Staged reconstruction for malunited fractures of the distal radius.

This prospective study assessed the outcomes of 26 symptomatic malunited distal radial fractures which were treated with an opening wedge corrective osteotomy and bone grafting with rigid fixation. An ulnar shortening osteotomy was subsequently required as a second-stage operation in five cases to restore normal ulnar variance. A wrist arthroscopy was indicated as a third stage procedure with persistent ulnar sided wrist pain in order to address central tears of the triangular fibrocartilage. Satisfactory functional scores were achieved by 20 of the 26 patients after distal radial osteotomy alone and, 24 of the 26 after subsequent ulnar shortening osteotomies and arthroscopy when necessary. The one, two or three stage concept of reconstructing the malunited distal end radius could optimise the outcome rather than using a single-stage strategy.

Reconstructive surgery in spinal tumours.

AIMS: This study reports 21 patients who underwent reconstructive surgery for destructive spinal tumours. MATERIALS AND METHODS: The mean age was 49 years (range: 39-71 years). Primary lesions were met in two cases. Secondary spinal tumours were diagnosed in 19 cases. Thirteen were breast carcinoma metastases (61.9%). The cervical spine was involved in four cases, thoracic spine in six cases, and the lumbar spine in 11 cases. One patient underwent decompression laminectomy and posterior pedicle screw stabilization. The others underwent tumour tissue excision, with spinal reconstruction with autogenous bone grafting, with or without vertebral body replacement prosthesis. Anterior and posterior stabilization of the vertebral column was also used. RESULTS: The objectives of surgery were achieved, in that early ambulation, easier nursing care, pain relief and neurological recovery were reported in all cases. No surgery-related complications were encountered. CONCLUSIONS: We recommend surgical intervention for such lesions where reasonable longevity is anticipated.

Triplane fracture of the distal tibia.

A prospective study of 21 triplane fractures of the distal tibia is presented. Nineteen cases (90.5%) had lateral triplane fractures, while the other two (9.5%) had medial triplane fractures. Two fragment fractures were encountered in 12 cases (57%); three fragment fractures in six cases (29%), and four fragment fractures in the remaining three cases (14%). Fourteen cases (67%) were managed non-operatively, while in seven cases (33%), open reduction and internal fixation was performed. Twenty patients (95%) were pleased with the final outcome. Objectively, 14 cases (67%) achieved excellent results.

Necrotizing fasciitis: a rare complication of total hip replacement.

Necrotizing fasciitis is a rare, but life-threatening emergency. We report a case history of necrotizing fasciitis in a previously healthy woman. A review of the literature suggests that this is the first report of necrotizing fasciitis complicating total hip replacement surgery.