Forty-six children with Monteggia fracture-dislocations have been studied. The circumstances of the accident could rarely be recalled so that the mechanism of injury remains unclear. The study did, however, confirm the importance of conservative management of the injury in children; unlike the adult variety, this gave very satisfactory results. Our review also supports the classification into three basic types of Monteggia lesion according to the direction of displacement of the dislocated radial head. For simplicity, all other types, variations or equivalents can be regarded as belonging to these basic patterns; in particular we include those controversial cases in which the radiohumeral dislocation is combined with a fractured olecranon

We have examined 167 patients who had a hemiarthroplasty for three- and four-part fractures and fracture-dislocations of the head of the humerus in a multicentre study involving 12 Austrian hospitals. All patients were followed for more than a year. Anatomical healing of the tuberosity significantly influenced the outcome as measured by the Constant score and subjective patient satisfaction. With regard to pain, the outcome was generally satisfactory but only 41.9% of patients were able to flex the shoulder above 90°. The age of the patient and the type of prosthesis significantly influenced the healing of the tuberosity, but bone grafting did not. Achievement of healing of the tuberosity was inferior in institutions at which less than 15 hemiarthroplasties had been performed (Mann-Witney U test, p = 0.0001)

Pain, stiffness, instability and degenerative arthritis are common sequelae of complex fracture-dislocations of the proximal interphalangeal (PIP) joint. Operations were carried out to obtain stability, followed by application of a dynamic external fixator in 20 patients with a mean age of 29 years. This provided stability and distraction, and allowed controlled passive movement. Most (70%) of the patients had a chronic lesion and the mean time from injury to surgery was 215 days (3 to 1953). The final mean range of movement was 12 to 86°. Complications included redislocation and septic arthritis, which affected the outcome. Four pin-track infections and two breakages of the hinge did not influence the result. The PIP Compass hinge is a useful adjunct to surgical reconstruction of the injured PIP joint

1 . A series of 166 fractures and fracture-dislocations of the dorso-lumbar spine has been reviewed. 2. A new method of classifying these injuries is suggested. 3. A type of fracture with lateral wedging, previously unidentified, which has certain distinctive clinical and anatomical features is described. 4. The factors responsible for redisplacement are discussed and it is considered that in most cases this is predictable from the outset. 5. At the present time orthodox treatment is based on the assumption that a perfect anatomical result is indispensable to a perfect functional result. Analysis of the results in the series now reported shows that there are no grounds for this assumption. 6. Treatment is discussed in the light of the foregoing conclusions. This is based on a division of cases into stable and unstable types, the recognition of which is of crucial importance

Aims

There is no consensus on the treatment of proximal humeral fractures. Hemiarthroplasty has been widely used in patients when non-surgical treatment is not possible. There is, despite extensive use, limited information about the long-term outcome. Our primary aim was to report ten-year patient-reported outcome after hemiarthroplasty for acute proximal humeral fractures. The secondary aims were to report the cumulative revision rate and risk factors for an inferior patient-reported outcome.

Of 54 patients with posterior dislocations of the hip of type I and type II (Stewart and Milford 1954), 47 were followed for a mean period of 6.7 years (2 to 11). Of these, 23 had dislocation with minimal lesions of the acetabulum (type I) and 24 had an avulsed dorsocranial fragment (type II). All were reduced by closed methods within six hours. The subsequent treatment of type I dislocations was conservative. At the beginning of the period type II injuries were treated conservatively, but surgery was increasingly chosen for later cases. Type I dislocations had significantly better results (p < 0.05) than type II fracture-dislocations, regardless of the method of treatment. There were no essential differences between the results of surgical and conservative treatment in type II dislocations

We reviewed 36 consecutive patients with Monteggia fracture-dislocations of the forearm; 28 had been treated within 24 hours and 8 had been referred a week or more after the initial injury with persisting or recurrent dislocation of the proximal radio-ulnar joint after treatment elsewhere. We treated 15 of the 16 complete fractures and 3 of the 11 incomplete fractures of the ulna by operative fixation. All the early fractures and six of the eight late referrals had good or excellent results. The two poor results were in patients with malalignment and dislocation of the radial head persisting for at least two weeks before definitive treatment. A good outcome after a Monteggia injury in a child requires early diagnosis and prompt, stable, anatomical reduction of the ulnar fracture. In our experience, selective operative fixation of unstable fractures provides reliable reduction and causes few complications

