Aim of the study: To evaluate the final outcome following joint distraction and reconstruction in patients with complex knee contractures in a select group with varied aetiology.

Materials and methods: Retrospective study of six patients (nine knees, 3 bilateral) with severe knee flexion contractures treated by gradual distraction using ring fixators. Most cases were syndromic or arthrogrypotic.. Case notes and radiographs were reviewed to assess the mobility and functional range of motion before and after the procedure.

Results: Staged procedures was carried out in 6 out of 9 knees accompanied by soft tissue releases, realignment of extensor mechanism and bony and joint realignment. The average age at operation was nine years and nine months and the mean follow up was 53 months. The average time spent in frame was 20 weeks. The correction was graded as good to excellent in 5 knees, fair in 1 and poor in 3 knees. The total arc of motion remained unchanged though the functional range of movement improved. The mobility improved significantly in most patients who were independent walkers with or without splints. Complications were of rebound phenomenon after frame removal in arthrogrypotic children, transient neuropraxia of common peroneal nerve in 2 epiphyseal separation in one and 3 sustained undisplaced fractures during mechanical distraction.

Conclusion: Syndromic and arthrogrypotic knee contractures are difficult to treat due to their severity and complexity. Planned staged procedures with joint distraction, patellar and bony realignment can produce satisfactory outcome in most making them functional independent ambulators.

This aim of this study is to evaluate the efficacy of the Plant Tan plate, a new implant introduced for comminuted proximal humerus fractures. This paper presents the results of 10 patients who underwent the procedure over a two year period.

Methods : Two and three part proximal humeral fractures continue to be a difficult problem and accurate fixation is necessary for optimum functional outcome.

Ten patient had plant Tan plate fixation for proximal humerus fractures from January 2002 till January 2004. Details including patient demographics, the type of fracture, the bone quality, significant co morbid factors, the surgical approach union rate and complications were noted. Outcome was assessed using the Constant score and comparing with the opposite side and the Oxford shoulder questionnaire.

Results : After an average follow up of 6 months, 80% of the patients were satisfied with the result of surgery at the time of the most recent examination. The union rate was 85 %. The significant complications were infection ( 20 % ) and the development of avascular necrosis (1/10). The screw penetration into the shoulder joint was found to be as high as 50 % though it was not associated with poor result.

Conclusion : The early results of the Plant Tan plate are encouraging with good functional results in most patients. Careful case selection with proper indication, accurate reduction, and subchondral screw placement with purchase in the inferior portion of the humeral head along with early mobilisation should be considered as key factors for better outcome.