Aims: Bioabsorbable self-reinforced polylevolactide (SR-PLLA) fixation devices have been used for several indications within orthopaedics and traumatology since the eighties, but their long-term effects in clinical use and in patients with rheumatoid arthritis (RA), however, are not wellknown, and were evaluated at the present study. Methods: Arthrodeses were fixed with SR-PLLA devices in 27 patients with RA (32 procedures: 22 of the wrist with rods, 7 of the talocal-caneal-calcaneocuboid-talonavicular (triple) and 3 of the talocrural (ankle) with screws and rods) and 16 ankle fractures with screws and/or rods. Outcomes were assessed clinically and radiographically in the long-term (mean 6.0, range 1.1–11.7 years). Computed tomography (CT) evaluation of the implants in a subgroup of 33 patients was performed. Results: All but one wrist fusion, 5/7 of triple fusions, 1 of 3 ankle fusions and all ankle fractures united. Functional results were generally good. In 5 ankle fractures degrading polymer material originating from uncut screw heads led to tissue reactions, and in 2 cases to exceptionally slow degradation. Conclusions: SR-PLLA implants served well as fixation devices for wristand triple arthrodeses in patients with RA and for ankle fractures. Difficulties occurred in bony healing of ankle arthrodeses. The SR-PLLA implants showed high biocompatibility as long as the correct operative technique was followed. Inside the bone, SR-PLLA implants degraded in 4 to 6 years. Slight bone resorption occurred.

Multiple hereditary exostoses is an autosomal dominant skeletal disorder in which there are numerous cartilage-capped excrescences in areas of actively growing bone. The condition is genetically heterogeneous, and at least three genes, ext1, ext2 and ext3 are involved. The reported risk for malignant transformation to chondrosarcoma has been from 0.6% to 2.8%. We have reviewed six generations of a family with 114 living adult members, 46 of them with multiple exostoses. Four have had operations for chondrosarcoma, giving the risk for malignant transformation as 8.3% in this family. Clinical and radiological examination revealed two additional patients with a suspicion of malignancy, but in whom the histological findings were benign. Reported elsewhere in detail, genetic linkage analysis mapped the causative gene to chromosome 11 and molecular studies revealed a guanine-to-thymine transversion in the ext2 gene. Patients with multiple hereditary exostoses carry a relatively high risk of malignant transformation. They should be informed of this possibility and regularly reviewed.

We used MRI to study a prospective series of 95 patients with inversion injuries of the ankle and no fracture on plain radiographs. We found an incidence of bone bruises of 27%, but these made no difference to the time of return to work, limitation of walking or physical activity, or the clinical outcome scores at three months.

We conclude that bone bruises have very little clinical significance after inversion injuries of the ankle.