An acute knee injury: tracking a two-year recovery online.

Current government policy aims to deliver high quality healthcare by recording accurate data at the point of giving care, storing it efficiently and displaying it in a format, which is easily interpreted by healthcare professionals and patients. Few published reports describe the benefits of collecting and reporting such data from the point of view of the patient. We report the case of a 62-year-old lorry driver who used a web-based system to track patient reported outcome measures (PROMs) following an acute knee injury to full recovery over a 24-month period. The system reports clinical outcome scores in real-time to the patient and their medical team, clearly illustrating and enhancing recovery from injury. This case reveals how local software meets the needs of the individual patient linking and integrating such local systems must be the future focus of eHealth within the NHS to release the benefits presented by the information revolution.

Pyrocarbon interposition arthroplasty for proximal capitate avascular necrosis.

INTRODUCTION: Avascular necrosis of the capitate head is a rare condition commonly treated with partial wrist fusion. Although good functional results are usually reported, a degree of stiffness is to be expected. We report a pyrocarbon interposition arthroplasty technique in a young sportsman with 3.5 years of follow-up. METHODS: A 15-year-old rugby player presented with a 6-month history of wrist pain and stiffness with no preceding injury. The necrotic bone was replaced with interposition of a pyrocarbon interposition implant (PI(2)) (Tournier, Grenoble, France), originally designed to replace the trapezium. A concave socket was created in the distal fragment to accommodate the implant and prevent dislocation. Regular follow-up included subjective and objective measures. RESULTS: He was pain free by 6 weeks and regained good functional range of motion and grip strength by 3 months. He returned to playing rugby at the 1-year follow-up. At 2 years, he remained asymptomatic. After 3.5 years, he had no limitations in his heavy manual work as a plant mechanic and retained a good functional range of motion including the dart-thrower's motion. CONCLUSIONS: Medium-term results appear to offer the benefits of being able to return to heavy manual labour as well as retaining a functional range of motion. It is difficult to predict long-term survival, but the outcome so far is encouraging, and conversion to midcarpal fusion remains a salvage option.

Problems associated with the excision of the hallux sesamoids.

Disorders of the hallux sesamoids can be a source of considerable pain and disability. Inappropriate or inept removal can lead to further disability and pain. Surgical intervention should only follow careful accurate assessment, appropriate investigation, and failure of conservative treatments.