Abstract

We hypothesise that the Masquelet induced membrane used for the reconstruction of large bone defects were likely to involve mesenchymal stem cells (MSCs), given the excellent resultant skeletal repair. This study represents the first characterisation in humans of the induced membrane formed as a result of the Masquelet technique.

Introduction

The concept of “bone graft expanders” has been popularised to increase the volume and biological activity of the implanted Material.

Introduction

Clavicle fractures can cause pain and functional impairment if not managed appropriately. This paper evaluates the prevalence of clavicular fractures, estimates number of cases requiring operative treatment, whether removal of implant is a frequent necessity and compares the final functional outcome of the operative and non-operative group.

Introduction: A single hip screw is the recommended method of fixation for slipped upper femoral epiphysis (SUFE). Current practice favours the placement of the screw in the centre of the femoral head on both anteroposterior and lateral planes to avoid the risks of chondrolysis and avascular necrosis (AVN).

Aims: To investigate the correlation between different positions of the screw in the femoral head and the prevalence of AVN, chondrolysis, late slippage, and the time to epiphyseal closure.

Methods: The clinical notes and radiographs of 38 consecutive patients (61 hips), who underwent single screw fixation for SUFE, were evaluated retrospectively with a mean follow up of 36 months. Two way ANOVA and post hoc test was performed to analyse the correlation between the different variables and the outcome, at 5% significance level.

Results: There were 16 acute slips, 18 chronic slips and 10 acute on chronic slips. 17 slips were treated prophylactically. Mild slip was encountered in 39 hips, moderate in 4 and severe in 1 hip. Central-Central position was only achieved in 51% of cases. The most significant results of the study were as follows. I: No significant difference between the time to epiphyseal closure and the position of the screw. II. No late slippage or chondrolysis was observed in our series.

Conclusion: Our results showed that the position of the screw, other than in the centre of the femoral head, has the ability to provide physeal stability and has no correlation with the timing to closure of the epiphysis and the risk of avascular necrosis or chondrolysis. We therefore recommend that other positions be considered if the “optimal central-central position” is not initially achieved specifically for the treatment of mild SUFE as the potential hazards from several attempts to achieve the optimum position outweigh the benefits.

Purpose of study: A single dynamic hip screw is the recommended method of fixation for slipped upper femoral epiphysis (SUFE). Current practice favours placement of the screw in the centre of the femoral head on both anteroposterior and lateral planes. This study investigated screw placement in the femoral head for SUFE and the prevalence of AVN, chondrolysis, late slippage, and time to physeal closure.

Method: Clinical notes and radiographs of 38 consecutive patients (61 hips), who underwent single screw fixation for SUFE, were evaluated retrospectively with a minimum follow up of 24 months (24–56). Two way ANOVA and post hoc tests were performed to analyse the correlation between the different variables and the outcome, at a 5% significance level.

Results: There were 16 acute slips, 18 chronic slips and 10 acute on chronic slips. 17 slips were treated prophylactically. Mild slip was noted in 39 hips, moderate in 4 and severe in 1 hip. A central-central position was only achieved in 50% of cases. No significant difference between the time to physeal closure and the screw position was found. No late slippage, AVN or chondrolysis occurred in this series.

Conclusions: Our results demonstrate that positions of the screw, other than in the centre of the femoral head, provide adequate stability. There is no correlation between screw position and the time to physeal closure, the risk of avascular necrosis or chondrolysis. We recommend that positions other than the “optimal central-central position” be accepted if not initially achieved, especially for mild SUFE. The potential hazards from several attempts to achieve the optimum position outweigh the benefits.