We describe a new technique of reconstruction of the deficient acetabulum in cementless total hip arthroplasty. The outer iliac table just above the deficient acetabulum is osteotomised and slid downwards. We have termed this an iliac sliding graft. Between October 1997 and November 2001, cementless total hip arthroplasty with an iliac sliding graft was performed on 19 patients (19 hips) with acetabular dysplasia. The mean follow-up was 3.4 years (2 to 6). The mean pre-operative Harris hip score was 45.1 which improved significantly to 85.3 at the time of the final follow-up. No patient had post-operative abductor dysfunction. Incorporation of the graft was seen after two to three months in all patients. Resorption of the graft and radiolucencies were infrequent. This technique is a useful alternative to femoral head autografting when the patient’s own femoral head cannot be used

1. A technique for bridging bone defects in the forearm with massive iliac graft and medullary nailing is described. 2. The results of fifteen operations are reviewed

To devise an operative approach to the management of acute posterior fracture-dislocation of the shoulder which restores or retains normal proximal humeral anatomy and allows the early restoration of a complete, stable range of motion. Since 1996 we have treated four male patients (five shoulders) aged between 19 and 54 years at the time of first dislocation with autogenous iliac grafting of the anterior humeral head defect for acute and acuteon-chronic posterior dislocation of the shoulder. Two patients had epilepsy: one of these patients had bilateral dislocations. Two patients had motorbike RTAs. The deltopectoral approach with vertical division of the subscapularis tendon was used in all cases. The defects comprised 20– 25% of the volume of the humeral head at the equator after preparation for grafting. Grafts were fixed with compression screws. The subscapularis tendon was repaired anatomically. Active-assisted rehabilitation was started immediately, restricting external rotation to the neutral position for six weeks, thereafter allowing full rotation and elevation as comfort allowed. The patient with bilateral dislocations died of unrelated causes 18 months after surgery. He was reported to have had no further dislocations, complete pain free functional use of both shoulders and no complications of the procedure. The remaining three patients were reviewed at a minimum of 20 months after surgery (average 35 months). All grafts had incorporated. There was no graft collapse or boundary arthrosis. The absolute Constant scores were 85.1, 90.9, and 89.2; the subjective shoulder scores were 98%, 90%, and 99%; the Oxford rating scale for pain scores were 14 out of 60, 13 out of 60, and 14 out of 60; and the Oxford rating scale for instability scores were 14 out of 60, 15 out of 60 and 15 out of 60. There were no redislocations, or complications of the procedures. Posterior stability appears more dependant on surface arc of contact than on capsular integrity, in contrast to the anteriorly unstable shoulder. Restoration of the articular surface arc of contact by segmental autogenous grafting retains normal humeral anatomy, allows normal motion with excellent cuff function, and a return to normal daily activities. The procedure has been shown to be safe at a minimum of 20 months

There is a high risk of the development of avascular necrosis of the femoral head and nonunion after the treatment of displaced subcapital fractures of the femoral neck in patients aged < 50 years. We retrospectively analysed the results following fixation with two cannulated compression screws and a vascularised iliac bone graft. We treated 18 women and 16 men with a mean age of 38.5 years (20 to 50) whose treatment included the use of an iliac bone graft based on the ascending branch of lateral femoral circumflex artery. There were 20 Garden grade III and 14 grade IV fractures. Clinical and radiological outcomes were evaluated. The mean follow-up was 5.4 years (2 to 10). In 30 hips (88%) union was achieved at a mean of 4.4 months (4 to 6). Nonunion occurred in four hips (12%) and these patients had a mean age of 46.5 years (42 to 50) and underwent revision to a hip replacement six months after operation. The time to union was dependent on age with younger patients achieving earlier union (p < 0.001). According to the Harris hip score which was available for 27 of the 30 hips with satisfactory union, excellent results were obtained in 15 (score ≥ 90 points), fair in ten (score 80 to 90 points), and poor in two hips (≤ 80 points). One patient aged 48 years developed avascular necrosis of femoral head six years after operation and underwent total hip replacement.

The management of displaced subcapital fractures of the femoral neck, in patients aged <  50 years, with two cannulated compression screws and an iliac bone graft based on the ascending branch of lateral femoral circumflex artery, gives satisfactory results with a low rate of complication including avascular necrosis and nonunion.

Cite this article: Bone Joint J 2014;96-B:1024–8.

