Achilles tendon rupture has been on the rise over recent years due to a variety of reasons. It is a debilitating injury with a protracted and sometimes incomplete recovery. Management strategy is a controversial topic and evidence supporting a definite approach is limited. Opinion is divided between surgical repair and conservative immobilisation in conjunction with functional orthoses. A systematic search of the literature was performed. Pubmed, Medline and EmBase databases were searched for Achilles tendon and a variety of synonymous terms. A recent wealth of reporting suggests that conservative regimens with early weight bearing or mobilisation have equivalent or improved rates of re-rupture to operative regimes. The application of dynamic ultrasound assessment of tendon gap may prove crucial in minimising re-rupture and improving outcomes. Studies employing functional assessments have found equivalent function between operative and conservative treatments. However, no specific tests in peak power, push off strength or athletic performance have been reported and whether an advantage in operative treatment exists remains undetermined.

Purpose Thirty-day mortality of patients with hip fracture is well researched and predictive; validated scoring tools have been developed (Nottingham Hip Fracture Score, NHFS). COVID-19 has significantly greater mortality in the elderly and comorbid patients which includes hip fracture patients. Non-operative treatment is not appropriate due to significantly higher mortality, and therefore, these patients are often exposed to COVID-19 in the peri-operative period. What is unclear is the effect of concomitant COVID-19 infection in these patients. Methods A multicentre prospective study across ten sites in the United Kingdom (responsible for 7% of hip fracture patients per annum in the UK). Demographic and background information were collected by independent chart review. Data on surgical factors included American Society of Anesthesiologists (ASA) score, time to theatre, Nottingham Hip fracture score (NHFS) and classification of fracture were also collected between 1st March 2020 and 30th April 2020 with a matched cohort from the same period in 2019. Results Actual and expected 30-day mortality was found to be significantly higher than expected for 2020 COVID-19 positive patients (RR 3.00 95% CI 1.57-5.75, p < 0.001), with 30 observed deaths compared against the 10 expected from NHFS risk stratification. Conclusion COVID-19 infection appears to be an independent risk factor for increased mortality in hip fracture patients. Whilst non-operative management of these fractures is not suggested due to the documented increased risks and mortality, this study provides evidence to the emerging literature of the severity of COVID-19 infection in surgical patients and the potential impact of COVID-19 on elective surgical patients in the peri-operative period.

Sixty patients undergoing total knee replacement were randomized to receive either a cold compression dressing (Cryo/Cuff, Aircast, UK) or a modified Robert Jones bandage immediately after surgery. The cold compression dressing was used for a minimum of 6 h per day throughout the hospital stay, and the modified Robert Jones bandage remained in place for 48 h from the time of operation. The 2 groups of patients were compared during their hospital stay for blood loss, range of movement, pain scores and need for analgesia. No difference was found between the 2 groups except for less blood loss in the surgical drains in the cold compression group (P<0.05). Postoperative complications were seen in both groups, but no complication was associated with either the cold compression dressing or the modified Robert Jones bandage. Résumé Etude randomisée de 60 patients qui, immédia-tement après une arthroplastie totale du genou ont eu soit un pansement compressif froid de type "Cryocuff" soit un pansement compressif de type Robert Jones. Le pansement froid a été utilisé 6 heures par jour pendant la durée de l'hospitalisation tandis que le pansement compressif de type Robert Jones a été laisse en place pendant 48 heures après l'opération. Aucune différence statistiquement significative n'a pu être mise en évidence entre les deux groupes, à l'exception des pertes sanguines dans le drainage, moins importantes dans le premier groupe de patients. Nous avons eu des complications post opératoires dans les deux groupes mais aucune corrélation n'a pu être établie entre ces complications et le type de bandage appliqué.

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We measured the bone mineral density in 22 patients with the cylindrical stemmed cobalt-chrome AML prosthesis (collared) and in 22 patients with the tapered stem titanium CLS prosthesis (collarless). DEXA scanning was undertaken at a mean of 40 months in the AML and 52 months in the CLS group from the time of implant insertion. In both groups the greatest mean loss of BMD was found in Gruen zone 7 and the least change in Gruen zone 5. In all zones the BMD loss was greater in the AML group but only statistically significant in zones 6 (P<0.05) and 7 (P<0.01). Although numerous factors affect BMD changes around cementless implants, this study suggests that less bone loss can be associated with the titanium CLS stem.Résumé Nous avons mesuré la densité minérale de l'os chez 22 patients porteur d'une prothèse AML en cobaltchrome à tige cylindrique (avec colerette) et chez 22 malades avec une prothèse CLS en titane avec une tige conique et sans colerette. Une scanographie DEXA a été entreprise en moyenne 40 mois après implantation des prothèses AML et 52 mois après prothèse CLS. Dans les deux groupes la plus grande perte moyenne de DMO a été trouvée dans la zone 7 de Gruen et le plus petit changement dans la zone 5 de Gruen. Dans tous les zone la perte de densité osseuse était plus grande dans le groupe AML mais statistiquement uniquement dans les zones 6 (P<0.05) et 7 (P<0.01). Bien que de nombreux facteurs affectent les changements de DMO autour des implants sans ciment, cette étude suggère qu'il y a moins de perte osseuse avec la tige CLS en titane.