The primary aim of this study was to determine the outcome of femoral shaft fractures due to gunshot injuries treated with primary intramedullary interlocking nails within 7 days of the injury.

A total of 53 patients were admitted to our institution between November 2003 and November 2005. The average age was 30 years (16–51 years). Associated neuro vascular damage was ruled out by clinical examination, and the patients were then put onto skin traction, given analgesics and tetanus toxoid, and treated with intravenous Cloxacillin 1g 6 hourly. 33 Patients were treated by intramedullary nailing with locking screw fixation at an average of 4 days post injury (range 2–7 days).

All patients were followed up for a minimum of 1 year, and there were no infections. The average time to fracture union was 136 days (120–180 days). The average hospital stay was 9 days. Only 2 patients did not return to their pre-injury activities, and these presented with pain and a limp, requesting disability grants.

We conclude that people sustaining gunshot fractures of the femoral shaft can be treated with intramedullary nailing after the golden 6–8 hours post injury, without the added fear of sepsis. This treatment still leads to a reduced hospital stay, and decreased costs in the management of these patients.

We reviewed eleven diaphyseal humerus fractures treated over an 18 month period, March 2004 to October 2005, using a single intramedullary Titanium Elastic Nail (TEN).

The mean age of 6 boys and 5 girls was 7.6 years. The longest follow up was twelve months. The mean period of implant insertion was 6 months. Diaphyseal fractures were most commonly the result of a fall (45%), and 3 (27%) were the result of motor vehicle accidents (MVA) with other associated injuries. Two (18%) were pathological fractures. All were closed fractures.

Nine of the eleven (81%) were treated by a closed reduction and a single retrograde TEN inserted percutaneously. Two required open reduction. There were no pre-operative or post-operative neurovascular complications. At mean follow up (6 months), there were ten satisfactory results (91%), with one complication of implant sepsis.

The use of TENs for diaphyseal humerus fractures in children has not been widely described in the literature as compared to their use for diaphyseal femoral fractures. Traditional teaching advocates conservative treatment for these fractures. We believe that in 4–12 year old patients, a single TEN is a viable option in the treatment of these fractures in that it gives over-all good results with minimal morbidity. It is easy, quick, allows early return to activities, and avoids some of the complications of conservative treatment such as those associated with prolonged immobilization and malunion.

Congenital pseudarthrosis of the tibia remains difficult to treat. With variable success, children are subjected to many surgical procedures. We review our experience using titanium elastic nails in this condition.

We have treated 10 patients, six boys and four girls. Five had associated neurofibromatosis and pseudarthrosis of the fibula. In seven children, a mean of four previous operations had been done. The mean follow-up time was 4 years.

In our patients, union occurred at a mean of 18 weeks, with a mean limb length discrepancy of 3 cm. The range of movement in the knee and ankle was good.

Our early results are encouraging.

Soft corns between the fourth and fifth toes can be disabling and are sometimes challenging to treat. Aside from shaving of corns by patients themselves, treatment modalities include corn excision with or without flaps, condylectomy, and excision of the base of proximal phalanx of the fourth toe with or without syndactalising the fourth and fifth web space.

Between July 1997 and March 2002, we treated 50 consecutive patients (70 toes) with soft corns. Over 80% of patients had associated hard corns and the rest had hard corns, soft corns and hallux valgus. We performed hemicondylectomy of the proximal phalanx and base excision of the middle phalanx of the fifth toe. Congruency of the proximal interphalangeal joint of the fifth toe was achieved.

The soft and hard corns were not excised and healed within eight weeks. Patients experienced immediate pain relief. One patient developed a painful neuroma and two needed subsequent surgery to the fourth toe. No soft corns recurred.

Proximal phalangeal hemicondylectomy with concomitant excision of the middle phalanx base of the fifth toe is a simple procedure offering immediate and lasting pain relief.

We aimed to assess static and dynamic bone changes in patients with rickets.

Transcortical iliac crest biopsies of 40 hospitalised children with rickets were taken after administration of two cycles of tetracycline 10 days apart to label new bone formation. Histomorphometric analysis was performed on appropriately stained undecalcified sections. Static and dynamic bone changes measured included the volume of bone and osteoid, trabecular and cortical bone dimensions and resorptive and mineralisation activities. We compared the results with normal values and noted the nature of the mineralisation fronts.

Trabecular osteoid volumes of 31 (78%) patients were above the normal range of 1.9% (±. 0.4%). Nine patients (22%) had atrophic osteoid. Of these, five patients were over the age of 20 years and therefore regarded as having osteomalacia and excluded from the series. Of the remaining four patients, one had renal disease, two had rickets associated with kwashiorkor-marasmus syndrome, and in one no cause could be found.

Tetracycline labelling was found more sensitive than subjective evaluation of the mineralisation fronts. Despite a balanced hospital diet, a bone formation rate of zero was found in three patients, indicating a need for vitamin D and mineral supplementation. In seven cases, decreased mineralisation lag times indicated a response to the balanced diet.

This study shows that histological analysis of labelled bone biopsies is helpful not only diagnostically but also in assessing response to management of deficiency states in children.

Between 1993 and 2000 we conducted a prospective study of 50 patients presenting late with ankle fractures. They all had with persistent pain, swelling, ankle deformity and difficulty with walking. Reasons for presenting late included fracture blisters, under-treatment, refusal of surgery and neglect. The mean age of patients was 44.1 years (20 to 82). The mean delay between injury and treatment was 18.4 weeks (4 to 64).

All patients underwent open reduction and internal fixation. Operations were more demanding when done after 24 weeks or in cases of Weber C fractures. Anatomical reduction was achieved in 88% of cases and clinical and radiological deformity corrected in all. All fractures went on to union and patients attained satisfactory motion. There were improvements in pain, swelling and walking. Three cases of deep sepsis were treated with debridement and antibiotics. Ankylosis developed in two patients and arthritis in seven.

The encouraging results suggest that symptomatic, malunited and displaced intra-articular ankle fractures should be treated surgically, even when presented late.