Frequently, radiological data is transferred verbally between ED/GP/LMO to the Orthopaedic registrar. Given the different medical backgrounds and presentation skills there is often a limit to the verbal description of the radiographs. The aim of this study is to determine the feasibility and benefits of concurrently using picture messaging of X-rays to enhance communication between ED and Orthopaedic Registrars to optimise patient care. The X-rays of 40 patients referred to orthopaedics OPD or admitted from the ED were photographed and retrospectively reviewed on a mobile phone screen (240 × 320) by an orthopaedic registrar along with a printout of the patient history and verbal description of the x-ray as interpreted by the ED staff. No further information was provided to the registrar. A questionnaire was completed to subjectively and objectively evaluate the therapeutic benefit of the image review. Patient(tm)s management was compared to management plans after image review and differences were attributed to the visual inspection of the x-rays on the mobile phone.

Concurrent to the retrospective review, the ED is currently trialling this with a Sony-Erickson K750i. After hours orthopaedic cases are sent via MMS to the registrar prior to consultation. In the emergency department, 10% of patients who presented with a fracture were reviewed in person by an orthopaedics registrar and none were admitted straight from ED whilst two were admitted following review at the OPD. X-rays of 40 patients were reviewed in this study. Twenty-seven patients presented with a fracture and four with islocations.

When the clinical data was reviewed alongside images of x-rays by an orthopaedic registrar, a difference in management plans were observed in 25% of cases and 7.5% where surgical intervention would yield a better result. Twenty-six of the twenty-seven fractures and four dislocations were successfully visualised on the MMS. In 18 cases, picture messaging provided additional information compared to verbal report alone. The limiting factor in picture messaging was the resolution and size of the radiograph. Ease of operation and portability was found to be satisfactory by both ED and Orthopaedic staff. Equipping the ED with the phone has enhanced communication with the orthopaedics department and increased the potential for optimising patient care. This will be formally assessed through questionnaires after 12 months trial of the phone.

Picture messaging is an inexpensive way of utilising technical advancements to improve patient care. Consistent with current literature, the quality of images was not sufficient as a diagnostic tool but rather a screening tool. Picture messaging is valuable practically and educationally and enhances the consultation and teaching process whilst encompassing medical staff who have limited skills in radiological description.

Over the centuries there has been a pattern of order developing from chaos in the behaviour of nations.

The 20th century has demonstrated major conflict between nations, and Defence Health has supported the core activity of the Australian Defence Force (ADF), which has been the aim of military medicine generally in all world defence forces. Preventative medicine and mass casualty treatment, as well as the maintenance of health and return to duty from minor injuries, has been a success for all traditional military medical structures.

It has been known that if the civilian population is supportive of the military effort, this is a significant advantage. The military medical assets directed in this manner to the local civilians builds bridges for lasting peace.

In 1989 the world changed, with the Cold War won and leaving the United States as the only super power. From that time, conflict has tended to be intrastate rather than between sovereign states, with a rise in communal or ethnic conflict. This situation is probably not going to change in the foreseeable future as there are no longer client states being controlled by super powers.

Since that time the Australian Defence Force has been involved in the treatment of indigenous Australian citizens, UN humanitarian missions and disaster relief. In fact the military medical assets of the ADF have been busier in the last 30 years in Military Operations Other Than War than in war itself.

The original concept of the Forward Surgical Teams developed in Adelaide was modular, encompassing a General surgeon, an Orthopaedic surgeon, an Intensive Care specialist and an Anaesthetist, and thus they were able to cover trauma sustained by most combat casualties. This module was man-liftable and able to be deployed by aircraft, by vehicle and also on board ship, augmenting existing medical facilities according to need.

This module in its varying forms has stood the Australian Forces well in Rwanda, Bougainville, East Timor, PNG, disaster relief and Aboriginal health missions.

