Inversion injuries of the ankle are common and most are managed adequately by functional treatment. A significant number will, however, remain symptomatic. Synovial impingement is one cause of continuing pain. This condition is often difficult to diagnose because the physical signs and investigations are non-specific. If the diagnosis is made, treatment by arthroscopic debridement has been shown to be highly effective. Our aim was to describe a new physical sign to help in the diagnosis of anterolateral synovial impingement in the ankle. A cadaver dissection demonstrated the anatomical basis for the physical sign and a prospective clinical study involving 73 patients showed that the lateral synovial impingement test had a sensitivity of 94.8% and a specificity of 88%. We describe the test and conclude that this physical sign will be of use to practitioners treating patients with chronic pain in the ankle after injury.

Objectives The aim of this study was to prospectively compare perioperative pain score and wound parameters, inclusive of postoperative swelling and erythema, between flank and midline ovariectomy (OVE) in cats, performed by final-year veterinary students. Methods Healthy cats presented for routine OVE were randomly assigned to either the midline or flank group after owner consent to participate in the study. Perioperative protocols were standardised for both groups. Clinical data were collected prior to surgery, intraoperatively, at 1 h postoperatively, at the time of discharge, and at 3 and 10 day postoperative re-examination appointments. Data recorded included duration of surgery and anaesthesia, intraoperative complications, Feline Acute Pain Scale (FAPS) scores, a simple descriptive scale of reaction to wound palpation (SDSwound), a dynamic and interactive visual analogue scale assessment of pain (DIVAS), and both a simple descriptive scale (SDSswelling) and a visual analogue scale (VASswelling) of surgical wound swelling. Results Thirty-eight cats received a flank OVE and 37 received a midline OVE. Duration of surgery, duration of anaesthesia and intraoperative complications did not vary significantly between the two groups. Cats in both groups had significantly higher FAPS scores after surgery ( P = 0.0002), with cats receiving a flank OVE having significantly higher pain scores compared with a midline OVE at 1 h postoperatively ( P = 0.0004) and at discharge ( P = 0.002). Swelling of the surgical wound (SDSswelling) was significantly higher in cats receiving a midline OVE at the time of discharge ( P = 0.048), as well as at the 3 day ( P <0.0001) and 10 day ( P = 0.001) postoperative re-examinations. FAPS scores were significantly higher in cats receiving a midline OVE at the 3 day ( P = 0.016) and 10 day re-examinations ( P = 0.045). No cats in either group suffered a wound breakdown or infection. Conclusions and relevance Our study does not support advocating a preferred surgical approach for feline OVE within a teaching environment.

The current study investigates instrument breakages during both emergency and elective orthopaedic surgery. Over a 2 year period a total of 7,775 procedures were performed. We found that 14 instruments were broken during 12 operative cases. Drill bits accounted for the largest proportion of breakages (11/14), and a specialist registrar was the lead surgeon in the majority (8/12) of cases. Only one case had a consultant as the lead surgeon. In seven cases the broken bit of the surgical instrument was left in the patient. Documentation of this peri-operative complication was deficient, and the patient was often not informed.Résumé Cette étude enquête sur les ruptures d'instrument pendant les opérations de chirurgie orthopédique urgentes ou programmées. Sur une période de deux années un total de 7775 interventions a été exécuté. Nous avons noté que 14 instruments ont été cassés pendant 12 opérations. Les éléments de la perceuse comptent la plus grande proportion de ruptures (11/14) et un chirurgien confirmé était le chef d'équipe dans la majorité (8/12) de cas. Dans 7 cas le morceau cassé de l'instrument a été laissé dans le malade. La documentation de cette complication opératoire était défectueuse et souvent le malade n'était pas informé.