The aim is to review the functional results of reconstruction of neglected Achilles Tendon Ruptures, in which the gap between the ruptured ends was a minimum of 6 cm. All ruptures had a gap of 6–8cm, intraoperatively, between the ruptured ends when the foot was put into plantigrade.

There are 9 patients in our case series, who presented with neglected Achilles Tendon ruptures over a six year period. All reconstructions were done by a single surgeon. All patients had a a reconstruction done using 2 strips of gastrocnemius aponeurosis turned down to bridge the gap, with the foot in plantigrade and augmented with flexor hallucis longus. The flexor hallucis longus was threaded through the distal stump and tenodesed and myodesed to the reconstructed Achilles tendon.

All patients were put in a non-weight bearing cast for 6 weeks followed by partial weight bearing, physiotherapy and strengthening exercises. There were no complications in our series. Six patients were available for assessment. At minimum of 2 years, AOFAS Score is 94.2, Ankle Hindfoot Visual Score of 0 in 5 and 5/10 in:

The SF 36 ranged from 75 to 96 for the various functions and patients rated the results from good to exellent with expectations of the surgery being met in most patients.

Reconstruction of Neglected Achilles Tendon Ruptures with a large gap are challenging. Methods proposed include transfers of various tendons, free grafts, allografts and synthetic materials. The gastrocnemius turn down flap with flexor hallucis longus augmentation can bridge a gap of 6–8cm with the foot in plantigrade. Rehabilitation can start after 6 weeks casting. The results show that most patients have achieved a good functional outcome and are satisfied to happy with the surgical outcome.

Introduction Retrograde nailing of femoral shaft fractures, through the knee joint, have been increasing. The indications for retrograde nailing are presently still evolving. This paper aims to discuss the indications for retrograde nailing

Methods We had conducted a prospective trial of nailing of femoral shaft fractures, using the retrograde approach. Nails were placed and reamed, with both distal and proximal locking done. Attention was given to the appropriate entry point. A literature review is also presented.

Results The set-up was easy. Operative time was a median of 70 minutes and average blood loss 200 mls. Time to union was 15 weeks with minimal complications, but dynamisation rates were high. No knee problems were found at a follow-up period of 47 months.

Conclusions The indications for retrograde nailing are ipsilateral femoral and acetabular fractures, ipsilateral patellar and femoral shaft fractures, ipsilateral tibial amd femoral shaft fractures, multiple trauma, femoral fracture with previous ipsilateral hip fusion, bilateral femoral shaft fractures, the obese or pregnant patient with a unilateral/bilateral femoral shaft fractures and perhaps the elderly with a unilateral femoral shaft fracture. We feel that the retrograde nailing is a useful technique for the orthopaedic surgeon to have in his/her armamentarium. Due to the longer union time and possible knee damage, indications should be respected.

Introduction: Nailing of the femoral shaft fractures has almost exclusively been done through the antegrade approach. This involves the use of a traction table and location of the entry point piriform fossa can be difficult especially in the obese or well-built patient. The set-up and operative time and blood loss can be considerable. We conducted a prospective study of nailing of femoral fractures, using the retrograde approach (through the knee joint) to measure the operating time, blood loss and knee function. A purpose built retrograde system was used (ART Nail ® ACE Medical Company-El Segundo, California)

Materials & Methods: Seventeen patients who had a femoral shaft fracture, either as an isolated injury, or with associated with other injuries were nailed using the Art Nail, using the retrograde approach. The patients were placed on a radiolucent table, with a bolster place under the knee joint. A stienmann pin was inserted into the ipsilateral tibia 1” inferior and posterior to the tibial tubercle. This was used to apply traction manually by an assistant. The surgical approach was to split the patella tendon and the knee joint was entered. Using a light source, the nail entry point at the intercondylar notch, 7mm anterior to the PCL, is located. The rest of the operative procedure was done according to the operative manual. Blood loss was estimated by the anaesthesiologist. A drain was inserted into the knee joint after a through wash-out and continuos passive motion was started when the drain was removed on the 2nd postoperative day.

Results: Fourteen had a single fracture while 3 had other associated fractures. The age range of was 28 to 67 years. Operative time was 60–100 minutes with blood loss ranging from 50–600 mls,with the median at 200mls. Post-operative drainage was 10–335 mls with median at 100mls. One patient developed distal deep vein thrombosis. Two patients were lost to follow-up. Union occurred at 12–20 weeks in fourteen patients, Two patients had to undergo dynamisation of the nail, one of which required a bone grafting to achieve union at 24 weeks. Two patients had a 1cm shortening of the limb and there were no malrotations. Two patients had < 5 degree medial–lateral angulation, on X-ray. At six months follow-up, fourteen patients had full range of motion at the knee joint, while one patient who had chondrocalcinosis had range of motion from 0 to 90 degrees. . The follow-up period is from 10–26 months. No patient complained of pain or instability of the knee joint

Conclusion: The retrograde approach is a safe and quick method of nailing femoral shaft fractures with no medium term effects on the knee joint.