Introduction

There is a drive to reduce length of stay in children undergoing limb reconstruction but a reduction in community physiotherapy input and a consequent pressure to ensure children are as independent as possible prior to discharge. This study aims to look at time taken and potential factors effecting the achievement of pre-set mobility goals and length of stay in this population

Shear plane non unions: biomechanical study and clinical application using an all wire Illizarov frame.

60 degree osteotomy of plastic tibiae were stabilised using four different Ilizarov frame configurations.

Models were loaded and shear displacement measured at the fracture site. The optimum frame design was identified and used in clinical practice.

The transfracture locked olive wire frame model offered the least displacement in the experimental model This frame model was used in two patients with shear plane non unions and both healed satisfactorily Both displacements had previously failed to unite with standard frame constructs.

Transfracture locked olive wire frame design is useful in the treatment of tibial non unions with shear plane.

Aim: To study a staged technique for the removal of the Ilizarov fixator following bony union.

Method: A prospective case series of all fractures treated by the senior author between May 2005 and May 2007 were reviewed. When patients were able to weight bear pain free with radiological evidence of healing, the frames were dynamised initially by loosening the rods across the fracture site, then by removing all rods across the fracture site and finally the frame was removed under general anaesthetic. Patients were followed up for 6 months clinically and radiologically.

Results: Of 39 fractures (38 patients) 37 underwent staged dynamisation. No patients required further, casting, bracing or walking aids after frame removal. There were no incidences of re-fracture, non-union or late mal-union at 6 months follow up.

Conclusion: The proposed method of staged dynamisation is a safe and useful technique for confirming fracture union and guiding frame removal

Aim: To determine the viability and long term survival of a unique Patellar reconstruction technique, using the posterior femoral condyle, at primary TKR, in patients with previous patellectomy.

Methods: The posterior lateral femoral condyle cut during total knee replacement was used as a non- vascularised bone graft to reconstruct the patella. A medial para- patellar incision was used to create a Patellar pouch. The patient was examined clinically at operation, 6 weeks, 12 months, 2 years and 4 years from operation. Clinical examination and radiographic evidence of patellar position and survival were used.

Results: The patient has a stable, well positioned patella, with no pain from the graft and no clinical evidence of Mal- tracking. Radiographs show excellent survival of the graft and good position at 4 years.

Conclusion: Patellar reconstruction using non- vascularised bone graft via a medial patellar pouch is a viable alternative surgical option to aid stability in those patients undergoing primary TKR with previous patellectomy.