1. The pathology and pathogenesis of dislocations and fracture-dislocations of the cervical spine has been reviewed. 2. A method of treatment using skeletal traction and manipulation under relaxant general anaesthesia is described. Results of treatment are given for all patients admitted to the Centre with flexion-rotation dislocations of the cervical spine complicated by neurological lesions, between November 1961 and December 1968. 3. After reviewing the literature and considering the results obtained in seventy-six cases, we advocate a policy of conservative management with gentle manipulation of the cervical spine in selected cases, reduction being maintained thereafter by skeletal traction. We reserve operation for the few cases that demonstrate late instability or for those rarer cases in which manipulation fails and the patient has either an incomplete neurological lesion or a double skeletal injury. 4. The low incidence of late instability after adequate conservative treatment is stressed, and the danger of overdistraction of the cervical spine by heavy traction in patients with severe ligamentous damage is emphasised

We assessed narrowing of the spinal canal in 39 burst fractures and fracture-dislocations of thoracolumbar vertebrae treated by the AO Internal Spinal Fixator, using CT preoperatively and at various stages postoperatively. Computer-aided planimetry was used to measure the narrowing, and its restoration shortly after instrumentation, or at 15 months. The mean initial reduction of canal area was to 63.7% +/- 18.8% of normal; this was restored to a mean of 95.4% +/- 21.2% of normal when measured either soon after surgery or at 15 months (p < 0.001 for both groups). There was more improvement in cases assessed later. For fractures from D12 to L3, the mean canal area was restored to 99.4% of normal; but at L4 or L5 the mean restitution was to only 60.9% (p < 0.05). We found no correlation between preoperative loss of area and amount of restoration, or severity of neurological deficit. Nor was there any correlation between the delay before surgery and the improvement achieved. The mechanism of fracture reduction appears to be a combination of distraction ligamentotaxis and forced hyperextension

Aims

Open reduction and plate fixation (ORPF) for displaced proximal humerus fractures can achieve reliably good long-term outcomes. However, a minority of patients have persistent pain and stiffness after surgery and may benefit from open arthrolysis, subacromial decompression, and removal of metalwork (ADROM). The long-term results of ADROM remain unknown; we aimed to assess outcomes of patients undergoing this procedure for stiffness following ORPF, and assess predictors of poor outcome.

1. Although fractures and dislocations of the talus have been described since 1608 the rarity of the more severe and complicated injuries has meant a dearth of accurate descriptions or classification in the literature. 2. A series of 228 injuries of the talus occurring in members of the Royal Air Force between 1940 and 1943 has been reviewed. 3. A simple but comprehensive classification of injuries of the talus is presented, together with a review of the pathological anatomy, clinical features, and methods of treatment. The importance of distinguishing between fractures and fracture-dislocations, and of watching carefully for displacements of the subtalar joint, is emphasised. 4. The important complications—infection, avascular necrosis and traumatic arthritis of the ankle or subtalar joint—are discussed. Infection may be the result of a compound injury, or may follow sloughing of the skin stretched over a displaced talus. Early reduction is, therefore, of great urgency in closed injuries. Avascular necrosis of the talus occurs in gross injuries when all or most of the soft-tissue attachments to the bone are severed. Revascularisation and regeneration will take place with patient conservative treatment. 5. The mechanism of injury is discussed. 6. The results of excision of the talus are poor. Every effort should be made to preserve the body of the talus, but if its loss is inevitable a useful foot can be regained by deliberate fusion of the tibia to the calcaneum

Aims

Heterotopic ossification (HO) is a potentially devastating complication of the surgical treatment of a proximal humeral fracture. The literature on the rate and risk factors for the development of HO under these circumstances is lacking. The aim of this study was to determine the incidence and risk factors for the development of HO in these patients.

Aims

We quantitatively compared the 3D bone density distributions on CT scans performed on scaphoid waist fractures subacutely that went on to union or nonunion, and assessed whether 2D CT evaluations correlate with 3D bone density evaluations.

Aims

The glenohumeral joint is the most frequently dislocated articulation, but possibly due to the lower prevalence of posterior shoulder dislocations, approximately 50% to 79% of posterior glenohumeral dislocations are missed at initial presentation. The aim of this study was to systematically evaluate the most recent evidence involving the aetiology of posterior glenohumeral dislocations, as well as the diagnosis and treatment.

Aims

This study reports the outcomes of a technique of soft-tissue coverage and Chopart amputation for severe crush injuries of the forefoot.

Most proximal humeral fractures are stable injuries of the ageing population, and can be successfully treated non-operatively. The management of the smaller number of more complex displaced fractures is more controversial and new fixation techniques have greatly increased the range of fractures that may benefit from surgery.

This article explores current concepts in the classification and clinical aspects of these injuries, reviewing the indications, innovations and outcomes for the most common methods of treatment.