Pectoralis major tendon rupture is a relatively rare injury, resulting from violent, eccentric contraction of the muscle. Over 50% of these injuries occur in athletes, classically in weight-lifters during the 'bench press' manoeuvre. We present 13 cases of distal rupture of the pectoralis major muscle in athletes. All patients underwent open surgical repair. Magnetic resonance imaging was used to confirm the diagnosis in all patients. The results were analysed using (1) the visual analogue pain score, (2) functional shoulder evaluation and (3) isokinetic strength measurements. At the final follow-up of 23.6 months (14-34 months), the results were excellent in six patients, good in six and one had a poor result. Eleven patients were able to return to their pre-injury level of sports. The mean time for a return to sports was 8.5 months. The intraoperative findings correlated perfectly with the reported MRI scans in 11 patients and with minor differences in 2 patients. We wish to emphasise the importance of accurate clinical diagnosis, appropriate investigations, early surgical repair and an accelerated rehabilitation protocol for the distal rupture of the pectoralis major muscle as this allows complete functional recovery and restoration of full strength of the muscle, which is essential for the active athlete.

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A retrospective study of 85 patients undergoing primary total knee replacement (TKR), who also received autologous blood transfusion (ABT) to compensate for the perioperative blood loss. In our series 16.4% of the patients needed allogenic blood transfusion. Of the remaining 83.4% only 49.5% received autologous transfusion. Autologous transfusion was withheld in 34.1% of cases either because the blood volume was inadequate or because the collection time exceeded the recommended time limit. The mean haemoglobin (Hb) level with or without autologous transfusion was 10 g, raising the question of the necessity of using autologous transfusion in primary total TKR. Résumé Etude rétrospective de 85 patients ayant eu une prothèse totale de genou avec transfusion autologue. Chez 16,4% des patients, une transfusion homologue a été nécessaire. Parmi les 83,4% de patients restant, seulement 49,5% ont reçu une transfusion autologue. La transfusion autologue ne fut pas possible dans 34,1% des cas soit à cause du volume inadéquate soit à cause du dépassement de la date de péremption. Avec ou sans transfusion autologue le taux moyen d'hémoglobine était de 10 g, posant la question de l'intêret des transfusions autologues dans la chirurgie du remplacement primaire prothètique du genou.

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Introduction:We reviewed the number of nailbed injuries referred to a busy plastic surgery department to identify areas of improvement.Methods: A retrospective study of 142 patients referred over a 12 month period. All notes were reviewed to analyse patient demographics, details of injury, ensuing operation and follow-up.Results: The mean age of patient was 24 years (1 month to 87 years), commonest injured finger was the middle (36%) with commonest cause trapping the finger in a door (33%). 75% of both internal and external referrals were seen within 24 h. All patients underwent operative management and 71% were operated on within 48 h of injury. The majority of operations performed by specialist registrars, under local anaesthetic (LA) and the native nail replaced. 75% of patients were offered follow-up appointments with 15% not attending. The complication rate was 6.4% with abnormal nail growth accounting for more than half. There is no difference in the complication rate in paediatric patients compared to adults. Clinical fellows performing the nailbed repair had an 18% complication rate compared to specialist registrars 1%; consultants and senior house officers had no complications. Having the procedure performed under LA had a 10% complication rate in comparison of 3% under G.A.Conclusions: Nailbed injuries are seen and managed promptly in the department. Complication rates were low and are affected by choice of operator and anaesthetic. More training or supervision may need to be given to non-training post middle-grade surgeons. With the low complication rate, follow-up should be in nurse-led dressing clinics.