Introduction. The action of the radial head in the stability of the elbow is currently admitted. Its conservation is not always possible in complex fractures. The association with a posterolateral dislocation of the elbow leads to a higher risk of instability of the elbow joint and also at a longer term to degenerative changes. Some authors recommend the use of metallic radial head implant, acting as a spacer. The results seems encouraging but should the resection arthroplasty associated with the repair of the medial collateral ligament be abandoned?. Material and methods. In an amount of 35 consecutive patients who were taken in charge for an elbow dislocation 26 were included in this retrospective study, 13 of them had the association of a dislocation and a fracture of the radial head. In all 13 cases the radial head was considered as inadequate with a conservative treatment and was resected. The patients were assessed clinically according to the American Shoulder and Elbow Surgeons score (ASES) and the Mayo elbow performance index with a mean follow-up of 13 years (ranging from 5 to 15). The degenerative changes were assessed on plan × rays and an additional axial view according to the 4 stages described by Morrey. Results. No redislocation occurred. According to the Broberg/Morrey index 92% of the patients were considered as having a good result. They returned to work with no hindering. Signs of osteoarthritis grade 1 or 2 were observed and were clinically well tolerated. There was no difference for this item between the patients who conserved their radial head and those who sustained a resection. All patients were satisfied although they were protecting their joint against overuse while working. Discussion. The studies about the use of prosthesis of the radial head offer similar functional results. Degenerative changes on the trochleo ulnar joint are identical in all type of treatment. In order to prevent stiffness in the elbow joint an early post operative rehabilitation is recommended, it justifies a surgical stabilization associated with the use of an adapted dynamic splint. Conclusion. In case of elbow dislocation with a fracture of the radial head when its preservation is impossible, the resection without any prosthetic replacement remains a reasonable option if associated with a repair of the medial collateral ligament. At long term the functional results are still good with mild signs of osteoarthritis eliminating ipso facto the problem of an implant survivorship

Introduction. Biomechanical studies have shown that a long, centrally placed screw is favourable in scaphoid fracture fixation. A volar percutaneous transtrapezial approach was developed to facilitate central screw placement. The purpose of this study was to evaluate radiographic changes at the ST-joint at long term follow up in patients where this approach was used. Method. Results were graded with use of the visual analogue scale (VAS) and modified Mayo wrist score. Radiographs of both hands, comprising an anteroposterior, lateral and 45 degrees pronated oblique view were obtained. Degenerative changes at the ST-joint were staged according to the modified Eaton & Glickel classification. Results. 34 patients with an average age of 34 years were followed at a mean of 6.1 years (4–9). Union was obtained in all at an average time of 6.4 weeks (6–10). There were no significant differences in VAS score and ROM, between the operated and nonoperated side (p>0.05). The mean Mayo wrist score was 93 (80–100). Three patients showed stage 2 osteoarthritis of the ST-joint. In 2 patients, stage 2 osteoarthritis was found in both the injured and uninjured side. One patient had asymptomatic stage 2 osteoarthritic changes at the injured side. Discussion. The advantages of the volar percutaneous transtrapezial approach include central screw placement, without the need for manipulation of the wrist. From the present study it can be concluded that the volar percutaneous transtrapezial approach to fix scaphoid fractures does not lead to significant radiographic degenerative changes in the ST joint at a follow-up of more than 6 years

Aims

Open reduction and plate fixation (ORPF) for displaced proximal humerus fractures can achieve reliably good long-term outcomes. However, a minority of patients have persistent pain and stiffness after surgery and may benefit from open arthrolysis, subacromial decompression, and removal of metalwork (ADROM). The long-term results of ADROM remain unknown; we aimed to assess outcomes of patients undergoing this procedure for stiffness following ORPF, and assess predictors of poor outcome.

