Purpose

To compare the post-operative morbidity, of a novel vertical approach, with that of the standard transverse one, for procurement of Autologous bone graft from the iliac crest, for the purpose of cervical spine fusions.

A prospective study on the management of 23 patients with complex high energy tibial fractures was carried out to assess the outcome following the use of different external fixators. They were all followed up clinically and radio logically till fracture union.

The average age 42 years (range 13–77 years) 17 male & 6 females. Fourteen were closed and 9 open. Eight were falls from height, 9 RTAs, one crush injury and one assault. All of the open fractures were grade 3. Six patients had proximal tibial fractures (one Schatzker Type-II, one Type-IV, two Type-V and two Type-VI) They united at an average of 20 weeks (range 10–40 weeks). Seven were Shaft fractures average duration to union 30 weeks (range 8–104 weeks), and eight were Pilon fractures (Two Ruedi & Allgower Type-II & Six Type-III) they united at an average duration of 13 weeks (range 7–20 weeks)

All patients achieved clinical and radiological union at a mean duration of 22 weeks. Sheffield Ring fixator [SRF] was used primarily in 11 patients, none failed. Two had initial monolateral fixators which were converted to SRF. Two were managed with Illizarov frames and three with hybrid fixators. Seven patients had an initial monolateral fixator, two failed and were converted to a Sheffield fixator, 2 planned conversion to an intramedullary nail, one developed a delayed union and was converted to a Sheffield fixator, only two continued till union. Nine patients developed pin tract infection needing Antibiotics, three of them developed Osteomyelitis, Four had failure of fixation needing a second operation.

Two developed malunion, one managed with total knee replacement, another required Ankle fusion. The average SF 12 score for the Sheffield group PCS was 52.1 and MCS of 51.7. For the Monolateral fixator group PCS was 47.2 and MCS of 48.1. For the Hybrid fixator group PCS of 34.7 and MCS of 42.7 and for the Ilizarov group PCS was 39.85 and MCS was 55.05.

In this cohort of complicated High energy Tibial fractures, those managed with Circular Frames especially SCF augmented with interfragmantary screws proved to be most successful with a very lower failure rate and better patient satisfaction.

Introduction and aim: In order to harness existing surgical skill and expertise of the operator trained in conventional total hip arthroplasty (THA) it would be advantageous to adopt a mini-incision surgery (MIS) THA technique that is similar. It would also make economic sense for MIS THA to be performed using existing conventional instrumentation available in every elective orthopaedic unit. The aim of this retrospective comparative study was to verify safety, efficacy and durability of this MIS THA technique via a modified anterolateral approach developed in our hospital by the senior author. This technique utilises standard instrumentation and does not require the use of an image intensifier.

Materials and Methods: The implants used in the study were the SL-Plus (Plus Endoprothetik AG, CH-Rotkreuz) and the EPF cup (Plus Endoprothetik AG, CH-Rotkreuz). We report on our experience of a consecutive series of 111 patients operated for osteoarthritis of the hip joint.

Results: Fifty-nine patients (53.2%) were implanted using MIS technique; the remainder (52 cases, 46.8%) were operated using conventional THA via traditional anterolateral approach. In patients undergoing MIS technique a skin incision averaging 8 cm (range 7.5 to 9 cm) was made over the greater trochanter with two thirds lying superior to its tip. The surgical procedure lasted forty minutes on average, and no excessive retraction was needed. The small incision can be extended with ease if access proves difficult, but this proved unnecessary in any of our cases.

The mean follow-up for the MIS THA group was 22.9 months compared to 33.1 months for the conventional THA group. All our MIS patients had less postoperative blood loss, needed less post operative painkillers, and mobilised earlier. There was however no significant difference in the duration of postoperative hospital stay between the two patient groups. We have had no incidence of dislocation and continue to use this technique during routine THA.

Discussion and conclusion: A review of the MIS THA literature is provided to compare this technique with those described by other authors. The authors believe this to be a safe, cost effective alternative to MIS THA techniques that require special instrumentation and the use of the image intensifier.