Purpose: The retrospective evaluation of long-term results after reconstructive radial osteotomy for mal-united distal radius fractures.

Material-Method: Twenty-eight patients (21 male and 7 female, average aged 46 years) with 23 dorsal and 5 palmar angulated malunited distal radius fractures were operatively treated during 1994–2002 in our department. The main indications were pain and functional impairment. Dorsal or palmar approach was used in proportion to the site of angulation. The preoperative average radial inclination, radial length and volar or dorsal tilt were 13.5 degrees, 6.3 mm and 23.5 degrees respectively. An open wedge radial osteotomy followed by interposition of trapezoidal iliac crest bone graft and fixation with plate ands crews was performed in all patients four months at least after the initial surgery. An ulnar leveling procedure was considered necessary in 2 patients.

Results: All patients were available in the last follow up evaluation (mean 3.7 years). The functional result according to Mayo wrist score was rated as very good in 15 patients, good in 7 and poor in 6. The average improvement in radial inclination was 14 degrees, in radial length 6.5 mm and in volar or dorsal tilt 21 degrees. The complication rate was 22.7%, including 2 material failures, 1 extensor pollicis longus rupture, 1 nonunion and 3 recurrences of the deformity.

Conclusion: Surgical reconstruction for malunion is technically demanding and may not completely restore the anatomy. Patient satisfaction, however, in terms of increased function, decreased pain and decreased deformity is sufficient high to warrant reconstructive treatment.

Aims. The purpose of this systematic review was to determine the rates of union for vascularized versus non-vascularized grafting techniques in the operative management of scaphoid nonunion. Secondary aims were to determine the effect of the fixation techniques used, the source of grafting, as well as the influence of fracture location (proximal pole) and avascular necrosis (AVN). Methods. A search of PubMed, MEDLINE, and Embase was performed in June 2021 using the Preferred Reporting Items for Systematic Review and Meta-Analyses statement and registered using the PROSPERO International prospective register of systematic reviews. The primary outcome was union rate. Results. There were 78 studies that met the inclusion criteria with a total of 7,671 patients (87.8% male, 12.2% female). The mean age was 27.9 years (SD 3.8) and the mean follow-up was 30.9 months (SD 25.9). The mean union rate was 88.7% (95% confidence interval (CI) 85.0 to 92.5) for non-vascularized grafts versus 87.5% (95% CI 82.8 to 92.2) for vascularized grafts (p = 0.685). Pooled analysis of trial data alone found a mean union rate of 82.4% (95% CI 66.9% to 97.9%) for non-vascularized grafts and 89.4% (95% CI 84.1% to 94.7%) for vascularized grafts (p = 0.780). No significant difference was observed in union rates between any of the fixation techniques used in the studies (p = 0.502). Distal radius and iliac crest graft source had comparable mean union rates (86.9% (95% CI 83.1 to 90.7) vs 87.6% (95% CI 82.2 to 92.9); p = 0.841). Studies that excluded patients with both proximal pole fractures and AVN (n = 14) had a mean union rate of 96.5% (95% CI 94.2 to 98.9) that was significantly greater than the mean union rate of 86.8% (95% CI 83.2 to 90.4) observed in the remaining studies (p < 0.001). Conclusion. Current evidence suggests vascularized bone grafting does not yield significantly superior results to non-vascularized grafting in scaphoid nonunion management. However, potential selection bias lessens the certainty of these findings. The fixation type or source of the graft used was not found to influence union rates either. Sufficiently designed and powered prospective randomized controlled trials in this area are needed. Cite this article: Bone Joint J 2022;104-B(5):549–558

