Percutaneous management of ununited femoral fracture.

We describe a percutaneous technique used for the management of non-union in a complex diaphyseal femoral fracture treated initially with intramedullary nailing. Seven months after the initial fixation, a proximal fracture gap failed to progress to union. A percutaneous procedure involving fracture gap freshening and supplementation with bone morphogenetic protein and demineralised bone matrix resulted in a satisfactory progression to union. The percutaneous procedure allowed less soft tissue insult around the fracture site, a short hospital stay, a fast return to the preoperative level of mobility and fracture union.

Seven-year outcome following Colles' type distal radial fracture. A comparison of two treatment methods.

Eighty-five patients were reviewed 7 years after prospective randomization to bridging external fixation or plaster immobilization for treatment of a Colles' type distal radial fracture. The Gartland and Werley score showed that most patients in each group had an excellent or good outcome and patient satisfaction was comparable and high in both groups. The fixator group had significantly less radial shortening (P<0.05). Despite a high level of radiographic malunion (50%) overall function, range of movement and activities of daily living were not limited. Twenty-five per cent of patients had minor radiological signs of post-traumatic arthritis although only one patient was symptomatic. We conclude that, in the long term, external fixation of distal radius fractures does not confer an improved outcome when compared to plaster immobilization.

The influence of the posterior cruciate ligament in the maintenance of joint line in primary total knee arthroplasty: a radiologic study.

The aim of this study was to compare 2 total knee arthroplasty (TKA) designs radiologically to determine if a posterior cruciate ligament (PCL)-substituting design led to a built-in error of elevation of the joint line postoperatively. The restoration of the true joint line is a goal in primary TKA, although its effect on outcome has not been established fully. A total of 47 patients had 56 TKAs performed by 2 surgeons using either the Howmedica Kinemax Plus (Rutherford, NJ) PCL-retaining or PCL-substituting TKAs. The patients were randomized to receive one of these designs, and the height of the joint line was assessed radiographically preoperatively and postoperatively. The joint line position preoperatively averaged 2.2 cm from the tibial tuberosity and postoperatively averaged 2.4 cm (PCL substituting) and 2.5 cm (PCL sparing). No difference in the thickness of the polyethylene insert used was seen with either design. The theoretical elevation of the joint line that occurs with the sacrifice of the PCL was not found to occur radiologically.

Dall-Miles plating for periprosthetic B1 fractures of the femur.

Eight patients (9 fractures) who have been treated with Dall-Miles plating in this unit between April 1996 and October 1997 for ipsilateral periprosthetic fractures around total hip replacement (7 cases) and total knee replacement (2 cases) have been reviewed. Four were men, and 4 were women. The average age at the time of operation was 77 years (range, 65-89 years). The average follow-up period was 14.6 months (range, 6-24 months). Three fractures healed satisfactorily with no evidence of malunion (3 of 9). The final result was unsatisfactory in the other 6 fractures. The femoral component had been inserted in a varus position in all the failures but was in a neutral position in the 3 successes. Procedures other than Dall-Miles plating might be more appropriate in the management of periprosthetic fractures in which the femoral component is in a varus position.