Aims

Nonunion occurs when a fracture fails to heal permanently, often necessitating surgical intervention to stimulate the bone healing response. Current animal models of long-bone nonunion do not adequately replicate human pathological conditions. This study was intended as a preliminary investigation of a novel rat nonunion model using a two-stage surgical intervention, and to evaluate the efficacy of a selective prostaglandin E2 receptor 4 agonist (AKDS001) as a novel nonunion therapeutic agent compared with existing treatments.

Aims. Congenital pseudarthrosis of the tibia (CPT) has traditionally been a difficult condition to treat, with high complication rates, including nonunion, refractures, malalignment, and leg length discrepancy. Surgical approaches to treatment of CPT include intramedullary rodding, external fixation, combined intramedullary rodding and external fixation, vascularized fibular graft, and most recently cross-union. The current study aims to compare the outcomes and complication rates of cross-union versus other surgical approaches as an index surgery for the management of CPT. Our hypothesis was that a good index surgery for CPT achieves union and minimizes complications such as refractures and limb length discrepancy. Methods. A multicentre study was conducted involving two institutions in Singapore and China. All patients with CPT who were surgically managed between January 2009 and December 2021 were included. The patients were divided based on their index surgery. Group 1 included patients who underwent excision of hamartoma, cross-union of the tibia and fibula, autogenic iliac bone grafting, and internal fixation for their index surgery. Group 2 included patients who underwent all other surgical procedures for their index surgery, including excision of hamartoma, intramedullary rodding, and/or external fixation, without cross-union of the tibia and fibula. Comparisons of the rates of union, refracture, limb length discrepancy, reoperations, and other complications were performed between the two groups. Results. A total of 36 patients were included in the study. Group 1 comprised 13 patients, while Group 2 comprised 23 patients. The mean age at index surgery was four years (1 to 13). The mean duration of follow-up was 4.85 years (1.75 to 14). All patients in Group 1 achieved bony union at a mean of three months (1.5 to 4), but ten of 23 patients in Group 2 had nonunion of the pseudarthrosis (p = 0.006). None of the patients in Group 1 had a refracture, while seven of 13 patients who achieved bony union in Group 2 suffered a refracture (p = 0.005). None of the patients in Group 1 had a limb length discrepancy of more than 2 cm, while ten of 23 patients in Group 2 have a limb length discrepancy of more than 2 cm (p = 0.006). In Group 1, four of 13 patients had a complication, while 16 of 23 patients in Group 2 had a complication (p = 0.004). Excluding removal of implants, four of 13 patients in Group 1 had to undergo additional surgery, while 18 of 23 patients in Group 2 had to undergo additional surgery following the index surgery (p = 0.011). Conclusion. A good index surgery of excision of hamartoma, cross-union of the tibia and fibula, autogenic iliac bone grafting, and internal fixation for CPT achieves union and minimizes complications such as refractures, limb length discrepancy, and need for additional surgeries

Introduction. Osteonecrosis of the femoral head usually progresses to collapse in up to 70% to 80% of all cases. Previous studies have shown high failure rates with non-operative treatment, whereas, some surgical options including bone grafting, core decompression, osteotomy and arthroplasty have been recommended. Total hip arthroplasty and hemiarthroplasty, either cemented or cementless, are the last resort for improving the functional outcomes for the elderly. However, salvage of the femoral head in relatively young patients is widely advocated. Thus vascularized bone grafting has been recommended to salvage the collapsing femoral head. The purpose of this study was to evaluate the prognostic factors related to the outcome of the vascularized iliac bone grafting in the treatment of osteonecrosis of the femoral head. Methods. A retrospective case series review study is presented. Between April 1987 and April 2003, 47 patients (51 hips) in the authors' hospital underwent vascularized iliac bone grafting for the treatment of osteonecrosis of the femoral head. Three patients were lost to follow-up, thus, 44 patients (48 hips), 38 men and 4 women, were included in the study. All patients underwent operation by one experienced senior surgeon. Patients were grouped according to related risk factors, i.e., trauma, corticosteroid, alcohol, and an idiopathic group. A radiographic scale, the Ficat and Arlet classification system, was used for grading the osteonecrosis. We set the conversion to total hip arthroplasty as the end point for survival of vascularized iliac bone grafting in this study. Kaplan-Meier survivorship analysis was used to determine the significance with regard to the risk factors, age, Ficat and Arlet staging, gender, and side. Results. The Kaplan-Meier survivorship analysis showed that the 5-year overall rate of graft survival was 68.5% (95% confidence interval: 52.7% to 80.0%), 10-year overall rate of graft survival was 61.5% (95% confidence interval: 44.4% to 74.8%), and 61.5% (95% confidence interval: 44.4% to 74.8%) at 15 years. There was no significant difference between the groups regarding the prognostic factors of etiology, gender, side, and stage. The only significant parameter was the age that the patients older than 50 years had the worst 5-year survival rate of the femoral head (p<0.05). Conclusion. Vascularized bone grafting is a technically demanding procedure when compared to conventional core decompression or arthroplasty. However, this technique can preserve the femoral head from collapse and preclude the need for arthroplasty in young patients

