Purpose The development of dry arthroscopic examination of the distal radioulnar joint (DRUJ) has changed our understanding of the anatomy of triangular fibrocartilage (TFC) tears. This paper aims to improve understanding of the anatomy and prevalence of TFC tears associated with DRUJ instability. Methodology A retrospective audit was conducted on all patients with symptomatic DRUJ instability who underwent dry arthroscopy of the wrist and DRUJ performed by the primary author over 12 months in 2020. Patients who did not have a tear of the TFC identified at arthroscopy or who exhibited signs of ulnocarpal impaction were excluded from the study. A description of the anatomy of the TFC tear and the result of the hook test was documented for all patients. Results A TFC tear was identified in 107 patients. All patients had a peripheral tear of the TFC. A partial tear of the foveal ligament was identified in 11 patients (10.3%) and a complete tear of the foveal ligament in 2 patients (1.9%). 2 patients had a complex tear of the TFC including a horizontal shear tear and a volar tear which extended into the lunotriquetral joint. Conclusion Dry arthroscopy of the RCJ and DRUJ is necessary to accurately evaluate the integrity of the foveal ligament. This study revealed that all tears of the TFC associated with DRUJ instability have a peripheral component and with increasing severity the tear extends between the floor of the ECU sheath and the foveal ligament. In the most severe expression of the injury, the foveal ligament is damaged (10%) and rarely is the foveal ligament completely torn (2%). The ability to define the anatomy of the TFC tear will enable surgeons to perform anatomically specific repairs.

Aims: Diabetic foot osteomyelitis (DFO) is the leading cause of non-traumatic limb amputation and is treated with a combination of wound care, antibiotics, and surgery. The use of antibiotic-impregnated bioresorbable bone filler (ARBF) for limb salvage in DFO compared to conventional treatment has not been systematically evaluated. This study conducted a comprehensive literature review and meta-analysis. Methods: MEDLINE, Embase, and CENTRAL were systematically searched for randomised controlled trials (RCTs) and observational studies. Quality was assessed using the Newcastle-Ottawa Risk of Bias Assessment Tool. Outcomes meta-analysed include limb salvage and wound healing. Qualitative synthesis of literature was performed to assess patient mortality, re-intervention, recurrence of infection. Certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Results: One RCT and 12 observational studies (860 participants) were identified. 3 studies were identified for meta-analysis with a control cohort. Risk of bias was low in most evaluated studies. ARBF may reduce the risk of major amputation (3 studies, 289 participants, RR 0.12, 0.03-0.41, I2 = 0; low certainty of evidence). ARBF treatment trended to improved wound healing but was not statistically significant (2 studies, 153 participants, RR 2.0, CI 95% 0.41 – 9.67, I2 = 96%; low certainty of evidence). Qualitative analysis (13 studies) identified a trend towards lower incidence of repeat intervention and lower risk of infection recurrence (11.8%, 8 studies, 476 participants). However, there was significant inconsistency in reporting. All-cause mortality for ARBF patients was 18.4% (7 studies, 434 participants). Conclusions: ARBF treatment of DFO, compared to conventional therapy, may lead to improved rates of limb salvage and wound healing. A high-quality RCT is necessary to confirm this conclusion due to a low certainty of evidence.

Background Diabetic foot infection (DFI) frequently occurs in the context of co-existing peripheral arterial disease, neuropathy and structural foot deformity, and is associated with high rates of amputation and mortality. Surgical management is multidisciplinary but often variably structured across orthopaedic and vascular services. Protocolised pathways have been proposed to standardise care delivery. Aims: To evaluate outcomes of a pulse-based, protocolised orthopaedic–vascular model for the management of DFI. Methods A retrospective cohort study was conducted of 269 patients undergoing operative management for DFI at a single tertiary centre (Jan 2020 to Jan 2022). Patients were triaged via a protocolised pathway according to pedal pulse status into orthopaedic or vascular care streams. Primary outcomes were 12-month all-cause mortality and major amputation. Secondary outcomes included operative burden, length of stay and readmission. Results Overall mortality was 11.9% and major amputation 5.9%. The protocolised model stratified patients into clinically distinct groups. Orthopaedic patients were younger with lower mortality (7.4%) and amputation (4.3%). Vascular patients were older and demonstrated higher mortality (23.9%) and amputation (7.5%). The combined cohort exhibited the highest treatment intensity, with greater operative burden (mean 3.92 procedures), length of stay (median 40 days) and readmission (51.3%). Conclusion A protocolised orthopaedic–vascular pathway provides a structured, multidisciplinary framework for the management of DFI and stratifies patients into clinically distinct groups. Outcome differences observed between pathways are consistent with underlying disease severity, while the combined pathway reflects the intensity of care required for complex limb salvage.

