Aims

Following cast removal for nonoperatively treated distal radius fractures, rehabilitation facilitated by advice leaflet and advice video were compared to a course of face-to-face therapy.

Aims

We aimed to evaluate the long-term impact of fracture-related infection (FRI) on patients’ physical health and psychological wellbeing. For this purpose, quality of life after successful surgical treatment of FRIs of long bones was assessed.

The development of the iron-cored electromagnet as a stimulator of bony union is described. In a clinical trial extending over eight years, 80 patients were treated for various forms of failed union. Their results are presented, as well as tentative conclusions regarding the indications and efficiency of the method. The latest, fully-portable apparatus is described

We undertook a retrospective study of 50 consecutive patients (41 male, 9 female) with an infected nonunion and bone defect of the femoral shaft who had been treated by radical debridement and distraction osteogenesis. Their mean age was 29.9 years (9 to 58) and they had a mean of 3.8 (2 to 19) previous operations. They were followed for a mean of 5.9 years (2.0 to 19.0). The mean duration of the distraction osteogenesis was 24.5 months (2 to 39). Pin-track infection was observed in all patients. The range of knee movement was reduced and there was a mean residual leg-length discrepancy of 1.9 cm (0 to 8) after treatment. One patient required hip disarticulation to manage intractable sepsis. In all, 13 patients had persistant pain. Bony union was achieved in 49 patients at a mean of 20.7 months (12 to 35). Although distraction osteogenesis is commonly used for the treatment of infected femoral nonunion with bone defects, it is associated with a high rate of complications

Arthrodesis of the knee is sometimes needed for failed total knee replacement, but fusion can be difficult to obtain. We describe a method of arthrodesis that uses the simple, inexpensive, Portsmouth external fixator. Bony union was obtained in all six patients treated with this technique. These results are compared with those obtained by other methods of arthrodesis

We treated 19 patients with established nonunion of the radius and/or ulna by the excision of avascular bone and the grafting of blocks of corticocancellous bone from the iliac crest, augmented by rigid plate fixation under compression. This allowed early mobilisation, and bony union was achieved between three and 24 months after operation in all but one of the patients. The single failure was attributed to the excessive length of the defect (100 mm) and inadequate fixation

In a prospective study, a double crossover wire with a compression spring was used to re-attach 52 un-united trochanters at revision operations on total hip arthroplasties. Bony union was achieved in 42 (81%) and was not influenced by the duration of the nonunion or the separation gap. The new method compared favourably with earlier revisions at which other methods of trochanteric re-attachment had been used

Aims

The use of frozen tumour-bearing autograft combined with a vascularized fibular graft (VFG) represents a new technique for biological reconstruction of massive bone defect. We have compared the clinical outcomes between this technique and Capanna reconstruction.

A case is described in which a large area of unstable skin overlying a tibial fracture was replaced by a single stage skin flap transfer, using microvascular surgical techniques. The shortening of treatment time and the improvement in the local blood supply compared to that provided by orthodox skin flaps are noted. The improved blood supply at the fracture site may have encouraged bony union

An operation is described in which a microvascular technique was used to transfer a living fibula, with its vascular pedicle intact, to replace the lower end of the radius after massive resection for giant-cell tumour. Angiography carried out six weeks later showed that the grafted bone was viable. Six months after operation the transplanted fibula showed no osteoporosis or bone resorption and bony union at the junction of host and graft

Sixteen severely haemophilic patients have undergone arthrodesis of one joint of the lower limb in the period 1966 to 1976. There have been nine arthrodeses of the knee and seven of the ankle. The follow-up period was from nine months to eight years. The arthrodeses were secured by internal fixation. The method was not without complications, but a satisfactory bony union resulted in all cases without further surgical intervention

1. A simple technique of arthrodesis of the hip is described. 2. Two triflanged nails are driven across the joint. The joint is not opened. No bone graft and no extensive fixation is used. 3. Symptoms were relieved in 90 per cent of patients and bony union was achieved in 63 per cent. Backache after operation was not a problem. 4. The period of hospitalisation was short and rapid return to heavy work was common

1. Ten cases are reported of subcapital fractures of the femoral neck with low fracture-shaft angles treated by wedge osteotomy and fixation by nail-plate. 2. A simple method of osteotomy to increase the fracture-shaft angle is described. 3. In eight fresh fractures bony union was obtained when nailing was followed by immediate osteotomy. 4. The alteration of the bony anatomy does not prejudice further reconstructive surgery should it become necessary

Five cases of congenital pseudarthrosis of the tibia successfully treated by a free vascularised fibular graft are described. Follow-up ranged from 5 to 34 months with a mean of 17.5 months. The technique, which includes radical excision of abnormal bone and soft tissue around the pseudarthrosis, also permits primary bone lengthening, and correction of deformity. The early results indicate that satisfactory bony union is achieved in a relatively short period of time

Five children with congenital pseudarthrosis of the tibia treated by free vascularised fibular grafts were followed up until skeletal maturity. The ipsilateral fibula was used in four cases, the contralateral fibula in one. All our cases achieved bone union, but leg length discrepancy, atrophy of the foot and ankle stiffness were frequent complications, due perhaps to the many previous operations. Vascularised fibular grafting might achieve better results if it were done as the primary procedure

A segment of tibia 4.5 centimetres long was removed from one hind limb of fifteen dogs. It was then replaced and the main vasculature was restored by a microsurgical technique. In eight controls the segment was replaced without such restoration. In two-thirds of the former cases the microvascular reconstruction was successful; the rate of infection was found to be reduced, bone union was guaranteed and the rate of union accelerated. Success or failure of the reconstruction was clearly demonstrated in five cases by early bone scanning using technetium-labelled polyphosphate

We have performed simple bone grafting in four elderly patients with pain due to unstable pseudarthroses in the osteoporotic spine after compression fracture. At operation, we observed abnormal movement of the affected vertebral body which was covered with a hypertrophic membrane; this seemed to inhibit the blood supply to the lesion. The thick membrane and avascular granulation in the false joint were excised and bone grafting carried out. Symptoms were dramatically improved immediately after operation and bony union was confirmed in the three surviving patients

1. Fibrous union of an osteotomy occurred in only 3 per cent of osteotomies done during a four-year period. 2. Delayed union sometimes gives rise to pain on bearing weight while union is in progress, and non-union is usually associated with disabling pain. 3. The most significant factors predisposing to delayed or fibrous union are inefficient fixation and excessive displacement. A high or very oblique osteotomy may also have an adverse effect upon the rate of bony union

1. Fifteen cases of bone transplantation for fibrous union of fractures of long bones are described, using boiled minced cancellous bone from cadavers. One transplant became infected but the infection responded to treatment. 2. In one patient with non-union of the shaft of the humerus, bony union was not obtained, but a good functional result obviated further treatment. 3. It is suggested that this relatively simple method of bone transplantation could be used more widely if its potentialities were appreciated more fully