A total of 14 women and seven men with a mean age of 43 years (18 to 68) who sustained a Mason type IV fracture of the elbow, without an additional type II or III coronoid fracture, were evaluated after a mean of 21 years (14 to 46). Primary treatment included closed elbow reduction followed by immobilisation in a plaster in all cases, with an additional excision of the radial head in 11, partial resection in two and suturing of the annular ligament in two. Delayed radial head excision was performed in two patients and an ulnar nerve transposition in one. The uninjured elbows served as controls. Nine patients had no symptoms, 11 reported slight impairment, and one severe impairment of the elbow. Elbow flexion was impaired by a mean of 3° (. sd. 4) and extension by a mean of 9° (. sd. 4) (p < 0.01). None experienced chronic elbow instability or recurrent dislocation. There were more degenerative changes in the formerly injured elbows, but none had developed a reduction in joint space. We conclude that most patients with a Mason type IV fracture of the elbow report a good long-term outcome

PURPOSE OF THE STUDY. The anterior approach to the thoracic and lumbar spine is used with increasing frequency for various indications. With the advent of prosthetic intervertebral disc replacement, its use has become even more frequent and has often been associated with serious complications. The aim of this study was to evaluate vascular complications in patients who underwent anterior spinal surgery of the thoracic and lumbar spine. MATERIAL. We performed a total of 531 operations of the thoracolumbar spine from the anterior approach. In 12 cases, after exposure of the body of the first or second thoracic vertebrae, we employed the Smith-Robinson technique to expose the cervical spine. We used sternotomy in six, posterolateral thoracotomy in 209, pararectal retroperitoneal approach in 239, anterolateral lumbotomy in 58 and the transperitoneal approach in seven patients. The aim of surgery was somatectomy in 190 patients and discectomy in 341 patients. Sternotomy and transperitoneal approaches were carried out by a thoracic or vascular surgeon and all the other procedures were done by the first author. The indications for spinal surgery included an accident in 171, tumour in 56, spondylodiscitis in 43 and a degenerative disease in 261 patients. METHODS. The Smith-Robinson approach was used for exposure of T1 or T2. Sternotomy was indicated for treatment of T2–T4 and also T1 in the patients with a short, thick neck. Access to T3–L1 was gained by posterolateral thoracotomy, in most cases performed as a minimally invasive transpleural procedure. For access to the lumbar spine we usually used the retroperitoneal approach from a pararectal incision or lumbotomy. We preferred the pararectal retroperitoneal approach in L2–S1 degenerative disease, L5 fractures, and L5–S1 spondylodiscitis. We carried out lumbotomy in patients with trauma, tumors and L1–L4 spondylodiscitis. The transperitoneal approach from lower middle laparotomy was used only in tumors at L5 or L4. The patients were followed up for 2 to 96 months (average, 31.4 months) after anterior spinal surgery. RESULTS. In 12 patients treated by the Smith-Robinson procedure and in six patients undergoing sternotomy, neither early nor late signs of any injury to major blood vessels or internal organs were recorded. The 209 patients with posterolateral thoracotomy were also free from any signs of vascular injury, but trauma to the thoracic duet was recorded in one case. We found injury to major blood vessels in three patients in the group treated by the pararectal retroperitoneal procedure. In the total of 531 anterior spinal surgery procedures this accounts for 0.56 %; of the 304 lumbar operations and 239 pararectal retroperitoneal operations it is 0.99 % and 1.26 %, respectively. In one patient the vascular injury was associated with trauma to the ureter. CONCLUSIONS. The technique of anterior approach is safe only in the hands of experienced spinal surgeons with long experience. In institutions where anterior spinal surgery is not a routine method it is advisable to involve a vascular or cardiac surgeon. However, the most important point is to know when not to operate

We have reviewed 20 women and three men aged 22 to 73 years, who had sustained a Mason type-IIb fracture of the neck of the radius 14 to 25 years earlier. There were 19 patients with displacement of the fractures of 2 mm to 4 mm, of whom 13 had been subjected to early mobilisation and six had been treated in plaster for one to four weeks. Of four patients with displacement of 4 mm to 8 mm, three had undergone excision and one an open reduction of the head of radius. A total of 21 patients had no subjective complaints at follow-up, but two had slight impairment and occasional elbow pain. The mean range of movement and strength of the elbow were not impaired. The elbows had a higher prevalence of degenerative changes than the opposite side, but no greater reduction of joint space. Mason type-IIb fractures have an excellent long-term outcome if operation is undertaken when the displacement of the fracture exceeds 4 mm

