The incidence and severity of diabetic hand infection presentations during the COVID-19 pandemic.

Level of evidence: IV.

A comparative study of 6-week and 12-week Radiographic Union Scores for HUmeral fractures (RUSHU) as a predictor of humeral shaft non-union.

Background: Non-union in non-operatively managed humeral shaft fractures are associated with significant morbidity. Hence, developing a robust system that could help with early diagnosis is important. We aimed to evaluate the validity of the Radiographic Union Score for HUmeral fractures (RUSHU) at 6 weeks (RUSHU-6) and test whether a RUSHU at 12 weeks (RUSHU-12) would be a better predictor of non-union. Methods: We retrospectively reviewed all non-operatively managed humeral diaphyseal fractures from 2012 to 2018. Statistical analysis was used to determine the cut-off RUSHU-12 and evaluate the effect of RUSHU-6 and RUSHU-12 on non-union prediction. Results: In sum, 32 patients had radiographs at 6 weeks post-injury, 27 of which also had radiographs at 12 weeks. A RUSHU cut-off of 9 was the best predictor of non-union at 12 weeks. Only RUSHU-12 had a statistically significant influence predicting non-union (P = 0.011) and there was a significant correlation (P = 0.003) between score progression from RUSHU-6 to RUSHU-12 and the development of non-union. Discussion: A RUSHU-12 of <9 and a low score progression between 6 and 12 weeks suggest superior predictive value in determining the likelihood of non-union. Further validation in the form of a large multicentred study is however required.

Van Nes rotationplasty as a treatment method for Ewing's sarcoma in a 14-month-old.

INTRODUCTION: In recent years, the rotationplasty procedure has become popular amongst tumour surgeons as an alternative to endoprosthetic replacement or amputation. There are very few documented cases of this technique in young patients with malignancy. PRESENTATION OF CASE: We describe an extremely rare case of Ewing's sarcoma in a 14-month-old boy that involved the entire length of the left femur. At initial presentation, pulmonary metastatic spread had occurred and there was no neurovascular involvement. Complete response to neo-adjuvant chemotherapy was achieved prior to performing the definitive surgical procedure. DISCUSSION: This case highlights the many reconstructive options and difficulties encountered in managing such extremely young patients with aggressive malignant disease. In this case, a complete femoral excision was necessary and various treatment options were explored. These included irradiation and re-implantation, endoprosthetic replacement and manufacturing a custom growing prosthesis. Taking future functional, psychological and social implications into consideration, we performed a total femoral excision and Van Nes rotationplasty of the tibia at our institute. Histological analysis of the tumour resection showed clear tumour margins and at 1 year clinical review, the patient demonstrates good functional outcome with no evidence of disease recurrence. CONCLUSION: Van Nes rotationplasty is a viable reconstructive option in young patients with sarcoma of the femur. We believe this to be the youngest reported case of rotationplasty in current literature.

Tuberculosis of the calcaneum masquerading as Haglund's deformity: a rare case and brief literature review.

An Asian man presented to the Foot and Ankle Clinic with a 5-month history of right ankle pain of gradual onset. He had a non-fluctuant swelling around the Achilles tendon insertion with a tender palpable lump. Radiograph demonstrated Haglund's deformity and also possible calcification at the attachment of the Achilles tendon for which he had an injection of a local anaesthetic and a steroid to treat the insertional Achilles tendinitis. A few months later, he developed acute anorexia, abdominal distension secondary to ascites and groin lymphadenopathy. Histology of the lymph node biopsy revealed granulomatous lymphadenitis consistent with tuberculosis (TB) and started on quadruple agent anti-TB treatment. The sample was not cultured. He developed constant ooze from his groin lymph node biopsy site and also fluctuance around the Achilles tendon and heel. Pus from the heel stained positive for auramine indicating TB calcaneum with subsequent culture for acid fast bacilli (AFB) confirming diagnosis of TB calcaneum.

Implant use for primary hip and knee arthroplasty: are we getting it right first time?

Implants used for hip and knee arthroplasties have recently come under increased scrutiny. In England, a large variety of prostheses are currently being used. With the need for savings within the NHS of up to £20 billion over the next five years, we should be 'getting it right first time' by using the most reliable implants with proven survivorship. The 8th Annual Report from the NJR (2011) reporting on prostheses used in 2010 was analysed to determine whether implants had published survivorship data. This study demonstrates that the majority of implants did have long-term results but a small percentage had no published data. The cost of these implants was calculated to see if the implants provided best value for money based on survivorship. Implant choice was also correlated to revision rates published in the NJR report (2011) to help determine whether their continued use was justified.

Displacement of a cemented femoral implant. A complication of manipulation of a dislocated total hip replacement.

Dislocation is a common complication of total hip replacement, which has been quoted in the literature as having an incidence of 1-4%. This is commonly treated with closed reduction. The authors present a case report of displacement of a cemented smooth-polished tapered femoral stem, which occurred while attempting closed reduction of a dislocated hybrid total hip replacement. The patient required full revision arthroplasty.