Background: Assessment of radiology is an integral part of fracture management in orthopaedic surgery. Mobile multimedia messaging (MMS) can be utilised in the referral process of patients with fractures. However, the reliability of using MMS in making management decisions in distal radius fractures has not been assessed. Methods: Radiographs of 20 consecutive cases of distal radius fractures managed with closed reduction and plaster, and 20 cases managed with open reduction and internal fixation (ORIF) were analysed retrospectively by two blinded orthopaedic surgeons on a computer and anApple iPhone 3GS. The interand intra-rater agreements were assessed. Results:Inter-rater agreement between the MMS group and the picture archiving and communication system (PACS) group were consistent among the surgeons (K -0.55, 0.80, p<0.001). However, the management decisions were different in seven cases (8.75%) in the study group. Conclusion: MMS x-ray pictures can be useful in formulating management plans for patients with distal radius fractures. With advancing technology smartphones will likely play a larger role in the communication process in delivering orthopaedic care.

Isolated instability of the index and middle finger carpometacarpal joints is uncommon. An unpublished injury pattern in a consecutive series of 13 elite boxers is described, with mid-term radiological and functional results of two novel surgical treatments. All the boxers (from Australia and the UK) were unable to compete owing to pain and weakness. Four boxers were managed initially by open reduction and temporary K-wire fixation. Nine boxers underwent primary carpometacarpal arthrodesis. All were able to return to their previous level of competition. One boxer who had undergone a soft tissue reconstruction competed at international level but required an arthrodesis because of recurrent symptoms. In elite boxers, simple reduction and wiring may be appropriate for an acute injury causing index or middle finger carpometacarpal joint instability, however, arthrodesis is the treatment of choice when instability and degenerative changes are present.

This study sought to determine the medium-term patient-reported and radiographic outcomes in patients undergoing surgery for hallux valgus. A total of 118 patients (162 feet) underwent surgery for hallux valgus between January 2008 and June 2009. The Manchester-Oxford Foot Questionnaire (MOXFQ), a validated tool for the assessment of outcome after surgery for hallux valgus, was used and patient satisfaction was sought. The medical records and radiographs were reviewed retrospectively. At a mean of 5.2 years (4.7 to 6.0) post-operatively, the median combined MOXFQ score was 7.8 (IQR:0 to 32.8). The median domain scores for pain, walking/standing, and social interaction were 10 (IQR: 0 to 45), 0 (IQR: 0 to 32.1) and 6.3 (IQR: 0 to 25) respectively. A total of 119 procedures (73.9%, in 90 patients) were reported as satisfactory but only 53 feet (32.7%, in 43 patients) were completely asymptomatic. The mean (SD) correction of hallux valgus, intermetatarsal, and distal metatarsal articular angles was 18.5° (8.8°), 5.7° (3.3°), and 16.6° (8.8°), respectively. Multivariable regression analysis identified that an American Association of Anesthesiologists grade of >1 (Incident Rate Ratio (IRR) = 1.67, p-value = 0.011) and recurrent deformity (IRR = 1.77, p-value = 0.003) were associated with significantly worse MOXFQ scores. No correlation was found between the severity of deformity, the type, or degree of surgical correction and the outcome. When using a validated outcome score for the assessment of outcome after surgery for hallux valgus, the long-term results are worse than expected when compared with the short- and mid-term outcomes, with 25.9% of patients dissatisfied at a mean follow-up of 5.2 years.

Background: New developments in mobile technology have had a profound effect on medical care worldwide.1 In orthopaedic surgery a variety of implants and devices are used, and knowledge about their designs, specific features and surgical techniques is essential. The purpose of this study was to assess whether orthopaedic surgical technique guides are readily available in an electronic format Methods: A list of thirty-two orthopaedic device companies currently trading in Australia was generated through a structured internet search and by reviewing a tertiary hospital database. The Apple store was searched for iPhone or iPad surgical technique applications for each company. Company websites were searched for downloadable surgical technique guides. Companies without downloadable surgical technique guides or iPhone applications were contacted via email or telephone to ask whether such products were in development.Results: Of the thirty-two orthopaedic device companies studied, twenty-two (68.8%) had surgical technique guides available for download on their websites. Four (12.5%) companies had an iPhone or iPad application available in the Apple store. Conclusion:Although many orthopaedic device companies have downloadable surgical technique guides on their websites, only a few had iPhone or iPad applications for their products. Further development of such products may be beneficial for orthopaedic surgeons.