Shoulder arthroplasty is the treatment of choice for a range of degenerative diseases. However, long term follow-up suggests almost half of patients graded their treatment as unsatisfactory. Component malalignment is thought the most likely cause. The anterior anatomical neck is used as a reference for the osteotomy. The objective of the study was to analyse the cartilage/metaphyseal interface to identify reference points that may recover version accurately. Twenty-four humeri were scanned using a Microscribe digitiser and surface laser scanner. Modelling software was used to analyse the Cartilage/metaphyseal interface. The retroversion angle was calculated for the normal geometry and for the standard osteotomy. An ideal osteotomy plane was then created for each specimen and the distance from the cartilage/metaphyseal interface determined, identifying points of least deviation. The reference points were used to simulate a new osteotomy for which retroversion was calculated. The novel osteotomy and traditional osteotomy were compared to the normal geometry. The mean retroversion for the normal geometry was 18.5±9.0 degrees. The mean retroversion for the traditional osteotomy technique was 29.5±10.7 degrees, significantly different from the original (p<0.001). The mean retroversion using the novel osteotomy was 18.9±8.9 degrees and similar to the normal geometry (p=0.528). The traditional osteotomy resulted in a mean increase in retroversion of 38%. The increase in version may result in eccentric loading at the glenoid and alter rotator cuff balance. The novel osteotomy resulted in more accurate recovery of head geometry and may improve clinical outcome

To our knowledge in medial unicompartmental knee arthroplasty (UKA) no study has specifically assessed the difference in outcome between matched gender groups. Previous unmatched gender studies have indicated more favourable results for women. Method. 2 groups of 40 of either sex was determined sufficient power for significant difference. These consecutively were matched with both the pre-operative clinical and radiological findings. Minimum follow up of 2 years, mean follow-up 5.9 years. Mean age at operation was 71 years. Results. In both groups, the mean IKS knee and function scores improved significantly (p< 0.001) post operatively. There were no significant differences were between the 2 groups. In both groups mean preoperative flexion was 130 degrees and remained unchanged at final follow-up. No significant differences in preoperative and postoperative axial alignment and in the number of radiolucent lines, between groups. With component size used there was a significant difference (p < 0.001) between the 2 groups. However the size of the femoral or tibial implant used was significantly related (p< 0.001) to patient height for both sexes. Radiolucent lines were more frequent on the tibial component, but were considered stable with none progressing. No revisions for component failure. 1 patient in each group developed lateral compartment degenerative change. Male group; one conversion to TKA for undiagnosed pain, three patients underwent reoperation without changing the implant. Female group; no implants were revised, and two patients required a reoperation. Kaplan-Meier 5-year survival rate of 93.46% (84.8; 100) for men and100% for women. The survival rate difference is not significant (p=0.28). Conclusion. These results suggest that there is no difference in outcome between sexes and that gender should not enter into the selection criteria for UKA. It also suggests that height and not gender is important to predict the appropriate UKA components

Purpose. Evaluation of our experience on the treatment of comminuted, radial head fractures, and of the outcomes of pyrocarbon prosthetic replacement in such cases. Materials and Methods. We evaluated 47 cases of prosthetic replacement, performed from May 2003 to July 2008. There were 18 males and 29 females with an average follow-up of 48 months (12 to 60). The Hotchkiss classification was used to characterize the fractures. The indicators for the procedure were type III fractures in 27 cases, type IV fractures in 10 cases, comminuted radial head fractures (associated with disruption in medial collateral ligament) in 3 cases, Monteggia variant in 5 cases, and Essex Lopresti in 2 cases. Functional outcomes were assessed using the Mayo Elbow Performance Index and the Visual Analog Scales (VAS) of pain, joint motion, and stability. Results. The mean VAS score for elbow pain was 1 (0.5–2.1). Patients showed an average arch of motion from 6 degrees to 140, with 75 degrees of pronation, and 67 of supination. By the Mayo Elbow Performance Index, 42 patients had good to excellent results, 3 fair, and 2 poor. The complications that we have encountered were: implant dislocations (2 cases), elbow stiffness (1), implant dissociation (1), stem rupture (1), and transient PIN palsy (2 cases with complete recovery of nervous function at 5 and 8 weeks). There was no persistent instability, infection, synosthosis, severe degenerative changes, or impingement. Conclusion. The pyrocarbon implants are a good treatment option in complicated, radial head fractures, but the outcome depends on the severity of the initial fracture and the associated lesions. We have also encountered a tendency towards overestimating the prosthesis size, causing restriction of motion, impingement, overstuffing, or dislocation. For these results we are now using the non-modular prosthesis in our center, but further studies are required