Aims. We hypothesized that there is no difference in the clinical and radiological outcomes using local bone graft versus iliac graft for subtalar distraction arthrodesis in patients with calcaneal malunion. In addition, using local bone graft negates the donor site morbidity. Patients and Methods. We prospectively studied 28 calcaneal malunion patients (the study group) who were managed by subtalar distraction arthrodesis using local calcaneal bone graft. The study group included 16 male and 12 female patients. The median age was 37.5 years (interquartile range (IQR) 29 to 43). The outcome of the study group was compared with a control group of ten patients previously managed by subtalar distraction arthrodesis using iliac bone graft. The control group included six male and four female patients. The median age was 41.5 years (IQR 36 to 44). Results. The mean American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score improved significantly in the study and the control groups (p < 0.001). Fusion was achieved in 27 patients in the study group at a median time of 13 weeks (IQR 12 to 14), while all the patients in the control group achieved fusion at a mean time of 13.2 weeks (11 to 15). The mean talocalcaneal height and talar declination angle improved significantly in both the study and the control groups (p < 0.001). There was no significant difference between both groups concerning the preoperative or the postoperative clinical and radiological measurements. Donor site morbidity was reported in four out of ten patients in the control group. Conclusion. Local calcaneal bone graft can successfully be used to achieve subtalar distraction arthrodesis with appropriate correction of alignment and calcaneal malunion. We recommend using local instead of iliac bone graft as it gave comparable results and avoids the possibility of donor site morbidity. Cite this article: Bone Joint J 2019;101-B:596–602

Background: Bone morphogenetic proteins (BMPs) induce new bone in patients with bone defects and at extraskeletal sites in animals. Standard treatment for symptomatic scaphoid non-unions is bone graft with or without internal fixation by a screw or wires. We tested the ability of human recombinant osteogenic protein-1 (OP-1, BMP-7) with compressed autologous or allogeneic bone graft to accelerate the healing of scaphoid non-union. Study Design: Randomized and controlled pilot study in 17 patients with a scaphoid nonunion. Methods: Patients were randomly assigned to one of three groups: (1) Autologous iliac graft (n=6), (2) Autologous iliac graft + OP-1 (n=6) and (3) Allogeneic iliac graft + OP-1 (n=5). Radiographic, scintigraphic and clinical outcomes were assessed throughout the follow-up period of 24 months. Results: OP-1 improved the performance of both autologous and allogeneic bone implants. Three dimensional helical CT scans and scintigraphy showed that the pre-existing sclerotic bone within proximal scaphoid poles was mainly replaced in OP-1 treated patients with well vascularized new bone. Addition of OP-1 to allogeneic bone implant equalized the clinical outcome with the autologous graft procedure and enabled circumventing the second donor graft harvest procedure resulting in less blood loss, shorter anesthesia and no pain at the donor side. Conclusion: This is the first evidence that a recombinant human BMP accelerates scaphoid bone non-union repair and resorption of sclerotic bone in this specific microenvironment. Clinical Relevance: OP-1 might be successfully used in healing of scaphoid non-union

Purpose of the study: Although the iliac autograft is the gold standard for single-level intervertebral fusion, complications and morbidity related to autologous graft harvesting from the iliac crest remain a point of concern. Bone morphogenic protein (BMP) has proven advantages for fusion of the intersomatic and posterolateral graft. This study compared the efficacy and tolerance of OP-1 compared with an autologous graft in patients with symptomatic spondylolisthesis. This study reports the preliminary results of a prospective randomised controlled trial comparing OP-1 with an iliac autologous graft for instrumented single-level posterolateral fusion for arthrodesis of grade 1 spondylolisthesis. Material and methods: Lamino-arthrectomy associated with a posteriolateral instrumented arthrodesis with an iliac autologous graft or a mixture of OP-1 and local autologous graft material was performed in 27 patients with spondylolisthesis leading to lumboradiculalgia or neurogenic claudication. The final outcome was time to fusion at one year on the scanner and plain x-rays. The Oswestry score and pain at the harvesting site as well as side effects were also noted. Results: The cohort included 27 patients. Three were excluded from the analysis, leaving 24 patients assessed at one year. The demographic data were comparable for the two groups regarding mean age (64 years versus 69 years for the OP-1 group). At one year, ten radiographically certain fusions were noted in the control group and eight in the OP-1 group. Two nonunions and one doubtful fusion were noted in the control group compared with three doubtful fusions in the OP-1 group. The mean Oswestry score was comparable in the two groups. The mean score in the control group improved from 49.5 to 28.5 compared with 45.9 to 29.7 in the OP-1 group. There was no secondary effect attributable to use of OP-1. There were no cases of systemic toxicity, nor heterotopic calcification or restenosis for the 11 patients in the OP-1 group. Conclusion: A fusion rate of 73% without secondary effects attributable to OP-1 was observed in this preliminary study. This study allows the conclusion that this technique is reliable, safe and, in terms of fusion, a valid alternative to autologous iliac crest graft. The main advantage resulting from the use of OP-1 is to avoid the morbidity linked with harvesting the iliac graft

