Fractures of the distal radius are commonly treated using volar locking plates. Several complications have been associated with this procedure, including extensor tendon irritation and rupture. It has been suggested that prominence of screws past the dorsal cortex may contribute to this complication. This study aimed to determine the ability of the skyline view to demonstrate screws penetrating the dorsal cortex. A volar locking plate was applied to a synthetic forearm model. Lateral, oblique, and skyline views were obtained, with the distal screws both beneath and 1 mm beyond the dorsal cortex. The images were shown to orthopaedic trainees who were asked to decide if screws penetrated the dorsal cortex. Subjects were correct in 83% of cases using the skyline view compared with 77% (p = 0.05, lateral) and 50% (p < 0.01, oblique). This study demonstrates the skyline view of the distal radius could be a useful and accurate addition to routine intraoperative fluoroscopy views.

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INTRODUCTION Templating of pelvic radiographs traditionally involved using implant-companyp rovided acetates which assumed am agnification of 115-120%. With the introduction of digital imaging, many departments are becoming filmless. Templating software has been designed to allow on-screen templating of digital images. Knowledge of the true magnification of the image is required for accurate measurement.PATIENTS AND METHODS Fifty consecutive postoperative pelvic radiographs were analysed using templating software. The implanted component was measured using an assumed magnification factor of 115%. The template image was then reset to the known component size, and the magnification factor was adjusted until the template covered the true component. RESULTS An assumed magnification factor of 115% oversized the acetabular component by am ean of 6m m( three component sizes) in all 50 components. The mean true magnification in our department was 127%.CONCLUSIONS Validation of the true magnification produced by ar adiology department using templatings oftware is as imple and reproduciblet echnique. It is recommended to all departments using digital images and templating software. Assumption of am agnification factor of 115% risks oversizing components by 6m m.

Surgeons should be aware that introduction of digital techniques of radiograph acquisition may reduce the magnification of the film and, therefore, reduce the accuracy of pre-operative templates supplied by the manufacturers of implants, resulting in incorrect selection of implants.

BackgroundApproximately 20% of patients experience chronic pain after total knee replacement. There is little evidence for effective interventions for the management of this pain, and current healthcare provision is patchy and inconsistent. Given the complexity of this condition, multimodal and individualised interventions matched to pain characteristics are needed. We have undertaken a comprehensive programme of work to develop a care pathway for patients with chronic pain after total knee replacement. This protocol describes the design of a randomised controlled trial to evaluate the clinical- and cost-effectiveness of a complex intervention care pathway compared with usual care.MethodsThis is a pragmatic two-armed, open, multi-centred randomised controlled trial conducted within secondary care in the UK. Patients will be screened at 2 months after total knee replacement and 381 patients with chronic pain at 3 months postoperatively will be recruited. Recruitment processes will be optimised through qualitative research during a 6-month internal pilot phase. Patients are randomised using a 2:1 intervention:control allocation ratio. All participants receive usual care as provided by their hospital. The intervention comprises an assessment clinic appointment at 3 months postoperatively with an Extended Scope Practitioner and up to six telephone follow-up calls over 12 months. In the assessment clinic, a standardised protocol is followed to identify potential underlying causes for the chronic pain and enable appropriate onward referrals to existing services for targeted and individualised treatment. Outcomes are assessed by questionnaires at 6 and 12 months after randomisation. The co-primary outcomes are pain severity and pain interference assessed using the Brief Pain Inventory at 12 months after randomisation. Secondary outcomes relate to resource use, function, neuropathic pain, mental well-being, use of pain medications, satisfaction with pain relief, pain frequency, capability, health-related quality of life and bodily pain. After trial completion, up to 30 patients in the intervention group will be interviewed about their experiences of the care pathway.DiscussionIf shown to be clinically and cost-effective, this care pathway intervention could improve the management of chronic pain after total knee replacement.Trial registrationISRCTN registry (ISRCTN92545361), prospectively registered on 30 August 2016.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2516-8) contains supplementary material, which is available to authorized users.