Background. The reported outcomes of unicompartmental knee replacement (UKR) for spontaneous osteonecrosis of the knee (SPONK) often derive from small series with an average followup of 5 years, enabling to generate meaningful conclusions. Therefore, we determined the long-term functional results and the 10-years survivorship of the implant in all patients with advanced SPONK of the medial tibio-femoral compartment treated with a unicompartmental knee arthroplasty at our institute. Methods. We retrospectively evaluated 84 consecutive patients with late stage SPONK. All patients received a pre-operative MRI to confirm the diagnosis, to exclude any metaphyseal involvement and to assess the absence of significative degenerative changes in the lateral and PF compartment. Mean age at surgery was 66 years and mean body mass index (BMI) was 28.9. In all cases, SPONK involved the medial compartment; in 77 cases the medial femoral condyle (MFC) was involved, while in 7 cases the pathology site was the medial tibial plateau (MTP). Radiological evaluation was conducted by 3 different radiologists and clinical evaluation according to KSS and WOMAC score was performed by 3 fellows from outside institutions, with no previous clinical contact with the patients, at a mean followup of 98 months. Results. We found a significant improvement in VAS score for residual pain self-assessment and maximum knee flexion (p<0.0001). The 10-year Kaplan-Meier survivorship with revision for any reason as endpoint was 89%. Mean results at final observation point for global KSS and WOMAC score were 87.1 (range 45–100; standard deviation 13.8) and 12 (range 0–44; standard deviation 10.3), respectively. No patient had significant radiographic signs of osteoarthritis progression in the lateral compartment or in the patello-femoral compartment at final evaluation. Conclusions. Our findings suggest that medial UKR performed for late stage SPONK of the medial tibio-femoral compartment in selected patients provides satisfactory long term clinical and radiographical results, with a 10-years Kaplan-Meier survivorship of the implant of 89%

Purpose. compare the radiological results in sagittal balance correction obtained with pedicle subtraction osteotomy (PSO) versus anterior-posterior osteotomy (APO) by double approach in adults. Material and Methods. between January of 2001 and July of 2009, fifty-eight vertebral osteotomies were carried out in fifty-six patients: 9 Smith-Petersen osteotomy (SPO), one vertebral resection osteotomy (VRO), 30 anterior-posterior osteotomies (APO) and 18 pedicle subtraction osteotomies (PSO), being the lasts two groups the sample studied (48 osteotomies). The mean age of the patients was 56.3 years (17–72). Initial diagnose was: 28 posttraumathic kyphosis, 7 postsurgical kyphosis, 7 adult degenerative disease, 4 ankylosing spondylitis and 2 congenital kyphoscoliosis. We evaluated the preoperative standing radiographs, the postoperative and at final follow-up by digital measurements with iPACS system viewer (© Real Time Image, USA, 2001). The mean follow-up was 54 months (6–98), and complications were analized. Results. The group APO had a mean preoperative thoracic kyphosis of 67 °, a mean lumbar lordosis of −42° and a mean sagital balance of 8.6°. The group PSO had a mean preoperative thoracic kyphosis of 41°, a mean lumbar lordosis of −22° and a mean sagital balance of 12.3°. The mean correction in the APO group was 29° in its thoracic kyphosis, 8° of lumbar lordosis and 6.5° in its sagital balance. The mean correction in the PSO group was 12° of the thoracic kyphosis, 25 in the lumbar lordosis and 8.4 cm in the sagital balance. The local correction obtained at the osteotomy level was 28° in the APO group and 25.3° in the PSO group. There were no statistically significant differences in the percentage of correction between both groups (p>0.05). In terms of complications, PSO group had lower complication rate (26.6%) comparing to ODV group (44.5%). Conclusions. APO and PSO are useful techniques to correct the global sagital balance in patients with a disturbance of the sagittal profile. The correction obtained with the PSO is similar to obtained with the APO. Patients undergoing an OSP had a lower complication rate than patients undergoing APO

