Septic arthritis is a potential catastrophic complication of intra-articular steroid injection. There is lack of evidence regarding the precautions that should be taken to avoid such a complication, as well as how often it is encountered. The aim of this study was to evaluate the antiseptic precautions taken during intra-articular steroid injection of the knee in the United Kingdom (UK), and estimate how often septic arthritis is encountered by health professionals in the UK following steroid injection of the knee. A questionnaire was posted to 100 orthopaedic surgeons, 100 rheumatologists and 50 general practitioners (GPs), asking them about the cases of septic arthritis following intra-articular steroid injection of the knee that they encountered during their practice and the precautions they take when injecting knees. The response rate was 76.4%; 57.6% of the respondents used alcohol swabs to clean the skin, and the remaining 42.4% used chlorhexidine or Betadine. Only 16.3% used sterile towels to isolate the injection site. There were 32.5% of respondents who routinely used sterile gloves when injecting, and a total of 46.6% used either sterile or non-sterile gloves. Also, 91.1% changed needles between drawing the steroid and injecting it into the joint. Only 24 respondents (12.6%) had encountered septic arthritis after steroid injection of the knee (18 once, 3 twice, 2 three times, 1 several times). We concluded that septic arthritis post intra-articular steroid injection of the knee is probably rare. There is a wide variation in the precautions taken to avoid such a complication. However, the trend seems to be towards minimal use of antiseptic techniques. Further large prospective studies are needed to determine how frequently septic arthritis of the knee is encountered post steroid injection, and the exact precautions that should be taken to avoid it.

Posterolateral rotatory instability is the most common type of symptomatic chronic instability of the elbow. In this condition the forearm complex rotates externally in relation to the humerus, causing posterior subluxation or dislocation of the radial head. The lateral ligament complex, radial head and coronoid process are important constraints to posterolateral rotatory instability, and their disruption is involved in the pathogenesis of this condition. The diagnosis relies on a high index of clinical suspicion, active and passive apprehension tests, and examination under anaesthesia. Surgical treatment has given consistently successful results. Open reconstruction of the lateral ligaments with a tendon graft has been the procedure of choice, with arthroscopic techniques emerging as a potential alternative.

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There is no universally accepted method of classification of tibial plateau fractures, with more than six classification schemes having been described. Of these, the Schatzker and AO/OTA classifications are the most commonly used methods for classifying such fractures. 1,2 There is little information regarding inter-and intra-observer variation when classifying tibial plateau fractures using the Schatzker and AO/OTA classification systems and hence this study was performed. Patients and MethodsThe Schatzker classification divides tibial plateau fractures into six types (Fig. 1). The AO/OTA classification divides proximal tibial fractures into types A, B and C. Each of the three types is divided into three groups described as 1-3, each of which having three further sub-groups. In this study, the broad AO/OTA classification consisting of the tibial plateau types and groups was used (Fig. 2). In the AO/OTA classification, each group ( e.g. B1, B2) is further subdivided into sub-groups(.1 to .3) but this division was not used for purposes of simplicity.Fifty tibial plateau fractures presenting to our hospital over a 4-year period were used. All patients had anteriorposterior (AP) and lateral radiographs, as per hospital protocol. To ensure good quality radiographs, the hospital protocol requires the clinician assessing each patient to repeat any poor-quality radiograph. To determine intra-and interobserver variation, each of six observers (two research fellows, two senior training orthopaedic surgeons [SpRs] and two lower limb orthopaedic and trauma consultants) independently assessed the AP and lateral radiographs of these 50 tibial plateau fractures and classified them according to the Schatzker and AO/OTA classifications. All participants in the study were familiar with both the Schatzker and AO/OTA classification systems. They were not given any clinical details regarding presentation or management of the The aim of this study was to evaluate the intra-and inter-observer variation of the Schatzker and AO/OTA classifications in assessing tibial plateau fractures, using plain radiographs.