BackgroundModern day clinical practice demands evidence justifying our choice of treatment methods. Cumulative sum techniques (cusum) are amongst the simplest statistical methods known. They provide rapid analysis and identification of trends in a series of data. This study highlights use of these techniques as an early performance indicator of a clinical procedure before its implementation.MethodsTwenty consecutive patients who underwent total hip or knee arthroplasty received a simple dressing – blue gauze and Tegaderm. Cusum charting was used to assess the dressing with regards to skin blistering. At an acceptable level of performance the curve would oscillate about the horizontal axis and the overall trend therefore said to be flat. If performance is unacceptable, the cusum slopes upward.ResultsThe cusum plot for the twenty patients did not cross the specified control limits. This showed that our simple dressing met specified standards with regards to wound blistering postoperatively.ConclusionWe recommend the use of this simple, yet versatile cusum technique in the early evaluation of a clinical procedure before its implementation.

Background: Football is officially the most popular sport in the world. In the UK, 10% of the adult population play football at least once a year. Despite this, there are few papers in the literature on tibial diaphyseal fractures in this sporting group. In addition, conflicting views on the nature of this injury exist. The purpose of this paper is to compare our experience of tibial shaft football fractures with the little available literature and identify any similarities and differences.

A 15-year-old female Highland dancer presented to the accident and emergency department with an ankle inversion injury on a background of several weeks of pain in the right foot. A radiograph of the right foot demonstrated a stress fracture at the base of the second metatarsal. She was treated conservatively with a below knee removable supportive walking boot with a rocker bottom sole. She re-presented to the accident and emergency department 3 weeks later with pins and needles in the right foot; she was given crutches to use along side the supportive walking boot. Radiographs 12 weeks after the first presentation showed healing of the stress fracture. The patient was now asymptomatic of the injury. She was unable to fully train for 12 weeks due to the injury. Conservative management was successful in this patient.