The purpose of this study was to validate the usefulness of SPECT/CT as an evaluation method for determining treatment and prognosis for patellofemoral cartilage lesions, based on MRI and arthroscopic findings. From August 2009 to February 2010, SPECT/CT was performed on 80 patients (24 male and 56 female, average 53.3 years old) with chronic anterior knee pain who had no degenerative changes or patellar malalignment on plain radiographs. Radioisotope uptake findings on patellofemoral joint from SPECT/CT were classified into three grades by one nuclear medicine specialist. In the patients who demonstrated poor improvements after conservative treatments, MRI and arthroscopy were performed. Patellofemoral cartilage conditions under arthroscopic finding (ICRS grades) were compared with SPECT/CT grading. In all cases, there were increased uptakes on patellofemoral joints. Eighteen cases showed low uptake (Group 1), 22 cases showed medium uptake (Group 2) and 40 cases high uptake (Group 3). At the follow-up examination after mean 1.7 months, 16 cases of Group 1 (89%), 14 cases of Group 2 (64%) and 28 cases of Groups3 (70%) responded positively to the conservative treatments. For those 22 cases showing poor improvement, MRI and arthroscopy were done. Damage or thinning of patellofemoral cartilage, subchondral cyst, edema and fissuring were observed in every case that underwent MRI. Every arthroscopic case was found that there was patellofemoral cartilage damage. Each of ICRS grade I and grade II was found in 2 cases from Group 1. Two cases of grade II, 4 cases of grade III, and 2 cases of grade IV were found in Group 2. Two cases of grade II, 4 cases of grade III, and 6 cases of grade IV were found in Group 3. There was significant difference in the success rate of conservative treatment between SPECT/CT grade 1 and 2 or 3. And there was significant association between SPECT/CT grade and ICRS grade (P=0.034). SPECT/CT could be a useful modality in determining the treatment and prognosis for patellofemoral cartilage lesions compared with MRI and arthroscopic findings

We re-examined clinically and radiologically 88 patients with a fracture of the lower leg at a mean follow-up of 15 years. Forty-three fractures (49%) had healed with malalignment of at least 5°. More arthritis was found in the knee and ankle adjacent to the fracture than in the comparable joints of the uninjured leg. Malaligned fractures showed significantly more degenerative changes. Eighteen patients (20%) had symptoms in the fractured leg. There was a significant correlation between symptoms in the knee and arthritis but not between symptoms and ankle arthritis or malalignment. We conclude that fractures of the lower leg should be managed so that the possibility of angular deformity and thereby late arthritis is minimised

Introduction. Because it typically afflicts older patients with poorer health and/or risk factors, spondylodiscitis can become life threatening. Lingering symptoms, which can be attributed to residual destruction as well as concurrent degenerative changes in the adjacent segments after inflammation has subsided, are frequently present after both conservative and operative therapies. Here, quality of life outcomes are presented for patients two years after operative and conservative treatment. Methods. 82 patients with spondylodiscitis were included prospectively from 01/2008. 28% of patients were treated conservatively (Group 1) and 72% operatively (Group 2). Clinical findings, SF-36, ODI, COMI, and a visual analog scale (VAS) were evaluated and compared between the groups at admission and follow-up (2 year FU). Results. Average patient age was 64.9 ± 6.3 years. Average inpatient hospital stay was 26.5 ± 16.9 days. Neurologic deficits were present in 39.0% of patients preoperatively and 18.3% at FU. Abscess formation was diagnosed in 89.0% of cases and intraspinal abscesses in 43.9%. Hospital mortality was 11.0% and total mortality 14.6% at FU. 6.1% of cases were lost to FU. The preoperative ODI scores averaged 75.4 ± 16.6, and did not vary significantly between the groups. At FU, with 33.9 ± 21.2, average score was significantly better (p<0.001). On the SF-36, preoperative average scores were PCS 25.7 ± 7.1 and MCS 37.3 ± 13.4, and at FU PCS 43.5 ± 10.1 (p<0.05) and MCS 47.7 ± 14.8 (p<0.05). COMI scores also showed significant (p<0.001) improvement (preoperatively 9.2 ± 1.0 and at FU 3.5 ± 2.2). On comparison, patients in Group 2 (VAS 8.3) preoperatively had more pain (p<0.05) than those in Group 1 (VAS 6.3), but there was no significant difference at FU (group 2 VAS 2.5 and group 1 VAS 3.0). Over 90% of operated patients reported that treatment helped, while over 30% of conservatively treated patients said that treatment helped a little or not at all. Discussion. In the pre-antibiotics era, the prognosis for spondylodiscitis was poor. Currently, it can still lead to serious health problems and become life threatening. Quality of life and physical limitations are markedly worse than for the general population. Compared to patients treated conservatively, patients treated with surgery have somewhat improved quality of life and significantly better patient satisfaction

