Introduction The aim of this study was to study radiological assessment, management and outcome of traumatic splenic injury over 15 years in a UK district general hospital. Method A retrospective database was established including all splenic injury cases from June 2002 to June 2017 by searching the clinical electronic database. We searched the radiological database for computed tomography reported phrases ‘spleen injury’, ‘laceration’, ‘haematoma’, ‘trauma’. We interrogated theatre records for operations coded as splenectomy and cross-referenced this with pathology. Records were reviewed for demographics, vital observations, documentation of American Association for the Surgery of Trauma (AAST) grading of splenic injury, subsequent management and outcomes. Results There were 126 patients identified with traumatic splenic injury, with male to female ratio three to one. Operative management was undertaken in 54/126 (43%) patients and selective non-operative management in the remaining. Splenic artery embolisation was undertaken in 5/126 (4%) and 2/126 underwent splenorrhaphy. Computed tomography was undertaken in 109/126 (87%) patients and AAST grading was reported in 18 (17%) patients. AAST grade reporting did not improve significantly when comparing the first 7.5 years with the latter (2/30, 7%; 16/79, 20%), respectively; p = 0.09). Selective non-operative management increased significantly over the studied period (14/34, 42%; 58/93, 62%; p = 0.04). The overall hospital mortality was 10.3%. Discussion and conclusion AAST grade reporting of splenic injury has remained sub-optimal over 15 years. Despite progression towards selective non-operative management, operative intervention remained unacceptably high, with splenectomy being the main therapeutic modality. Standardisation through an integrated multidisciplinary diagnostic and management pathway offers the optimal strategy to reduce trauma-induced splenectomy.

No abstract

A below knee amputation can be fashioned using a long posterior flap, or skew flap.Contemporaneous studies comparing the two are lacking. We review both short and long-term outcome of patients who have undergone BKA by either technique. This study suggests that rates of residual limb failure (requiring surgical revision) are equal between the two surgical methods used. However, functional outcomes in unilateral amputees using a prosthetic limb were better in those who had received a long posterior flap amputation. ConclusionsBoth techniques appear equivalent for rates of surgical residual limb failure. Functional outcomes may be better with the LPF.

Editor -We read with great interest the study by Partanen et al., 1 which found the presence of medical students during general practice consultations to be satisfactory for all participants, and that three really does not constitute a crowd.