We have done emergency vascularized composite graft by microsurgical technique for severe open fractures. It is essential for open injury to cover bones, joints, tendons etc. Vascularized composite graft for open fracture with tissue defect covers bone etc., prevents infection and promotes subsequent early functional recovery. Eighteen patients aged 3–55year old with an average age of 23.1y.o. were treated with this methos. Traffic injuries of leg and foot in children were the most common and others were open severe fracture with tissue defects. The composite graft employed were peroneal osteocutaneous flap, latissimus dolsi flap, parascapular flap and groin flap. The advantage of these flaps to cover the damaged structure primrily facilitatrs rapid tissue repair without infection and scar formation. In fact, except one reoperation due to a skin necrosis in parascapular flap, all grafted flaps successfully repaired the severe damaged bone and joint. Sufficient perfusion of antibiotics by these vascularized flap prevents infection in all cases. Primary emergency vascularized composite graft for severe open fracture with tissue defect is shown to be extremely useful method with rapid repair and functionnal recovery.

Introduction: To improve the therapeutic results for AO type C intraarticular distal radius fractures in young and middle-aged patients, it is important to achieve and maintain anatomical reduction, and evaluate and treat soft-tissue injuries. We previously employed arthroscopically assisted reduction and percutaneous pinning (ARPP) combined with external fixation. Since 2003, we have employed ARPP combined with open reduction and internal fixation (ORIF) using volar locking plates.

Methods: The subjects were twenty-six patients under 60 years old. The patients comprised thirteen men and thirteen women aged from 16 to 57 (mean 43.5) years. The type of fracture according to the AO classification was C1 in six patients, C2 in ten, and C3 in ten. The follow-up period was 12–18 (mean 13.5) months. The radial inclination (RI), volar tilt (VT), and ulnar variance (UV) were measured radiographically at the time of injury, immediately after surgery, and at final evaluation. The Mayo wrist score was used for clinical evaluation.

Results: Union was achieved in all patients. The triangular-fibrocartilage complex injury was detected in nineteen patients, the scapholunate-interosseous ligament injury in twenty-three, and the lunotriquetral-interosseous ligament injury in nineteen. Radiographic evaluation showed that the mean RI, VT, and UV at presentation, immediately after surgery, and at final evaluation was 12.8, 21.0, and 20.9 degrees, −15.4, 9.7, and 9.6 degrees, and 3.10, 0.30, and 0.35 mm, respectively. The Mayo wrist score averaged 87.6 points.

Conclusion: Although treatment of AO type C intraarticular distal radius fractures is difficult, ARPP combined with ORIF achieved relatively good results.

The posterior cruciate ligament (PCL) was imaged by MRI throughout flexion in neutral tibial rotation in six cadaver knees, which were also dissected, and in 20 unloaded and 13 loaded living (squatting) knees. The appearance of the ligament was the same in all three groups. In extension the ligament is curved concave-forwards. It is straight, fully out-to-length and approaching vertical from 60° to 120°, and curves convex-forwards over the roof of the intercondylar notch in full flexion. Throughout flexion the length of the ligament does not change, but the separations of its attachments do.

We conclude that the PCL is not loaded in the unloaded cadaver knee and therefore, since its appearance in all three groups is the same, that it is also unloaded in the living knee during flexion. The posterior fibres may be an exception in hyperextension, probably being loaded either because of posterior femoral lift-off or because of the forward curvature of the PCL. These conclusions relate only to everyday life: none may be drawn with regard to more strenuous activities such as sport or in trauma.

Open reduction for developmental dislocation of the hip (DDH) is invasive and sometimes results in femoral head deformity while open reduction has been the first choice in case non-operative reduction is failed in.

We treated 3 patients with 3 affected hips using minimum invasive arthroscopic reduction method. Pre-operative MRIs represented these 3 hips had obstruction of interposed thick limbus. The average age of patients treated by this method was 23 months.

This method consists of arthrogram, arthroscopic limboplasty, and arthroscopic reduction. This series of maneuvers was able to lead unreducable hips to the reduction position.

Post-operative MRIs represented that the interposed thick limbus had been removed to the outside of acetabulum and the limbus covered the reduced femoral head. There were no signs of residual subluxation of the hips in radiographic examination.

This new minimum invasive arthroscopic reduction method have a possibility to take the place of the invasive open reduction in the treatment of DDHs with obstruction of interposed thick limbus.