We describe a posterior approach to the elbow which combines the advantages of both splitting and reflecting the triceps. It gives protection to the ulnar nerve and its blood supply during the operation while providing excellent exposure of the distal humerus. During closure, the triceps muscle can be tensioned, thereby improving stability of the elbow. This approach has particular relevance to unlinked total elbow arthroplasty allowing early rehabilitation of the joint

We describe the reconstruction of a defect of the medial malleolus which was the result of an accident in a ten-year-old child. A graft from the iliac crest, with the apophyseal cartilage and perichondrium, was used for reconstruction of the medial malleolus, the growth plate and the adjacent metaphyseal defect, respectively. The soft-tissue defect was covered with a free scapular flap with microvascular anastomosis. Three years after the injury stability of the ankle is excellent with adequate growth of the reconstructed epiphyseal plate

The results of fifty-one Manchester knee arthroplasties in forty-one patients are reviewed and discussed. Excellent and good results were obtained in 85.4 per cent of arthroplasties. Varus and valgus deformity can be corrected and stability preserved or restored. Complications occurred in only twelve patients but resolved in all except one

We have reviewed 104 patients who had partial resection of the fibula for use as a graft. Only 44 were completely free from symptoms, and six had developed significant ankle instability which had required reconstruction by a sliding graft. This procedure successfully restored ankle stability in all six cases

1. A simple method of subtalar fusion, suitable for use in children, is described. 2. Although it is intended to provide stability for some years until a complete subtalar fusion can be carried out, further operation may not be necessary. 3. Its use is not advocated over the age of eleven or twelve

We report our experience of surgical treatment for instability of flail knees after poliomyelitis in 228 patients. We made carefully selective use of soft-tissue release, extension osteotomy of the femur, and a patellar bone block for hyperextension. After six to nine years follow-up, 87% of the patients had retained significant improvement in stability and walking ability

A carefully planned operation may be expected to check increasing deformity without doing harm, and to make subsequent bony stabilisation easier. In favourable cases it may be possible to restore muscle balance and stability, making further surgery unnecessary. A longer follow-up is necessary to determine to what extent this ideal can be achieved

Sprain of the pisiform triquetral joint is a definite clinical entity. It presents as a "tenosynovitis" of the flexor carpi ulnaris muscle from which it can be distinguished by the tests described. The disability in most cases is such that operation is justifiable. Fusion of the pisiform-triquetral joint is preferred to excision of the pisiform because it restores stability to the wrist with the least disturbance to related structures

Aims

Single-stage revision is not widely pursued due to restrictive inclusion criteria. In this study, we evaluated the results of single-stage revision of chronically infected total hip arthroplasty (THA) using broad inclusion criteria and cementless implants.

1. An oblique displacement osteotomy of the distal third of the first metatarsal is described for the correction of adolescent hallux valgus. 2. No fixation of the fragments is necessary, stability depending upon displacement in the over-corrected position for two weeks. 3. A follow-up of twenty-five operations has shown only one failure, from recurrence of the deformity. There have been no complications

Persistent dislocation of the elbow after a fracture of the coronoid process is a difficult problem. We have performed an open reduction with reconstruction of the coronoid by an osteocartilaginous graft from the ipsilateral olecranon for two patients. Both achieved a painless, stable joint with a functional range of movement. The joint surface of the graft has a similar curve to that of the coronoid giving good congruency and stability. The technique is simple and the graft is obtained through the same incision

Thirty patients with atlanto-axial subluxation were operated on using the Mitsui Memorial Hospital System. The follow-up averaged one and a half years, and the results were satisfactory in comparison with other operative methods, all patients regaining almost normal function. Stability and safety are the main advantages of this procedure, with almost complete correction of subluxation in most patients

In ipsilateral mid-clavicular and scapular-neck fractures, the mechanical stability of the suspensory structures is disrupted and muscle forces and the weight of the arm pull the glenoid fragment distally and anteromedially. To prevent late deformity we recommend internal fixation of the fractured clavicle by a plate and screws. We treated seven patients with this unusual injury; all achieved an excellent functional result without deformity

We report the use of long curved Kuntscher nails to maintain stability during arthrodesis of nine infected and five uninfected failures of total knee replacement. The curvature of the nail helps positioning and avoids the need for cortical perforation. A single-stage operation was possible in most cases. Union rates are comparable with those of other series and even patients with delayed union have satisfactory function

Aims

The aim of this study was to report the outcomes of different treatment options for glenoid loosening following reverse shoulder arthroplasty (RSA) at a minimum follow-up of two years.

We measured the sagittal laxity in 70 knee replacements at least six months after surgery, using a KT 1000 arthrometer. With an unconstrained prosthesis (the Oxford meniscal knee) anteroposterior stability was normal in joints known to have intact cruciate ligaments. There was increased laxity in those which lacked an anterior cruciate ligament. In knees with an intact anterior cruciate ligament, sagittal laxity did not increase with time

Children with flail feet who have control of their hips and knees are able to walk but are unable to stand still and find it difficult to walk slowly. These problems have been overcome in fifty-three children with flail feet due to myelomeningocele by fitting them with below-knee orthoses which provide maximum stability and yet allow normal walking. The biomechanical principles and the development of the orthoses are discussed

Nonunion of intertrochanteric fractures is uncommon but its effects are disabling. We describe a modification of the medial displacement and valgus osteotomy of Dimon and Hughston (1967) which we used in seven fractures, six of which united within 16 weeks. Postoperatively, hip function was good. The method provides good initial stability, a source of cancellous bone graft, good postoperative hip abductor function and reliable healing of the nonunion without the need for intraoperative imaging

The management of radial head fractures complicated by ligamentous disruption remains a matter of controversy. The use of a silicone radial head implant to provide temporary stability is thought to help to protect the ligaments during healing. The reported complications of long-term implantation of a silicone replacement include fracture, dislocation, synovitis, lymphadenitis and subchondral resorption. We now report one case in which an inflammatory process resulted in generalised cartilage degeneration. This has not previously been noted