Purpose: Total ankle arthroplasty remains a difficult procedure. Some patients require revision surgery for arthrodesis. Material and methods: We report nine patients with total ankle arthroplasties mainly implanted for post-traumatic osteoarthritis whose results deteriorated, requiring arthrodesis. One of these patients had rheumatoid arthritis. Revision surgery was performed six months to seven years after arthroplasty. Arthrodesis was required for pain related or not to implant loosening or talar necrosis. One patient developed a major deviation of the hind foot secondary to progressive loosening. One patient developed infection early. An iliac graft was used to fill the bone defect in eight patients. An anterior plate-screw fixation was used for six patients, crossed screws for one, a tibiotalar nail for one, and an external fixator for one (with infection). Results: Eight patients achieved bone healing with good pain relief. The functional result depended on the type of arthrodesis: talocrural alone or extended to the torsion couple. Discussion: The evolution of ankle prostheses toward better bone sparing has allowed, in our experience, for revision arthrodesis under relatively good conditions using an iliac graft. We have not preferred one standard type of fixation but the anterior plate fixation has provided excellent stability

Objectives: To evaluate the clinical and radiological outcome following anterior interbody fusion using a femoral cortical allograft packed in the centre with autogenous iliac graft combined with posterior pedicle fixation. Design: A prospective study of 30 consecutive adult patients diagnosed with lumbar degenerative disc disease. Summary of background data: Various fusion options have been described in the literature with various clinical and radiological outcomes. Narrowing of the disc space is thought to be the primary cause of all the potential secondary spondylotic changes; the ideal corrective surgery would be one that reconstitutes the disc space interval. A hybrid graft consisting of a femoral cortical allograft (FCA) ring packed in the centre with autogenous cancellous iliac graft seems to be an ideal option as one should capitalize on the mechanical strength of the cortical ring and the biological strength of the cancellous autogenous graft. Methods: 15 patients with failed back surgery, 15 patients with primary degenerative disc disease. Mean age was 43 years. All patients had preoperative radiographs, MRI scanning, discography was not used in this study. All femoral allografts were processed by freeze drying and sterilized using ethylene oxide. The protocol for surgery consisted of: . * Left sided retroperitoneal muscle splitting approach. * Anterior hybrid interbody grafting. * Pedicle screw fixation without grafting. Results: There were no complications from using the allograft. Intraoperative and postoperative complications were seen in 3 patients. After a minimum follow up of 2 years good clinical outcome was achieved in 83 % using Ricciardi et al criteria, solid fusion was achieved in 98%. Conclusion: The results in this study continue to support the efficacy of using hybrid interbody grafts to achieve a successful fusion, however there is discrepancy between the radiological and clinical outcome which merits additional investigations

Aims: Study our experience and short term results using a mix of osteoconductive (HA) and osteoinductive (AGF) materials. Methods: From October 2001 until June 2002, we have treated bone defects in 9 patients. Seven male and 2 female. Mean age 10.4 years (range 4–18 years). Mean follow-up: 5.6 months (range 3–9 months). AGF was obtained after autologous blood centrifugation according to blood volume, knowing the patient height and weight (Nadler Score). AGF was obtained through previous concentrate of platelets and red cells, with a further concentration, reducing its volume to 1/3. 10 c.c. of thrombin (500 UI) and HA (500R) were added, just before applying it to the patient. Total surgery time for preparation AGF was 20–30 minutes. Clinical cases treated were: varus osteotomy in Perthes (1 case- 11%); curettage in osteomyelitis (2 cases- 22%); essential cyst, after conventional corticoid treatment failure (2 cases- 22%); forearm pseudoarthrosis (2 cases- 23%) and triple arthodesis by valgus pronated spastic foot (2 cases- 22%). We never use autologous iliac graft with AGF- HA. Results: We have obtained radiological and clinical consolidation in all bone defects after 3–4 months. Radiological success is not clear after 4 months in one of the osteomyelitis cases (12’5%). Conclusions: 1. The iliac graft harvest morbility is about 9.4%- 49%. 2. A 2nd approach is avoided in children and adolescents. 3. With the use of AGF- HA we avoid morbility, diseases transmission, reduced surgery time and offer an alternative to autologous grafting