Introduction: Osteonecrosis of the femoral head remains a challenging problem especially in young patients. The purpose of this study was to evaluate the clinical results of a viable iliac bone graft for treating osteonecrosis of the femoral head. Materials and Methods: Seventy-one hips in 52 patients underwent a viable iliac bone graft (9 hips-vessel pedicle iliac bone graft and 62 hips-muscle pedicle iliac bone graft). The clinical and radiographic results were evaluated after an average of 3 years and 4 months (range, 2 to 5 years). Patient age ranged from 20 to 40 years with an average of 31 years. Twenty-three hips were classified as Ficat stage 2 disease and 48 as stage 3 disease. The causes of osteonecrosis were excessive alcohol consumption in 30, steroid use in 13, posttraumatic in 4, decompression sickness in 1, and unknown in 23 hips. The clinical results were evaluated based on the patients’ satisfaction and pain score. The radiographical results were evaluated by serial follow-up roentgenography and pinhole bone scintigraphy. Results: The clinical and radiological results were satisfactory. Overall, the survival rate was 96 percent. Excellent results were obtained in 15 hips, good in 39, fair in 6 and poor in 8. Three hips underwent total hip replacement, including one infected case. Excellent or good results were obtained in 82 percent of stage 2 cases and in 65 percent of stage 3 cases. The serial roentgenographic examination revealed a gradual incorporation of the grafted bone, and the scintigraphic examination revealed a gradual increase in the uptake which suggested an increased blood supply to the femoral head. Discussion: The overall results of viable iliac crest bone grafting were very satisfactory. This technique is recommended particularly for young patients with stage 2 or 3 osteonecrosis of the femoral head. Pinhole bone scintigraphy was quite useful for evaluating the healing process after the revascularization procedure

Introduction: The efficacy and complications of the transarticular screw procedure have been reported by many authors. However, few have reported this procedure for child younger than 10 years old. We have treated two children for atlantoaxial subluxation with transarticular screws, using a soft collar without a halo-vest, and have achieved bone union in good reduced position. Methods/results. Case 1: a 5-year-old boy with mental retardation and cerebellar infarction due to an insufficiency of the vertebral artery resulting in severe atlantoaxial instability. He presented with a high degree of congenital atlantoaxial subluxation complicated by Os odontoideum. He has been treated with transarticular screw and iliac bone graft by Brooks procedure. Case 2: an 8-year-old boy with congenital spondyloepiphyseal dysplasia and a right valgus knee. He, too, presented with a high degree of congenital atlantoaxial subluxation complicated by Os odontoideum, and has been treated with transarticular screw and iliac bone graft by Brooks procedure. In both cases, we used two half-thread cortical screws with a diameter of 2.7mm and a length of 30mm for the transarticular screw procedure. Discussion/conclusion: Rigid external fixation was obtained by Halo-vest. This method, however, would be expected to cause mental stress for the child patient and the family. More rigid internal fixation would be required to resolve this problem. More rigid internal fixation can be obtained with the transarticular screw, and postoperative orthosis can be performed easily, without the need for a Halo-vest

