Opening wedge proximal tibial osteotomy has become more popular in recent years, particularly in the management of medial compartment osteoarthritis. Unfortunately, fixation failures and/or non-unions of this osteotomy still occur.

The aim of this study is to review two cases of failed opening wedge osteotomies salvaged with the Taylor Spatial frame.

Both cases were reviewed clinically and radiographically and an analysis of their deformity was carried out. If required, metalware was removed and the Spatial frame applied and the deformity gradually corrected with either repeat osteotomy (case 1) or distraction of the non-union (case 2) until ideal alignment had been achieved. When the osteotomy regenerate had satisfactorily hardened, the frame was removed, and the patients were initially protected in a range of motion brace.

Both patients achieved the desired correction of their deformities and union of their osteotomies, and had the frames removed at an average of 124 days following application.

The Taylor Spatial frame is a very powerful tool for correcting complex multi-apical deformities in the juxta-articular region of the proximal tibia through minimally invasive techniques.

This study reviews Total Hip Arthroplasty (THA) in the subcapital femoral neck fracture population looking at early complications.

Primary THA’s performed in our institution for femoral neck fractures between 1999 and 2001 were reviewed. The case records were obtained from the hospital patient information database. Medical charts, including operation and outpatient notes, were used to obtain information on the level of experience of the surgeon, supervision and complications.

Sixty five THA’s were performed on 65 patients with the average age of 77. Trainee Registrars performed 62%, 15% with a consultant assistant and consultants performed 38%. There were 19 (30%) medical complications giving a total complication incidence of 38%. All of the procedures were performed via the Hardinge direct lateral approach. There were 6 (9%) surgical complications, including one deep infection requiring revision. There were no dislocations or peri-operative deaths. The one-year mortality was 9% (equal to expected mortality of age related population without fracture).

Primary THA’s for displaced subcapital fracture in “community ambulators” is a safe and reliable procedure with an acceptable rate of surgical complications. Although there were a large number of minor medical complications documented, the 12-month mortality for this group remained the same as the population normal.

CPT is a rare disorder often leading to multiple surgical procedures in an attempt to achieve union but frequently ending in amputation.

The author presents a personal series of four cases (ages 3 + 4, 3 + 4, 4 + 3, 7 + 9 years) three of which had had a total of ten previous procedures. All patients underwent removal of previous fixation, excision of the abnormal periosteal tissue, freshening of the bone ends and “ram rodding” together under compression with the application of an lIizarov frame. A separate proximal osteotomy was performed for lengthening. The non-union was grafted primarily at the time of fixator application. Following frame removal a custom made telescopic nail was inserted in the three most recent cases. Average frame time was 263 days (184–301). All four cases have healed primarily and remain healed (19, 28, 31 and 70 months) post frame removal. The case not treated with a nail underwent bending of the proximal regenerate bone and required a second osteotomy to correct the deformity. Other than pin infections managed by antibiotics and local cares, the only other complication was the backing out of a cross-locking wire from the IM nail which required reinsertion.

The use of the llizarov frame enables a radical excision of pathological tissue and rigid compression of the non-union with concurrent restoration of limb length. The telescoping rod that is locked in the epiphyses proximally and distally enables normal rehabilitation of the joints without the need for prolonged bracing. The ongoing success of this treatment has encouraged the author to recommend it as the primary management for established congenital pseudarthrosis of the tibia.