Purpose: Failure of the glenoid component is the main complication of total shoulder prostheses. When surgical revision is necessary, the surgeon has the option of a new implantation or non-prosthetic plasty (glenoido-plasty). The purpose of the present work was to analyse results obtained with these two techniques in order to propose proper indications. Material and methods: This retrospective study included 16 patients, mean age 62 years at revision surgery. Fialures included loosening of a cemented glenoid implant (n=9) and failure of non-cemented implants (3 defective anchors, 4 unclipped polyethylene inserts). Mean time to revision was 39 months (2–178) after primary implantation. A new glenoid implant was cemented in nine patients (group A). Seven patients (group 2) had glenoidoplasty with an iliac graft in four. Results: A mean follow-up of 37 months (19–73), the Constant score had improved from 18 points before revision to 52 points (+34). Two patients experienced a complication requiring a second revision (infection, instability) and one patient underwent subsequent surgery for biceps tenodesis. For the group with glenoidoplasty with iliac graft, insertion of an inverted prosthesis was achieved during a second operative time. In group 1, the mean Constant score at last-follow-up was 63 points (+45) with the pain score of 11, movement score of 29. In group 2, the mean Constant score was 37 (+19) with pain at 6 and motion at 16. In this group, the mean score was 48 points with a glenoid graft and 21 points with simple implant replacement. Discussion: Revision surgery for a failed glenoid implant remains a difficult procedure but can be effective for pain relief and improved motion score. The small number of patients in this series makes it difficult to perform statistical analysis but the results do point in favour of prosthetic reimplantation when the bone stock is sufficient. For other patients, a graft would be preferable to simple implant removal. This would allow secondary revision if possible

Purpose: Meralgia paraesthetica is usually caused by entrapment of the lateral femoral cutaneous nerve (LFCN) at the inguinal ligament. We present our experience with 114 patients who underwent surgical management for meralgia paraesthetica. Material: We reviewed 114 patients (48 men, 66 women, five bilateral cases) who underwent surgery for meralgia paraesthetica between 1987 and 1999; local anaesthesia was used for neurolysis in most cases. We identified five aetiologies: idiopathic (n=69, three bilateral), abdominal surgery (n=19), iliac graft harvesting (n=12, one bilateral), hip surgery (n=7), trauma (n=7, one bilateral). Methods: We analysed outcome at more than two years follow-up for the entire series and by aetiology using a standard 12-point evaluation scale accounting for residual pain, sensorial disorders, and patient satisfaction. Results: The overall results were good, mean score 9/12 (range 1–12). Ninety-two patients were very satisfied or satisfied. Among the 27 patients who were not satisfied, five developed recurrence. Mean time to full pain relief was 70 days (range 1 – 364 days). Recovery of thigh sensitivity was noted at 128 days (range 1 – 364). Discussion: The essential criteria of poor prognosis were duration of the meralgia before surgery and its aetiology. Neurolysis of an LFCN injured by trauma or iliac graft harvesting provided less satisfactory results (scores 7 and 6 respectively) than for idopathic meralgia paraesthetica or abdominal-surgery injury (scores 9 and 10 respectively). Eight of the neurolysis procedures in this series did not provide satisfactory results (score 5). Conclusion: Neurolysis appears to be the surgical treatment of choice for mearlgia paraesthetica. In skilled hands, neurolysis can be performed under local anaesthesia, although certain difficulties can be encountered: obesity, modified anatomy due to prior operations, nerve variability (frequent). Knowledge of these different elements is essential not only to achieve neurolysis but also prevent iatrogenic injury