Introduction. The purpose of this study was to evaluate the outcome of vascularized iliac bone grafting for idiopathic osteonecrosis of the femoral head. Methods. We reviewed the clinical and radiological results of 35 operations performed on 29 patients who had osteonecrosis of the femoral head (ONFH) in which a pedicle iliac bone grafting was performed for minimum follow-up of 10 years. The average age was 35 years (range, 17 to 62 years). According to the Japanese Orthopaedic Association classification for ONFH, there were 28 stage 2, 7 stage 3-A, 17 type C-1 hips, and 18 type C-2 hips. After a bone tunnel of 1.5 × 5 cm was made in the anterior aspect of the femoral head and curettage of necrotic lesion was performed, the pedicle bone with the deep circumflex iliac artery (DCIA) was inserted into the anterolateral portion of the femoral head. The average follow-up period was 13 years and 6 months. Weight bearing was not allowed for 2 months after the operation. Survival rate of the femoral head was calculated by Kaplan-Meier methods, and collapse of the femoral head and configuration of the femoral head was investigated at final follow-up. Results. Collapse of the femoral head occurred in 19 hip joints of 35 studied. Although only 16 of 28 stage 2 hips showed collapse, all 7 stage 3 hips collapsed. Four of 17 hips (24%) showed collapse in patients with type C-1 necrosis, whereas, 15 of 18 hips (83%) developed collapse in patients with type C-2 necrosis. When the bone graft was inserted in the anterolateral portion of the femoral head, the incidence of collapse was reduced. In patients without collapse for more than 12 years, osteoarthritic change was evident in 5 hips between 12 to 19 years after operation. Conclusion. In this study, we found that collapse of the femoral head occurred or progressed in almost half of our patients, and these findings allowed us to clarify the operative indications for DCIA pedicle bone graft. In patients with stage 3, DCIA pedicle bone graft could not prevent collapse of the femoral head. While 13 of 17 hips with type C-1 were prevented from collapse, only 3 of 18 with type C-2 did not show collapse. These results indicate that DCIA bone graft may be indicated for stage 2, type C-1 necrosis. However, technical demands of this surgery tend to make it a less routine application for the treatment of ONFH

This prospective randomized multicenter study compares two methods of bone defect treatment in tibial plateau fractures: a bioresorbable calcium phosphate paste (Alpha-BSM) that hardens at body temperature to give structural support versus Autogenous iliac bone graft (AIBG). One hundred and eighteen patients were enrolled with a 2:1 randomization, Alpha-BSM to AIBG. There was a significant increased rate of non-graft related adverse affects and a higher rate of late articular subsidence (three to nine month period) in the AIBG group. A bioresorbable calcium phosphate material is recommended in preference to the gold standard of AIBG for bone defects in tibial plateau fractures. This prospective randomized multicenter study was undertaken to compare two methods of bone defect treatment: a bioresorbable calcium phosphate paste (Alpha-BSM –DePuy, Warsaw, IN) that hardens at body temperature to give structural support and is gradually resorbed by a cell-mediated bone regenerating mechanism versus Autogenous iliac bone graft (AIBG). One hundred and eighteen adult acute closed tibial plateau fractures, Schatzker grade two to six were enrolled prospectively from thirteen study sites in North America from 1999 to 2002. Randomization occurred at surgery with a FDA recommendation of a 2–1 ratio, Alpha BSM (seventy-eight fractures) to AIBG (forty fractures). Only internal fixation with standard plate and screw constructs was permitted. Follow-up included standard radiographs and functional studies at one year, with a radiologist providing independent radiographic review. The two groups exhibited no significant differences in randomization as to age, sex, race, fracture patterns or fracture healing. There was however, a significant increased rate of non-graft related adverse affects in the AIBG group. There was an unexpected significant finding of a higher rate of late articular subsidence in the three to nine month period in the AIBG group. Recommendations for the use of AIBG for bone defects in tibial plateau fractures should be discouraged in favor of bioresorbable calcium phosphate material with the properties of Alpha BSM. We believe further randomized studies using AIBG as a control group for bone defect support of articular fractures are unjustified. A bioresorbable calcium phosphate material is recommended in preference to the gold standard of AIBG for bone defects in tibial plateau fractures. Funding: DePuy, Warsaw, IN

