The proper management of radial head fractures is difficult and controversial. The radial head is intra-articular, part of the forearm ring and participates in both flexion and extension as well as in pronosupination. Our main goal in treating those fractures is anatomic restoration of the joint surface and early mobilization. Excision of the radial head, a well described procedure, may result in elbow instability and proximal migration of the radius. In this work we tried to avoid those complications by either conserving the head (ORIF) or by using a Radial head prosthesis.

Material and Methods: 20 Patients were enrolled into the study between 2003–2004. They were divided into 2 groups. 10 patients had ORIF and in patients the Corin Radial head prosthesis was used. Post-op all patients started immediate CPM. All patients were followed-up for 12–28 months (average 18.6). XR were taken each time and clinical examination was done, ROM was noted as well as muscle strength. Elbow stability was tested only on the 2^nd month post op. Patient satisfaction was noted based of their function ability, and the amount of pain. Pain was rated on a scale of 1–10.

Results: Both groups passed the surgery uneventfully. No neurovascular damage nor infection were noted. In clinical examination the elbow was found to be stable in both groups. Decreased ROM in compare with the other elbow was found in both groups, but was more prominent in he ORIF group. One patient in the ORIF group in which biodegradable rod was used developed moderate synovitis that passed without intervention after 9 weeks. XR reveled that one patient in the ORIF group developed Heterotopic ossification, no dislocation or subluxation of the prosthesis was seen. Regarding to pain, in the ORIF group the patients rated their pain as milder in compare to those in the prosthetic group.

Conclusions: Both methods result in stable elbow but the ORIF group showed tendency to experience less pains and the prosthesis group showed tendency to better ROM.

In the last years there has been a new enthusiasm for the use of resurfacing THA. With the experience gained we have learned that there are some absolute and relative contraindications (i.e. inflammatory arthritis, AVN, poor bone stock, sever distortion of thehip anatomy, varus neck, small head). In order to over come those contraindications and in the light of the fact that reliable long-term effectiveness of hip replacement in young active patients remains problematic we have started to use metaphyseal prosthesis. The metaphyseal implant minimizes bone resection, violets less the native bone of the proximal femur, has favorable remodeling characteristics and facilitate revision once needed. Due to its small size and the varus orientation limited or minimal approach is easy and safe.

Material and methods: The Mayo Conservative hip was used in 65 patients during the years 2000–2005. 3 patients were lost to follow-up and were not included. Avrage age was average 44.6. The basic etiology was osteoarthritis (38), AVN (12), RA (4), DDH (4), distorted proximal femur (2) and revision after failed resurfacing THA (2). Follow-up was 6–58 months (average 45.2). XR were taken each time and clinical examination was done, gait pattern was noted as well as ROM and muscle strength Patient satisfaction was noted based on their function ability, using of waking aids and the amount of pain.

Results: We had 2 cases of intraoperative proximal femur crack that were treated with tension wire; no other intraoperative complication was noted. None of the patients developed infection and no one had dislocation. Pain was reduced from sever in all patients to mild or none in 90% (56/62), moderate in 8% (5/62) and sever in one patient (2%). Pre operative ROM was reduced and painful. Painless, near normal ROM was achieved in all patients and only 5 needed walking stick (all of them between 6–12 month post operative). Follow-up XR showed no sign of bone subsidence or loosening

Conclusions: Metaphyseal prosthesis can be a good alternative to resurfacing arthroplasty. Our experience show that the procedure is safe and medium term results are good to excellent.

Introduction: Historically Surface Replacement of the Hip exhibited a high failure rate due to femoral head loosening attributed to polyethylene wear debri, originating from the acetabulum. A metal on metal bearing resurfacing prosthesis has been developed to address this problem.

The authors’ early experience using this prosthesis is presented.

Material and methods: 48 patients underwent metal on metal hip Resurfacing Arthrolplasty (Cormet 2000R Corin U.K.) of the hip between 1999–2001. 43 patients suffered from osteoarthritis and 3 from avascular necrosis.

29 males and 19 females underwent the procedure with a mean age of 60 years (45–74).

In 20 hips a posterior approach was used and in 28 our saggital trochenteric osteotomy.

A cementless prosthesis was implanted in 30 patients and the femoral prosthesis was cemented in 18 patients.

Results: All but two patients had an improved hip score with 95 % of the patients reporting a good to excellent result. There were 2 femoral neck fractures one early and one late. One patient had severe heterotrophic ossification and one a transient partial sciatic nerve palsy.