Purpose of the Study. At our Department, we prefer surgical treatment of all patients with Type II and III fractures of the dens, regardless of the age, with the exception of non-displaced fractures or perfectly reduced fractures in young patients. Material and Methods. We treated surgically 28 patients 65 years old and older with dens fractures. The group consisted of 13 men and 15 women with a mean age of 77.4 years (range, 65–90 years). According to the type of treatment, anterior srew fixation or posterior C1–C2 fixation, the whole cohort was divided into 2 groups that were subdivided into two age groups of patients 65–74 years old and 75 years old and older. The age group of patients 65–74 years old included 8 patients with a mean age of 68.5 years and the mean age of the age group of patients 75 and more years old was 81 years. The injury was caused in 22 cases by a fall, in 5 by a car accident. Only in 1 case the injury was caused differently. Neurological deficits were found in three patients, all of them Frankel D type. All patients with injury to the dens underwent radiograph examination in the lateral and transoral projections and CT scan including the sagittal and frontal reconstructions of the atlantoaxial complex and in most cases also MRI examination to eliminate injury to the transverse ligament of the atlas. Based on these examinations, the type of injury was determined and method of treatment indicated. Final retrospective evaluation of the patients was carried out at the interval of 12 to 78 months after the primary surgery (mean 31.3 months) taking into account aetiology of the injury, type of injury, neurological finding, method of treatment, union of the dens fracture line or, where appropriate, C1–C2 fusion, stability of the spine and the final outcome. Statistical analysis was based on X2-test. Results. Comparison of the two age groups showed a statistically significant difference in the mortality (p<0.05), with 0% in the younger group and 40% in the older group. In total, mortality within 6 weeks after the injury accounted for 28.6%. Comparison of surgical techniques revealed 21.4% mortality after anterior screw fixation of the dens and 35.7% mortality after posterior instrumented fusion. The difference was statistically insignificant (p>0.05). Of the 20 surviving patients, 11 were treated with anterior screw fixation and 9 with posterior instrumented fusion. In the two groups there was only one case of nonunion of the dens (9.1%) and one fibrous callus in the region of C1–C2 fusion and the fracture line in the dens (11.1%). The difference was again insignificant (p>0.05). Conclusions. Active surgical treatment conduces considerably to the improvement of the quality of life of elderly patients after dens fractures. Surgical technique should be tailored to the patient's general condition, and osteoporosis and degenerative changes of the spine in particular. Mortality is influenced by the patient's age rather than by the surgical technique used. Elderly patients with a neurological deficit mostly die of associated diseases regardless of the method of treatment

