Background Patients with Achilles tendon rupture who have non-operative treatment have traditionally been treated with immobilisation of the tendon in plaster casts for several weeks. Functional bracing is an alternative non-operative treatment that allows earlier mobilisation, but evidence on its effectiveness and safety is scarce. The aim of the UKSTAR trial was to compare functional and quality-of-life outcomes and resource use in patients treated nonoperatively with plaster cast versus functional brace. Methods UKSTAR was a pragmatic, superiority, multicentre, randomised controlled trial done at 39 hospitals in the UK. Patients (aged ≥16 years) who were being treated non-operatively for a primary Achilles tendon rupture at the participating centres were potentially eligible. The exclusion criteria were presenting more than 14 days after injury, previous rupture of the same Achilles tendon, or being unable to complete the questionnaires. Eligible participants were randomly assigned (1:1) to receive a plaster cast or functional brace using a centralised web-based system. Because the interventions were clearly visible, neither patients nor clinicians could be masked. Participants wore the intervention for 8 weeks. The primary outcome was patient-reported Achilles tendon rupture score (ATRS) at 9 months, analysed in the modified intention-to-treat population (all patients in the groups to which they were allocated, excluding participants who withdrew or died before providing any outcome data). The main safety outcome was the incidence of tendon re-rupture. Resource use was recorded from a health and personal social care perspective. The trial is registered with ISRCTN, ISRCTN62639639.

Technical skills have been shown to transfer very well from bench models to practical use. The central two rays of 30 forelimbs of pigs were dissected and anatomical observations were made. The rays contained deep and superficial flexor tendons enclosed in a fibro-osseous tunnel and these were present in all 60 specimens. The fibrous part of the tunnel had specific constant condensations in annular and oblique directions which were present in all 60 rays. The anatomy of the porcine forelimb digital flexor tendon system is sufficiently similar to the human system to be used as a model for surgeons wishing to master the technical aspects of zone II flexor tendon repair. This paper proposes the porcine forelimb as a bench model for zone II flexor tendon repair.

We present, along with a literature review, the case report of a 6-year-old boy, involved in a high-speed motor vehicle accident, who sustained a seat belt injury of the lumbar spine. We discuss the clinical presentation of thoracolumbar fractures in children, the sensitivity of clinical examination and radiographic evaluation and the associated abdominal injuries that are commonly present with seat belt spinal injuries. Computerized tomography is limited in the detection of soft tissue spinal fractures because these fractures occur in the plain of the section. Plain lateral x-rays of the lumbar spine and computerized tomographic three-dimensional reconstruction images can be helpful but they cannot evaluate the extent of the soft tissue injury. The magnetic resonance imaging scan is the best diagnostic tool to provide the diagnosis.