A method of closed unlocked femoral nailing using only ultrasound guidance from the beginning to end of the operation is described. The method was evaluated as a prospective study in 150 cases of unilateral uncomminuted or very minimal comminuted (Winquist I) femoral shaft fracture who could be operated on within one week. There were 132 males and 18 females whose ages ranged from 16 to 70 years (average, 26). The interval from injury to operation averaged 2.3 days (range, 1–7). Twenty seven cases were Winquist I comminution and 123 cases were non- comminuted fractures. Hundred and forty five cases (97%) were successful with the method with an average operation time of 35.8 minutes (range, 30–50). Of five failure cases; one had nail incarceration, one had accidentally torn flexible reamer and three were not able to pass the guide wire from the proximal femoral canal into the distal femoral canal within ten minutes. The ultrasound which is more available in most hospital and no radiation hazard can be used as an alternative method for monitoring the fracture alignment in closed unlocked femoral nailing with a very high succes rate. This method will be very helpful for the developing country where the C-arm image intensifier is not available.

We have compared the sonographic findings of six femoral fractures with soft-tissue interposition which required open reduction with those of a control group of 40 other femoral fractures. Ultrasound assessment before operation showed that the fractured end of the proximal fragment had penetrated the quadriceps muscle anteriorly while the distal fragment lay beneath it. Transverse scans showed less soft-tissue thickness over the end of the proximal fragment in the problem cases. Radiographic image intensification did not provide any additional information. Ultrasound is of value in demonstrating soft-tissue interposition at the fracture site before femoral nailing.

We used ultrasonography in ten children with pulled elbow to compare measurements of the radiocapitellar distance (RCD) on the affected and the unaffected sides. Similar measurements were made in a group of ten age-matched normal children. The mean RCD in pronation of the affected and normal sides in the patients with pulled elbows was 7.2 mm +/- 0.7 and 3.8 mm +/- 0.5, respectively (p < 0.0001). In the normal children the mean RCD in pronation was 4.5 mm +/- 0.5. We conclude that ultrasonography is of value for documenting pulled elbow in children.

We compared the results in two groups of patients with late reduction of posterior elbow dislocations, one of which had lengthening of the triceps (group A, n = 36) and the other did not (group B, n = 34). The elbows had all been dislocated for more than one month and less than three months. The patients in group B had better clinical results and significantly less postoperative flexion contracture (p < 0.05).

We describe a method of closed, unlocked nailing for femoral fractures using ultrasound instead of an image intensifier. Radiography was used only to confirm that the guide wire had been passed into the intramedullary canal of both fragments. The method succeeded in 26 of 30 cases. The failures all occurred in fractures which could not be reduced within 20 minutes. The operating time in those nailed successfully with ultrasound control was not different from the time for 30 control cases using conventional methods with an image intensifier.

Several methods for the correction of cubitus varus have been described, but most reported series are small and show a high rate of complications. We report a six-year personal experience of 77 osteotomies by a new technique which provides rigid fixation and allows correction of both varus and rotation deformities. It also prevents lateral bulging at the level of the osteotomy. In 58 cases followed up for an average of 16 months, there were no serious complications, a satisfactory carrying angle and no significant loss of movement, giving 88% excellent or good results.