We reviewed 15 patients, nine girls and six boys, with chronic anterior dislocation of the radial head which was treated by ulnar osteotomy, external fixation and open reconstruction of the elbow joint but without repair of the annular ligament. Their mean age was 9.5 years (5 to 15) and the mean interval between the injury and reconstruction was 22 months (2 months to 7 years).

All radial heads remained reduced at a mean follow-up of 20 months (6 months to 5 years). Normal ranges of movement for flexion, extension, pronation and supination were unchanged in 96.1% (49/51) and worse in 3.9% (2/51). Limited ranges of movement were improved in 77.8% (7/9), unchanged in 11% (1/9) and further decreased in 11% (1/9).There were two superficial pin-track infections and two cases of delayed union but with no serious complications. Reconstruction of the radiocapitellar joint is easier using external fixation since accurate correction of the ulna can be determined empirically and active functional exercises started immediately. Only patients with a radial head of normal shape were selected for treatment by this method.

We studied prospectively the regional inflammatory response to a unilateral distal radial fracture in 114 patients at eight to nine weeks after injury and again at one year. Our aim was to identify patients at risk for a delayed recovery and particularly those likely to develop complex regional pain syndrome. In order to quantify clinically the inflammatory response, a regional inflammatory score was developed. In addition, blood samples were collected from the antecubital veins of both arms for comparative biochemical and blood-gas analysis.

The severity of the inflammatory response was related to the type of treatment (Kruskal-Wallis test, p = 0.002). A highly significantly-positive correlation was found between the regional inflammatory score and the length of time to full recovery (r² = 0.92, p = 0.01, linear regession). A regional inflammatory score of 5 points with a sensitivity of 100% but a specificity of only 16% also identified patients at risk of complex regional pain syndrome. None of the biochemical parameters studied correlated with regional inflammatory score or predicted the development of complex regional pain syndrome.

Our study suggests that patients with a distal radial fracture and a regional inflammatory score of 5 points or more at eight to nine weeks after injury should be considered for specific anti-inflammatory treatment.

We identified 11 women with a mean age of 74 years (65 to 81) who sustained comminuted distal radial and ulnar fractures and were treated by volar plating and slight shortening of the radius combined with a primary Sauvé-Kapandji procedure.

At a mean of 46 months (16 to 58), union of distal radial fractures and arthrodesis of the distal radioulnar joint was seen in all patients. The mean shortening of the radius was 12 mm (5 to 18) compared to the contralateral side. Flexion and extension of the wrist was a mean of 54° and 50°, respectively, and the mean pronation and supination of the forearm was 82° and 86°, respectively. The final mean disabilities of the arm, shoulder and hand score was 26 points. According to the Green and O’Brien rating system, eight patients had an excellent, two a good and one a fair result.

The good clinical and radiological results, and the minor complications without the need for further operations related to late ulnar-sided wrist pain, justify this procedure in the elderly patient.

We present a method for the reducing a displaced radial head in children, by rotating the forearm while pressing over the displaced fragment. This has been successful in a series of 10 cases.

1. The age of the patient has no influence on the incidence of non-union in fractures of the forearm in adults.

2. The degree of displacement of the fracture is an important factor in non-union, and is related to the violence of the injury.

3. Fractures of one bone unite better than fractures of both bones, and this is due to the stabilising effect of the intact bone.

4. Open and comminuted fractures have a much higher incidence of non-union.

5. The lowest incidence of non-union, allowances being made for other significant factors, was in cases treated conservatively; and after that in cases treated by plating followed by immobilisation in plaster.

6. Plating without subsequent immobilisation in plaster is a method to be abandoned, but there is some advantage in waiting for ten days, until post-operative oedema has been absorbed, before applying the plaster.

7. In cases in which several factors predisposing to non-union are present in the same patient, it seems justifiable to supplement plating by cancellous onlay strips as a primary procedure.

8. In cases of non-union the cancellous insert graft described by Nicoll succeeded in 94·5 per cent of the cases, many of which were exceptionally difficult problems. In 75 per cent union occurred within four months of grafting.

9. The restoration of mobility, either after union of the fracture or after grafting operations, was never a serious problem in the present series.

The results of thirty synovectomies of the elbow for rheumatoid arthritis are reported. Satisfactory relief of pain was obtained in twenty-seven elbows and the range of movement was improved in twenty-one. The classical operation includes excision of the radial head but in this series approximately half the radial heads were conserved with comparable results. The results of synovectomy do not significantly deteriorate with time up to ten years and the operation can be done with good results, especially in respect of relief of pain, even in elbows with relatively advanced rheumatoid disease. Radiographic assessment is not of much help in evaluating the results of the operation, but is essential in selection of elbows for synovectomy.

There is some radiological, clinical and histological evidence to show that a fibular graft inserted into the forearm may continue to grow.