Aims

To propose a new method for evaluating paediatric radial neck fractures and improve the accuracy of fracture angulation measurement, particularly in younger children, and thereby facilitate planning treatment in this population.

Background. Acetabular fractures occur as a result of high-velocity trauma and are often associated with other life threatening injuries. Approximately one-third of these fractures are associated with dislocation of the femoral head but there are only few studies documenting the long term outcomes of this group of acetabular fracture. Methods. This was undertaken at the Royal Infirmary of Edinburgh which provides the definitive orthopaedic treatment for all major trauma including all acetabular fractures for the South East of Scotland. We retrospectively reviewed patients who sustained an acetabular fracture associated with a posterior hip dislocation from a prospectively gathered trauma database between 1990 to 2010. Patient characteristics, complications and the requirement for further surgery were recorded. Patient outcomes were measured using the Oxford Hip score and Short Form SF-12 health survey. Results. A total of 99 patients were treated over a 24 year period. The mean age was 41.3 years. The majority were male (75%). Road traffic accidents were the most common mechanism of injury (47%). The most common Letournal & Judet classification was a posterior wall fracture. Complications such as Sciatic Nerve Palsy was 12.1%, DVT 3%, Infection 5%, Heterotopic ossification 6.1%, Avascular necrosis at 11.1% and 19.2% went on to have a total hip replacement. The mean Oxford Score for Native hip was 34.7 and 31.8 for those who converted to hip replacement. SF12 Physical score was was 40.3 and 39 for the native hips and converted hips respectively. And the SF12 Mental score was 45.5 and 44.9 for the native hips and converted hips respectively. Conclusions. This is the first study to present the long term outcomes following an acetabular fracture dislocation. Our study suggests there is considerable disability in this group of patients and the requirement for subsequent THR has inferior patient reported outcomes. Level of Evidence. Cohort study, Level 2B

To assess the outcome of Quadricepsplasty in limb reconstruction for stiff knees, and to analyze the contributing factors. Thirteen patients underwent quadricepsplasty over the last 11-years for severe extension contractures of the knee, in the Limb Reconstruction Service. Ten cases were posttraumatic treated with External fixation, and three were non-traumatic causes, with an average interval between injury and quadricepsplasty of 10 years (range, 2–55). Eight patients had leg lengthening with an average of 6.5cm (range, 3–14), with simultaneous deformity correction. Post-operatively all the patients had continued passive motion except one with a fused hip. Two to six weeks post-operatively, nine patients necessitated manipulation under anesthesia due to noteable loss of movement. Preoperatively the average flexion was 24°(10–40), which improved in the operating room to 98°. After an average follow up of 15 months post-operatively they lost a mean of 18° flexion, with a final flexion 80°. Three patients developed an extension lag of 10° post-operatively. Two had deep infection with unsatisfactory results. Using Judet’s classification, we had 8 (53%) excellent or good, 6 (40%) fair, and one poor (7%) result. The unsatisfactory results were associated with deep infection, long fixator time and a long interval between injury and quadricepsplasty. Quadricepsplasty provides good results for severe extension contraction of the knee. Judet’s technique of disinsertion and muscle sliding addresses the problem of pin site tethering on the lateral side of the femur. Since this procedure is not free of complications and always demands intensive postoperative rehabilitation, it should be reserved for patients with severe extension contraction

Purpose: Appropriate treatment of fractures of the acetabulum is well known but there is a risk of subsequent degeneration. Few reports of series reviewed after ten years are available. We report a series of 136 treated fractures of the acetabulum with a mean follow-up of 16 years. Material and methods: Between 1972 and 1996, a total of 554 fractures of the acetabulum were treated. An independent operator reviewed 136 cases. The Judet Letournel classification was applied. Reduction was studied on the AP and 3/4 oblique views of the pelvis using the SOFCOT (November 1981) criteria. Intra- and postoperative parameters (blood loss, complications) were noted. Functional outcome was assessed with the Postel-Merle-d’Aubigné score. Results: Orthopaedic treatment was used for 38% of the fractures. Forty-one percent were non-displaced and 54% were minimally displaced; 5% of patients had a contraindication for surgery. Reduction was achieved in 28% of the displaced fractures. Among the patients treated orthopaedically, 71% had a good or very good outcome. Anatomic reduction was achieved in 80%. The main complications were sciatic nerve injury (14%), heterotopic ossifications (18%), infection (5%) and intraarticular screws (5%). Good or very good outcome was achieved in 69%. A total hip arthroplasty was implanted in 19% at mean 8 years. Factors significantly related with poor outcome (p< 0.05) were age, posterior displacement, and surgeon experience. There was a good correlation between the function score and radiological signs of osteoarthritis. Discussion: This is the longest follow-up reported in the literature. For operated patients, the percentage of good and very good outcomes was lower than in other series despite a good rate of anatomic reduction which thus is not a guarantee of good long-term outcome. Other prognostic factors found in the literature include fracture of the femoral head, type of fracture, and quality of the reduction. Long term follow-up remains essential for pertinent analysis of joint surgery