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>> A 12 year old girl presented to the emergency department after an inversion injury to her left ankle. She was able to bear weight but had some tenderness at the lateral joint line. X ray imaging showed a discrete, well corticated, bony mass at the distal end of her fibula. She was referred to the on-call orthopaedic team with a presumed fracture. She was treated for her ankle sprain and recovered well. These radiographical findings are typical of an anatomical variant known as an os subfibulare. It is important not to misinterpret this as an avulsion fracture, which would usually have ill defined and irregular borders. Should these accessory bones cause ongoing pain and ankle instability, surgical management is advocated. (This item was first published in the BMJ, 2008;336:1138; patient consent obtained.)¹

Alpesh Kothari specialist trainee year 2
alpesh_kothari@hotmail.com
Jerome A Davidson specialist trainee year 1 Department of Trauma and Orthopaedics, Milton Keynes General Hospital, Milton Keynes MK6 5LD
Student BMJ 2008;: |

>> Scientists have recently confirmed Popeye’s claim that spinach builds muscles (Journal of Agricultural and Food Chemistry 2008 Apr 30; doi: 10.1021/jf073059z). Spinach has long been known to be rich in nutrients such as calcium and iron, but until now its ability to increase strength has never been proved. When placed on samples of human muscle in a laboratory, the chemicals in spinach sped growth by up to 20%. Unfortunately for people looking to follow Popeye’s example, with the hope of increasing muscle mass, the team estimates that humans would have to eat more than 1 kg of spinach every day.

>> From July companies that run cigarette vending machines in Japan will be prosecuted if tobacco is sold to anyone under the legal age limit, 20. To thwart prosecution a vending machine is being developed that counts facial wrinkles and skin sags to check a smoker’s age. People who fail the test will have to show the machine an identity card to establish that they are legally allowed to smoke. Concerns about the accuracy of this method exist, particularly for older smokers who have maintained baby faced looks (http://news.bbc.co.uk, 12 May, “Japanese smokers to face age test”).

>> Spanish teenagers will be encouraged to use a virtual portal through the online virtual world Second Life if they are too embarrassed to speak to a doctor about sexually transmitted disease or a drug problem. A real doctor will log on and offer advice to the anonymous patient, both of whom will see an image of a consulting room with a doctor and a typical patient. Doctors endorse this method of consultation, saying, “Teenagers do not often suffer serious illnesses, but they often expose themselves to risks that can develop into problems in the future” (www.guardian.co.uk, 10 May, “Teenagers to take embarrassing ailments to Second Life doctors”).

>> Research indicates that subcutaneous body fat, particularly on the buttocks, may help to reduce the risk of developing type 2 diabetes, whereas visceral fat raises the risk of ill health (Cell Metabolism 2008;7:410-20). Researchers from Harvard Medical School worked on mice. When subcutaneous fat was moved to the abdominal area, body weight, fat mass, and blood sugar concentrations fell, and the mice became more responsive to insulin. In contrast, moving abdominal visceral fat to other parts of the body had no effect. The researchers concluded that the kind of fat, rather than its location, was the most important variable.

>> Here’s a chance for medical students who are budding writers to write a biography of 5000 words and win £200 (€250; $390). The Society of Medical Writers holds the Roger Bacon biography award every two years, and the closing date for the next one is 1 December 2009. Entry is free, and the biography can be about anyone with medical connections—from family and friends to someone famous. The winning entry will be published in The Writer. Contact Dr Dorothy Crowther, Corner Croft, Lonsties, Keswick, Cumbria CA12 4TD for entry forms.

>> A study has confirmed that sitting for long periods is as dangerous as flying for raising the risk of potentially fatal blood clots (Journal of the Royal Society of Medicine 2008;101:237-43). Office workers who sit at a desk for eight hours a day and spend more than three hours without stretching double their risk of developing deep vein thrombosis, scientists have warned. They advise workers who sit at their computer for most of the day to carry out leg and foot exercises, which are recommended during long haul flights. An estimated one in 2000 people develop the condition each year in Great Britain.

>> Breast feeding needs a lot of effort from mothers, but there is an added incentive: it reduces your risk of rheumatoid arthritis. Compared with women who had never breast fed, women who had breast fed for 13 months or more were half as likely to get rheumatoid arthritis, a recent study has found (Annals of the Rheumatic Diseases 2008 May 13; doi: 10.1136/ard.2007.084707). Women who had breast fed for one to 12 months were 25% less likely to get the disease. Taking oral contraceptives did not seem to be protective and neither was simply having children and not breast feeding.

   

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