Background. Osteoarthritis of basal joint of the thumb represents one of the commonest degenerative diseases of the hand and wrist region. Depending on the severity of clinical symptoms surgical treatment is often recommended. Resection arthroplasty of the CMC joint with tendon interposition can be regarded as the gold standard. The aim of our study is to compare the Burton Pellegrini technique with a new modified technique of resection arthroplasty with interposition of local capsule tissue. Materials and Methods. We retrospectively evaluated 2 groups of patients. Two Consultant Surgeons took part in the study, one for each group, with each consultant performing trapeziectomies using only one of the techiniques for all his patients. The first group underwent trapeziectomy and local capsule interposition. It consists of 26 patients with a female/male ratio of 20/6, an average age of 64 years (range 53–88), an average follow up of 3.15 years (range 9–1) and a left/right ratio of 16/10. The second group underwent a standard Burton Pellegrini including flexor tendon interposition. It consists of 13 patients with a female/male ratio of 5/8, an average age of 68 years (range 58–85), an average follow up of 4.46 years (range 9–1) and a left/right ratio of 5/8. The outcomes were compared using the Michigan Hand Outcomes Questionnaire. A 2-tailed independent samples t-test was used for the statistical analysis of our data. Results. We found that there is significant difference between the two procedures only on the ability of working in present, t = 2.153 and p = 0.038. However, there is no significant difference between the other parameters we examined: overall hand function, t = 0.237 and p = 0.814; activities of daily living using the operated hand, t = 0.194 and p = 0.847; activities of daily living using both hands, t = 0.184 and p = 0.855; overall activities of daily living, t = 0.204 and p = 0.839; pain, t = 0.123 and p = 0.903; aesthetics, t = 1.063 and p = 0.295; satisfaction, t = 0.628 and p = 0.534; total score, t = 0.509 and p = 0.613. Furthermore, the overall score for the two procedures suggests that there is no significant difference between them. Conclusions. The new modified procedure is simpler and quicker than the traditional operation and avoids the morbidity of tendon harvesting. The overall outcome score for the two operations is equal, suggesting that there is no advantage to the more complex procedure. We have shown a difference between the two procedures in post op working ability, being better in the group with local capsule interposition

The Essex-Lopresti injury (ELI) of the forearm is a rare and serious condition which is often overlooked, leading to a poor outcome.

The purpose of this retrospective case study was to establish whether early surgery can give good medium-term results.

From a group of 295 patients with a fracture of the radial head, 12 patients were diagnosed with ELI on MRI which confirmed injury to the interosseous membrane (IOM) and ligament (IOL). They were treated by reduction and temporary Kirschner (K)-wire stabilisation of the distal radioulnar joint (DRUJ). In addition, eight patients had a radial head replacement, and two a radial head reconstruction.

All patients were examined clinically and radiologically 59 months (25 to 90) after surgery when the mean Mayo Modified Wrist Score (MMWS) was 88.4 (78 to 94), the mean Mayo Elbow Performance Scores (MEPS) 86.7 (77 to 95) and the mean disabilities of arm, shoulder and hand (DASH) score 20.5 (16 to 31): all of these indicate a good outcome.

In case of a high index of suspicion for ELI in patients with a radial head fracture, we recommend the following: confirmation of IOM and IOL injury with an early MRI scan; early surgery with reduction and temporary K-wire stabilisation of the DRUJ; preservation of the radial head if at all possible or replacement if not, and functional bracing in supination. This will increase the prospect of a good result, and avoid the complications of a missed diagnosis and the difficulties of late treatment.

Cite this article: Bone Joint J 2014;96-B:1385–91.

Aims

The treatment of late presenting fractures of the lateral humeral condyle in children remains controversial.

We define the long-term outcomes and rates of further operative intervention following displaced Bennett’s fractures treated with Kirschner (K-) wire fixation between 1996 and 2009. We retrospectively identified 143 patients (127 men and 16 women) with a mean age at the time of injury of 33.2 years (18 to 75). Electronic records were examined and patients were invited to complete the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire in addition to a satisfaction questionnaire. The time since injury was a mean of 11.5 years (3.4 to 18.5). In total 11 patients had died, one had developed dementia and 12 patients were lost to follow-up. This left 119 patients available for recruitment. Of these, 57 did not respond, leaving a study group of 62 patients. Patients reported excellent functional outcomes and high levels of satisfaction at follow-up. Median satisfaction was 94% (interquartile range 91.5 to 97.5) and the mean DASH score was 3.0 (0 to 38). None of the patients had undergone salvage procedures and none of the responders had changed occupation or sporting activities. Long-term patient reported outcomes following displaced Bennett’s fractures treated by closed reduction and K-wire fixation show excellent functional results and a high level of patient satisfaction. The rate of infection is low and similar to other surgical procedures with percutaneous K-wires.

Cite this article: Bone Joint J 2015;97-B:1004–6.