We have assessed the long-term results after operative and non-operative treatment of undisplaced and displaced calcaneal fractures.

At a mean of 6.5 years, we reviewed 70 patients with a calcaneal fracture who were divided into four groups: group 1, 18 patients with undisplaced fractures and a normal Böhler’s angle (BA) who had been treated non-operatively; group 2, 23 with intra-articular fractures and a BA < 10° who had been treated non-operatively; group 3, 13 with intra-articular fractures and a BA > 10° who had been treated surgically; and group 4, 16 with intra-articular fractures and a BA < 10° who had been treated surgically.

The results were assessed by a clinical score considering pain, return to work, return to physical activity, change in shoe-wear and the requirement for subtalar arthrodesis.

Patients with undisplaced calcaneal fractures had a good outcome. Those with displaced fractures treated surgically who presented at follow-up with a BA > 10° had a satisfactory functional outcome and those with displaced fractures who had non-operative treatment had a poor outcome. The poorest outcome was consistently seen in patients who were treated operatively without restoration of BA. Open reduction and internal fixation of intra-articular calcaneal fractures can only be expected to benefit those patients in whom nearly anatomical reconstruction is obtained.

We have carried out a prospective study to determine whether the basic descriptive criteria and classifications of diaphyseal fractures of the tibia determine prognosis, as is widely believed. A number of systems which are readily available were used, with outcome being determined by standard measurements including fracture union, the need for secondary surgery and the incidence of infection. Many validated functional outcomes were also used. The Tscherne classification of closed fractures proved to be slightly more predictive of outcome than the others, but our findings indicate that such systems have little predictive value.

1. Fifty tibial fractures treated by intramedullary nailing during seven years have been presented. There were twenty-eight closed and twenty-two open fractures.

2. The use of the method for treating open (compound) fractures is discussed.

3. The indications for intramedullary nailing are outlined.

1. A series of 110 cases of trochanteric fractures treated by internal fixation with the Capener-Neufeld nail-plate is presented. The age incidence, mortality, complications and functional results are discussed in detail.

2. The results are compared with those of two series of cases treated conservatively: a) 101 cases treated conservatively in hospital; b) 25 cases sent home by reason of shortage of hospital beds.

3. From a consideration of these three series, and from study of similar series of cases reported in the literature, it is concluded that routine operative treatment of trochanteric fractures offers the advantages of lowered mortality, improved function, economy of hospital beds, and greater comfort and mobility of the patient.

4. Certain points in the management of cases during the operation and in the convalescent period are discussed.

1. A series of 196 fractures of the patella has been reviewed.

2. The treatment adopted was excision of the whole bone—l0l; excision of part of the bone—33; open reduction and suture—18; suture with later excision—14; no operation—30.

3. The average time of post-operative disability varied from 3·6 to 5·3 months. The time was appreciably less when operation was carried out before the fourteenth day than when it was done later.

4. An attempt was made to follow up, two to five years after injury, those patients in whom the result was not influenced by other major injuries of the limbs or by unexpected complications. Replies to questionnaires were received from 116 patients.

5. Of these, all regained a good range of movement, varying from 90 degrees of flexion to full movement, whether treatment was by excision of part or all the bone, or by open reduction and suture.

6. The late results of excision of the patella, as estimated by the patients themselves two to five years after treatment, showed that there was considerable residual disability.

7. After total excision of the bone only 5 per cent. of patients considered that the knee was normal; 90 per cent. complained of aching; 60 per cent. complained of "giving way." After excision of one fragment, about half the patients regarded the knee as normal and half complained of aching and stiffness.

8. The number of fractures in this series treated by accurate internal fixation was too small to make justifiable comparisons.

9. The indications for non-operative treatment, open reduction and accurate internal fixation, excision of one fragment, and excision of the whole bone are discussed.

10. Excision of part or all the patella is often inevitable, but some claims made in the past for the results of this operation are not substantiated.

Aims. Periprosthetic fractures (PPFs) around cemented taper-slip femoral prostheses often result in a femoral component that is loose at the prosthesis-cement interface, but where the cement-bone interface remains well-fixed and bone stock is good. We aim to understand how best to classify and manage these fractures by using a modification of the Vancouver classification. Methods. We reviewed 87 PPFs. Each was a first episode of fracture around a cemented femoral component, where surgical management consisted of revision surgery. Data regarding initial injury, intraoperative findings, and management were prospectively collected. Patient records and serial radiographs were reviewed to determine fracture classification, whether the bone cement was well fixed (B2W) or loose (B2L), and time to fracture union following treatment. Results. In total, 47 B2W fractures (54.0%) and one B3 fracture (1.1%) had cement that remained well-fixed at the cement-bone interface. These cases were treated with cement-in-cement (CinC) revision arthroplasty. Overall, 43 fractures with follow-up united, and two patients sustained further fractures secondary to nonunion and required further revision surgery. A total of 19 B2L fractures (21.8%) and 19 B3 fractures (21.8%) had cement that was loose at the cement-bone interface. These cases were managed by revision arthroplasty with either cemented or uncemented femoral components, or proximal femoral arthroplasty. One case could not be classified. Conclusion. We endorse a modification of the original Vancouver system to include a subclassification of B2 fractures around cemented femoral prostheses to include B2W (where cement is well-fixed to bone) and B2L (where the cement is loose). Fractures around taper-slip design stems are more likely to fracture in a B2W pattern compared to fractures around composite beam design stems which are more likely to fracture in a B2L pattern. B2W fractures can reliably be managed with CinC revision. Cite this article: Bone Joint J 2021;103-B(1):71–78

We reviewed 286 consecutive patients with a fracture of a pubic ramus. The overall incidence was 6.9/100 000/year in the total population and 25.6/100 000/year in individuals aged over 60 years. The mean age of the patients was 74.7 years and 24.5% suffered from dementia. Women were affected 4.2 times more often than men. After injury, geriatric rehabilitation was frequently required and although most surviving patients returned to their original place of residence, their level of mobility was often worse. The overall survival rates at one and five years were 86.7% and 45.6%, respectively. Multiple logistic regression analysis showed that age and dementia were the only independent significant factors to be predictive of mortality (p < 0.05).

Patients with a fracture of a pubic ramus had a significantly worse survival than an age-matched cohort from the general population (log-rank test, p < 0.001), but this was better than patients with a fracture of the hip during the first year after injury, although their subsequent mortality was higher. Five years after the fracture there was no significant difference in survival between the two groups.

We describe 24 fractures of the tuberosity of the calcaneus in 22 patients. Three were similar to the type of avulsion fracture which has been well-defined but the remainder represent a group which has been unrecognised previously. Using CT and operative findings we have defined the different patterns of fracture of the calcaneal tuberosity. Ten fractures extended into the subtalar joint, but did not fit the pattern of the common intra-articular fracture as described classically. We have defined a new pattern which consists of a fracture of the medial calcaneal process with a further fracture which separates the upper part of the tuberosity in the semicoronal plane.

Non-operative treatment of displaced fractures resulted in a mis-shapen heel and a poor functional outcome. Open reduction and internal fixation with either a plate or compression screw did not give satisfactory fixation.

We prefer to use an oblique lateral tension-band wire. This technique gave excellent fixation and we recommend it for the treatment of displaced fractures of the tuberosity of the calcaneus.