Distraction osteogenesis is widely used for leg lengthening, but often requires a long period of external fixation which carries risks of pin-track sepsis, malalignment, stiffness of the joint and late fracture of the regenerate. We present the results of 20 cases in which, in an attempt to reduce the rate of complications, a combination of external fixation and
The risk of articular penetration during tibial nailing is well known, but the incidence of unrecognised damage to joint cartilage has not been described. We have identified this complication in the treatment of tibial fractures, described the anatomical structures at risk and examined the most appropriate site of entry for tibial nailing in relation to the shape of the bone, the design of the nail and the surgical approach. We studied the relationship between the intra-articular structures of the knee and the entry point used for nailing in 54 tibiae from cadavers. The results showed that the safe zone in some bones is smaller than the size of standard reamers and the proximal part of some nails. The structures at risk are the anterior horns of the medial and lateral menisci, the anterior part of the medial and lateral plateaux and the ligamentum transversum. This was confirmed by observations made after nailing 12 pairs of cadaver knees. A retrospective radiological analysis of 30 patients who had undergone tibial nailing identified eight at risk according to the entry point and the size of the nail. Unrecognised articular penetration and damage during surgery were confirmed in four. Although
We report the use of Grosse-Kempf reamed
As there is little information on the factors that influence fracture union following
We reviewed 63 patients with fractures of the distal tibial metaphysis, with or without minimally displaced extension into the ankle joint. The fractures had been caused by two distinct mechanisms, either a direct bending force or a twisting injury. This influenced the pattern of the fracture and its time to union. All fractures were managed by statically locked
The case reports of four patients with breakage of the
1. A method of hip fusion with the aid of a straight
Fractures of the femur are the most incapacitating fractures in children. Conservative treatment necessitates a long stay in hospital for traction and subsequent immobilisation in an uncomfortable cast. This treatment is not well tolerated, especially in adolescents. Moreover, near the end of growth, accurate reduction is necessary, as malunion is no longer correctable by growth. Stable elastic
We describe a patient with fractures of both bones of the forearm in whom flexible
We made a prospective study of 208 patients with tibial fractures treated by reamed
There is concern about the incidence and serious nature of infection after
We report the use of elastic stable
We used 15 pairs of femora from fresh human cadavers to study the effects of the size and location of the entry hole for an
Exchange nailing for failure of union after primary
We have studied the medium- and long-term effects of femoral
In two hospitals, 115 consecutive open femoral shaft fractures were treated by meticulous wound excision and early locked (97) or unlocked (18)
In a consecutive series of 498 patients with 528 fractures of the femur treated by conventional interlocking
We randomised prospectively 44 patients with fractures of the shaft of the humerus to open reduction and internal fixation by either an
We report a prospective study of 26 cases of fracture of the distal third of the femur treated with the Derby