Introduction and Aims:. The surgical treatment of fractures of the scaphoid with delayed presentation or with established non-union pose a formidable challenge with reported failure rates between 15% and 45%. The aim of this study is to report the results of percutaneous versus open fixation with bone grafting of these fractures. Method:. 34 Consecutive patients who underwent surgery between 2009 and 2013 for delayed presentation and established non-union of scaphoid fractures have been reviewed retrospectively. There were 27 males and 7 females with a mean age of 31 years (15 to 66). The mean delay from time of injury to operation was 12 weeks (4 weeks to 11 months) in the percutaneous fixation group and 19 months (5 months to 6 years) in the open fixation group. 19 Patients were treated with percutaneous screw fixation alone and 15 patients underwent open reduction and internal fixation supplemented with autogenous corticocancellous iliac bone graft. The classification of Slade and Dodds (2009) was used as a guide for surgical treatment and the Mini-Acutrak headless compression screw was used as the fixation device in all cases. Results:. Patients underwent final clinical and radiological assessment with plain radiographs 6 months following their surgery. There was one failed union in the percutaneous fixation group and there was one failed union in the open fixation group. One patient in the open fixation group was lost to follow up. No serious complications were recorded in either group. Conclusion:. The success of percutaneous internal fixation for acute fractures of the carpal scaphoid may be extended to include scaphoid fractures with delayed presentation and fractures of the scaphoid with established nonunion. However, appropriate patient selection is necessary to ensure optimal outcomes

Aims

Several artificial bone grafts have been developed but fail to achieve anticipated osteogenesis due to their insufficient neovascularization capacity and periosteum support. This study aimed to develop a vascularized bone-periosteum construct (VBPC) to provide better angiogenesis and osteogenesis for bone regeneration.

Introduction: There are few long-term studies after Zielke ventral derotation spondylodesis (VDS). We present a minimum 17 year follow-up study to assess factors predicting distal adjacent disc degeneration. Material/Methods: Twenty-eight patients with thora-columbar AIS operated in 1982 have been retrospectively evaluated. Mean age 16,3 years, minimum follow-up 15 years. Anterior fusion was performed with rib graft. Results: Mean pre-op Cobb angle was 65 ± 23°, post-op correction rate was 61,2 ± 12,4%. Mean angulation of end vertebra was 32 ± 10°, post-op corrected to a mean of 8° (correction rate 79%). Mean post-op Th10/L2 kyphosis was 10°. Rod breakage was seen in 17 patients. Conclusion: Thoracolumbar kyphosis was associated both with proximal implant breakage and with segmental lordosis and degeneration of the distal adjacent segment. Disc angulation in the AP plane seems to be good tolerated. Anterior support with iliac bone graft or cages is expected to overcome these complications

There is still some controversy about the treatment of nonunion of the lateral humeral condyle in children. Twelve patients with symptomatic long standing nonunion of the lateral humeral condyle were treated by internal fixation with iliac bone graft. The age range of the patients 8 years to 25 years. There were 10 males and 2 females. The time from the original fracture to nonunion ranged from 2 years 6 months to 13 years averaging 6 years 3 months. The indication for surgery was pain and deformity and weakness in elbow. Follow up ranged from 16 months to 6 years averaging 32 months. Bony union was achieved in all cases. Strength of the elbow were restored in all cases. All patients were painfree in the elbow strenuous activities. Postoperative elbow motion was decreased in four patients with an average loss of 10.5 degree of the motion present before surgery. The valgus deformity was improved. Surgical osteosynthesis for long standing nonunion of the lateral humeral condyle is recommendable method

Autogenous iliac bone grafts has been proved to be the most reliable mean to achieve a solid fusion in spine surgery. The purpose of our study is to evaluate that healing process of the ilium after been used as donor site of bone grafts in the treatment of adolescent idiopathic scoliosis. Eighteen patients underwent posterior spinal fusion for progressive adolescent idiopathic scoliosis between 1989 and 1993. Thirteen patients were female and five were male with a mean age at the time of operation of 14.6 years (12–33). The same surgeon performed all procedures with nearly identical technique using the Hart-shill frame as stabilizing instrumentation. The average of the number of levels involved in spinal fusions was 10.3 levels. In all cases the autogenous bone graft used was harvested from the right posterior iliac crest. All patients were reviewed at least fourteen years after surgery. CT scans were performed in all 18 patients in order to evaluate the status of ossification at the donor site. CT scans of the ilium showed that bone deficit was present in 9 cases (50%) and in 9 cases (50%) it was found that both cortical and cancellous bone was fully restored. Using the T-student test we found that bone reformation was independent from the number of levels fused and the amount that was harvested. Our important result is that younger patients with smaller Risser’s line have greater capability to restore bone stock at this area. In conclusion ICBG remains the most effective mean to achieve fusion in spinal surgery. The iliac wing and especially the periosteum of immature patients (Risser 3,4) seem to have great capabilities to regenerate the bone defects

