The aim of this study was to compare two types of knee arthrodesis.

Fourteen patients underwent arthrodesis of the knee in a single institution. Seven had a customised coupled nail (the Mayday arthrodesis nail), and six had external fixation applied, one patient had both procedures undertaken. Twelve patients had infected knee arthroplasty, one had recurrent dislocation following arthroplasty and one had an infected open meniscetomy. Comparison was made with the external fixation in which only two cases achieved bony union compared with all eight (100%) using the customised nail. Time to bony union was also considerably shorter in the later group, as was the length of hospital stay.

We conclude that a customised intra-medullary nail is a superior method of knee arthrodesis compared with external fixation.

Aim and methods: We present our results on the treatment an outcome of femoral non-unions in our institution as tertiary referral centre. Retrospective analysis was performed using the ASAMI criteria.

Results: 19 patients, 12 men and 7 women were retrospectively assessed. Mean age was 40 years (range 17–72). 11 fractures were in the diaphysiseal area and 8 were in the supracondylar area. 5 cases were infected non-unions. Time from fracture to definitive treatment varied from 5 to 88 months (mean 21 months).

Open technique was used in 18 cases. In 8 cases we have used autogenous cancellous bone graft and in 3 cases BMP7 was used in addition to bone graft. 9 cases were treated with Ilizarov frame without bone graft, 6 with plate and bone graft, 3 with intramedullary nail and 1 with bone graft alone. Internal bone transport was carried out in 5 cases to achieve limb length equality.

Fracture union was achieved in 16 patients with 7 excellent and 8 good results as per ASAMI criteria. 15 cases achieved excellent to good functional results. Because of persistent infection, 2 distal femoral non-unions required transfemoral amputation. Treatment was discontinued due to psychiatric illness in 1 patient with Ilizarov frame. Two of the patients in supracondylar group developed knee stiffness. Pin tract infection is a common complication in Ilizarov group.

Conclusion: Adequate reduction and stabilization is key to success. Non-unions without any complications can be treated with exchange nail or open reduction and plating. Ilizarov method is effective for non-unions complicated by distal location, infection and bone loss. Psychological assessment is important before considering Ilizarov method of treatment.

Introduction Morbidity associated with wound complications may translate into disability and quality-of-life disadvantages for patients treated with radiotherapy (RT) for soft tissue sarcoma (STS) of the extremities. Functional outcome and health status of extremity STS patients randomized in a phase III trial comparing pre-operative versus post-operative RT is described.

Methods One hundred and ninety patients with extremity STS were randomized after stratification by tumor size dichotomized at 10 cm. Function and quality of life were measured by the Musculoskeletal Tumor Society Rating Scale (MSTS), the Toronto Extremity Salvage Score (TESS), and the Short Form-36 (SF-36) at randomization, six weeks, and three, six, 12, and 24 months after surgery. One hundred and eighty-five patients had function data.

Results Patients treated with post-operative RT had better function with higher MSTS (25.8 v 21.3, P < .01), TESS (69.8 v 60.6, P =.01), and SF-36 bodily pain (67.7 v 58.5, P =.03) scores at six weeks after surgery. There were no differences at later time points. Scores on the physical function, role-physical, and general health sub-scales of the SF-36 were significantly lower than Canadian normative data at all time points. After treatment arm was controlled for, MSTS change scores were predicted by a lower-extremity tumor, a large resection specimen, and motor nerve sacrifice; TESS change scores were predicted by lower-extremity tumor and prior incomplete excision. When wound complication was included in the model, patients with complications had lower MSTS and TESS scores in the first two years after treatment.

Conclusions The timing of RT has minimal impact on the function of STS patients in the first year after surgery. Tumor characteristics and wound complications have a detrimental effect on patient function.