joint contact pressures from 0.48 to 0.14 MPa, and reduced patellar stability (all p < 0.05). CONCLUSIONS: These findings provide basic scientific rationale to support the role of quadriceps strengthening to resist patellar lateral maltracking and rebalance the articular contact pressure away from the lateral facet in patients with normal patellofemoral joint anatomy.

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We report a case of congenital kyphosis in a 5-year-old child. Although she was presented before the age of 1 year to her local orthopaedic unit, a definitive diagnosis of unsegmented vertebra was made when she was referred to our unit. The child was treated with posterior fusion, which improved part of the deformity and completely prevented progression. We discuss the case and the condition, which if ignored can lead to progressive painful deformity and paralysis.

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Hip fractures are a significant cause of mortality and morbidity in the elderly. It is important to identify factors that predict an increased mortality following hip fracture. The aim of this study was to identify significant predictors of mortality at 6 and 12 months following hip fractures. Three hundred patients above the age of 65 were identified who were admitted in to the hospital with fracture neck of femur. Two hundred and seventy-four patients were operated and were included into the study. Variables collected were age, gender, significant comorbidities, admission albumin level and admission total lymphocyte count (TLC). Admission time and subsequent time to surgery were also analysed. Our study showed that albumin and TLC were found to be the only clearly significant mortality predictors at 12 months and a delay of up to 4 days to surgery does not significantly increase the mortality at 12 months.

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Necrotising fasciitis of the extremities is a rapidly progressive, potentially life threatening soft tissue infection. Early diagnosis, aggressive surgical and critical care management is vital in preventing mortality. This series reports the clinical presentation, behaviour of inflammatory markers, histological, microbiological and radiological findings in seven cases, which presented to our orthopaedic unit over the last one year. Seven patients (4 male and 3 female) were included. Usual presentation was spreading erythema and pain. Duration of symptoms varied from 3 to 14 days. All except one case affected the lower limbs. The average Laboratory risk indicator for necrotising fasciitis (LRINEC) score on the day of presentation was 5. Imaging demonstrated subcutaneous oedema, fluid and air pockets in muscular planes. Group A beta haemolytic Streptococcus was the most common organism isolated from culture. Treatment modalities included antibiotics, immunoglobulins and surgical debridement. Four of the patients showed full remission. However, three (one with pre-existing carcinoma) of them succumbed to the condition.

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We report a case of neglected anterior dislocation of the hip. A young man presented 5 months following a fall from a tree where he sustained the injury. An MRI of the hip confirmed avascular necrosis of the dislocated head of femur. A modified girdlestone operation was performed leaving the patient with a painfree functional hip.

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Group B streptococci (GBS) birth canal colonisation in pregnant women and women of child-bearing age is well known. The recognition and incidence of infections caused by these organisms in non-pregnant and elderly adults are increasing. Clinical manifestations of GBS infections can range from simple skin and soft tissue infections to fatal meningitis in newborns. GBS as a cause of septic arthritis of the hip associated with pregnancy is previously unreported. We report a case of septic arthritis of the hip joint caused by GBS in a 30-year-old woman with a history of recent childbirth. Delay in recognition and lack of timely appropriate treatment of this condition henceforth led to severe destruction of the joint, requiring ultimate reconstruction of the joint with cemented total hip arthroplasty. This case report highlights the atypical presentation and rapidly destructive nature of this infection with catastrophic consequences.

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