Background: The role of early radiographic imaging in the management of distal radius fractures (DRFs) is unclear. The aim of this study was to assess whether early post-operative radiographs for DRFs influences the ongoing management of this patient group. We hypothesize that routine early radiographs do not influence the management of DRFs. Methods: This was a retrospective review of patients undergoing open reduction and internal fixation using a volar locking plate between 2012 and 2017 at our institution. Patients were identified using hospital electronic databases. Clinical information was gathered from the electronic health records and PACS systems and analysed on a spreadsheet. An early post-operative radiograph was defined by the authors as imaging on a patient’s first postoperative visit. Results: 237 patients were identified. The median number of days patients were reviewed post-operatively was 13 (interquartile range 9–16). 172 (73.1%) patients had early post-operative radiographs, with 100 (58.1%) intra-articular and 72 (41.9%) extra-articular fractures. Of patients who underwent imaging, 7 (4.0%) had their post-operative fracture management altered (7 intra-articular, 0 extra-articular) with 1 (0.58%) requiring immediate surgical revision as indicated by imaging. Conclusions: Our study questions the value of routine early post-operative radiographs in the management of distal radius fracture fixations, in particular if the fracture is extra-articular. This is of importance in the setting of constrained resources and represents a poor use of limited healthcare facilities, as well as unnecessary radiation exposure.

Fractures involving the anterior process of the calcaneus (APC) are rare, underdiagnosed, and carry a significant increase in morbidity if not identified acutely. Identifying patients with intra-articular fracture extension is crucial as they may benefit from surgical fixation to reduce the risk of morbidity and posttraumatic osteoarthritis. There are no specific guidelines in the United Kingdom regarding the management of these fractures, and there is little evidence regarding optimal management, mainly limited to case reports and small sample observational trials. Previous reports of surgical intervention have described excision of fragments or fixation using single cancellous screws.A 55-year-old man fell from a height of 2 metres, sustaining an APC fracture extending into the calcaneocuboid joint. This was identified on plain radiographs following a virtual fracture clinic referral from the emergency department and further investigated with computed tomography scanning.He underwent open reduction and internal fixation with a locking T-plate and screws three weeks post-injury to restore congruence of his articular surface. Following a period of non-weight-bearing and progressive physiotherapy, he reported an excellent functional outcome six months post-operatively, measured by the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score of 90%.In the absence of specific guidelines for these fractures, this case provides an example of good initial functional outcomes following surgical fixation using a locking plate and screws, the first such fixation of an APC fracture described in the literature. This case can also be seen as a useful reminder of the need for an index of clinical suspicion for these injuries, given that up to 40% may be missed in the emergency department. While now fairly widespread, not all hospitals will have a virtual fracture clinic system in place, meaning emergency department practitioners must be wary of these injuries before discharging patients with suspicious histories and examination findings with no follow-up. Examination techniques that may help differentiate APC fractures from ankle sprains are discussed to provide clinicians with evidence to support a suspicion of these injuries in the emergency department.

BackgroundFemoral neck fractures are common injuries. Although many studies have compared two-hole dynamic hip screw (DHS) versus multiple cannulated cancellous screw (CCS) fixation for undisplaced intracapsular fractured neck of femurs (NOF), there is no consensus on which surgical technique results in better outcomes. The aim of our study was to compare DHS and CCS for undisplaced NOFs. The primary outcomes were reoperation and mortality rates at one year postoperatively. MethodologyA retrospective analysis was performed involving all patients who underwent fixation with DHS/CCS for an undisplaced intracapsular NOF at our hospital between January 2016 and December 2020. All patients had a minimum follow-up time greater than one year. All patients underwent a standardised NOF protocol. Patients either underwent DHS or CCS fixation according to surgeon preference, and there was no randomisation to either group. ResultsA total of 41 patients underwent fixation with DHS compared to 32 who underwent CCS. The reoperation rate at one year was 9.8% in the DHS group compared to 6.3% in the CCS group. This difference was not statistically significant (p = 0.588). The one-year mortality rate was similar between groups at 22.0% and 21.9% in the DHS group and the CCS group, respectively (p = 0.994). Registrar-level surgeons performed 80.5% of DHS compared to 59.4% of CCS, and consultant surgeons performed 4.9% of DHS compared to 25% of CCS. ConclusionsThere was no significant difference in revision rates or complications seen between CCS and DHS. A significantly higher percentage of CCS fixations were performed by consultant-grade surgeons at our hospital compared to DHS. This study provides further data on the choice of fixation method for intracapsular fractures. It also reports on the grade of the operating surgeon at our unit, which may be a factor in the quality of fixation and ultimately reoperation rates.

Gastrocnemius tightness of > 13° may be considered abnormal. Most patients with foot and ankle pathology do not have abnormal degrees of gastrocnemius tightness compared with controls, but it is present in over a third of patients with forefoot pathology. Cite this article: Bone Joint J 2018;100-B:945-52.