Introduction: Arthrodesis of the knee nowadays is used as a salvage procedure, commonly for patients with a failed TKR or in infected trauma cases. We present 4 patients with extensive bone defects following septic sequelae of trauma treated by Arthrodesis of the knee joint.

Materials and Methods: Four patients (avg. 46.5 years; range 37–57 years; three male and one female) with longstanding infected non-union fractures (3 months–2 years) at the knee joint (three Tibial plateau and one distal femur) were treated by initial debridement and removal of dead or infected bone. This led to substantial bone defects (6–12 cm) of the debrided bone at the knee joint. The patients then underwent bone transport with a circular frame to compensate for this bone defect before achieving an Arthrodesis of the knee joint. Three patients also had a free muscle flap for soft tissue coverage before bone transport was begun.

Results: Arthrodesis of the knee was achieved in all patients at an average time of 26 months (20–32 months). None of the patients have any active infection of the limb.

Discussion and Conclusions: Knutson et al (1984) said that massive bone loss may substantially reduce the success rate of Arthrodesis of the knee. Wilde and Stearns (1989) noted decreased fusion rates with greater degrees of bone loss. In our series the bone defects were a sequelae of infective non-union, this further complicates the healing process. However, using circular frame for Bone transport to overcome the defect and to achieve compression at the Arthrodesis site is a useful technique for such challenging cases.

Introduction: Infected non-union in the forearm is a rare and challenging situation. It can result in persistent deformity, shortening, bone loss, joint stiffness and disability. Secondary procedures are often required for correction of bone defects and deformity. Bone transport may be the only realistic method of treatment.

Case presentation: 56-year-old gentleman referred with an infected non-union of left distal radius. He underwent bone debridement with ilizarov frame application for distraction osteogenesis. After a period of one month, a longitudinal transport wire was inserted through the distal segment to the proximal segment and distraction was carried using this wire. This was supplemented by iliac crest bone graft and OP-1 substitute at docking stage. The frame was removed at 18 months, following which he sustained a refracture. ORIF with bone graft was performed. Finally a good consolidation was achieved. There was about 50% loss in pronation and supination and about 15 degrees short of full extension at the final followup.

Another 57-year-old gentleman referred for an infected non-union of the ulna with a severe bone defect. He was treated with a TSF application and corticotomy for distraction osteosynthesis. There has been a satisfactory progress in the bone transport and recently underwent a docking procedure with bone graft insertion.

Discussion: Post traumatic infected non-union with segmental bone defect in the forearm can be successfully managed with bone transport. Unlike tibia, where this procedure is commonly done, forearm bones have a complex soft tissue envelope which can rule out the use of external transport, especially in the radius. We found the longitudinal wire technique useful for transport of radius. Internal fixation can be used to salvage initial failures, provided that infection and substantial bone defects have been eliminated. This treatment is intensive and difficult for patient and surgeon.

Introduction: Arthrodesis of the knee nowadays is used as a salvage procedure, commonly for patients with a failed TKR or in infected trauma cases. We present 4 patients with extensive bone defects following septic sequelae of trauma treated by Arthrodesis of the knee joint.

Materials and Methods: Four patients (avg. 46.5 years; range 37–57 years; three male and one female) with longstanding infected non-union fractures (3 months–2 years) at the knee joint (three Tibial plateau and one distal femur) were treated by initial debridement and removal of dead or infected bone. This led to substantial bone defects (6–12 cm) of the debrided bone at the knee joint. The patients then underwent bone transport with a circular frame to compensate for this bone defect before achieving an Arthrodesis of the knee joint. Three patients also had a free muscle flap for soft tissue coverage before bone transport was begun.

Results: Arthrodesis of the knee was achieved in all patients at an average time of 26 months (20–32 months). None of the patients have any active infection of the limb.

Discussion and Conclusions: Knutson et al (1984) said that massive bone loss may substantially reduce the success rate of Arthrodesis of the knee. Wilde and Stearns (1989) noted decreased fusion rates with greater degrees of bone loss. In our series the bone defects were a sequelae of infective non–union, this further complicates the healing process. However, using circular frame for Bone transport to overcome the defect and to achieve compression at the Arthrodesis site is a useful technique for such challenging cases.

Introduction: Nonunion of long bone fractures is rare in the skeletally immature. Many of these injuries threaten the survival of the limb and attempts to salvage the limb can only be justified if the ultimate limb function out performs that of a prosthesis. To our knowledge there has been no report of functional outcome following the treatment of such injuries. We report the outcome of a series of patients treated for tibial bone loss and nonunion at average follow-up of 52 months.

Patients and method: Nine children aged 18 months to 17 years were treated. Three patients had established nonunion ranging from 7 months to 6 years, three had bone loss (1–6cm) and three had fractures in which nonunion were anticipated (1 Gustilo IIIb and 2 Tcherne III’s). Five injuries involved the physeal growth plate (2 with partial physeal loss – Peterson VI).

Treatment involved wound excision for open fractures, debridement of devascularised bone and stabilisation with monolateral fixators (2 patients) and circular fixators (7 patients). Five patients had unifocal treatment, four had multifocal treatment (3 bone transports). Duration of non-union or bone loss ranged from 3 to 72 months, average 17 and median 12. Treatment time ranged from 3 to 12 months, and was not related to the complexity of treatment. The longest treatment times occurred when segments of devascularised bone had been left unexcised, a situation we termed “bone loss insitu”.

An independent observer assessed the patients. Functional outcome was measured using the Short Musculoskeletal Assessment Form, a validated outcome assessment tool (Swiontkowski et al. JBJS [A], 1999).

Results: At the latest follow-up (average 52 months), the mean range of knee motion was 3–125° and mean ankle range was 13° dorsiflexion, 35° plantarflexion. Physeal arrest was present in three children (limb length discrepancy 2–4 cm) but with no deformity. Functional outcome revealed a “Dysfunction Index” of 0–19% (ave. 7%) and a “Bother Index” of 0–16% (ave. 6%).

Conclusion: Limb salvage of severe tibial fractures in which nonunion were established or anticipated were worthwhile. Good function can be obtained. The duration of treatment was not related to the complexity of treatment but was increased by leaving sterile but avascular bone unexcised.

We describe a 15-year-old boy with a posterior dislocation of the hip, fracture of the posterior column of the acetabulum and separation of the femoral capital epiphysis. To our knowledge no previous case in a child has been reported. Such high-energy injuries are extremely rare, and a poor outcome is expected.

We advocate early referral to a specialised tertiary centre, and the use of a modification of Delbet’s classification to reflect the complexity and displacement which may occur with this injury.