Purpose: Scaphotrapezotrapezoidal (STT) pain is common but often asymptomatic. Medical treatment may be proposed if symptoms become bothersome. In case of failure, several surgical solutions may be proposed. The purpose of this work was to assess outcome in a series of eleven STT arthrodeses performed for isolated STT osteoarthritis. Material and methods: Ten patients, three men and seven women (11 hands), mean age 63 years, developed STT osteoarthritis which was treated by arthrodesis. All patients experienced pain for daily life activities and had diminished wrist movement. According to the Crosby radiographic classification, three were one grade I, four grade II, and five grade II with carpal misalignmen t. One patient had chondrocalcinosis and six had tendinitis of the flexor carpi radialis. The anterior approach was used for three patients and the lateral approach for seven. Nine patients had an iliac graft to fill bony defects resulting from anterior wear. Pin fixation was used in six cases and staple fixation in five. An antebrachiopalmar cast was maintained for at least six weeks after surgery. Results: At mean follow-up of 62 months, the pain score improved in all patients (p=0.05). There was no significant difference in motion, excepting decreased wrist extension (12°, p=0.03). Grasp and pinch force were not modified by STT arthrodesis. All patients were able to resume their former recreational and occupational activities. There was no worsening of the five cases with intracarpial deaxation. Four patients developed non-union (three pin fixations, one staple fixation), which was symptomatic in only two. These patients underwent successful revision using the same fixation technique. There were no complications. Discussion: Like other series reported in the literature, our series of STT arthrodeses demonstrated effective pain relief. However, unlike former work, we were unable to obtain a significant reduction in the radial inclination force, or radio-carpal conflict. The other therapeutic option is resection of the distal pole of the scaphoid which provides more rapid clinical results but which leads to inevitable misalignment of the carpus. Conclusion: We have decided to retain STT arthrodesis with iliac graft for patients with STT osteoarthritis, especially for young patients

Purpose: Necrosis of the navicular bone, described by Müller then Weiss in 1927, is an uncommon finding, unlike talonavicular degeneration which is a rather frequent complication of talipes planovalgus. Between 1985 and 2000, we cared for 25 patients with this condition. The purpose of this retrospective analysis was to describe the clinical and radiological presentation and attempt to reconstruct its natural history with the aim of determining therapeutic indications. Material and methods: We analysed 25 cases of navicular bone necrosis observed in 14 women and 3 men (eight bilateral cases). Mean age of the patients was 39 years (range 16–59). The diagnosis of necrosis was established on the basis of structural alterations (densification, bone defects) and in the more advanced cases, flattening and “expulsion” of the navicular bone. We looked for clinical signs and described the radiological aspect of the necrotic zone. A computed tomography was available in 14 cases and magnetic resonance imaging in the five most recent cases. Results: Pain was the major sign in all cases. One-third of the cases occurred in a foot with prior planovalgus. History taking revealed elements suggestive of an aetiology in three cases: probable Köhler-Mouchet disease in a 16-year-old boy, sickle cell disease in a 35-year-old man, and prolonged walking with signs suggesting stress fracture in a 40-year-old woman. In the other 19 cases (11 women and 1 man, 7 bilateral cases), necrosis was considered idiopathic. Radiologically, we used the Ficat classification (described for hips): stage 0 with normal x-ray and strong uptake on scintigram (n=1), stage 1 with a normally shaped navicular bone but condensation or bone defect, stage 2 with modification of the shape of the bone without signs of degeneration, stage 3 where changes in the shape of the bone are associated with narrowing of the talonavicular then cuneonavicular space. Computed tomography included frontal and horizontal slices as well as lateral reconstructions indispensable to assess the posterior part of the interarticular spaces. Treatment was surgical in 12 cases and medical in 13. Well tolerated forms were treated with plantar ortheses with regular surveillance. Surgical procedures included triple arthrodesis (early in our experience), mediotarsal arthrodesis (n=2), talonavicular arthrodesis (n=7) and talocuneate arthrodesis with replacement of the scaphoid by an iliac graft (n=2). The natural course of necrosis was studied in the cases without surgery. The first sign was medial mediotarsal pain. At this stage scin-tigraphy or MRI was required for positive diagnosis. At stage 0 condensation of the navicular bone, confirmed by computed tomography, preceded bone flattening then expulsion upwardly and medially, sometimes with fragmentation and onset of talonavicular degeneration. Cuneonavicular degeneration appeared to occur later (except in one case). Long-term results of surgery were good with pain relief and renewed activity. Discussion: The clinical presentation initially described as Müller-Weiss disease or scaphoiditis, which concerns a bilateral condition generally occurring after trauma and sometimes with a favouring factor (alcoholism, osteoporosis), appears somewhat different from our description. Mechanical factors predominated in our patients and the aetiologies were quite similar to those observed in Kienböck syndrome. Excessive pressure on the navicular bone, which leads to avascular necrosis, flattening, and expulsion, is undoubtedly the essential cause of this condition. It is well tolerated in some individuals and can lead to spontaneous fusion. In this situation, treatment can be limited to surveillance or orthopaedic care. If the functional impact is important, surgical treatment can be proposed, generally limited to talonavicular arthrodesis. If the navicular bone is sclerosed and flat, the remaining fragment can be replaced by an iliac graft to achieve talocuneate fusion. Conclusion: Necrosis of the navicular bone appears to be less uncommon than in the classical description, particularly in black women aged 25–50 years. A more precise study of favouring anatomic factors (length of the medial ray, size of the talar neck, depression of the medial arch) could provide further information concerning the aetiology which appears to be similar to that of Kienböck disease

