Aim

Shelf acetabuloplasty is part of the armamentarium for the treatment of Legg-Perthes-Calve disease. Surgeons have used it to increase the anterolateral cover of the deformed head in advanced stages of the disease. However, others, including the senior author, advocate its use for containment of the diseased femoral head earlier in the disease, for both the prevention of further femoral head extrusion and as an aid in the remodelling process. The current study presents the results of this procedure performed from August 1999 to February 2010.

The aim of the study was to assess the medium term outcome for complex proximal humeral fractures treated with the long proximal humeral internal locking system (PHILOS) plate fixation.

All patients who had long PHILOS plate fixation of proximal humerus fractures with metaphyseal or diaphyseal extension over a three year period at our institution were included in the study. Patients had their case notes and radiographs reviewed. Patients were also contacted to assess functional outcome using the Visual Analogue Scale (VAS) for pain, DASH, Oxford shoulder score (OSS) and Stanmore Percentage of Normal Shoulder Assessment (SPONSA).

Out of an initial cohort of 34 patients, 1 died, 2 patients had unrelated illnesses resulting in them being unable to complete the assessment and 6 were lost to follow-up, leaving 25 patients (74%) for review. All patients had proximal humeral fractures with metaphyseal or diaphyseal extension requiring long plate osteosynthesis. One patient had the procedure for non union following initial treatment with an intra medullary nail and the rest were acute injuries. The patients were followed up after a mean of 27 months (range 11–60). The length of plate used varied from 5 to 12 holes for the shaft region.

There was 1 wound infection. 3 patients had non unions which required bone grafting and revision internal fixation. At final follow-up, mean pain was 3.6 (95% Confidence Interval 2.5–4.8) with only 4 patients having residual pain greater than 5 on the VAS scale. Mean DASH score was 41.2 (95% CI 32.0–50.4), mean OSS was 29.1 (95% CI 24.3–33.9) and mean SPONSA was 63.9% (95% CI 50.8–77.2)

The long PHILOS plate appears to represent a good treatment option for complex proximal humerus fractures with favourable medium term results and few complications.

The aim of the study was to assess the rate of greater tuberosity non union in reverse shoulder arthroplasty performed for proximal humerus fractures and to assess if union is related to type of fracture or the intraoperative reduction of the greater tuberosity.

All cases of reverse shoulder arthroplasty for proximal humerus fractures at our institution over a three year period were retrospectively reviewed from casenotes and radiologically and the position of the greater tuberosity was documented at immediate post op, 6 months and 12 months. Any malunion or non union were noted.

A total of 27 cases of reverse shoulder arthroplasty for proximal humeral fractures were identified. 4 cases did not have complete follow up xrays and were excluded from analysis. The average age at operation of the cohort of the 23 remaining patients was 79 years (range 70–91). The greater tuberosity was anatomically well positioned intraoperatively in 17 of the 23 cases.

At the end of 12 months there were 4 cases of tuberosity non union (17%), all except one occurring in poorly intraoperatively positioned greater tuberosity. 50% (3 out of 6) of greater tuberosities displaced further and remained ununited if the intraoperative position was poor. Only 6% (1 out of 17) greater tuberosities did not unite if the greater tuberosities was reduced anatomically. Intra operatively position of the greater tuberosity was strongly associated with their union (Fischer's exact test p<0.05). Union of greater tuberosity was not statistically associated with fracture pattern (Fischer's exact test p=0.48).

Our case series show a low rate of tuberosity malunion after reverse shoulder arthroplasty for proximal humerus fracture. Good positioning and fixation of the greater tuberosity intra operatively is a strong predictor of their uneventful union to shaft.

Aim

We evaluated the outcome of conservative versus surgical treatment in lateral humeral condyle fractures in children. The management in some of these fractures remains controversial, ultimately relying upon the individual practitioner.

Purpose

To analyse the early results of unconstrained pyrocarbon joint replacements in patients with osteo-arthritis of the metacarpo-phalangeal joints.

The purpose of this study was to describe our experience of the Calaxo Osteoconductive interference screw (Smith & Nephew) when used for both femoral and tibial graft fixation in Double Bundle ACL reconstruction.

Since May 2006, all patients with an ACL deficient knee were reconstructed using the Double Bundle technique. All were followed prospectively and outcome data collected. Evidence of fixation failure was established subjectively by clinical examination (Lachman, Anterior Draw, Pivot Shift) and objectively via KT-1000 arthrometer. Following ethical approval, post-operative CT scans (immediate and 1 year) were performed on our first 10 patients allowing assessment of tunnel dimensions/fill.

Thirty two patients (29 male, 3 female) with a mean age of 30 (range 18-46) were included. At last follow-up, no evidence of graft/fixation failure was found; KT-1000 mean side-side difference 1.4mm (range −3 to +6). All patients had a positive pivot shift preoperatively which was abolished postoperatively. One patient had a postoperative infection with no other complications reported. Radiologically the screws did not show complete resorption but areas of new bone were identified.

