Radiographic evaluation of calcaneal fractures: To measure or not to measure

Objective: The aim of this study was to correlate the functional outcome after treatment for displaced intra-articular calcaneal fracture with plain radiography. Design: The design was a prognostic study of a retrospective cohort with concurrent follow-up. Patients: A total of 33 patients with a unilateral calcaneal fracture and a minimum follow-up of 13 months participated. Patients filled in three disease-specific questionnaires, graded their satisfaction and the indication for an arthrodesis was noted. Standardised radiographs were made of the previously injured side and the normal (control) side. Different angles and distances were measured on these radiographs and compared with values described in the literature. The differences in values in angles and distances between the injured and uninjured (control) foot were correlated with the outcome of the questionnaires, and the indication for an arthrodesis. Results: None of the angles correlated with the disease-specific outcome scores. Of the angles only the tibiotalar angle correlated with the VAS (r=0.35, p=0.045) and only the absolute foot height correlated with the indication for an arthrodesis (odds=0.70, CI=0.50-0.99). Conclusion: In this study the radiographic evaluation correlated poorly with the final outcome. Measurements on plain radiographs seem not to be useful in determining outcome after intra-articular calcaneal fractures

Early Weight Bearing of Calcaneal Fractures Treated by Intraoperative 3D-Fluoroscopy and Locked-Screw Plate Fixation

Operative therapy of intraarticular fractures of the calcaneus is an established surgical standard. The aim is an accurate reduction of the fracture with reconstruction of Boehler’s angle, length, axis and subtalar joint surface. Intraoperative 3D-fluoroscopy with the Siremobil Iso-C 3D® mobile C-arm system is a valuable assistant for accurate reconstruction of these anatomical structures. Remaining incongruities can be recognized and corrected intraoperatively. The achieved reduction can be fixed by the advantages of an internal fixator (locked-screw plate interface). In the period of October 2002 until April 2007 we operated 136 patients with intraarticular fractures of the calcaneus by means of anatomical reduction, and internal plate fixator under intraoperative control of 3D-fluoroscopy. All patients were supplied with an orthesis after the operation which allowed weight bearing of 10 kg for 12 weeks for the patients operated between October 2002 and October 2004 (Group A). Transient local osteoporosis was observed in all X-Rays at follow-up after an average of 8,6 months. Therefore we changed our postoperative treatment plan for the patients operated between November 2004 and April 2007 (Group B). Weight bearing started with 20 KG after 6 weeks, was increased to 40 KG after 8 weeks and full weight bearing was allowed after 10 weeks for these patients. In no case a secondary dislocation of the fracture was seen. No bone graft was used. At follow up the average American Foot and Ankle Society Score (AOFAS) were 81 for Group_A, compared to 84 for Group B, treated with earlier weight bearing. Autologous bone graft was not necessary even if weight bearing was started after a period of six weeks postoperatively. The combination of 3D-fluoroscopy with locked internal fixation showed promising results. If the rate of patients developing subtalar arthrosis will decrease by this management will have to be shown in long term follow up

Research shareholding and investment in England and Wales: approaches, sources and methods

There is considerable scope for increasing the understanding of the history of share ownership. Existing studies of shareholders in the UK are limited in the industries, time periods and shareholder populations they study. This article outlines the methods used by the authors in an ESRC-funded study of shareholders in companies in England and Wales from 1870 to 1930. Data were drawn from companies' shareholder records — the Form Es submitted annually to the Registrar of Companies and the share registers and ledgers maintained by companies. The article outlines the rationale for the industrial sectors selected for study, the choice of companies and the basis on which shareholder records were sampled. The resulting database contains details of over 29,000 individual shareholders who collectively had over 33,000 shareholdings, and is larger and more representative of the investor population than any previously compiled in the UK

Role of computerised tomography in management of intra-articular fractures of the os calcis

This study aimed to look at the role played by the CT scan in decision making in the management of intra-articular fractures of the calcaneum. Twenty-four patients with intra-articular fractures of the calcaneum were included. Their initial radiographs and CT films were blinded and assessed by three independent observers. Based on this they were selected for operative or non-operative management. The actual management was also recorded. The data were then subjected to statistical analysis to look at the association between the decision from radiograph, that from the CT scan and the actual management undertaken. Non-parametric tests for related samples were performed to look at the association between the actual management and the decisions made by assessing the radiographs and the CT scans. For all three observers, there was no significant difference between the actual management and decisions made by assessing the plain radiographs or the CT scan. There was also no significant difference between the radiograph-based and the CT-based decisions. However, the Cochran Q test showed that there was significant variation among the three observers for the CT-based assessment. Our results, show that the CT scan should only be done when a definite decision is made to operate on a patient, based on plain radiographs. Calcaneal fractures which are selected for non-operative management, based on X rays, should not have a CT scan as a routine as it provides no valuable additional information affecting the management decision

'She possessed her own fortune': Women investors from the late nineteenth century to the early twentieth century

There is a growing literature on the history of investment in Britain. However, the role played by women as investors has been almost wholly ignored. This paper argues that women were an important class of stock market investors and produces empirical evidence, most notably share registers, to show that women engaged in a number of different types of investment, and were important in both public and private companies as long-term holders of securities in the nineteenth and early twentieth centuries. The article concludes by suggesting the impact of these findings on our understanding of women's financial position and of their role in corporate governance