We performed a prospective, randomised study on 50 patients with Tscherne C1 tibial diaphyseal fractures comparing treatment with reamed and unreamed intramedullary nails. Our results show that reamed nailing is associated with a significantly lower time to union and a reduced requirement for a further operation. Unreamed nailing should not be used in the treatment of the common Tscherne C1 tibial fracture

We report three patients having transoral fusion at C2/3 or C3/4 after fractures, with no infections or surgical complications and sound union. The operative technique and the relative merits of different approaches to the upper cervical spine are discussed and the transoral approach to the anterior aspect of the upper three cervical vertebrae is commended to the specialist surgeon

The results of a prospective multicentre study of the Herbert differential pitch bone screw used to treat 50 scaphoid fractures and non-unions are presented. All fresh fractures and four of the five fracture-dislocations united, an overall union rate of 92%. Although the technique is demanding, the Herbert screw can achieve excellent results in the management of scaphoid fractures

Objectives

Opening wedge high tibial osteotomy (HTO) is an established surgical procedure for the treatment of early-stage knee arthritis. Other than infection, the majority of complications are related to mechanical factors – in particular, stimulation of healing at the osteotomy site. This study used finite element (FE) analysis to investigate the effect of plate design and bridging span on interfragmentary movement (IFM) and the influence of fracture healing on plate stress and potential failure.

Our study describes a posterolateral approach to the distal humerus for open reduction and internal fixation of displaced fractures of the lateral condyle. A total of 20 patients had open reduction and internal fixation over a four-year period using this approach, and at a mean follow-up of 12 months had full union, range of movement and no complications, either clinical or radiological. This approach is well suited to the exact visualisation and accurate reduction of this difficult fracture with minimal dissection of tissues

Callus formation and the rate of union of nailed fractures of the femur has been determined in 22 patients with associated head injuries and compared with that in a group of patients with similarly treated fractures but without head injuries. The comparison confirms the widely held view that, in patients with head injuries, fractures frequently heal with excessive callus and at a faster rate than normal

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

1. A series of fractures of the forearm has been treated by exceptionally rigid internal fixation with a special plate and screws. 2. The plate and screws are described. 3. The results of rigid fixation are found to be: i) reliability of union, and ii) good final function. 4. The lessons learned regarding the application of the plate and the after-treatment of the forearms are recounted

Four military recruits with complete distraction-type stress fractures of the femoral neck were treated conservatively. The radiographic diagnosis was made within two weeks of the onset of symptoms and the activities of the patients were matched to the clinical and radiographic progress of fracture healing. None of the fractures displaced and union occurred uneventfully. Our experience suggests that prophylactic internal fixation of these fractures is not necessary

1. Thirteen cases of non-union of the epiphysis of the lateral condyle of the humerus were studied. Ten followed minor lateral luxations of the epiphysis; three were sequelae of open reduction and soft-tissue suture of major displacements. 2. In three cases in which non-union developed while the patient was under observation, union was secured after bone grafting by a technique described

We treated 24 patients with nonunion of tibial shaft fractures by locked intramedullary nailing, 18 by open and six by closed techniques. Union was achieved in 22 patients, failing only in two patients with active infection. Locked nailing prevented recurrence of deformity and allowed the patients to mobilise without external support. Supplementary bone grafting was essential only for major defects

We describe a technique of femoral derotation osteotomy performed according to the Ilizarov principles of percutaneous corticotomy and fixation with a frame. We performed 24 femoral osteotomies in 16 patients, four with cerebral palsy and 12 with idiopathic femoral anteversion. All had rapid union and there were few complications. The advantages of the method include early ambulation, good control of rotation and axial alignment, and minimal scarring

1. A patient is described, the thirty-fourth reported, who shows all the skeletal changes of pycnodysostosis with the exception of the oral findings. 2. It is suggested that the pseudarthroses of the tibiae in our patient cannot be taken as evidence against normal union because of the possibility of inadequate management of the fractures. 3. We consider that the use of strong intramedullary nails in the treatment of long bone fractures in these cases is advisable

1. An analysis of 171 cases of compression arthrodesis in the knee is presented. 2. A total success rate of 98·8 per cent was revealed. 3. The average time between operation and walking free of splintage was nine weeks. 4. When the compression was removed, after an average period of four weeks, 88·2 per cent of the knees already showed clinical union

Our aim in this prospective study was to evaluate a minimally invasive technique for percutaneous arthrodesis of the small joints in the hand. Thirteen arthrodeses were undertaken in 11 patients, eight women and three men. After the percutaneous removal of articular cartilage, the bony surfaces were aligned in a predetermined position and stabilised using a percutaneous screw system. The mean follow-up was 38.6 months (36 to 56). Bony union was achieved in 12 cases (ten patients) between nine and 12 weeks after surgery. In one patient a second operation was required to obtain union and another developed a painless nonunion after premature removal of the implants

Acute fractures of the scaphoid were randomly allocated for conservative treatment in a Colles’-type plaster cast with the wrist immobilised in either 20° flexion or 20° extension. The position of the wrist did not influence the rate of union of the fracture (89%) but when reviewed after six months the wrists which had been immobilised in flexion had a greater restriction of extension. We recommend that acute fractures of the scaphoid should be treated in a Colles’-type cast with the wrist in slight extension

1. Three pantalar, one ankle and subtalar, and three ankle arthrodeses have been performed by a technique, the essential step of which is the insertion of a transarticular graft from below. Union has occurred in four to five months. 2. A method is described of determining the degree of equinus before the operation and securing it during the operation. 3. Pantalar fusion by this technique compares favourably with the methods described so far

We report a new method of ankle arthrodesis which combines an anterior approach with a dowel technique of bone grafting and screw fixation. In 20 ankles of 20 patients, ten with osteoarthritis, eight with rheumatoid arthritis and two others, we achieved 19 solid bony fusions and one painless fibrous ankylosis. The average time to union was 12.5 weeks. Patient satisfaction was high and the functional results were as good as for other reported methods, with fewer complications

We have reviewed the results of the Sofield-Millar operation on 58 long bones in ten patients. If more than three osteotomies were undertaken the time to union of the bone was significantly prolonged (p< 0.001) with significant thinning of the bone (p< 0.02). We have used a modified technique in order to minimise surgical trauma and devascularisation of the bone. The rod is introduced under the control of an image-intensifier. Small surgical exposures are made only at the sites of corrective wedge osteotomies. The number of osteotomies is kept to the minimum

We describe three cases of traumatic myositis ossificans in which fractures occurred through a mature, quiescent ossification mass. None of the fractures reactivated the original pathological process, no callus was formed and union did not occur. The nonunion became painless over a period of months. This unusual late complication of myositis ossificans seems to require only symptomatic treatment by temporary splintage and subsequent mobilisation. We could find no previous report of a similar case