We present three cases of recurrent instability of the elbow in association with the Ehlers-Danlos syndrome. The pattern of instability has not previously been reported. We describe our procedure for achieving stability using a bone graft to the olecranon fossa which gave a functional range of movement

1. The danger of fracture and subsequent pseudarthrosis in congenital anterior bowing of the tibia is emphasised. The fate of seven such patients is described. 2. With the object of preventing fracture, early and urgent bone grafting is advocated

In Africa the amount of joint replacement surgery is increasing, but the indications for operation and the age of the patients are considerably different from those in the developed world. New centres with variable standards of care and training of the surgeons are performing these procedures and it is important that a proper audit of this work is undertaken. In Malawi, we have pioneered a Registry which includes all joint replacements that have been carried out in the country. The data gathered include the age, gender, indication for operation, the prosthesis used, the surgical approach, the use of bone graft, the type of cement, pressurising systems and the thromboprophylaxis used. All patients have their clinical scores recorded pre-operatively and then after three and six months and at one year. Before operation all patients are counselled and on consent their HIV status is established allowing analysis of the effect of HIV on successful joint replacement. To date, 73 total hip replacements (THRs) have been carried out in 58 patients by four surgeons in four different hospitals. The most common indications for THR were avascular necrosis (35 hips) and osteoarthritis (22 hips). The information concerning 20 total knee replacements has also been added to the Registry

Aims

This study aimed to develop a virtual clinic for the purpose of reducing face-to-face orthopaedic consultations.

We report the results of using a combination of fixator-assisted nailing with lengthening over an intramedullary nail in patients with tibial deformity and shortening. Between 1997 and 2007, 13 tibiae in nine patients with a mean age of 25.4 years (17 to 34) were treated with a unilateral external fixator for acute correction of deformity, followed by lengthening over an intramedullary nail with a circular external fixator applied at the same operating session. At the end of the distraction period locking screws were inserted through the intramedullary nail and the external fixator was removed. The mean amount of lengthening was 5.9 cm (2 to 8). The mean time of external fixation was 90 days (38 to 265). The mean external fixation index was 15.8 days/cm (8.9 to 33.1) and the mean bone healing index was 38 days/cm (30 to 60). One patient developed an equinus deformity which responded to stretching and bracing. Another developed a drop foot due to a compartment syndrome, which was treated by fasciotomy. It recovered in three months. Two patients required bone grafting for poor callus formation. We conclude that the combination of fixator-assisted nailing with lengthening over an intramedullary nail can reduce the overall external fixation time and prevent fractures and deformity of the regenerated bone

We report a unique case of juxtacortical osteoblastoma of the humeral shaft, which simulated the appearance of an extraosseous extension of Gaucher-cell deposits. The tumour was treated successfully by curettage and bone grafting. We can find no previous report of this association between osteoblastoma and Gaucher’s disease

The optimal method for the management of neglected traumatic bifacetal dislocation of the subaxial cervical spine has not been established. We treated four patients in whom the mean delay between injury and presentation was four months (1 to 5). There were two dislocations at the C5-6 level and one each at C4-5 and C3-4. The mean age of the patients was 48.2 years (27 to 60). Each patient presented with neck pain and restricted movement of the cervical spine. Three of the four had a myelopathy. We carried out a two-stage procedure under the same anaesthetic. First, a posterior soft-tissue release and partial facetectomy were undertaken. This allowed partial reduction of the dislocation which was then supplemented by interspinous wiring and corticocancellous graft. Next, through an anterior approach, discectomy, tricortical bone grafting and anterior cervical plating were carried out. All the patients achieved a nearly anatomical reduction and sagittal alignment. The mean follow-up was 2.6 years (1 to 4). The myelopathy settled completely in the three patients who had a pre-operative neurological deficit. There was no graft dislodgement or graft-related problems. Bony fusion occurred in all patients and a satisfactory reduction was maintained. The posteroanterior procedure for neglected traumatic bifacetal dislocation of the subaxial cervical spine is a good method of achieving sagittal alignment with less risk of iatrogenic neurological injury, a reduced operating time, decreased blood loss, and a shorter hospital stay compared with other procedures

