Septic arthritis is a potentially devastating condition. Early and aggressive joint lavage and debridement combined with appropriate antimicrobial therapy is imperative. A high index of suspicion is necessary in haemodialysis patients; the diagnosis of septic arthritis must be presumed until proven otherwise.

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Foot and ankle pathologies cause a significant disease burden on rheumatoid patients. Forefoot pathologies causes pain, callosities and possibly ulceration, and can cause problems with footwear. Forefoot correction in rheumatoid patients has historically comprised of excision of diseased joints. While satisfaction was high with this procedure, complications, changing expectations and improvement in medical therapy have raised expectation of patients, physicians and surgeons alike. This review assesses the role of joint preserving osteotomies and arthrodesis, as well as associated complications. It also describes the role of the multidisciplinary team in the management of these patients.

We read with interest the article by Lim et al. 1 The authors concluded that manipulation is not recommended in patients with slipped capital femoral epiphysis, because of a higher risk of avascular necrosis. However, no significant differences in outcome or complication rates were shown in their study for those treated with fixation alone or manipulation with fixation. Patients with acute unstable slips undergoing manipulation and fixation within 24 hours have been reported to have better, 2 comparable, 3 or worse 4 results than those undergoing fixation alone or delayed fixation. More randomised controlled trials are needed to answer this question.

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