We have shown satisfactory results with use of the Calaxo screw when used in Double Bundle Reconstruction. We have not had any cases of the adverse local soft tissue reaction, which has led to this screw being withdrawn from clinical use. Even when using a total of four screws in each knee. A previous study published by Seibold (2007) has shown tunnel widening and communication when suspensory fixation is used in Double Bundle reconstruction. This has the potential risk of leading to fracture between the tunnels. This has not been seen with the Calaxo screw which may be a result of the biological action of the screw which should ultimately lead to a reduction in these risks.

Introduction: The purpose of this study was to describe our experience of the Calaxo Osteoconductive interference screw (Smith & Nephew) when used for both femoral and tibial graft fixation in Double Bundle ACL reconstruction.

Methods: Since May 2006, all patients with an ACL deficient knee were reconstructed using the Double Bundle technique. All were followed prospectively and outcome data collected.

Evidence of fixation failure was established subjectively by clinical examination (Lachman, Anterior Draw, Pivot Shift) and objectively via KT-1000 arthrometer.

Following ethical approval, post-operative CT scans (immediate and 1 year) were performed on our first 10 patients allowing assessment of tunnel dimensions/fill.

Results: Thirty two patients (29 male, 3 female) with a mean age of 30 (range 18–46) were included. At last follow-up, no evidence of graft/fixation failure was found; KT-1000 mean side-side difference 1.4mm (range −3 to +6). All patients had a positive pivot shift preoperatively which was abolished postoperatively. One patient had a postoperative infection with no other complications reported. Radiologically the screws did not show complete resorption but areas of new bone were identified.

Discussion: We have shown satisfactory results with use of the Calaxo screw when used in Double Bundle Reconstruction. We have not had any cases of the adverse local soft tissue reaction, which has led to this screw being withdrawn from clinical use. Even when using a total of four screws in each knee.

A previous study published by Seibold (2007) has shown tunnel widening and communication when suspensory fixation is used in Double Bundle reconstruction. This has the potential risk of leading to fracture between the tunnels.

This has not been seen with the Calaxo screw which may be a result of the biological action of the screw which should ultimately lead to a reduction in these risks.

Introduction: We describe a novel, innovative and inexpensive method of producing a reinforced articulating cement spacer using a commercially available hip cement mould.

Methods: After adequate debridement and removal of original implants during the first of a two-stage revision procedure, an articulating cement spacer is created using a conventional mould and is reinforcing using a central stainless steel rod extending from the head to the tip using a novel technique that will be described in detail.

Results: We currently have a cohort of six consecutive patients in whom this novel cement spacer has been used. All patients were able to at least partially weight bear and none of the spacers fractured. Five have been explanted at second stage surgery after a minimum of 8 weeks in situ. One patient has been unable to undergo a second stage due to medical co morbidities and continues to mobilise with walking aids on the spacer 1-year post implantation.

Discussion: The articulating cement spacer described is produced using a technique that is simple, reproducible and allows a reinforced spacer to be created inexpensively without the need for special equipment. The spacer described provides a number of advantages over previously described or currently available commercial cement spacers. As it is reinforced it provides increased strength and allows partial weight bearing without risk of spacer fracture, a recognised complication of unreinforced spacers. As it uses a mould the surface remains smooth allowing easier insertion and minimising further bone loss with articulation. As it is fabricated intra-operatively, rather than being premanufactured, antibiotics can be added to the cement used to make the spacer according to known organism sensitivities.

Conclusion: We describe the first ever smooth, articulating, moulded cement spacer that can be inexpensively fabricated intra-operatively without the requirement for special equipment.

Aim: To describe and evaluate the use of the limited contact plate in complex humeral shaft fractures.

Certain sub-groups of humeral shaft fractures can be very difficult to treat. These ‘complex fractures’ include fractures in very osteoporotic bone, those associated with shoulder or elbow prosthesis, non-unions and those associated with intra articular extensions and dislocations.

The AO limited contact plate (LCP) is a new form of fixation whether the screw heads lock into the holes in the plate. The plate is not designed to cause compression and does not need to lie perfectly adjacent to the bone.

Methods: A prospective study of six consecutive complex humeral shaft fractures treated with LCP plate. Rate of union, complications, and subjective and objective outcome (DASH scores) are analyzed.

Results: Union occurred in 9/10 patients. The final patient is progressing to union. There were no serious complications. Good subjective and objective outcome in all patients.

Conclusion: This heterogeneous series of complex and complicated humeral shaft fractures all pose significant management problems. Treatment with the LCP plate demonstrated good results with no significant complications. This completely new rational for treatment seems particularly suitable for the treatment of complex or complicated humeral shaft fractures.