1. Thirty-three cases of congenital pseudarthrosis of the clavicle are presented. 2. The lesions all occurred in the right clavicle and are thought to be due to abnormal intrauterine development rather than non-union of birth fractures. 3. Methods of treatment are reviewed. Excision and bone grafting is favoured

A method of repairing the defect in spondylolisthesis by internal fixation with screws and bone grafting is described. Sixteen patients have been operated upon with only one failure. In two cases the spine was re-explored for incidental complications and the defect was found to have fused solidly

A case of bilateral congenital pseudarthrosis of the olecranon is described. The clinical features, radiological appearance and prognosis are distinct from the type of congenital pseudarthrosis of the forearm reported previously. The lesion appeared to be a localised failure of ossification within the proximal ulnar metaphysis. Excision, stabilisation and bone grafting led to rapid fusion

We report our experience in 42 patients, using corticocancellous bone grafts and lag screw fixation for un-united scaphoid fractures. Using a grading system, we analysed the suitability of the method for three types of nonunion. We recommend the operation for the treatment of scaphoid nonunion, except where there is avascular necrosis of the proximal pole

We report the reconstruction of two cases of floating thumb by transplanting the distal two-thirds of the fourth metatarsal. Opponensplasty was performed after six months and resulted in satisfactory morphological and functional results. The metatarsal defect was filled by a full-thickness iliac bone graft including the apophysis. This prevented shortening of the fourth toe and formed a new metatarsophalangeal joint

A technique of subtalar arthrodesis by means of metallic internal stabilisation and autogenous cancellous bone grafting is described. Of forty-eight feet with mobile pes planus treated by this method forty-five gained union after an average of seven and a half weeks in a below-knee weight-bearing plaster, and forty-three had satisfactory correction of the deformity

We report four cases of fracture of the cuboid treated by open reduction, bone grafting where necessary and internal fixation. We recommend this treatment where there is appreciable displacement of one or more of the articular surfaces. The preliminary results were better than those previously reported for conservative treatment or for later midtarsal fusion

1. A method of bridging gaps in long bones is described, using cancellous insert grafts supplemented by internal fixation with a metal plate. 2. The experimental work on transplantation of bone is reviewed in so far as it affects the practical problem of bone grafting. 3. Twenty-seven cases have been treated, with no failures. Seven of these are presented as illustrations

We report our experience of the use of the Ilizarov technique to treat nine patients with severe compound tibial fractures. The mean defect in bone was 6.3 cm, and four cases were infected. All nine patients had satisfactory union and function without the use of bone grafts or antibiotics. The Ilizarov technique was very satisfactory; there were no major complications

We report two patients, each with a giant-cell tumour of the distal radius treated by curettage and bone grafting. Local recurrence of the tumour occurred in the autograft and in the adjacent soft tissues in both patients, and was successfully treated by local excision; one patient also had radiation therapy. Both remain well 20 years and five years later

We describe a case of osteosarcoma of the scaphoid bone, which to our knowledge is only the second reported case of osteosarcoma in the carpus. A 38-year-old man complained of intense pain in the right wrist and had curettage and a bone graft for a lesion in the scaphoid. Histological examination showed this to be an osteosarcoma. Below-elbow amputation was performed and adjuvant chemotherapy given. There has been no evidence of recurrence or metastases at 33 months after amputation

Four patients with lumbosacral fracture-dislocation are presented. The common mechanism of injury was hyperflexion with compression. A rotational element may be implicated in single facet dislocation. Although lumbosacral fracture-dislocations can be managed conservatively, the best method of treatment is open reduction and bone grafting as soon after injury as possible. Only this will ensure complete correction of the deformity and prevent later deterioration