Background: The optimal surgical approach to base of coracoid fractures (Eyres III-V, Ogawa I) remains a contentious topic for an exceedingly uncommon fracture pattern.(1) This is partly due to the anatomical restrictions interfering with the optimal insertion angles for screw fixation.(2) This article describes the first reported use of a novel transclavicular approach to the base of coracoid. Clinical Case: A male rugby player in his early twenties sustained a shoulder injury from a blow to the left shoulder. Subsequent X-ray and CT found an acute comminuted base of coracoid fracture with anteromedial displacement of the coracoid process, as well as a comminuted scapular body fracture with extension into the glenoid neck. 16 days post-injury, the patient underwent open reduction and internal fixation (ORIF) of the base of coracoid via an extended deltopectoral approach and crescenteric clavicular osteotomy. Sufficient space was created through release of soft tissues and dissection of the rotator interval. Anatomical reduction was confirmed with intraoperative imaging and the coracoid was fixated with partially threaded cannulated screws. Post-operatively, the patient was compliant with 6- weeks of restricted weight bearing in an abduction sling followed by rehabilitation. Conclusion: The transclavicular approach is a novel surgical technique allowing for optimal ORIF of the base of coracoid under direct visualisation. This article illustrates a promising solution to this area of contention and warrants further comparative studies. References: 1.Pires RE, Giordano V, de Souza FSM, Labronici PJ. Current challenges and controversies in the management of scapular fractures: a review. Patient Saf Surg. 2021 Jan 6;15(1). 2. Trikt van, Dobbe G, J. C. E. Donders, Streekstra GJ, P. Kloen. The “coracoid tunnel view”: a simulation study for finding the optimal screw trajectory in coracoid base fracture fixation. Surg Radiol Anat. 2019 Jul 4;41(11):1337–43.

Introduction/background: Pelvic ring injuries (PRI) in traumatic shock are associated with over 30% mortality even in high income countries’ mature trauma systems, but recent Australian data showed no haemorrhage related mortality in this group. We aimed to describe the epidemiology, management and outcomes of PRI with haemodynamic instability managed in a state’s only Level 1 adult trauma centre. Design: We conducted a retrospective cohort study of all trauma patients with major PRI (Abbreviated Injury Scale (AIS) > 3) and hemodynamic instability (defined as systolic blood pressure (SBP) <90 mmHg or a shock index (heart rate (HR)/SBP) > 0.7) presenting to the state adult trauma centre between 2013 and 2022. Data on demographics, injury patterns, management strategies, and outcomes were collected from the State Trauma Registry and hospital records. Results: Of 1369 patients with pelvic or acetabular fractures during the 10-year study period, 152 (11%) had major PRI with hemodynamic instability at presentation. Most were male (72%) with a median age of 35 years. Motor vehicle and motorbike crashes accounted for 52% of injuries. The median Injury Severity Score was 33. Massive transfusion protocols were activated in 45% of cases, while angioembolisation was utilised in 5.9%. Overall in-hospital mortality was 7.2% and mortality due to haemorrhage was 2% Conclusions: In our mature trauma system, hemodynamically unstable PRI patients’ low mortality is consistent with the recently reported outcomes of best performing centres.

Background: Accurate diagnosis of native joint septic arthritis (NJSA) and Inflammatory arthropathies for appropriate and timely management. This study presents preliminary findings from the SPECTRAL Biobank evaluating spectroscopy as a rapid, objective method for differentiating NJSA from Pseudogout and Gout. Method: 1-2mL of joint fluid aspirates (JFAs) were collected following microbiological assessment from Northern Health Microbiology Laboratory. Samples were stored and analysed at the Northern Centre for Health Education Research laboratory. Patient demographic/clinical data, including diagnostic results of the JFAs, were recorded. JFAs were analysed utilising Fourier Transform Infrared and Ramen Spectroscopy, whereby each sample generated a unique spectral signature (~60 seconds). Spectroscopy is a non-destructive, chemically label-free, reproducible, and repeatable chemical analysis technology. Prior to analysis, the clinical and/or microbiological diagnosis was recorded for each sample for comparative analysis. Machine Learning Models of the Spectral Signatures were established utilising a) Unsupervised Cluster Analysis (CA) b) Principal Component Analysis (PCA) and c) Partial Least Squares Discriminant Analysis (PLS-DA). Results: More than 225 synovial fluid samples were collected between July 2024 and November 2025, with the following relevant confirmed diagnoses: 30 pseudogout, 41 gout, and 19 NJSA. Post spectral scanning; Machine Learning Models (CA, PCA and PLSDA) showed distinct grouping and clear delineation of Gout, Pseudogout, and Infection compared to one another. Thus, spectroscopic analysis of JFA may be used for rapid diagnostic classification of NJSA and inflammatory arthropathies with a confidence level of 95%. Specificity of NJSA, Pseudogout, and Gout were 98%, 95%, and 100% respectively, while sensitivity was 80%, 88%, and 75%. Conclusion: Spectroscopy shows great promise as an adjunct diagnostic tool, providing rapid and reliable differentiation of joint arthropathies.