Aims: Operative treatment of trochanteric fractures in patients with below knee amputation on the same limb is a rare and challenging problem. This is difficult not only because of the absence of foot but also due to coexisting medical problems. The aim of this study was to analyse the problems involved in the treatment of this rare problem. Methods: We reviewed 13 such patients being treated at East kent Hospital Trust over 7 years between Nov 1993 and Dec 2000 constituting less than. 026% of total fracture neck of femur patients. All patients were treated by DHS fixation. Six of these had Reverse boot traction applied during surgery and seven of these had upper tibial pin traction. Results: We observed that boot traction is easy and quick method with less complications. Also these patients rehabilitated better than pin traction group. They started using their prosthesis in 3 days as compared to 7 days in pin traction group. Patients in whom Reverse boot technique was used were discharged home earlier (in 14 days as compared to 21 days) than patients who had pin traction applied during surgery. Results: Although this study included a very small number of patients but it is a largest of its type. Based on our results we recommend that reverse boot traction should be used in all such patients.

Aims: Operative treatment of trochanteric fractures in patients with below knee amputation on the same limb is a rare and challenging problem. This is difficult not only because of the absence of foot but also due to coexisting medical problems. The aim of this study was to analyse the problems involved in the treatment of this rare problem.

Methods: We reviewed 13 such patients being treated at East kent Hospital Trust over 7 years between Nov 1994 and Dec 2001 constituting less than .026% of total fracture neck of femur patients. All patients were treated by DHS fixation. Six of these had Reverse boot traction applied during surgery and seven of these had upper tibial pin traction.

Results: We observed that boot traction is easy and quick method with less complications. Also these patients rehabilitated better than pin traction group. They started using their prosthesis in 3 days as compared to 7 days in pin traction group. Patients in whom Reverse boot technique was used were discharged home earlier (in 14 days as compared to 21 days) than patients who had pin traction applied during surgery.

Results: Although this study included a very small number of patients but it is a largest of its type. Based on our results we recommend that reverse boot traction should be used in all such patients.

We studied the arterial anatomy and the effect of four-part fractures on the vascularity of the humeral head, using barium sulphate perfusion of 16 cadaver shoulders. The main arterial supply to the humeral head was via the ascending branch of the anterior humeral circumflex artery and its intraosseous continuation, the arcuate artery. There were significant intraosseous anastomoses between the arcuate artery and: 1) the posterior humeral circumflex artery through vessels entering the posteromedial aspect of the proximal humerus; 2) metaphyseal vessels; and 3) the vessels of the greater and lesser tuberosities. Simulated four-part fractures prevented the perfusion of the humeral head in most cases. If, however, the head fragment extends distally below the articular surface medially, some perfusion of the head persists by the posteromedial vessels. These vessels are important in the management of comminuted fractures of the proximal humerus.

Previous perfusion studies of the rotator cuff have demonstrated an area of hypovascularity in the distal part of the supraspinatus tendon. This has been implicated in the pathogenesis of its rupture. We performed a quantitative histological analysis of the vascularity of the tendons of supraspinatus and infraspinatus. Vessel number, size and the percentage of the tendon occupied by vessels were measured at 5 mm intervals from the humeral insertions to the muscle bellies. Both tendons were hypovascular in their distal 15 mm. No significant difference was demonstrated between the vascularity of supraspinatus and infraspinatus. We conclude that factors other than vascularity are important in the pathogenesis of supraspinatus rupture.