Another 57-year-old gentleman referred for an infected non-union of the ulna with a severe bone defect. He was treated with a TSF application and corticotomy for distraction osteosynthesis. There has been a satisfactory progress in the bone transport and recently underwent a docking procedure with bone graft insertion.
Treatment involved wound excision for open fractures, debridement of devascularised bone and stabilisation with monolateral fixators (2 patients) and circular fixators (7 patients). Five patients had unifocal treatment, four had multifocal treatment (3 bone transports). Duration of non-union or bone loss ranged from 3 to 72 months, average 17 and median 12. Treatment time ranged from 3 to 12 months, and was not related to the complexity of treatment. The longest treatment times occurred when segments of devascularised bone had been left unexcised, a situation we termed “bone loss insitu”. An independent observer assessed the patients. Functional outcome was measured using the Short Musculoskeletal Assessment Form, a validated outcome assessment tool (Swiontkowski et al. JBJS [A], 1999).
We describe a 15-year-old boy with a posterior dislocation of the hip, fracture of the posterior column of the acetabulum and separation of the femoral capital epiphysis. To our knowledge no previous case in a child has been reported. Such high-energy injuries are extremely rare, and a poor outcome is expected. We advocate early referral to a specialised tertiary centre, and the use of a modification of Delbet’s classification to reflect the complexity and displacement which may occur with this injury.