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.

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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.