Acute compartment syndrome (ACS) is a surgical emergency warranting prompt evaluation and treatment. It can occur with any elevation in interstitial pressure in a closed osseo-fascial compartment. Resultant ischaemic damage may be irreversible within six hours and can result in long-term morbidity and even death. The diagnosis is largely clinical with the classical description of ‘pain out of proportion to the injury’. Compartment pressure monitors can be a helpful adjunct where the diagnosis is in doubt. Initial treatment is with the removal of any constricting dressings or casts, avoiding hypotension and optimizing tissue perfusion by keeping the limb at heart level. If symptoms persist, definitive treatment is necessary with timely surgical decompression of all the involved compartments. This article reviews the pathophysiology, diagnosis and current management of ACS.

Elastofibroma dorsi is an uncommon, benign, slow-growing soft-tissue tumour of uncertain aetiology. It classically presents as an ill-defined mass at the inferior pole of the scapula with symptoms which include swelling, discomfort, snapping, stiffness and occasionally pain. We report the symptoms, function and outcome after treatment of 21 elastofibromas in 15 patients. All were diagnosed by MRI and early in the series four also underwent CT-guided biopsy to confirm the diagnosis. In all, 18 tumours were excised and three were observed. After excision, the mean visual analogue score for pain decreased from 4.6 (0 to 10) pre-operatively to 2.4 (0 to 8) post-operatively (p = 0.04). The mean shoulder function, at a mean follow-up of 4.2 years (3 months to 16 years), was 78.1% (30 to 100) using the Stanmore percentage of normal shoulder assessment scoring system. The mean range of forward flexion improved from 135 degrees (70 degrees to 180 degrees ) to 166 degrees (100 degrees to 180 degrees ) after excision (p = 0.005). In four patients a post-operative haematoma formed; one required evacuation. Three patients developed a post-operative seroma requiring needle aspiration and one developed a superficial infection which was treated with antibiotics. Our findings support previous reports suggesting that a pre-operative tissue diagnosis is not necessary in most cases since the lesion can be confidently diagnosed by MRI, when interpreted in the light of appropriate clinical findings. Surgical excision in symptomatic patients, is helpful. It has been suggested that elastofibroma is caused by a local tissue reaction and is not a true neoplastic process. A strong association has been noted between elastofibroma and repetitive use of the shoulder, which is supported by our findings.

a b s t r a c tAims: We aim to review the results, complications and outcomes of a single surgeon's series of lower limb lengthening in patients with achondroplasia.Methods: Ten achondroplastic children underwent limb lengthening. The patients, medical records and radiographs were reviewed. Results:The average age at the time of the index operation was 7.8 years. A single surgeon undertook all procedures. The average total length gain was 20.5 cm. The commonest complication was a fractured femur after removal of the frame.Conclusion: Although complication rates were high (70%), none were left with any long-term sequelae and all were pleased with the results.

Chondral and osteochondral defects in the knee are common and may lead to degenerative joint disease if treated inappropriately. Conventional treatments such as microfracture often result in fibrocartilage formation and are associated with inferior results. Additionally, microfracture is generally unsuitable for the treatment of defects larger than 2–4 cm2. The osteochondral autograft transfer system (OATS) has been shown to produce superior clinical outcomes to microfracture but is technically difficult and may be associated with donor-site morbidity. Osteochondral allograft use is limited by graft availability and failure of cartilage incorporation is an issue. Autologous chondrocyte implantation (ACI) has been shown to result in repair with hyaline-like cartilage but involves a two-stage procedure and is relatively expensive. Rehabilitation after ACI takes 12 months, which is inconvenient and not feasible for athletic patients. Newer methods to regenerate cartilage include autologous stem cell transplantation, which may be performed as a single-stage procedure, can have a shorter rehabilitation period and is less expensive than ACI. Longer-term studies of these methods are needed. Cite this article: EFORT Open Rev 2020;5:156-163. DOI: 10.1302/2058-5241.5.190031

The bacteriological investigation of an outbreak of Legionnaires' disease in Glasgow Royal Infirmary affecting 16 patients is described. Most of the patients had been treated in high-dependency areas on two floors of the hospital supplied by the same two air-conditioned ventilation systems. The source of infection was traced to contamination of a cooling tower from which a plume of spray discharged into the intake vents of the two ventilation systems. Rubber grommets within the cooling tower probably provided a nidus of infection there. The control and management of the outbreak are discussed: a policy of frankness about the course and progress of the investigations was adopted and helped to allay anxiety on the part of both staff and media.