A clinical and radiological study was conducted on 97 total hip replacements performed for congenital hip dislocation in 79 patients between 1989 and 1998 using a three-dimensional custom-made cementless stem. The mean age at operation was 48 years (17 to 72) and the mean follow-up was for 123 months (83 to 182).

According to the Crowe classification, there were 37 class I, 28 class II, 13 class III and 19 class IV hips. The mean leg lengthening was 25 mm (5 to 58), the mean pre-operative femoral anteversion was 38.6° (2° to 86°) and the mean correction in the prosthetic neck was −23.6° (−71° to 13°). The mean Harris hip score improved from 58 (15 to 84) to 93 (40 to 100) points. A revision was required in six hips (6.2%). The overall survival rate was 89.5% (95% confidence interval 89.2 to 89.8) at 13 years when two hips were at risk.

This custom-made cementless femoral component, which can be accommodated in the abnormal proximal femur and will correct the anteversion and frontal offset, provided good results without recourse to proximal femoral corrective osteotomy.

Introduction. Knee arthrodesis is a limb salvage procedure considered as an alternative to an amputation in case of severely infected total knee arthroplasties, associated with large damage of the extensor mechanism. The techniques are various and the series in the literature not always homogenous. In this study we assessed the results of knee arthrodesis performed with two monolateral external fixators in two perpendicular planes .

Material and methods . This retrospective series of 19 knee arthrodeses was done in 18 patients, which were 65 years old on average. All patients had severe damage on their extensor mechanism associated with an infection of their implant. In all cases the infection was documented and patients were treated by antibiotics during on average 9 months. The first surgical step consisted in a debridement of the knee which was provisionally fixated with the lateral external fixator. The second step consisted in the removal of the infected implant or of the spacer . The bony surfaces were freshened and the anterior external fixator was applied with a compressive effect on the fusion site . Full weight bearing was allowed 45 days after surgery.

Results. Radiological fusion was observed in 17 cases after 4,6 months on average and the external fixators were removed after 8 months on average. Two patients experienced wound healings problems that required additional plastic surgery. Two cases were revised and bone grafting was performed. One patient suffered from malunion at the last follow up ( 7 years in this study).

Discussion. This type of fixation avoids internal fixation in septic conditions. The transquadricipital pins of the anterior fixator are well tolerated. The rigidity of the combination of two monolateral fixators in two perpendicular planes allows quick reloading , which is essential in old patients, often debilitated by numerous procedures.

Conclusion. Arthrodesis is functionally an acceptable alternative to an amputation in these patients. This technique is reliable, has the advantage of avoiding an internal device in an infected knee, of stabilizing the fusion site thanks to the biplanar fixation and of allowing quick weight bearing,.

Using radiography and computer tomography (CT) we studied the morphology of 83 hips in 69 Caucasian adults with osteoarthritis secondary to developmental dysplasia of the hip (DDH). A previously published series of 310 hips with primary osteoarthritis was used as a control group. According to the Crowe classification, 33 of the dysplastic hips were graded as class I, 27 as class II and 23 as class III or class IV.

The intramedullary femoral canal had reduced mediolateral and anteroposterior dimensions in all groups compared with the control group. Only in Crowe class II hips was the femoral neck-shaft angle increased. The proximal femur had more anteversion in all the developmental dysplasia of the hip groups, ranging from 2° to 80°. Templated measurement of acetabular dimensions for plain radiography closely matched measurements taken by CT.

The results of our study confirm the observations previously confined to the Japanese population.

Purpose: Wrist fractures are often seen in elderly subjects who cannot generally tolerate aggressive fixation of unstable fractures. Percutaneous intra-focal pinning (Kapandji) is usually employed. The purpose of this study was to compare the classical treatment of unstable extra-articular fractures of the lower quarter of the radius with posterior displacement with a modified pinning technique.

Material and methods: This prospective radiological study concerned two groups of randomised patients aged 30 – 70 years who were hospitalised for surgical treatment of Pouteau-Colles fractures. In the first group, all patients were treated by the classical intra-focal technique using one or two dorsal pins and one lateral pin (group K). In the second group, all patients were treated by fixation with one or two infrafocal dorsal pins and a third pin inserted transfocally (group KM). Preoperative care, anaesthesia, and postoperative care (21 days immobilisation, pin removal at 45 days) were the same in both groups. The following anatomic measurements were made on the radiographs at day 1, 21, 45, and last follow-up: radial inclination on the lateral and AP views, bistyloid line.

Results: Group K included 49 patients, mean age 45 years. Group KM included 46 patients, mean age 54 years. There was no statistical difference between groups for age, gender, side, type of fracture. Radial inclination on the AP view was 19.2 (10–27 in group KM and 23.2 (19-30) in group. On the lateral view, radial inclination was 0 (−11 to 20) in group KM and −5.7 (−25 to 2) in group K. The proportion of bistyloid lines considered satisfactory was not different between groups.

Discussion: Infra-focal pinning can have limitations for maintaining reduction to bone healing. The Kapandji technique modified by use of a third transstyloid pin appears to provide better stabilisation of unstable fractures of the lower extremity of the radius, particularly in older subjects who cannot tolerate aggressive surgery. This preliminary study should be completed by a radio-clinical analysis in a larger number of patients to confirm these results.