Background. Leg length discrepancy (LLD) after intramedullary nailing of femoral shaft fractures is a common problem reported in up to 43% of cases. Comminuted fractures with radiographic loss of bony landmarks have an increased possibility of being fixed with unequal leg lengths. Aims. The purpose of this report is to evaluate the efficacy of routinely obtaining a CT scanogram post-operatively on patients of comminuted femoral shaft fractures treated with intramedullary nailing and immediate correction of limb length inequality if indicated. Results. Twenty one patients with comminuted femoral shaft fractures that were treated with intramedullary nailing and underwent a CT scannogram for evaluation of LLD were included in the study. There were 12 patients with Winquist III and 9 with a Winquist IV fracture pattern. Following surgery leg lengths were measured from the CT scanograms using a computerised measuring ruler. The largest leg length discrepancy noted on scannogram was 4 cm. The average limb length discrepancy was 0.67 cm. Eight patients had a discrepancy of 1cm or greater. We also measured the tibial length in all patients and found only 3 patients with exactly equal tibial lengths. A tibial length discrepancy less than 5mm was observed in 11 patients. In 7 patients it was between 5-9mm and in 3 patients it was 10mm or greater. Four patients underwent leg length correction during the same admission. Conclusion. The decision to undertake correction of the LLD is primarily dependant on the degree of discrepancy. The degree of LLD that requires correction remains undefined. In this study LLD of greater than 15mm was considered for equalisation. Immediate equalisation saves cost, morbidity, delayed sequelae and litigation. Tibial length discrepancy may contribute to the total leg length discrepancy and requires consideration. We recommend a post-operative scanogram costing $380 in patients of comminuted femoral shaft fractures treated with intramedullary nailing

Background. Comminuted radial head fractures are challenging to treat with open reduction and internal fixation. Complicating matters further, radial head fractures are often associated with other elbow fractures and soft tissue injuries. Radial head arthroplasty is a favorable technique for the treatment of radial head fractures. The purpose of this study was to evaluate the functional outcomes of radial head arthroplasty using Modular Pyrocarbon radial head prosthesis in patients with unreconstructible radial head fractures. Methods. This single surgeon, single centre study retrospectively reviewed the functional and radiological outcomes of 21 consecutive patients requiring radial head arthroplasty for unreconstructible radial head fractures between July 2003 and July 2009. Patients were at least one year post-op and completed a Short-Form 36 (SF-36) questionnaire, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and the Mayo Elbow Performance Index (MEPI). These patients were independently physically examined and their post-operative radiographs were independently reviewed. Results. 21 patients (9 males and 12 females) were reviewed at a minimum of 12 months follow-up. The mean DASH score was 10.8 (0-34.1), the mean SF-36 physical score was 76.9 (35-96), the mean SF-36 mental score was 83.8 (60-94), and their MEPI score was 86.4 (70-100). Patients maintained 90% of their grip strength in their injured arm when compared to their un-injured arm and had 17. o. of fixed flexion in the affected arm. Radiologically, 14 cases had some degree of post-traumatic osteoarthritis, 12 cases had evidence of heterotrophic ossification, 5 had some evidence of periprosthetic lucency and 3 of our cases were radiologically but not functionally ‘overstuffed’. Conclusion. Radial Head Arthroplasty with Pyrocarbon Radial Head Prosthesis is a safe and effective option when treating unreconstructable comminuted radial head fractures yielding good functional and radiological outcomes and remains the treatment option of choice at our institution