The use of percutaneous Kirschner wires [K-wires] and plaster is a popular method of treatment for displaced distal radius fracture. However, multi-database electronic literature review reveals unsurprisingly different views regarding their use.

From August 2002 till June 2004, 280 distal radial fractures were admitted to our orthopaedic department. They were recorded prospectively in the departmental trauma admissions database. We studied the 87 cases treated with the K-wires and plaster technique. They were classified according to the AO classification system. The mean patient age was 53 [5-88] years. The mean delay before surgery was 7 [0-24] days. We studied the complications reported by the attending orthopaedic surgical team. 48 out of 87 patients [55.1%] were reported to have complications.

We analysed the displacement and the pin tract infection, as they were the main reported complications. 28 out of 87 patients [32%] had displacement [9 had further surgery to correct the displacement, 19 did not have any further surgery as the displacement was accepted]. 11 out of 87 patients [12.6%] had pin tract infection [7 needed early removals of the K-wires and systematic treatment]. Further analysis showed no statistically significant relation between the complications rate and the age of the patients, the delay before surgery or the type of the fractures.

We demonstrate a considerable high displacement and infection rate with the use of K-wires and plaster technique for fixation of distal fracture irrespective of the age of the patients, the delay before surgery or the fracture classification. There are other methods for fixation of the distal radial fracture with proven less morbidity which should be considered.

Introduction: Patients suitable for hip resurfacing are often young, active, in employment and have bilateral disease. One-stage bilateral total hip replacement has been demonstrated to be as safe as a two-stage procedure and more cost effective. The aim of this study was to compare the results of one-stage with two stage bilateral hip resurfacing.

Methods: Between July 1994 and August 2006 a consecutive series of 93 patients underwent bilateral hip resurfacing within a year. 34 patients in the one-stage group. 44 patients in the two-stage group. The age, gender, diagnosis, ASA grade, total operative time, blood transfusion requirements, medical and surgical complications, length of stay, revision and costs were recorded.

Results: There were no significant differences in age, gender, and ASA grade between the two groups. There were 4 minor complications in the one stage group and 5 in the two-stage group. All complications were of a short-term nature. There was no significant difference in the blood transfusion requirements. There was a significantly longer total mean hospital stay of 5 days (95% c.i. 4.0–6.9) for the two-stage group. No patients had undergone a revision. The hospital received a mean of £6338 per patient for the one-stage group and a mean of £9726 per patient for the two-stage group. However, this included a longer total hospital stay, two anaesthetics and on average two extra out-patient appointments.

Conclusions: This study demonstrates no detrimental effects when performing a one-stage bilateral hip resurfacing in comparison to a two-stage procedure. The advantages of the one-stage procedure are that total hospital stay is reduced by a mean of 5 days and the cost is reduced by a mean of £3388 per patient, a 35% reduction of the cost of a two-stage procedure. These benefits do not appear to come at the cost of increase complications.

We report the results of contained bone defects after curettage of benign bone tumours of the distal radius treated without bone grafting or the use of bone substitute. 11 consecutive patients treated with follow-up of 3 to 11 years (mean 5.7 years) were studied. The mean age at diagnosis was 27 (range 11 to 55). There were7 males and 4 females. Histological diagnosis was giant cell tumour in 8 and aneurismal bone cyst in 3 patients. The mean bone defect at diagnosis was 23.7cm3 (9.2 – 68cm3). Pathological fracture was present in 5 patients prior to surgery. We observed full radiological consolidation of the defects in all the patients within 12 months of surgery. Radiologically detectable osteoarthritis was noted in 5 patients (grade 1 in two patients, grade 2 in one and grade 4 in two patients). Development of osteoarthritis was significantly related to size of the defect and involvement of the joint by the original tumour. No patient without joint involvement developed osteoarthritis. There was no relationship between pathological fracture and development of osteoarthritis.

We conclude that contained bone defects in the distal radius do rapidly consolidate without the use of bone grafting or bone substitute. The bone remodels nicely over time. Development of osteoarthritis is related to the damage to the articular defect caused by the tumour.

Purpose of study: Curettage with bone grafting is the accepted method of treating benign tumours of the talus. However, the natural history of ungrafted defects at this site is unknown. We report a series of 8 patients (6 male and 2 female) who underwent curettage of the talus without subsequent bone grafting.

Methods and results: 6 patients had chondroblastoma, one had osteoblastoma and one had an intraosseous ganglion. 4 lesions were located in the talar neck, 3 in the talar dome and one in the talar body. Mean age at presentation was 21.7 years. Mean tumour volume was 16cm3 (range 3.5–48cm3). Post-surgical follow-up was collected at a mean of 35 months (range 5–84 months).

The bone defect consolidated fully, with no talar collapse, in all 8 cases. 5 of the 8 patients had no pain and full range of movement at last follow-up. 4 patients had no evidence of osteoarthritis at last follow-up, 2 patients had OA grade 1, one had OA grade 2, and one had OA grade 3 pre-operatively which then progressed to grade 4. One patient had two episodes of local recurrence which were treated by curettage and bone grafting, then by radioablation.

Conclusion: Our results suggest that curettage alone leads to good consolidation of talar defects without an increase in complications. We conclude that bone grafting is not a necessary adjunct to the curettage of talar lesions.

Patients considered suitable for total hip resurfacing arthroplasty often have bilateral disease. The peri-operative complications, transfusion requirements, hospital stay, outcome and costs in patients undergoing one-stage bilateral total hip resurfacing were compared with a group of patients undergoing a two-stage procedure. A total of 92 patients were included in the study, of which 37 (40%) had a one-stage and 55 (60%) had a two-stage resurfacing. There were no significant differences in age, gender, or American Society of Anaesthesiologists grade between the groups (p = 0.31, p = 0.23, p = 0.13, respectively). There were three systemic complications in the one-stage group (8.1%) and one in the two-stage group (1.8% of patients; 0.9% of procedures). There was no significant difference in the complication rate (p = 0.72) or the transfusion requirements (p = 0.32) between the two groups. The one-stage group had a reduced total hospital stay of five days (95% confidence interval 4.0 to 6.9; p < 0.001), reduced length of time to completion of all surgery of five months (95% confidence interval 2.6 to 8.3; p < 0.001), and the reduced cost was 35% less than that of a two-stage procedure. However, the total anaesthetic time was significantly longer for the one-stage group (p < 0.001; 95% confidence interval 31 to 52).

This study demonstrates that consideration should be given to one-stage surgery for patients with bilateral symptomatic disease suitable for metal-on-metal hip resurfacing. A one-stage procedure appears to have benefits for both the patient and the hospital without additional complications.