aplastic anaemia is characterised by anaemia, leucopenia, and thrombocytopenia. The defect is cellular with an increased tendency to infection and bleeding.4 Although prejudicial to the success of skin grafting, it is not a contraindication provided deficiencies are corrected perioperatively, haemostasis is achieved before grafting, and the formation of haematoma is avoided afterwards.Each of these children had a chronic cutaneous manifestation ofa haematological or immunodeficiency disease. Healing was assumed to be abnormal because of a defect in either humoral or cellular defence mechanisms. This assumption delayed referral for surgery by some months in each case, but debridement followed by split skin grafting produced rapid healing.We thank Professor J M Chessels and Dr D A Atherton for their permission to report on patients under their care. Case 2-A 16 year old army recruit was admitted on the same date with a four day history of malaise, vomiting, sore throat, blistering around the mouth, dry cough, and pleuritic pain on the left side. He had also developed central abdominal pain. On examination he had a fever, with a temperature of 39 2°C. Respiratory examination disclosed signs of left basal consolidation, which was confirmed by chest radiography, and abdominal examination showed epigastric and umbilical tenderness and tenderness in the right iliac fossa, with rebound tenderness. He was treated with penicillin and erythromycin, and his temperature settled within 24 hours. The tenderness in his right iliac fossa persisted for three days; the presumptive diagnosis was mesenteric adenitis. He was discharged after one week.

In these early results, the anticipated functional gains of RSA over hemiarthroplasty were not realized, suggesting the use of RSA for treatment of proximal humeral fractures should remain guarded. Larger prospective trials are necessary to identify the optimal management of patients in this situation.

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Partial rupture of the distal biceps tendon exhibits features similar to that of complete disruption, including acute antecubital pain, weakness of elbow flexion, and forearm supination, and differs only in the fact that the biceps tendon is still palpable in the partial rupture. There are 2 etiologies, first acute traumatic (such as a sudden eccentric contracture) and second, chronic degenerative tendon disease. For accurate diagnosis, a high index of suspicion must be employed. Initial investigations should include plain x-ray and a magnetic resonance scan. Partial tears <50% may be treated with nonoperative management or with surgical debridement of the surrounding synovitis. Tears >50% should be treated with division of the remaining tendon and surgical repair of the entire tendon as a single unit. Surgical endoscopy provides the ability to further quantify the extent of a distal biceps tear and to treat with debridement. This technique, however, should only be used in experienced hands.

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Scaphoid fractures are the most common fractures of the carpus, accounting for 79% of all carpal fractures. Early diagnosis of scaphoid fractures is imperative owing to potential complications following the fracture, including non-union, avascular necrosis, carpal instability and osteoarthritis. Plain radiography remains the initial imaging modality to assess scaphoid fractures. Magnetic resonance imaging (MRI) is excellent in the detection of clinically suspected, but initially radiographically negative, scaphoid fractures. Cost-effectiveness analysis studies have demonstrated MRI is effective in this setting. Gadolinium enhanced MRI has been shown to be superior to unenhanced MRI in the detection of avascular necrosis. Computerized tomography scan is the preferred modality to assess the intricacies of scaphoid fracture, including fracture location and deformity, as well as union status. This review paper explores the recent advances in imaging of the scaphoid, with reference also to avascular necrosis and non-union following a scaphoid fracture.

Intraosseous ganglia (IOGs) of the lunate are a relatively rare, but by no means insignificant, condition because treatment by traditional open curettage and bone grafting can lead to ongoing pain and stiffness of the wrist.An arthroscopically assisted minimally invasive technique of debridement and grafting of the lunate IOG is discussed, as well as the history of the condition, indications and contraindications, surgical technique with postoperative rehabilitation, and potential complications.The outcomes of 8 patients with persistent symptoms and typical radiographic and bone scan findings were assessed independently preoperatively and postoperatively by using a modified Green and O'Brien wrist score. The intraosseous cyst was drilled under arthroscopic and fluoroscopic guidance via either a volar or dorsal portal, depending on the position identified on the computed tomography scan. Average follow-up time was 3.8 years (range, 1-5.6 yrs). All patients returned to employment within 4 months. Wrist scores improved 34 points, from 51 to 85 points, by 1 year after surgery, with trabeculation being noted within the grafting lunate. The greatest improvements were seen in visual and analog pain scores, reducing from 68.3 to 11.2, and flexion-extension arcs, which increased from 98 to 114 degrees.The technique of arthroscopically assisted debridement of IOGs of the lunate is safe, with minimal morbidity and recurrence of symptoms during the follow-up period.