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

We reviewed 31 patients at a mean of five years after mallet deformity of the finger had been treated with a thermoplastic splint. Intra-articular fractures were present in 35% of patients. Osteoarthritic changes had developed in 48%, most in association with fracture, and 29% had a swan-neck deformity. There was a loss of extension greater than 10° in 35%; the average deficit at the interphalangeal joint was 8.3° and the average flexion arc was 48.5°. Despite these findings, patient satisfaction was generally high, with little evidence of functional impairment

Slipped capital femoral epiphysiolysis (SCFE) is a rare condition with a unknown aetiopathogenesis. An early diagnosis and treatment is essential to minimize premature degeneration of the joint. The authors reviewed the cases treated between 1980 and 2005 in our institution. This study was aimed at evaluating patients with hip epiphysiolysis surgically treated by canullated screws or pinning and previously controlled by short-term follow-up, in order to evaluate radiographic medium/ long term evolution, looking for evidence of degenerative arthritis or femoroacetabular impingement. We performed a retrospective review of the clinical notes and radiographs of all patients with slipped upper femoral epiphysis who were surgically treated at our institution between January 1980 and December 2005. These patients performed radiographs to detect evidence of osteonecrosis, chondrolysis, degenerative arthritis or femoroacetabular impingment. To grade the radiological osteoarthritic changes the grading system of Kellgren and Lawrence was used. These changes were correlated with the existence of femoroacetabular impingement. The radiological results were correlated with the Loder'sclassification of stability and the morphological classification. 43 patients were reviewed, corresponding to 47 treated hips. AP and Lowenstein x-ray views were taken in all patients. The alfa angle and the head-shaft angle were measured in the Lowenstein view (frog-leg). Of 16 patients with impingement only 1 patient didn't present pistol grip deformity. 4 contralateral hips also presented the deformity. The mean alfa angle was 99,4. 43% of the patients with unstable hips have impingment. In stable hips this percentage is of 35%. The Patrick test was positive in 30% of the hips with SCFE and only 17% of the unafected hips. The Kellgren and Lawrence scale was very diferent between trhe SCFE and control groups, with 43% grade 2, 17% grade 3 and 6% grade 4, versus 30% grade 2, 6% grade 3 and 0% grade 4. Some patients show bilateral pistol grip deformity and clinical signs of impingment, despite only having one hip with SCFE

We describe a series of 20 patients with ununited fractures of the femoral neck following neglected trauma or failed primary internal fixation who were seen at a mean of 7.5 months (2 to 18) following injury. Open reduction and internal fixation of the fracture was performed in all patients, together with a myoperiosteal flap on the quadratus femoris muscle pedicle.

Union occurred at a mean of 4.9 months (2 to 10) in all patients. The mean follow-up was for 70 months (14 to 144). There was no further progression in six of seven patients with pre-operative radiological evidence of osteonecrosis of the femoral head. One patient had delayed collapse and flattening of the femoral head ten years after union of the fracture, but remained asymptomatic.

This study demonstrates the orthopaedic application of myoperiosteal grafting for inducing osteogenesis in a difficult clinical situation.