[Dislocation and necrosis of the first, second and third wedges. Management with the Masquelet technique. A case report]. / Luxación y necrosis de la primera, segunda y tercera cuña, manejo con técnica de Masquelet. Reporte de un caso.

The induced membrane technique was first described by Masquelet in 1986. It was initially used for the reconstruction of long bone shaft defects, particularly of the femur and tibia. The technique consists of two stages. During the first stage a membrane is induced to provide support to the grafts and supply growth factors that contribute to provide a favorable receiving bed for the future graft. During the second stage the poly-methyl-methacrylate spacer is removed and replaced with bone grafts, usually harvested from the iliac crest. Given that this technique has proven good results, it started to be used at other bone sites. We present herein the case of a patient with a large bone defect in the midfoot in whom the Masquelet technique was used with iliac crest grafts. Arthrodesis with a distal radius plate was performed to improve medial column stability, with favorable clinical and functional results.

Short-term results of the Ascension pyrolytic carbon metacarpophalangeal joint replacement arthroplasty for osteoarthritis.

INTRODUCTION: Osteoarthritis of the metacarpophalangeal joints is difficult to manage due to the high demands placed on any prosthesis. We report the preliminary results of our experience using the Ascension pyrolytic carbon implant. METHOD: A pyrocarbon metacarpophalangeal joint replacement was implanted into seven patients (10 metacarpophalangeal joints) with osteoarthritis. Patients were reviewed both clinically and radiologically. RESULTS: At a mean follow-up of 2.2 years (1-4 years) there were no implant failures nor loosenings. Pain scores improved from 68% to 3% postoperatively, and there was a very high rate of patient satisfaction. CONCLUSION: Pyrocarbon implants are a promising solution to a condition which may be otherwise difficult to treat surgically.

'Doctor, when can I drive?': an update on the medico-legal aspects of driving following an injury or operation.

In line with recent changes in UK legislation, we updated our position regarding the determination of fitness to drive. The responsibility for determining the fitness to drive of an individual now rests entirely with the Driving and Vehicle Licensing Agency (DVLA). Previous work on this subject was reviewed, updated published documents were evaluated and a literature search on fitness to drive following an injury or operation was carried out. We should advise our patients to drive once they feel safe, but they should be careful during the earlier stages of rehabilitation. If in any doubt, the driver should contact the DVLA and take advice accordingly from their medical advisors.

Use of the coventry infant hip screw in the treatment of nonunion of fractures of the distal humerus.

Between 1993 and 2000 we treated 14 patients with nonunion of fractures of the distal humerus; 11 had already had previous fixation which had failed. The mean time to surgery was 21 months after injury. All the fractures were very low which made it difficult to obtain a firm hold of the small distal fragment. The problem of fixation was addressed by inserting a Coventry infant hip screw into the humeral condyles. The screw has a thread of wide diameter which gives excellent purchase on the small distal fragment. The condyles can then be compressed on to the humeral shaft using a 4.5 mm narrow tibial dynamic plate. Of these 14 difficult cases of nonunion, 12 progressed to union.

Prophylactic plating of the donor site of osteocutaneous radial forearm flaps.

We carried out a retrospective study of fracture morbidity of radial forearm osteocutaneous donor sites. During a period of three-and-a-half years, 12 patients had had composite flaps taken, and 5 of them had subsequently fractured the radius. We then elected to plate the radius prophylactically and found that over a period of just over two years, none of the 8 patients who had had prophylactic plating at the original harvesting operation had subsequently fractured the radius.