Combined bony and vascular injuries present challenging problems to orthopaedic and vascular surgeons. The use of temporary intraluminal vascular shunts produces significant reductions in ischaemia time and allows fracture stabilisation to be performed before definitive, delicate vascular repair. We report our management of a five-week-old infant who sustained a comminuted fracture of the femur with arterial and venous injuries in a shooting incident. Paediatric nasogastric feeding tubes were used as temporary vascular shunts to re-establish the distal circulation. Stabilisation of the fracture was then followed by vascular reconstruction and soft-tissue surgery, with a good result. We emphasise the need for skills from several surgical disciplines in the management of complex combined injuries.

We cultured human osteoblasts from trabecular bone explants and confirmed their phenotype by alkaline phosphatase assay, increased cyclic adenosine monophosphate production in response to prostaglandin E2 and radiographic micro-analysis of nodules of calcification. The osteoblasts were seeded on to demineralised human bone fragments and examined at ten-day intervals over a 50-day period by scanning electron microscopy. During this time the bank bone became progressively repopulated by the cultured osteoblasts. This system may offer a means of graft enhancement in elective orthopaedic and maxillofacial surgery by delivery of cultured autologous human osteoblasts to bone defects.

We performed 20 de la Caffiniere trapeziometacarpal arthroplasties for osteoarthritis occurring only at this joint and reviewed all patients after periods of up to ten years. Eighteen arthroplasties were satisfactory postoperatively, although all 20 patients had a satisfactory range of motion and only one experienced pain after surgery such that it impeded normal function. Failure occurred in two patients and was due to overreaming of the trapezium during surgery and a traumatic dislocation. A radiolucency between the prosthesis and bone was observed in one arthroplasty, although this patient was asymptomatic. We recommend arthroplasty using the de la Caffiniere prosthesis as a satisfactory method of treatment for the osteoarthritic trapeziometacarpal joint.

Augmentation of the acetabular component of total hip replacements is a method of increasing stability and preventing recurrent dislocation. We report a series of mechanical experiments designed to evaluate the turning moments and angles required to dislocate standard, long posterior wall and two different augmented prostheses.