The ‘Pi’ plate is an anatomical titanium plate recently introduced for the internal fixation of comminuted intra-articular distal radius fractures. We report our experience with this implant in a prospective series of twelve patients with an average age of thirty six years (range, 26–52 years). A dorsal approach with release of the EPL tendon and extra-compartmental exposure of the radius between the second and fourth extensor compartments was employed in all cases. Iliac bone graft and a styloid K-wire were used to augment the plate fixation. Post-operatively, active mobilisation was started after wound healing. Wrist motion and grip strength measurements were made at six weeks, three months and six months by the therapist. At six months, patients recovered an average of 85% of range of movement compared with the opposite wrist, except for palmar flexion (65%). No loss of reduction was observed on follow-up radiographs. Complications were compartment syndrome, intraoperative EPL rupture and two cases of extensor tendonitis requiring implant removal. The ‘Pi’ plate affords rigid fixation of distal radius fractures permitting early rehabilitation. It is however a demanding technique that is not without complications

Several methods of surgical treatment for pyogenic spondylitis have been reported including anterior approach, staged and simultaneous anterior decompression and posterior stabilisation. The use of anterior implants in the presence of infection presents still a challenge for spine surgeons. Retrospective analysis of the clinical and radiological outcome of patients suffering from pyogenic spondylitis of the cervical and lumbar spine necessitating surgical treatment for intractable pain, instability and neurologic impairment. Seventeen patients with spondylitis associated or not with paravertebral abscess were treated by one stage surgery (first: anterior decompression and placement of titanium mesh cage, filled with autologous iliac bone graft; second: posterior transpedicular instrumentation and fusion). The age of the patients was 54 ±15 years. Most of the patients had systematic problems such as lung tuberculosis, hepatic cirrhosis, diabetes mellitus or chronic renal failure. Patients were evaluated before and after surgery in terms of pain and neurological level, sagittal spinal balance and radiological fusion. All 17 patients were followed for 45 months. Average duration of both surgeries was 4.5 hours. The VAS score improved from 7 (preoperatively) to 2 (postoperatively). The correction of the segmental kyphotic deformity was 6o, without loss of correction or cage migration or instrumentation failure. All patients with incomplete neurologic impairment improved postoperatively. There was neither migration of mesh cage nor posterior instrumentation failure at the follow up observation. There was an approach-related abdominal hernia. This clinical study showed that patients with cervical and thoracolumbar osteomyelitis necessitating surgery for certain indications can successfully undergo instrumented combined, one-stage, same-day surgery. The presence of the mesh cage anteriorly at the site of infection had not negative but beneficial influence on the course of infection healing, and it additionally stabilised the affected segment, maintaining sufficient sagittal profile

Aims: a) To review donor site morbidity and record problems coming out during bone harvesting, b) to evaluate bone graft adequacy and effectiveness. Methods: Senior author operated 127 patients using cancellous bone autografts (from May 1988 to September 2001). Bone grafts were obtained from iliac crest (83 patients), proximal tibial metaphysis (39 patients) and other donor sites (5 patients). In all cases intraopera-tive problems and early postoperative problems were recorded. Late postoperative problems were evaluated either subjectively (questionnaire) or clinically for 109 patients. Minimum length of follow up was 12 months. Results: In all the cases, the goals of graft harvesting were accomplished. Generally, grafts were adequate in quantity and quality (apart from 2 cases in which grafts were taken from proximal tibial metaphysis). Blood loss from the proximal tibia was less than iliac bone. Iliac pain was more severe than tibial, resulting to delayed mobilization and pain could persist for a long period of time. Conclusions: Proximal tibial metaphysis, as a donor site, is associated with far less morbidity than iliac and it should be chosen in patients with lower-extremity fractures or nonunions. Harvesting from tibia is adequate and easier comparing to iliac. Tibial bone grafts were as effective as iliac, despite that iliac bone graft is widely used and generally referred as a better quality autologus bone graft

