Rib fracture fixation by orthopaedic and cardiothoracic surgeons has become increasingly popular for the treatment of chest injuries in trauma. The literature, though mainly limited to Level II and III evidence, shows favourable results for operative fixation. In this paper we review the literature and discuss the indications for rib fracture fixation, surgical approaches, choice of implants and the future direction for management. With the advent of NICE guidance and new British Orthopaedic Association Standards for Trauma (BOAST) guidelines in production, the management of rib fractures is going to become more and more commonplace.

This review explores recent advances in fixator design and used in contemporary orthopaedic practice including the management of bone loss, complex deformity and severe isolated limb injury.

Ankle replacements have improved significantly since the first reported attempt at resurfacing of the talar dome in 1962. We are now at a stage where ankle replacement offers a viable option in the treatment of end-stage ankle arthritis. As the procedure becomes more successful, it is important to reflect and review the current surgical outcomes. This allows us to guide our patients in the treatment of end-stage ankle arthritis. What is the better surgical treatment – arthrodesis or replacement?

This review examines the future of total hip arthroplasty, aiming to avoid past mistakes

Mechanical alignment has been a fundamental tenet of total knee arthroplasty (TKA) since modern knee replacement surgery was developed in the 1970s. The objective of mechanical alignment was to infer the greatest biomechanical advantage to the implant to prevent early loosening and failure. Over the last 40 years a great deal of innovation in TKA technology has been focusing on how to more accurately achieve mechanical alignment. Recently the concept of mechanical alignment has been challenged, and other alignment philosophies are being explored with the intention of trying to improve patient outcomes following TKA.

This article examines the evolution of the mechanical alignment concept and whether there are any viable alternatives.

Stem cells are a key component of regenerative medicine strategies. Particular areas of musculoskeletal application include cartilage and bone regeneration in arthritis and trauma. There are several types of stem cell and this article will focus on the adult derived cells. The review includes current issues and future developments.

Modern athletes are constantly susceptible to performance-threatening injury as they push their bodies to greater limits and endure higher physical stresses. Loss of performance and training time can adversely and permanently affect a sportsperson’s career. Now more than ever with advancing medical technology the answer may lie in biologic therapy. We have been using peripheral blood stem cells (PBSC) clinically and have been able to demonstrate that stem cells differentiate into target cells to enable regenerative repair. The potential of this technique as a regenerative agent can be seen in three broad applications: 1) articular cartilage, 2) bone and 3) soft tissue. This article highlights the successful cases, among many, in all three of these applications.

Chris Lavy is an orthopaedic surgeon in Oxford (UK) who lived and worked in Malawi for ten years. There he helped build an orthopaedic hospital and research unit. He was also one of the founders of COSECSA, the regional college of surgeons for East and Central Africa in 1999.