Background: Local recurrence after conservative surgery for breast cancer usually results from growth of residual cancer adjacent to the excised primary tumour or from multicentric disease. Complete local excision (CLE) confirmed histologically is essential to ensure that the risk of local recurrence is minimal. This study was undertaken to determine that clinical or radiological factors may assist the surgeon at the time of surgery to achieve this aim. Methods: A retrospective review of 101 cases treated by conservative surgery identified 70 cases of CLE and 31 of incomplete local excision (ILE). Clinical, surgical and histopathological data were taken from hospital records. Mammographic features and those of specimen X-rays were evaluated without knowledge of the histopathological outcome of surgery. Results: Complete excision was significantly associated with type of operation (lumpectomy vs wide local excisiodquadrantectomy, P < 0.003), absence of calcification (P < 0.03) and the presence of a mass on mammography (P = 0.05). Tumour size (> 2.5 cm) and the presence of extensive ductal carcinoma in situ (DCIS) were associated with incomplete excision (P = 0.0005). No relationship was demonstrated with patient age, breast size, breast density, tumour grade, receptor status, axillary nodal status or spicules on X-ray and completeness of excision. Specimen X-ray had a positive predictive value of 94% with CLE. Conclusions: Clinical and pre-operative marnmographic parameters are important for predicting CLE for breast cancers treated by breastconserving surgery. Specimen radiology for palpable lesions can confirm excision of the cancer and permit re-excision of breast tissue at the time of initial surgery. Its role in determining CLE should be further evaluated.

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Lisfranc injury is increasingly being recognised in the high-performance athletic cohort, particularly in contact sports. In this cohort, there is a pattern of low-energy Lisfranc injury which combines magnetic resonance findings of both ligamentous sprain and adaptive bone stress response that infers a longer timeframe of stress than the duration of symptoms would suggest. This has not been previously described, and the authors believe that this is an unrecognized subset of midfoot sprain in the context of sustained stress to the midfoot. This retrospective case report describes MRI findings of three index cases of this entity in professional athletes presenting with acute foot pain. Two responded with conservative management whilst the third ultimately required surgery. All athletes were eventually able to return to play.

Distal tibiofibular joint (DTFJ) arthrodesis has been proposed as a motion-preserving salvage option in cases of chronic syndesmotic disruption and degeneration. It is an uncommonly performed procedure with few cases reported in the literature. The aim of this study was to conduct a review of the literature in order to examine the appropriate indications, operative techniques, and outcomes. The authors' also present a case for inclusion. Twenty cases of DTFJ arthrodesis were identified for inclusion. Nine operations were performed in males and 11 in females. The average patient age was 41.1 years. The indication for all arthrodeses was chronic pain instability. Symptoms were a result of disruption of the DTFJ secondary to: (a) previous fracture malunion (n = 12), (b) soft tissue injury (n = 6), or (c) osteochondroma (n = 2). DTFJ arthrodesis has been successfully utilized in cases of syndesmosis disruption secondary to osteochondroma, fracture and soft tissue injury in low-demand and high-demand adult patients of any age and activity level. Arthrodesis can be performed through an anterior or lateral ankle approach. Fixation with 2×3.5 mm screws across the DTFJ impacted with autologous bone graft provides sufficient fixation. Patient should nonweight bear on an immobilized ankle for a minimum of 6 weeks, or until bony union is evident on imaging. Level of Evidence: Diagnostic Level IV.