Darren F. Lui

Foot drop--an unusual presentation of exertional compartment syndrome.

INTRODUCTION We report the case of a 67-year-old male presenting to our service with a foot drop after a short history of increasingly symptomatic exertional compartment syndrome. Magnetic resonance imaging (MRI) was supportive of the diagnosis, and the diagnosis confirmed with compartment pressure measurement. This is an atypical presentation and highlights the need to consider exertional compartment syndrome in those outside the ‘‘elite athlete’’ demographic.

The Evaluation of the Inverted Supinator Reflex in Asymptomatic Patients

Study Design. A prospective study was undertaken over a 6-month period to determine the incidence of the inverted supinator reflex in asymptomatic, neurologically normal individuals. Objective. The objective of our study is to assess asymptomatic patients for the presence of the inverted radial reflex and to determine its clinical relevance. Summary of Background Data. The inverted radial reflex sign is commonly used in clinical practice to assess cervical myelopathy. It is unknown whether the sign correlates with the presence or severity of myelopathy, and no consensus exists regarding the significance of a positive sign in asymptomatic individuals. Methods. Patients attending the Trauma Clinic at our institution were invited to participate. Each patient was examined neurologically and specifically for the presence or absence of the Babinski test, Hoffmans sign, the finger escape sign, static and dynamic Rombergs test, and the inverted supinator reflex. Patients were excluded if they had any history of neck pain, any history of neurosurgical procedure or spinal surgery, any known neurologic disorder or deficit, or if there was any outstanding medicolegal case. Results. We examined 277 patients in 6-month period. The male to female ratio was 1.1:1. The mean age was 27 years (range, 16–78). The incidence of the inverted supinator reflex was 27.6% (75/271). Of the 75 positive patients, the inverted supinator reflex was present bilaterally in 39% (29/75). Nine of 75 patients (10%) had an associated positive Hoffmans sign but had no other signs suggestive of myelopathy. The proportion of patients with a positive inverted supinator reflex reduced with increasing age (Pearson correlation coefficient > 0.80). Conclusion. This study demonstrates that an isolated, inverted supinator reflex may be a variation of normal clinical examination. We believe that an isolated inverted supinator reflex, in the absence of other clinical findings, is not a reliable sign of cervical myelopathy; however, it must be interpreted with caution in the older patient.

Giant cell tumour in the foot of a skeletally immature girl: a case report

We present a case of delayed diagnosis of a benign giant cell tumour (GCT) of the third metatarsal in a skeletally immature girl. The patient underwent en bloc excision of the tumour. The tumour had replaced the third metatarsal and had infiltrated the surrounding soft tissue and the second and fourth metatarsal bases. Deep, lateral and medial margins were all involved. A high index of suspicion is needed when evaluating any tumours of the foot, because the compact structure of the foot may delay diagnosis. Early detection is important for avoiding amputation, as the hindfoot and midfoot are classified as one compartment and radical resection is impossible to achieve. Tumours grow faster in the foot than in other bones. GCT in this location and age-group are rare and should be considered in the differential diagnosis of a destructive bony lesion in skeletally immature patients.

Effect of body mass index on functional outcome in primary total knee arthroplasty - a single institution analysis of 2180 primary total knee replacements

AIM To evaluate the effect of body mass index (BMI) on short-term functional outcome and complications in primary total knee arthroplasty. METHODS All patients undergoing primary total knee arthroplasty at a single institution between 2007 and 2013 were identified from a prospective arthroplasty database. 2180 patients were included in the study. Age, gender, BMI, pre- and post-operative functional scores [Western Ontario and McMaster University Arthritis Index (WOMAC) and SF-36], complications and revision rate were recorded. Patients were grouped according to the WHO BMI classification. The functional outcome of the normal weight cohort (BMI < 25) was compared to the overweight and obese (BMI ≥ 25) cohort. A separate sub-group analysis was performed comparing all five WHO BMI groups; Normal weight, overweight, class 1 obese, class 2 obese and class 3 obese. RESULTS With a mean age of 67.89 (28-92), 2180 primary total knee replacements were included. 64.36% (1403) were female. The mean BMI was 31.86 (18-52). Ninty-three percent of patients were either overweight or obese. Mean follow-up 19.33 mo (6-60 mo). There was no significant difference in pre or post-operative WOMAC score in the normal weight (BMI < 25) cohort compared to patients with a BMI ≥ 25 (P > 0.05). Sub-group analysis revealed significantly worse WOMAC scores in class 2 obese 30.80 compared to overweight 25.80 (P < 0.01) and class 1 obese 25.50 (P < 0.01). Similarly, there were significantly worse SF-36 scores in class 2 obese 58.16 compared to overweight 63.93 (P < 0.01) and class 1 obese 63.65 (P < 0.01) There were 32 (1.47%) superficial infections, 9 (0.41%) deep infections and 19 (0.87%) revisions overall with no complications or revisions in the normal weight cohort (BMI < 25). CONCLUSION Post-operative functional outcome was not influenced by BMI comparing normal weight individuals with BMI > 25. Patients should not be denied total knee arthroplasty based solely on weight alone.