Introduction We present our earliest series of computer assisted minimally invasive fixation of intertrochanteric hip fractures using the dynamic hip screw.

Methods The first five cases of computer assisted minimally invasive dynamic hip screw fixation of intertro-chanteric femur fracture are presented. We used the Medivision Computer Navigation system. Our operative techniques, pitfalls and tricks are presented. All were performed in the standard lateral approach to the femur on a traction table. The minimally invasive cases had a incision length of 5 cm compared with an average length of 13.9 cm for the conventional procedure.

Results Technical difficulties in screw placement exists and screw head positions tends to be superior. There was one case of implant cutout. The others recovered uneventfully. Fluoroscopy time is halved, sparing the surgeon from excessive radiation. Operative time is prolonged by about 20 minutes. Patient satisfaction has been very good.

Conclusions Our procedure is safe and predictable. Patient satisfaction is high. The small wound allows for less pain and tissue dissection enabling faster and more effective rehabilitation. The instrumentation is based on the existing DHS system and there is no need to change inventory. The option of day surgery and same day discharges for hip fracture patients using this technique is tantalising.

Experience with thirty-eight Asian children and adolescents who presented with either stiffness of the knee, genu recurvatum, habitual dislocation of the patella or congenital lateral dislocation of the patella showed that all those disorders were manifestations of contracture of the extensor mechanism, which fell into two groups according to the components involved. In Group I the main components affected were in the midline of the limb, namely rectus femoris and vastus intermedius; these patients presented with varying degrees of stiffness of the knee, or worse, with genu recurvatum. In Group II the main components involved were lateral to the midline of the limb, namely vastus lateralis and the ilio-tibial band; these patients presented with habitual dislocation of the patella, or worse, congenital lateral dislocation of the patella. In both groups untreated patients developed secondary adaptive changes such as subluxation of the tibia or marked genu valgum which made operative procedures more formidable and less effective. Release of the contracture should therefore be performed as early as possible.