Our data suggest that the prevalence of vitamin D insufficiency and deficiency is common in patients presenting with fractures in southeastern Australia and is not confined to elderly patients. All patients with fractures should be assessed for vitamin D levels and treated in accordance with vitamin D deficiency guidelines.

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Background and Objectives: To validate the European Organization for Research and Treatment of Cancer (EORTC) model using an Australian cohort and to identify variables within our cohort that may predict non-muscle invasive bladder cancer (NMIBC) recurrence and progression. Methods: A retrospective chart review of patients undergoing transurethral resection of bladder tumour (TURBT) at a single academic institution between 1995 and 2015 was performed (n = 366). Only patients with available TURBT pathology having initial Ta or T1 disease were included (n = 255).EORTC risk groups were calculated for individual patients and compared to actual recurrence rates using a binomial method comparing observed and expected proportions. Results: In our cohort of 255 patients, there were 209 men and 46 women, with a median age of 69 years (range 18-93). Intravesical therapy was given to 59% (n = 152). In total, 142 patients (56%) experienced cancer recurrence, with median recurrence and progression free survival at 11 months and 25.5 months respectively.Comparison of EORTC estimates to actual recurrence proportions at 1, 3 and 5 years showed the EORTC calculator underestimated the actual recurrence that occurred. However, only EORTC group "score 1-4" estimate was statistically significant compared to the actual recurrence (at 1 year, predicted 24% vs actual 33%, p < 0.001). Conclusion:In validating the EORTC risk calculator in our Australian cohort, we found the calculator underestimated NMIBC recurrence for most of our patients. Longer follow-up time and a larger sample size may assist with validation but true differences in population and treatment may exist. Our results suggest for now, care should be exercised when applying these risk tables to an Australian population.

Purpose Inferior glenoid labral tears are an uncommon but distinct shoulder injury. Only a small number of studies have reported outcomes following arthroscopic repair. The aim of the current study was to report minimum 2-year outcomes following inferior labral repair and to compare outcomes and risk factors associated with the injury to non-inferior labral tears. Whether preoperative MRI or MRA identified inferior labral tears was also assessed. Methods A prospective study of 162 consecutive patients undergoing arthroscopic glenoid labral repair, excluding isolated superior labral tears, was conducted. Of the 130 patients available for follow-up, 18 (13.7%) had an inferior labral tear ("Down Under lesion"), the remainder had anterior, posterior or mixed anterior/posterior lesions that did not include the inferior pole. Mean follow-up time for the Down Under group was 44 months (SD 10, range 27-57), and 30 months (SD 14, range 4-60) for the non-Down Under group. Postoperative outcomes included the Oxford Shoulder Instability Score and recurrent instability. Associations between Down Under lesions and injury mechanism, instability at presentation, recurrent instability and family history were assessed with multivariable logistic regression. Preoperative MRI or MRA reports by radiologists were examined to determine if Down Under lesions were identified. Results Oxford Shoulder Instability Scores indicated that most patients in both groups had little pain or shoulder problems postoperatively (average Oxford Score 41; 48 = no symptoms). Oxford Scores were not significantly different between the Down Under and non-Down Under groups. Four patients (22.2%) in the Down Under group had recurring symptoms (pain and instability) compared to 12 (10.6%) in the non-Down Under group; this difference was not statistically significant (adjusted OR 1.09, 95% CI 0.19,4.77). Family history of shoulder instability was positively associated with a Down Under lesion (adjusted OR 5.0, 95%CI 1.51,16.7). MRI or MRA identified 52.9% of Down Under lesions. Conclusion Down Under lesions were an infrequent type of glenoid labral injury, yet postoperative outcomes were similar to other labral tears. Patients with Down Under lesions had a significant risk factor due to family history of shoulder instability. MRI and MRA could not reliably identify Down Under lesions. Level of evidence Level III.

At our institution, approximately 700 people receive extracorporeal shockwave lithotripsy (ESWL) annually.Considered a relatively safe procedure, complications do occur. Some of the reported complications include those relating to the passage of stone fragments, infection and the potential for damage to neighbouring structures, specifically cardiovascular, gastrointestinal structures and the unborn foetus. 1,2 A 53-year-old male underwent ESWL for a 17-mm right mid-zone renal calculus. He was an otherwise well gentleman with no past history of renal calculi. His co-morbidities were significant only for a history of chronic back pain. He had no prior history of renal calculi. His regular medications at the time of treatment were oxycontin, pregabalin and diazepam. He was not taking any oral anticoagulant medication.The patient in question had presented to the emergency department 3 weeks prior to his ESWL treatment with severe right-sided abdominal pain and two computer tomography (CT) proven renal tract calculi -an 8-mm ureteric calculus causing moderate rightsided hydronephrosis and a 17-mm renal calculus in the inferior calyx treated with cystoscopy and stent insertion.Three weeks later, the patient re-presented for his scheduled ESWL treatment. He underwent a routine procedure receiving 3000 shocks at 80% power. Post-procedure, the patient was noted to be in considerable pain. A CT abdomen/pelvis was completed that evening demonstrating a right-sided perinephric haematoma with active contrast extravasation and pseudoaneurysm (Fig. 1). The patient then underwent digital subtraction angiography embolization later that evening revealing four segmental bleeding vessels.Following the embolization, the patient continued to have significant back pain. The pain was such that repeat CT abdominal angiogram was performed demonstrating ongoing active bleeding at the lateral interpolar region of the right kidney. Further digital subtraction angiography was completed with embolization of multiple branches of the right renal artery (Fig. 2). There had been a considerable decrease in the patient's haemoglobin, which dropped as low as 62 g/L over this time and was transfused.After the second embolization procedure, it was felt that the patient's condition had stabilized and he was discharged from intensive care unit to the urology ward. Over the subsequent 24-h period, the patient became increasingly haemodynamically unstable, requiring a further four units of packed red blood cells. At this point, given that multiple attempts at embolization had failed to successfully stem the ongoing haemorrhage, the decision was made to perform an Fig. 1. CT KUB performed post-ESWL procedure demonstrating a large right subscapsular haematoma.Fig. 2. Demonstrates multiple attempts at coil embolization of the bleeding renal vessels.