Developmental Hip Dysplasia (DDH) presents considerable technical challenges to the primary arthroplasty surgeon. Autogenous bulk grafting using the femoral head has been utilised to achieve anatomic cup placement and superolateral bone coverage in these patients, but reported outcomes on this technique have been mixed with lack of graft integration and subsequent collapse seen as an early cause of failures. Achieving union and incorporation of the autogenous graft have been identified as key determinants of a successful outcome with this technique. The main factors affecting incorporation are stability of the construct and host-graft bone contact. We describe a novel technique combining the use of bulk autograft with an iliac osteotomy, which provides primary stability and optimises direct cancellous-cancellous bone contact.

21 hips in 21 patients with DDH underwent this technique and were followed for a mean 8.1 years. The pre-operative radiographic classification was Crowe type I in 12 hips (57%), type II in 4 hips, and type III in 5 hips, and the mean Sharp angle was 49.6° (range 42–60°). All grafts united by year. At time of follow up, there was no radiographic evidence of graft collapse or loosening. There were no reoperations.

Our study has shown that this technique variation combining an iliac osteotomy with bulk autograft in cases of developmental hip dysplasia provides early stability and reliable graft incorporation, together with satisfactory clinical and radiological outcomes in the medium term. Longer term study is necessary to confirm the clinical success of this procedure.

Introduction and purpose: To assess the validity of determining polymorphonuclear leukocytes in frozen intraoperative samples for diagnosing infections in hip and knee prosthetic revision surgery.

Materials and methods: We reviewed the 146 revisions (83 hips and 63 knees) carried out between 1996 and 2002. We analysed the polymorphonuclear leukocytes per high-magnification field in frozen intraoperative sections (diagnostic test) and periprosthetic tissue culture (gold standard). We evaluated sensitivity (S), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), Youden index, positive likelihood ratio (PLR) and negative likelihood ratio (NLR). We compared the intraoperative results with the analysis of the same samples embedded in paraffin in the knee group.

Results: In the knee group we found S=66.7% (CI 95%); Sp=89.7% (CI 95%); PPV=81% (CI 95%); NPV=81.4% (CI 95%); Youden index=0.56; PLR=6,5 (CI 95%); and NLR=0.4 (CI 95%). In the analysis of the same samples in paraffin (postoperative) we found S=91% (CI 95%); Sp=87% (CI 95%); PPV=81% (CI 95%); NPV=94% (CI 95%); PLR=7 (CI 95%); NLR=8.7 (CI 95%) (significant differences between the two analyses with p< 0.05). In the hip group we found S=50%; Sp=100% (CI 95%); PPV=100%% (CI 95%); NPV=94.9% (CI 95%); Youden index=0.5; and NLR=0.5 (CI 95%).

Conclusions: The analysis of the validity of the test showed that the presence of polymorphonuclear leukocytes is related to infection, but negative results of the test do not rule out infection. It is a quick, low-cost test that we recommend for inclusion in the diagnostic protocol for hip revision surgery.

Introduction and Objectives: This study was designed to analyze the results of treatment of proximal humeral fractures using the Hoffman external fixator, evaluated using the Neer classification and Constant scale.

Materials and Methods: From January 1987 to June 1996, a total of 53 patients with proximal fractures of the humerus were treated using external fixation. Two of these cases had multiple injuries and died in the intensive care unit (ICU). For this reason, follow-up was done of the remaining 51 cases. There were 34 males (67%) and 17 females (33%). Average age was 52 years (range: 26–80). It is important to note that, of this group, 21 patients had multiple injuries in addition to the fracture of the humerus. There were 7 with craneoencephalic trauma, 11 with thoracic trauma, 3 with abdominal trauma, and 12 with fractures of other extremities. Eleven (20.7%) of the patients required admission to the ICU. Most frequent aetiologies were automobile accident in 31 cases (61%), accidental fall in 15 cases (29%), and other causes in 5 cases (10%). No significant difference was found based on the side that was affected. Fracture types in this study were as follows: Type III displaced fracture, 2 parts: 23 cases (45%); type IV displaced fractures, 3 and 4 parts: 15 cases (27%); type V displaced fractures of 3 and 4 parts: 10 cases (20%); type VI fractures of 3 and 4 parts with anterior luxation, 3 cases (8%) (Table 1). Three fractures were open Grade II or Grade III fractures (Couchoix), and 2 with associated comminuted fractures of the ipsilateral humerus.

Results: Clinical development was assessed in the 51 cases at an average of 20 months after removal of the external fixator (maximum 6 years).

* Pain: Average score 11.3 *Daily-life activities: Average score 14.7 points out of a maximum 20 points; 80% of patients achieved activity similar to pre-fracture levels. * Mobility: Average score was 24.6 out of 40. * Strength: Average score was 17 points. Overall average score for all patients out of 100 points on Constant’s scale was 67.7. Complications included local infection of the wound at the screw site in 4 cases, all of which were proximal screws. Algodystrophy was present in 3 patients. Three patients presented subacromial conflict after consolidation. No surgical iatrogenic injuries to vascular or nervous tissues were noted. Subjective results: Patients showed good acceptance of the external fixator due to the fact that it caused them little incapacity during treatment.

Discussion and Conclusions: External fixation is a quick and simple method which avoids entering the arm and affords similar results. As a minimally-invasive treatment technique, in case of failure, any other method may be used, including replacement arthroplasty, since passive movement of the shoulder is maintained from the beginning.