Discussion: Conservative Hip Arthroplasty with Femoral Head and acetabular resurfacing is an attractive concept. Violation of the upper femoral canal is prevented and bone stock is preserved. Improved applications of metallurgical and tribological principles increases the predictability of metal on metal bearing surface function and prevents the catastrophic polyethylene wear previously observed in hip resurfacing procedures.

The principles of metal on metal bearing surfaces, Resurfacing Arthroplasty of the hip and the early clinical results and complications are discussed.

Fractures of the proximal humerus occur predominantly in the elderly patient population. There has been a tendency over the last 15 years to perform surgical procedures to reduce and hold these fractures while the bone and soft tissue heal. The osteoporotic nature of the bone does not allow adequate fixation of the bone and therefore fixation techniques are inadequate to allow optimal soft tissue rehabilitation.

A study was performed to observe the results of non-surgically treated displaced fractures of the proximal humerus in the elderly.

The encouraging results are presented and discussed.

Non-surgical management of displaced fractures of the proximal humerus achieves a good functional shoulder although not normal in this predominantly sedentary population. The question arises as to quality of function after surgical management of these difficult fractures compared to non surgical management and if surgical management is indicated in these elderly usually frail patients with low demand from their shoulders.

Introduction: Polyethylene wear of the prosthetic knee tibial component is currently the main cause of medium and long term failure of total knee arthroplasty. The use of a mobile bearing knee prosthesis is intended to decrease the rate polyethylene wear and therefore delay medium and long term failure. We present our five year clinical results of a mobile bearing knee prosthesis.

Material and methods: 150 mobile bearing knee arthroplasties implanted between 1993 and 1996 in our institution were followed. 15 knees were lost to follow up. All knees followed up were operated on for osteoarthritis.

The British Orthopaedic Association knee function score was used to access the clinical results and the Knee Society Radiographic evaluation was used for radiological evaluation.

Results: 33% of patients achieved an excellent result, 52% a good result, and only 3% were not satisfied with the end result.

Flexion was greater than 90 degrees in 97% of the patients.

Three knees required re-surgery, 1 for deep sepsis, 1 for patello femoral problems and 1 for a fractured polyethylene component.

No knee required revision for polyethylene were or loosening.

Conclusions: Our mid term results are comparable to those of other prosthesis both mobile and fixed bearing knees as far as revision and radiological and functional scores are concerned. We noted that patient satisfaction in the face of good radiological and functional scores is less than would be expected.

Thirty-two dysplastic hips with secondary osteoarthritis, in 28 patients aged 18 to 42 years, were treated by combined intertrochanteric and Chiari osteotomy. They were followed up for 2.5 to 10 years. Pain was the main presenting symptom in all the patients. The indication for surgery was based on the severity of disease with respect to congruency, secondary degenerative change and degree of dysplasia. The average pre-operative Harris hip score was 47.7 and the majority had severe dysplasia with degenerative changes. On final review the average score was 88. The radiographic appearances of degenerative arthritis regressed in 72% of hips and dysplasia was improved in all cases. The results of this conservative form of surgery are better in hips with less severe dysplasia and mild secondary degenerative change.

In a prospective study of 132 patients with an average age of 35 years, unstable intra-articular fractures of the distal radius were treated by external fixator. Only 15 cases required limited open reduction. Follow-up was for a mean of 42 months. There were few complications and 83% of patients had good or excellent results. There was a statistically significant correlation between the severity of the fracture and the clinical outcome, irrespective of radiological restoration. Articular and soft-tissue damage following violent compressive forces may lead to a degree of functional impairment.

We present a new method of trochanter stabilisation designed for use in difficult revision hip arthroplasties. A fixator is secured to the metaphysis of the femur, and its two malleable prongs encompass the trochanter fragment and stabilise it using the tension band principle. The fixator is versatile, simple to apply and has better mechanical properties than any technique using wires. We reviewed 49 revisions after a mean follow-up of 40 months. Patients had been mobilised early, but there were no detachments or displacements from the initial postoperative position. Although 31% of patients were osteoporotic and 16% had poor trochanter fragments, there was bony union in 46 of the 49 hips, the remaining three developing stable fibrous union.

A total of 138 revision hip arthroplasties in 134 patients, all operated upon by one surgeon, were followed for an average of 7.4 years. The overall results were reasonable, with good to excellent Mayo hip scores in 62% and little or no pain in 86%. These results were independent of body weight, age, primary diagnosis and type of arthroplasty used. The incidence of radiological loosening was alarming, though comparable to that found in other series. Our findings indicate that it may be wise to replace both components even when, after careful assessment before and during operation, one of them seems to be securely fixed.

We report a case of transverse fracture through the body of the axis. This fracture was unstable, had been produced by extension forces and was managed conservatively. The classification of such fractures is discussed.