The National Institute for Health and Clinical Excellence (NICE) guidelines from 2011 recommend the use of cemented hemi-arthroplasty for appropriate patients with an intracapsular hip fracture. In our institution all patients who were admitted with an intracapsular hip fracture and were suitable for a hemi-arthroplasty between April 2010 and July 2012 received an uncemented prosthesis according to our established departmental routine practice. A retrospective analysis of outcome was performed to establish whether the continued use of an uncemented stem was justified. Patient, surgical and outcome data were collected on the National Hip Fracture database. A total of 306 patients received a Cathcart modular head on a Corail uncemented stem as a hemi-arthroplasty. The mean age of the patients was 83.3 years (sd 7.56; 46.6 to 94) and 216 (70.6%) were women. The mortality rate at 30 days was 5.8%. A total of 46.5% of patients returned to their own home by 30 days, which increased to 73.2% by 120 days. The implant used as a hemi-arthroplasty for intracapsular hip fracture provided satisfactory results, with a good rate of return to pre-injury place of residence and an acceptable mortality rate. Surgery should be performed by those who are familiar with the design of the stem and understand what is required for successful implantation.

Cite this article: Bone Joint J 2013;95-B:1538–43.

Purpose of Study We present a method of treating these infected humeral shaft non-unions with an open debridement procedure followed by stabilisation with the Ilizarov frame.

Materials Thirteen infected non-unions of the humerus in adult patients have been treated by this method. Ten patients have completed their treatment and three are still undergoing treatment.

The site of the non-union is approached through the pre-existing scar and any remaining metalwork is removed. The ends of the non-union are mobilised and bone is resected from both ends until there is fresh bleeding. The two bone ends are fashioned such that one will fit as a spike inside the medullary cavity of the other. The bone ends are held in position with two temporary K wires until the frame has been applied.

A standard four ring Ilizarov frame is applied with Rancho pins in the proximal humerus and a half ring in the distal humerus. The temporary K wires are removed and the frame is compressed to increase the contact between the bone ends. The routine hospital stay is one week and the patients are given intravenous antibiotics throughout their admission.

They are reviewed in the outpatient clinic at monthly intervals and the frame is used to compress the bone ends by two to three millimetres on each visit. When there are radiographic signs of union the frame is removed under a general anaesthetic.

Results Nine of the ten patients who have completed their treatment have gone on to union in a mean of 8.25 months with a good functional result. Unfortunately three patients had transient radial nerve palsies.

Conclusions This technique has achieved union and eradication of infection in nine out of ten patients in whom all other forms of treatment had failed.

The validation of a new classification of the external fixator screw-bone interface.

Screw loosening significantly affects the stability of an external fixator, however radiographs are normally taken to assess bone healing and not screw loosening. This study was performed to assess the inter and intra-observer reliability of radiographic features of external fixator screw loosening. Eight observers were shown plain radiographs of 120 external fixator bone-screw interfaces on two occasions, and were asked to grade the screws according to the following features.

Solid screw.

The overall kappa value for this study was 0.29, with the component values ranging from 0.15 to 0.41. To determine if the reliability could be improved, two observers classified 192 digitised radiographs of external fixator screws. On the first occasion the radiographs were shown at a size, brightness and contrast equal to the original film. On the second occasion the radiographs were subjected to image enhancement and magnification. This showed improvement in all the kappa values, the overall value increasing to 0.39, with similar improvements in the component parts. Unfortunately no observations were made of loose screws, therefore, two observers were asked to classify 160 digitised images of screws which were selected with a bias in their outcome, to remain solid or become loose. The observers obtained a kappa value > 0.50 for loose screws.

A classification system for the bone-screw interface is of value both in research and clinical practice. Despite the fact that standard radiographic views were used the classification system described shows satisfactory inter and intra-observer reliability and this improved when digital enhancement was applied.