14 unstable comminuted intraarticular fractures of the distal radius were treated by the use of the A/O mini-external fixator. The distal pins were inserted in the distal fragment, thus leaving the wrist joint free to mobilize. Clinical results were assessed at 3 to 12 months using the Sarmiento demerit point system. Nine were male and five female, with a mean age of 37 years. Ten fractures were closed and four were open. 11 patients (78.5%) had an excellent functional score and three (21.5%) had a good score. All patients had normal wrist morphology with an average radial length of 11 mm, radial angle of 23 degrees and a mean volar angle of 12 degrees. 12 patients had anatomical radio-carpal and radio-ulnar joints and two patients had a step less than 2 mm at the radio-carpal surface. This method has proved in our experience to be reliable in maintaining the position as well as allowing early functional recovery.

A 63-year-old woman presented with fever, confusion, dysarthria (slurred speech), new-onset thrombocytopenia (26 3 10 9 /L platelets) and mild transaminitis 2 weeks after a tick bite to the left thigh. Physical examination was negative for splenomegaly, rash, or any other focal deficits. A review of the peripheral smear confirmed morulae inside the neutrophils suggestive of a diagnosis of human granulocytic anaplasmosis (HGA). Serologies for Lyme disease, Rocky Mountain spotted fever, ehrliciosis, and anaplasmosis were negative. A reverse-transcription polymerase chain reaction for HGA was positive. Anaplasma antibodies may take 2 to 3 weeks to become positive and thus have low negative predictive value in acute presentations. The patient responded well to intravenous doxycycline with recovery of platelets (.200 3 10 9 /L), resolution of fever, transaminitis, and confusion. At the time of discharge, she still had dysarthria as an unusual isolated neurological manifestation of HGA not reported before. Computed tomography scan and magnetic resonance imaging of the brain did not show any lesions that could explain dysarthria.Review of peripheral smear in patients with thrombocytopenia and history of tick bite should focus on inclusion bodies in granulocytes and monocytes.For additional images, visit the ASH IMAGE BANK, a reference and teaching tool that is continually updated with new atlas and case study images. For more information visit http://imagebank.hematology.org.

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10. When a piece of the suspected tissue is removed for microscopic examination and no evidence of carcinoma is found, the existence of a simple stricture must not be inferred. SOCIETIES' PROCEEDINGS. ROYAL SOCIETY OF MEDICINE.-OTOLOGICAL SECTION.