Bulk osteochondral allograft for massive Hill-Sachs defect combined with Latarjet procedure for bipolar bone loss in anterior instability.

A proportion of patients with anterior glenohumeral instability present with bipolar bone loss comprising large Hill-Sachs lesions and substantial glenoid defect. These are surgically difficult cases to treat. We describe a novel surgical procedure of bulk size-matched osteochondral allograft reconstruction for massive Hill-Sachs lesions combined with the Latarjet procedure for these challenging cases.

Functional rating for knee arthroplasty: comparison of three scoring systems.

This study evaluated the reliability of three rating systems for total knee arthroplasty. Twenty-nine patients were assessed by six observers with the American Knee Society Score, the British Orthopaedic Association Score, and the Oxford 12-item questionnaire. The inter- and intraobserver variations were calculated for the American Knee Society Score and the British Orthopaedic Association Score, as was the reproducibility of the Oxford 12-item questionnaire. Components of the scores were evaluated for agreement using Kappa statistics. The British Orthopaedic Association Score had smaller interobserver variation compared to the American Knee Society Score, and the greatest reproducibility of the three systems. This was attributed to the equal weighting of its component variables. The Oxford 12-item questionnaire, a self-administered questionnaire that eliminates interobserver error, emerged as the most reliable system. Observer experience affected the reliability of the American Knee Society Score and the British Orthopaedic Association Score. Subjective variables were more reliable and reproducible than the objective components.

Treatment of established and anticipated nonunion of the tibia in childhood.

Nonunion in long bone fractures is rare in the skeletally immature patient. The authors report the outcome of a series of patients treated for tibial bone loss and nonunion at average follow-up of 66 months. Nine children aged 18 months to 17 years were treated. Three patients had established nonunion ranging from 7 months to 6 years, three had bone loss (1-6 cm), and three had fractures in which nonunion was anticipated (one Gustilo IIIb and two Tscherne III). Treatment involved wound excision for open fractures, debridement of devascularized bone, and stabilization with monolateral fixators (two patients) and circular fixators (seven patients). Five patients had unifocal treatment and four had multifocal treatment (three bone transports). Treatment time ranged from 3 to 12 months and was not related to the complexity of treatment. Functional outcome was measured using the Short Musculoskeletal Functional Assessment, a validated outcome assessment tool. At the latest follow-up (average 66 months), the mean knee flexion was 134 degrees and mean ankle range was 12 degrees dorsiflexion, 31 degrees plantar flexion. Physeal arrest was present in three children (limb length discrepancy 2-4 cm), but with no deformity. Functional outcome revealed a "Dysfunction Index" of 0% to 19% (average 7%) and a "Bother Index" of 0% to 16% (average 6%). Good function can be obtained following treatment of these severe injuries.