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Aims: Large population-based studies have demonstrated increased prevalence of rotator cuff disease amongst diabetics. Recent studies have suggested comparable clinical outcomes from rotator cuff repair despite suggestions of increased complication rates amongst diabetics. However, there is a relative paucity of studies considering the effect of diabetes upon complication rate. We aim to report and quantify the effect of diabetes on complication rates following arthroscopic rotator cuff repair. Materials and methods: A retrospective review of a consecutive series of patients undergoing arthroscopic rotator cuff repair between January 2011 and December 2014 was performed. Diabetic status and complication data defined as infection, frozen shoulder, re-tear or re-operation were collected and interrogated. Results: A total of 462 patients were included at median follow-up of 5.6 years. Diabetics were significantly more likely to experience frozen shoulder (15.8% vs. 4.4%, p = 0.001), re-tear (26.3% vs. 15.6%, p = 0.042) or at least one complication following surgery (35.1% vs. 22.7%, p = 0.041) compared to non-diabetics. These equated to odds ratios of 4.03, 1.94 and 1.84, respectively. Conclusions: Diabetic patients are almost twice as likely to experience complications following arthroscopic rotator cuff repair, including double the risk of repair failure and more than four times the risk of frozen shoulder. [ABSTRACT FROM AUTHOR]

This randomised trial compared the results of carpal tunnel decompression using the TM Indiana Tome (Biomet, Warsaw, Indiana, USA) and a standard limited palmar open incision. Two hundred patients were randomly selected to have a carpal tunnel decompression with either the Indiana Tome or a limited palmar technique. They were assessed clinically for 3 months and using the Levine–Katz self-assessment evaluation for 7 years. After 7 years, there were 62 returned questionnaires from the open group and 53 from the Tome group. There were no significant differences in functional scores, pain, scar tenderness, pinch and grip strength at 3 months. There were two complications in the open group and nine in the Tome group, including one median nerve injury. There was both a higher rate of immediate complications, and more recurrences and persisting symptoms at 7 years in the Indiana Tome group. [ABSTRACT FROM PUBLISHER]

The results of surgery for Dupuytren’s disease were prospectively assessed to see if there is a correlation between hand function, the degree of deformity and the post-operative result. A total of 42 patients were followed-up for 6 months. The mean flexion deformity was 81 pre-operatively and 32 post-operatively. The mean Sollerman score improved from 71 (out of 80) pre-operatively to 77 post-operatively. There was a significant correlation between the degree of deformity and the Sollerman score, and also between the improvement in deformity after surgery, and the Sollerman score. We conclude that hand function is worsened by increasing deformity in Dupuytren’s disease and improved by correction of the deformity. [ABSTRACT FROM PUBLISHER]

We present the case of a rock climber with a rupture of the A3 flexor sheath pulley. The diagnosis was confirmed with Colour Doppler Imaging (CDI) and with B-mode ultrasound imaging, and the surgical repair was evaluated in the same way. Vertical displacement of the flexor tendon meant that using CDI measurements of the longitudinal movements was not possible. However, using computer analysis of digitized B-mode images from texture patterns identified in the tendons, the vertical and longitudinal components of movement during flexion were calculated. The repair of the pulley was shown to produce tendon movement ratios nearer those of the control digit of the opposite hand. [ABSTRACT FROM PUBLISHER]

The International Commission on Radiological Protection's (ICRP) system to protect the living components of the environment is designed to provide a broad and practical framework across different exposure situations. The framework recognises the need to be able to demonstrate an adequate level of protection in relation to planned exposure situations, whilst also providing an ability to manage existing and emergency situations in an appropriate way. In all three exposure situations, the release of radionuclides into the natural environment leads to exposures of non-human biota (wildlife), as well as having the potential for exposures of the public. How the key principles of the ICRP system of radiological protection apply in each of these exposure situations will be discussed. Using examples, we will demonstrate how the overall approach provides a mechanism for industry to assess and demonstrate compliance with the environmental protection objectives of relevant (national) legislation, and to meet stakeholder expectations that radiological protection of the environment is taken into consideration in accordance with international best practice. However, several challenges remain, and these will be discussed in the context of the need for additional guidance on the protection of the environment. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented from a reader discussing a case involving the revision of failed Sauve-Kapandji procedure for Madelung's deformity with an unusual anatomical variant.