Extracorporeal Irradiation and Reimplantation (EIR) of tumor bearing bone segments is an alternative reconstruction method for major osseous resections. In contrast with endoprosthetic reconstruction, EIR is a biologic solution and after a prolonged healing and remodeling period it is expected to create a structural and metabolic almost normal bone. After oncologic resection the bone segment is cleaned from adhered soft tissues and send to irradiation which kills malignant and normal cells. Reimplantation consists of fixation, mostly by plates, vascularised fibular graft insertion in the medullary canal, iliac bone graft in critical sites and ligamentous sutures. Since 2001 fifteen patients were submitted to EIR in our institution. Resections affected seven distal femurs, four proximal tibias, one acetabulum, one iliac bone and the proximal forehand bones once which bear 11 osteosarcomas, 2 Ewing’s sarcomas, 1 chondrosarcoma and 1 rhabdomyosarcoma. There were six males and nine females with age ranging from five to 55 years. Ten patients were submitted to osteoarticular reconstructions, three to intercalary and two to partial pelvis reconstructions. Local recurrence leading to amputation occurred in one patient and resection of an infected innominate bone occurred once. Three patients died two to nine months after surgery because of their disease. Five patients had metaphyseal fractures after one to 14 months after surgery. Four patients had no fracture; three of them had intercalary resections. The patient with osteoarticular resection and no fracture had his metaphyseal region injected with cement which prevented fracture and after 23 months have not developed osteoarthritis. All the cases in which a vascularised fibular graft was implanted progressive fusion of the living and dead bones were observed. As a conclusion EIR is a good alternative for intercalary resections. For osteoarticular resections improvement of the method are necessary to prevent fracture and ligamentous laxity

Introduction: Modern nailing techniques are the gold standard in the treatment of multifragmentary fractures of femur. Nevertheless, the use of plate and screws, in accordance with the principles of biologic fixation, remains an effective alternative. Aim: The purpose of this retrospective study is the evaluation of the results of biologic fixation, with plate and screws, of multifragmentary femoral fractures. Material – Methods: Our material consists of 32 multifragmentary subtrochanteric and diaphyseal femoral fractures that were treated in our department, between 1992 and 2000, in accordance with the principles of biologic fixation with plates and screws. All fractures were reduced indirectly with traction on the fracture table without any direct manipulation at the comminution zone. Emphasis was given to the restoration of the proper length, axial and rotational alignment of each fracture. The exposure of the femur was done proximally and distally to the fracture site through two separate incisions of the vastus lateralis near its insertion to the linea aspera. There was no direct exposure of the comminution zone. The fixation was done with a long bridge plate, without the use of interfragmentary screws. No iliac bone graft was used in the primary procedures. Results: Twenty nine of the fractures (91%) united, without serious complications, within 3–5 months. One fracture failed to unite and had to be operated upon with a new plate and screws and additional bone grafting. In another one, the plate was bent, due to early weight bearing, and had to be exchanged with a nail. The third fracture united in a mild varus position, as some of the screws were broken and the plate was mildly bent. Conclusions: The bio-“logic” use of plate and screws in the treatment of multifragmentary fractures of femur gives excellent results, comparable with those of the modern nailing techniques

Introduction: Stress fracture of the femoral head is a rare condition and usually occurs in people with poor bone quality as an insufficiency fracture. We evaluated the clinical aspects of subchondral fatigue fractures of the femoral head (SFFFH) that occurred in young healthy people. Materials and Methods: Between January 1998 and November 2001, 7 cases of SFFFH in 5 patients were treated. The characteristics of this condition were ascertained by assessing the clinical course and findings of radiographs, bone scintigrams, and magnetic resonance (MR) images. Results: All patients were male military recruits in their early twenties. Pain developed within 6 months after recruitment. On initial radiographs, definite abnormal findings were observed in 3 hips of 2 patients. In 2 of them, the femoral head was markedly collapsed. In the other 4 hips, no definite abnormal findings were noticed. The bone scintigrams showed increased radionuclide uptake in the femoral head. MR images demonstrated localized abnormal signal intensity areas (bone marrow edema pattern) in the femoral head. In all cases, MR crescent signs were observed. In the cases without collapse of the femoral head, the pain decreased gradually and disappeared completely in 6 months with improving findings on follow-up MR images. The collapsed cases needed surgical treatment: total hip arthroplasty or strut iliac bone grafting. Discussion: When a military recruit or an athlete is complaining of hip pain, a high index of suspicion for SFFFH is necessary to prevent the collapse of the femoral head. Bone scintigrams are of great value as a screening tool. Osteonecrosis of the femoral head can be differentiated by the findings on MR images

Aims

This study aimed to evaluate the effectiveness of the induced membrane technique for treating infected bone defects, and to explore the factors that might affect patient outcomes.

Aims

There are concerns regarding complications and longevity of total elbow arthroplasty (TEA) in young patients, and the few previous publications are mainly limited to reports on linked elbow devices. We investigated the clinical outcome of unlinked TEA for patients aged less than 50 years with rheumatoid arthritis (RA).