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We aimed to determine the reliability, accuracy and the clinical role of digital templating in the pre-operative work-up for total knee replacement. Initially a sample of ten pre-operative digital radiographs were templated by four independent observers to determine the inter- and intra-observer reliability of the process. Digital templating was then performed on the radiographs of 40 consecutive patients undergoing total knee replacement by a consultant surgeon not involved with the operation, who was blinded to the size of the implant inserted. The Press Fit Condylar Sigma Knee system was used in all the patients. The size of the implant as judged by templating was then compared to that of the size used. Good inter- and intra-observer agreement was demonstrated for both femoral and tibial templating. However, the correct size of the implant was predicted in only 48% of the femoral and 55% of the tibial components. Albeit reproducible, digital templating does not currently predict the correct size of component often enough to be of clinical benefit.

Dislocations of the carpometacarpal joints of the ring and little fingers are common and are frequently missed at presentation. We describe a radiographic observation which assists in the confirmation of the diagnosis.

The relative anatomy of the internal jugular vein (IJV) was studied in 25 patients undergoing cardiac catheterization under general anaesthesia, with the use of a portable ultrasound probe. In 14 of cases the IJV was anterior, 1 anterolateral and in 10 lateral to the carotid artery between the two heads of the sternocleidomastoid muscle. At the level of the cricoid cartilage, in six cases the IJV was anterior, three anterolateral and in 16 of children the IJV was lateral to the carotid artery. When attempting to cannulate the IJV, because of the variability in relationship of the IJV to CA the technique used should be modified depending upon the level at which cannulation is attempted. The position of the IJV in the child appears to be so variable extra care should be taken when cannulating the IJV and it should not be assumed that the techniques used in adults are directly transferable.

Patients with delayed surgery for ankle fracture had a longer postoperative length of hospital stay. Surgery should be performed within 24 hours of injury to minimise the length of hospital stay.

Level of Evidence: V, Expert Opinion

ObjectivesWe reproduced a frequently cited study that was published in the British Medical Journal (BMJ) in 1981 assessing the extent of ‘snow-and-ice’ fractures during the winter period.SettingThis study aims to provide an insight into how things have changed within the same emergency department (ED) by comparing the findings of the BMJ paper published 33 years ago with the present date.ParticipantsAs per the original study, all patients presenting to the ED with a radiological evidence of fracture during three different 4-day periods were included. The three 4-day periods included 4 days of snow-and-ice conditions and two control 4-day periods when snow and ice was not present; the first was 4 days within the same year, with a similar amount of sunshine hours, and the second was 4 days 1 calendar year later.Primary and secondary outcome measuresTo identify the frequency, distribution and pattern of fractures sustained in snow-and-ice conditions compared to control conditions as well as comparisons with the index study 33 years ago.ResultsA total of 293 patients with fractures were identified. Overall, there was a 2.20 (CI 1.7 to 3.0, p <0.01) increase in risk of fracture during snow-and-ice periods compared to control conditions. There was an increase (p <0.01) of fractures of the arm, forearm and wrist (RR 3.2 (CI 1.4 to 7.6) and 2.9 (CI 1.5 to 5.4) respectively).ConclusionsWhile the relative risk was not of the magnitude 33 years ago, the overall number of patients presenting with a fracture during snow-and-ice conditions remains more than double compared to control conditions. This highlights the need for improved understanding of the impact of increased fracture burden on hospitals and more effective preventative measures.

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