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

Gold standard for the management of non-union is open surgical debridement, stabilisation, and autologous bone grafting. LIPUS is becoming more popular, yet the evidence is still inconclusive. LIPUS involves the use of ultrasound at the fracture site with little risk to the patient. The purpose of this study was to assess effectiveness and cost benefit of LIPUS in the management of non-unions post sustaining an open fracture. We retrospectively reviewed 29 patients with open fractures with established non-union undergoing LIPUS since 2010 (4 females, mean age 48) range 3–27 months, mean 9 months, either post injury or last intervention. All were tertiary referrals, sustaining injuries to the following areas; Tibial 21, Femur 6, Humerus 2, Radius 1. Definitive fixation being; 9 TSF's, 11 IMN's, 9 plates. (undergoing a mean 2.4 procedures). Aside from sustaining an open fracture, 7 had risk factors for non-unions 5 smokers, 2 NSAID's. Failure of treatment was based on undertaking bone grafting. In 28 patients (1 lost to follow up) union was achieved in 71% (mean 157 days). All were screened for infection, 4 had organisms on enrichment culture. 8 (5 Gustillo Anderson Grade 3A/B) injuries did not show evidence of callus formation, LIPUS was discontinued and grafting performed. Open fractures were graded as; 7 Grade 1, 4 Grade 2, 8 Grade 3A, 10 Grade 3B being received. Of these; 20 underwent primary closure, 6 free flaps and 3 SSG. The cost of LIPUS is approx £2500, compared bone grafting using autologous iliac crest graft with no medical comorbidities of £3715. This case series further supports union rates after LIPUS. Cost and morbidity benefit of utilising LIPUS over opting for bone grafting initially is £1215 per patient. Whilst autologous bone grafting is currently the gold standard, it is not without morbidity. We achieved union rates of 71% despite a number of patients having recognised risk factors, showing that LIPUS is a useful resource in the management of non-union

Acute osteomyelitis of the radius or ulna in children is rare and may be associated with complications including pathological fracture, growth disturbance and cosmetic problems. Purpose:. To highlight the outcome of acute pyogenic osteomyelitis of the forearm bones in children. Methods:. Eleven children were treated for osteomyelitis of the radius (6) and ulna (5) over 15 years. Staphylococcus aureus was cultured following initial incision and drainage. Two had signs of compartment syndrome. Late complications included gap defects of 2–6 cm (radius 1 and ulna 2). Larger defects with physeal involvement were seen in the distal ulna (4) proximal radius (1) and whole radius (1). The late clinical features included pseudarthrosis (9), distal radioulnar instability (3), radial head dislocation (3) and “radial clubhand” type deformity (1). Treatment:. Gap defects <2 cm were filled with autogenous grafts (3). Segmented iliac crest grafts threaded over a K wire were used in 1 patient with an 8 cm gap defect. Radio-ulnar synostosis was performed in 4 cases. The carpus was centralized onto the ulna in 1 child. Results:. Reconstructive grafts healed by 6–12 weeks. Residual elbow contracture <30° occurred in 3 children. Ten children had improved grip strength and stability of the wrist and elbow and forearm length was decreased by 2–5 cm. The child with a radial clubhand deformity had severe shortening and stiffness of the hand. Conclusion:. Osteomyelitis of the forearm bones can be missed and present late. Complications include disproportionate growth, proximal or distal radio-ulnar instability and radial clubhand type deformity. Treatment is challenging requiring reconstruction of gap defects. Radio-ulnar synostosis is a useful salvage procedure to improve function and cosmesis

Scaphoid injuries remain a challenge in both diagnosis and subsequent management. Untreated scaphoid non-union leads to inevitable osteoarthritis. Non-unions are picked up via an established management pathway in out trust and treated surgically with a standardised technique of non-vascularised bone grafting and retrograde screw fixation. Patients that underwent primary screw fixation and grafting for scaphoid non-union between 2004-2008 were reviewed. These patients were followed up clinically and radiologically. They were assessed for time to union, complications, DASH score, patient satisfaction and return to work. In addition comparison was made between the use of Herbert screw and Twinfix screw fixation and between tricortical iliac crest graft and corticocancellous distal radial bone graft. Forty-two consecutive patients underwent surgery of which 35 (83%) were available for follow up. Mean follow up was 39 months (range 13-72). 31 (89%) patients had gone on to radiological union. Of those united the mean DASH score was 11. Mean time to union was 4.4 months (range 2-15 95% CI 3.3 – 5.5). 95% of patients were satisfied with their operation and would recommend it to a friend in the same situation. No significant difference in outcomes were identified between Herbert screw and Twinfix screw fixation or between iliac crest or distal radial bone grafting techniques. This study has shown encouraging results for an established protocol for management of scaphoid non-union. Outcomes are as a good as any published comparable series in the literature and provide further support to the use of this technique

Introduction. Significant donor site morbidity (3–61%) has been associated with tri-cortical iliac crest bone graft harvesting and reconstruction of the defect has been shown to reduce it. Chitra-HABG (Chitra-Hydroxyapatite-Bio-active glass ceramic composite) is an indigenously developed ceramic which has been evaluated as a bone graft substitute. Aim. To prospectively validate the hypothesis that iliac crest donor site morbidity is a structural issue and reconstructing the crest reduces its incidence. The study also evaluates the efficacy of Chitra - HABG as a material for reconstructing the crest. Methods. 26 cases of iliac crest reconstruction with Chitra-HABG blocks were prospectively evaluated. Outcome measures were donor site morbidity as assessed clinically and radiological assessment for ceramic incorporation, dissolution, fragmentation and migration. Results. At the end of one year from surgery, 25 patients (96.15%) had no donor site pain. Radiological evaluation showed that ceramic incorporation was complete in 21 cases, partial in three and absent in two. Partial dissolution of ceramic was noticed in three patients and migration in one. Conclusion. The present study validates our hypothesis that the donor site morbidity following tri-cortical iliac crest graft harvesting is probably a structural issue and it can be reduced by reconstruction of the defect. It also highlights the fact that the Chitra-HABG block is an excellent material for reconstruction of the iliac crest defect, as it gets incorporated into the surrounding bone without adverse effects. Significance. Study describes a simple and effective method to decrease iliac crest donor site morbidity. Level of evidence: IV. Study Design. Prospective study. Summary. Prospectively evaluate the efficacy of Chitra-HABG blocks for iliac crest reconstruction