Syndesmosis screws: how many, what diameter, where and should they be removed? A literature review.

Although screw fixation remains the most commonly used method of syndesmosis fixation, the ideal screw size, placement, and number remain controversial. In addition, there has been debate as to whether the screw should always be removed, and a number of studies have looked at radiological and functional outcomes. In addition a number of cadaveric models have been developed, but the correlation between cadaveric findings and functional outcomes remains unclear. This systematic review of the literature aims to summarise the available evidence on how many screws should be placed, of what diameter, through how many cortices, at what level, and whether they should be removed.

Patella fracture in a boy with bilateral inferior pole bipartite patellae.

We present the case of a 12 year old boy who had bilateral inferior pole fragment (Saupe type 1) bipartite patellae, and who sustained a traumatic separation through the right patella while playing basket ball, the left remaining asymptomatic. We have reviewed and discussed the previously published literature and case reports.

How useful is templating for total knee replacement component sizing?

This study aims to assess the accuracy of digital templating at our institution, by comparing the templated component sizes with those implanted, and to determine whether templating the preoperative films had any measurable difference on the radiographic outcome, and if, where there was a mismatch between the implanted and templated sizes, the templated size would have been preferable. While a number of studies have evaluated the accuracy of both acetate and digital templating, none has to our knowledge looked back at post-operative radiographs and reviewed these in light of the templated and implanted sizes. Data was collected from 90 PFC Sigma (DePuy, UK) total knee replacements done sequentially, 45 of whom were templated digitally using a calibrating ball and Agfa Orthopaedic Tools software. Postoperative radiographs were graded independently for correct sizing. All templates were within one size of the implanted prosthesis. The femoral component appeared to be more often oversized on the postoperative radiographs in the non-templated group. In addition, most tibial trays that were found be too small had been templated to a larger size. There was a trend towards tibial trays templated too large to have been templated to a smaller size. We conclude that digital templating with a calibrating device is a useful part of preoperative planning for total knee arthroplasty.

Thoracolumbar spinal fixation for camptocormia in Parkinson's disease.

A man with early non-fluctuating Parkinson's disease developed disabling camptocormia. The patient was treated with posterior thoracolumbar fixation, which subsequently had to be augmented with anterior interbody fusion. Although the patient ultimately achieved excellent sagittal correction, his postoperative course was complicated and prolonged. Therefore, although this case demonstrates that spinal fixation surgery can be successful, it should probably only be offered after subthalamic nucleus deep brain stimulation has been unsuccessful, or for well motivated patients who express a strong wish for this major reconstructive surgery.

White-out from a Wii: traumatic haemothorax sustained playing Nintendo Wii.

A case is reported of a patient who sustained a significant haemothorax while playing with a Nintendo Wii console.

Does long-term chloramphenicol cause anaemia in Malawi?

Common clinical practice in many tropical paediatric departments is that chloramphenicol courses are limited to 2 weeks due to concerns about anaemia. However, this approach is not supported by current research and animal models. We used chloramphenicol for 6 weeks in 146 children with septic arthritis. All the children improved clinically. Most children were anaemic on presentation (mean haemoglobin [Hb] 8.43 SD 1.9), but the anaemia improved rapidly with clinical resolution of the infection and was maintained at 6 months after presentation (mean Hb 10.57 SD 1.86).

The incidence of septic arthritis in Malawian children.

The incidence of septic arthritis in Malawian children was estimated by assessing the incidence in the relatively enclosed district of Chikwawa. We found an incidence of approximately one in 5,000 in the under-five age group and one in 13,000 in the 5-15 age group.

Quantitative validation of media for transportation and storage of Streptococcus pneumoniae.

The need to design effective Streptococcus pneumoniae vaccines and to monitor resistance means that it is essential to have efficient methods to determine carriage rates. Two liquid media, consisting of skim milk, glycerol, glucose, and tryptone soya broth (STGG) or skim milk, glycerol, and glucose (SGG) alone, were evaluated for their ability to maintain pneumococcal viability. Optimal recovery of S. pneumoniae was achieved when swabs were transferred to STGG medium prior to plating onto blood agar-gentamicin selective plates (22%) compared to 7% when plated out directly (P < 0.0001 by Fisher's exact test). Both STGG and SGG media are appropriate for the long-term storage of pneumococci and primary swab samples at -70 degrees C, with no decrease in viable count observed following repeated freeze-thaw cycles. Samples could be stored refrigerated for up to 3 days in either STGG or SGG medium with no significant loss of viability. Viability decreased progressively in storage at 20 to 30 degrees C, with greater losses of viability occurring at the higher temperatures. There were no significant differences in viability between isolates in the two media. STGG preserved pneumococci significantly better (about twofold) than SGG medium at 21 degrees C (P < 0.0001) and 30 degrees C (P < 0.0001). Samples can be stored for 4 and 2.5 days at 6 to 8 degrees C, 28 and 17 h at 21 degrees C, and 15 and 7 h at 30 degrees C in STGG and SGG media, respectively. For field studies undertaken in resource-limited environments, SGG medium can be prepared by using locally available materials. The quantitative data reported in this study will enable researchers to plan appropriate transport and storage protocols.