Aims

Reverse total shoulder arthroplasty (rTSA) can be used in complex cases when the glenoid requires reconstruction. In this study, a baseplate with composite bone autograft and a central trabecular titanium peg was implanted, and its migration was assessed for two years postoperatively using radiostereometric analysis (RSA).

To compare the clinical outcomes of instrumented fusion for single level degenerative spondylolisthesis with local bone versus iliac crest bone graft. Fifty patients (32 female, 18 males) operated on by the author over a 3 year period were reviewed. All cases had a single level decompression and instrumented fusion for a degenerative spondylolisthesis. 25 patients had iliac crest graft and 25 had morcelised local bone graft. Patients were followed up for 6 months. Pre and postoperative visual analogue pain scores and Roland disability scores were recorded. Inpatient notes were reviewed for duration of surgery and duration of stay. There was no difference in age, sex and severity of pre operative symptoms between the two groups. There was no significant difference in improvement in Roland score between the two groups but pain scores were lower in the local graft group although this was not statistically significant. Duration of surgery (140 vs 175min) and hospital stay (4.3 vs 5.1 days) were lower in the local bone graft group.6 patients in the iliac crest graft group complained of donor site pain vs none in the local graft group at 6 months. Usage of morcelised local bone graft resulted in clinical outcomes comparable to iliac crest bone graft in patients undergoing decompression and fusion for a single level degenerative spondylolisthesis. Duration of surgery, hospital stay and donor site pain are reduced when local bone was utilised

1. A forty-nine-year-old man had a chondrosarcoma arising from the body of the seventh thoracic vertebra. The tumour protruded into the mediastinum and also into the spinal canal where it displaced the spinal cord. 2. At operation all the seventh thoracic vertebra and parts of the sixth and eighth were removed together with the tumour. The thoracic spine was reconstructed by inserting two iliac bone-blocks between the cut bodies of the sixth and eighth vertebrae and by wiring two strong "A. O." plates to the transverse processes of the third to the sixth and the eighth to the tenth vertebrae. 3. The patient was nursed in a plaster-of-Paris bed for three and a half months. 4. One year and three months after operation, the patient was walking and well, with no signs of recurrence or metastasis. Radiographs showed that a block-vertebra had been created from the iliac grafts and the two cut vertebrae

Background. Medial opening-wedge high tibial osteotomy is one of the common surgical procedures in treatment of knee deformities. Many methods have been proposed to fill the medial side osseous gap. The results of using allograft as void filler compared to iliac crest autograft has not been subject to a randomized clinical trial. The purpose of this study was to examine the results of medial opening-wedge high tibial osteotomy using iliac crest allograft as compared to iliac crest autograft. Materials & Methods. Forty-six patients with genovarum deformity were enrolled based on specific inclusion and exclusion criteria and were randomly assigned into two groups. Medial opening-wedge high tibial osteotomy was done using iliac crest allograft (23 patients) or autograft (23 patients) and the osteotomy site was internally fixed using proximal tibial T-plate. All patients were followed-up to 12 months after surgery. Anatomical indices of proximal tibia, complications of treatment, and functional outcome (using WOMAC osteoarthritis index) were assessed for both groups. Results. The amount of correction (degrees), recurrence of the deformity and loss of correction and time to clinical or radiologic union were similar in both groups with no statistically significant difference. Duration of operation was significantly less in allograft group (66.6±3.6 versus 52.9±5.3 minutes, p<0.001). Incidence of surgical site infection did not significantly differ in two groups. No nonunion or delayed union was encountered in either group. Some patients reported more intense postoperative pain in iliac graft harvest site than tibial osteotomy site. Patients in both groups had statistically significant improvement in WOMAC index postoperatively (with no statistically significant difference between groups). Conclusions. According to the results of this study, iliac crest allograft may be safely used in medial opening-wedge high tibial osteotomy with comparable efficacy to iliac crest autograft in patients who do not accept the morbidity of autograft harvest