It may be that further health modules can be developed, such as a Burns module, a Paediatric module and a Primary Care module, building on the increasing medical knowledge base, sub-specialisation and advancing technology. These building blocks can come together to form significant hospitals if necessary.

The ADF has provided first-world medicine and third-world medicine, producing a dichotomy in requirement for medical skills and technology, depending on circumstances. Being busy enhanced our logistical support systems and organisational skills. Medical experience was gained, and the foundation for lasting peace and building communities was established.

If war is considered the greatest social disease left then the pathology of war is in history. The diagnosis is easy but the treatment and prevention difficult.

Early in an emergency the military medical assets of any defence force are able to be deployed under difficult living conditions, and can provide health care for those who have survived the disaster whether it be man-made or natural.

Introduction: This is a report of a new anatomical feature in the knee. This finding to our knowledge has never been described before. The feature consists of a shallow oval impression in the synovium on the femoral surface of the floor of the suprapatellar pouch over the lateral side just before the trochlear entry to the lateral femoral condyle. Clinical correlation was considered to be a separate study and not part of this anatomic description.

Methods: During arthroscopy of the knee the presence or absence of the “entry feature” was noted, entered on a database consecutively and prospectively. All arthroscopies were carried out by the senior author. 21 cadaveric knees (formalin preserved) were dissected.

Results: Out of 457 consecutive knee arthroscopies carried out by the senior author the “entry feature” was present in 294 and not noticed in 163. Histology of the synovium in this region was normal. 21 formalin preserved cadaveric knees demonstrated the “entry feature” in 17 and absent in 4.

Conclusion: We propose the “entry feature” as a new anatomical landmark for the arthroscopic knee surgeon. It gives an initial impression of the patellar position on the synovial floor just before commencing its excursion towards the trochlear.

Repair of large rotator cuff tears can be a demanding technical exercise, particularly when patients are elderly and tissue quality for repair is poor. In 25 patients we have used a method of tying rotator cuff sutures over a screw fixation post at the level of the surgical neck to secure the torn cuff to the greater tuberosity while healing occured. This study reports the results of these patients. 25 patients (27 shoulders) of average age 68.5 years were reviewed at an average of 22 months post surgery (range 3– 52 months). 4 patients (6 shoulders) were workers compensation injuries. The Constant method of shoulder assessment and visual analogue pain scores were used. Constant scores improved from an average of 30.6 pre-operatively to 75.2 post operatively. Pain scores improved from an average of 7.2 pre-operatively to 2.2 post operatively.

Over 80 % of patients reported being very satisfied with the results of their procedure. 2 patients reported being unsatisfied with their procedure. Workers compensation patients had poorer results for pain and function than the group average but still reported good satisfaction with the procedure. 4 complications occurred. 2 patients had re- tears of their cuff after falls. One was repaired with side to side suturing and the other was re-repaired to the post. 1 wound infection occurred requiring arthroscopic shoulder lavage and final removal of the implant.

This shoulder subsequently healed with good function. One patient had significant shoulder pain requiring surgery and removal of the fixation post. There were no other cases of screw irritation and no axillary nerve palsy or deltoid avulsions were found.

Conclusions: This method of fixation is simple, strong, safe and gives results at least equivalent to if not better than other reported methods. The technique is a useful one to have in the surgical repertoire when dealing with large rotator cuff tears in older patients.

We studied the origin of extensor carpi radialis brevis using 40 fresh frozen human cadaver specimens. Ten were stained with haematoxylin and eosin and trichrome which showed the collagenous structure of the extensor tendons at their origin. Gross anatomical observation showed that there was no definitive separation between brevis and communis at the osseotendinous junction. The histological findings confirmed the lack of separation between the two tendons. The extensor tendons were in close proximity to the joint capsule but trichrome staining showed no interdigitation of the tendon with the capsule. The validity of ascribing the pain of lateral epicondylitis to extensor carpi radialis brevis must be questioned. It appears to arise more from the ‘common extensor’ origin.