Final accepted manuscriptWhilst single-radius designs of total knee replacement (TKR) have theoretical benefits, the clinical advantage conferred by such designs is unknown. The aim of this randomised, controlled study was to compare the short-term clinical outcomes of the two design rationales. 105 knees were randomised to receive either single radius (Scorpio, Strkyer, Newbury, UK; SR group) or multiple radius (AGC, Biomet, Bridgend, UK; MR group) TKR.Patient reported outcomes (Oxford Knee Score, OKS and Knee Society Score, KSS) were collected at six weeks, six months, and one year following surgery.No knees were revised. There was no difference in primary outcomes: OKS was 39.5 (95%CI 36.9-42.1) in the SR group and 38.1 (95%CI 36.0-40.3) in the MR group (p=0.40). KSS was 168.4,, in the SR group; 159.5, (95%CI 150.5-168.5) in the MR group (p=0.16). There was a small but statistically significant difference in the degree of change of the objective subscale of the KSS, favouring the SR design (p=0.04), but this is of uncertain clinical relevance. The reported benefits of single-radius designs do not provide demonstrable functional advantages in the short-term.

To evaluate the outcome of a fibular nail in the treatment of open and closed unstable ankle fractures in a nondesigner centre. Methods: In a retrospective cohort study, a total of 39 ankle fractures (14 open and 25 closed) treated with a locking fibular nail were evaluated between 2012 and 2015 in a non-designer level I major trauma centre. Postoperative radiographs were analysed to assess the quality of reduction (McLennan and Ungersma marking system), fracture union and complications. Three patient reported outcome scores (Olerud and Molander score (OMAS), American Association of Orthopaedic Surgeons (AAOS) foot and ankle score and 12-Item Short Form Survey (SF-12)) were collected to obtain an overall measure of the patient's physical and mental outcome. Results: The adequacy of reduction data was available for 38 of 39 cases; 33 (87%) achieved good, 3 (8%) fair and 2 (5%) poor ratings, based on the McLennan and Ungersma marking system. Thirty-five (12 open and 23 closed) patients were available for initial follow-up. Five (14.3%) of 35 had documented complications (2 of 12 in the open cohort and 3 of 23 in the closed cohort). All fibular fractures treated with the fibular nail went on to unite. Twenty-three (66%) of 35 patients were available at 1-year followup for measurement of objective outcome. The combined mean OMAS for both groups was 53.7 (0-85) with statistically better results (59.5 (25-85) vs. 37.3 (0-75)) in favour of the closed versus open injuries, respectively. The mean AAOS score was also statistically better for the closed group than the open, 70.3 (30-95) versus 46.6 (20-77), respectively. The mean SF-12 score (physical component) was 40 (21.6-52.4) in the closed group versus 36.1 (19.4-51.5) in the open group; the mean mental component was 42.5 (26.6-54.3) in the closed group versus 38.8 (28.4-60.5) in the open group, these however were not statistically different. Conclusion: Fibular nails are an effective alternative for the treatment for both closed and open unstable ankle fractures with soft tissue compromise.

No abstract

We present the case of a 31-year-old man who sustained a hyperplantar flexion injury of his right ankle, and was evaluated using computed tomography and MRI to assess for osseous and ligamentous injury. The MRI and CT studies demonstrated a tibioastragalus anticus of Gruber (TAAG) muscle in the lower limb's anterior compartment. To our knowledge, the imaging of this muscle has not been previously described. The TAAG muscle arises from the lower third of the anterolateral tibia and the interosseous membrane. Its tendon passes laterally, deep to the tibialis anterior and extensor hallucis longus tendons, and inserts onto the anterior superolateral neck of the talus in a fan-like manner. Knowledge and recognition of this tendon are important for both diagnostic accuracy and surgical planning, and could potentially be used as a tendon transfer or graft in the appropriate clinical setting. The presence of this accessory muscle should not be confused with a pathological condition.

Ann R Coll Surg Engl 2013; 95: 228-229We read with interest the review on plantar fasciitis (PF) by Cutts et al. While this was an excellent account of the pathology and management of the condition, it was disappointing that management using a gastrocnemius release was totally excluded, especially as the authors had recognised reduced ankle dorsiflexion and tightness of the Achilles tendon as risk factors for PF. In fact, a number of modern series reported in the literature have used this technique in preference to local surgery on the plantar fascia.Riddle et al found that individuals with ≤0º of dorsiflexion are 23 times more likely to get PF compared with the group of individuals who had >10º of ankle dorsiflexion. 1 Cheung et al showed a relationship between the PF and equinus. 2 Achilles tendon loading has twice the amount of straining effect on the plantar fascia than body weight. They conclud-ed that lengthening of the Achilles tendon may benefit PF. Patel and DiGiovanni found that 83% of 254 patients with PF had limited dorsiflexion and 57% of 254 had an isolated gastrocnemius contracture. 3 Maskill et al performed gastrocnemius recession on 25 patients with PF who had failed 6 months of conservative therapy. 4 The average visual analogue scale score improved from 8.1 to 1.9 at 19.5 months.We reported on proximal gastrocnemius lengthening on 21 heels with chronic PF. 5 At follow-up, 81% had reported total or significant pain relief following the surgery. Local surgery on the plantar fascia has a poorer outcome and longer recovery with problems associated with lateral column dysfunction and arch collapse. We believe that a gastrocnemius release is a simple way of treating a patient with PF who has failed to respond to conservative management and that it should be considered before plantar fascia release when surgical intervention is contemplated. References 1. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for plantar fasciitis: a matched case-control study.

No abstract

few vascular technologists who were concerned about the performance of this examination and more than a few patients who complained about it.We certainly would not deny the validity of the physiologic observations Dr Gee had made, particularly regarding the medical student exhausted after his or her study of (we hope) arterial anatomy. In light of his observations, it may indeed be beneficial to distribute OPGs to our medical students for ocular relaxation. I know we have at least two in our laboratory that we are not using, and I would be glad to contribute to such an excellent cause.The ocular flow velocity data were recorded from contralateral eyes of all patients but were not analyzed in this report. There was a wide variety of contralateral carotid disease that would have made interpretation of these data difficult and certainly not possible to be stratified on the basis of sex and the small number of patients. Nevertheless, in the evaluation of normative values in our laboratory, we have noted no identifiable differences in ophthalmic artery or central retinal artery flow velocities between the sexes.