Osteochondral lesions of the talus: aspects of current management.

Osteochondral lesions (OCLs) occur in up to 70% of sprains and fractures involving the ankle. Atraumatic aetiologies have also been described. Techniques such as microfracture, and replacement strategies such as autologous osteochondral transplantation, or autologous chondrocyte implantation are the major forms of surgical treatment. Current literature suggests that microfracture is indicated for lesions up to 15 mm in diameter, with replacement strategies indicated for larger or cystic lesions. Short- and medium-term results have been reported, where concerns over potential deterioration of fibrocartilage leads to a need for long-term evaluation. Biological augmentation may also be used in the treatment of OCLs, as they potentially enhance the biological environment for a natural healing response. Further research is required to establish the critical size of defect, beyond which replacement strategies should be used, as well as the most appropriate use of biological augmentation. This paper reviews the current evidence for surgical management and use of biological adjuncts for treatment of osteochondral lesions of the talus.

Trends in the provision of primary care dental general anaesthesia in the north of England, 1991/92 to 1994/95.

AIM: To investigate trends in the provision of primary care dental general anaesthesia (PCDGA) and any association with dental caries. DESIGN: Cross-sectional analysis of data about the provision of PCDGA in the general dental service and community dental service from 1991/92 to 1994/95. SETTING: The former North Western, Mersey, Northern and Yorkshire regions. METHOD: The combined rates of PCDGAs in the general dental service and community dental service, from 1991/92 to 1994/95 were calculated and compared with the levels of caries from the NHS dental epidemiology programme. RESULTS: All regions except the North Western had a lower rate at the end of the 1991 study but only the Northern region had a lower rate in 1994/95 than in 1993/94. Only weak correlations were found between the PCDGA rate in a health authority and the level of dental caries. CONCLUSIONS: PCDGA rates did not continue to decline during the period of this study. One of the principal recommendations of the Poswillo report was that the use of general anaesthesia should be avoided wherever possible. Other initiatives, perhaps the development of criteria for selection of patients, may be necessary if further reductions in PCDGA rates are to be achieved.