Aims. Our aim was to investigate the outcomes of patients with a displaced fracture of the glenoid fossa who are treated conservatively. There is little information in the literature about the treatment of these rare injuries non-operatively. Patients and Methods. We reviewed 24 patients with a mean age of 52 years (19 to 81) at a mean of 5.6 years (11 months to 18 years) after the injury. Results. At final follow-up, the mean Constant and Murley score was 79 points (18 to 98); the mean Western Ontario Shoulder Instability Index score (WOSI) was 77% (12 to 100) and the mean Rowe score was 93 points (50 to 100). Fractures with little intra-articular displacement (≤ 3 mm) had an uneventful outcome. Those with intra-articular displacement of ≤ 3 mm had a significant better mean Constant and Murley score than those with displacement of ≥ 5 mm and/or a fracture gap of ≥ 5 mm. Poor clinical results such as nonunion and post-traumatic osteoarthritis were associated with displaced or angulated glenoid fragments and significant intra-articular displacement. Conclusion. Glenoid fossa fractures with displacement of ≥ 5 mm should be treated surgically if the patient’s condition allows. Displacement and angulation can lead to nonunion and a poor outcome if the degree of displacement results in a persistent fracture gap in the glenoid fossa or if the angulation of fragments leads to malunion. Cite this article: Bone Joint J 2016;98-B:1074–9

An experimental method is described which permits observations on the early stages of repair after acute displacement of the upper femoral epiphysis. Because the epiphysis is intra-articular, displacement brings about avascular necrosis which is slowly repaired by ingrowth of callus and blood vessels from the stump of the neck. As the bulk of the epiphysial plate remainsattached to the epiphysis, it acts as a barrier to successful revascularisation. Deliberate removal of the epiphysial cartilage allows earlier revascularisation. It is suggested that in clinical cases reduction be done through the epiphysial plate rather than through the neck, and that it be accompanied by curettage of the remaining part of the epiphysial plate from the under surface of the head

Aims: Severe proximal tibia fractures, which include intra- and extraarticular fractures with metaphyseal-diaphyseal dissociation, pose a difþcult treatment problem for the surgeon with signiþcant complication rates. The aim of this study is to report the experience with a series of consecutive severe proximal tibial fractures treated with hybrid external þxators. Methods: Between 1997 and 2001, we treated 118 cases of proximal tibia fractures of which 52 were treated with hybrid external þxation. Inclusion criteria for hybrid treatment was severe soft-tissue injury, intra-articular displacement, and unstable fracture patterns involvment. In addition to routine demographic data, objective data collected included healing, deformity, complications, and motion. Patient were also evaluated with an SF-36 12 months after healing. Results: All proximal tibial fractures healed without additional procedures. Most patients demonstrated healing by 16 weeks. Accuracy of redution was 0–1mm in 28 patients, 2–3 mm in 19 patients, and 4–5 mm in 4 patients and greater than 5 mm in one patient. Only 5 (10%) of the 52 patients had an angular malunion greater than 6û. One case had a loss of reduction. Four patients developed a mild varus deformity. Radiographic and clinical evidence of degenerative arthritis was seen in 12/52 (23%) patients 18 months after healing. The SF-36 proþlese were health state/rate, daily activity, work activity, emotional problems, pain. Conclusion: We found that hybrid external þxation is a good alternative method for treatment of meta- and/or epiphiseal fractures. The technique and post-op management we describe respects soft-tissue and bone biology and allows early articular mobilization

Introduction: Fractures of the scapula are rare injuries. When they do occur, they are usually caused by high-energy trauma and some of the patients may have significant associated injuries. Most fractures are minimally displaced and amenable to nonsurgical treatment. Open reduction and internal fixation of intra-articular fractures are considered if there is a glenohumeral sub-luxation secondary to fracture or if there is an intra-articular displacement greater than 5 mm. Patients and Methods: This study consisted of 33 Pts from Israel and Macedonia (28 M, 5F, 18–74 year old, mean 43.5Y) followed for 2–5 years (mean 3.5Y). Fractures were classified according to Idelberg following analysis of plain radiographs and computerized radiographs. 26 patients had undisplaced or minimally displaced fractures of the glenoid and were treated conservatively by collar and cuff for three weeks, then followed by physiotherapy. The remaining seven patients had comminuted fractures with marked displacement of the glenoid and some degree of shoulder subluxation and were treated surgically. Six patients were treated by open reduction and osteosynthesis by rigid plates (3) or by screws alone (3). The 7. th. patient who was treated surgically, a 73-year-old female, had a displaced fracture of the glenoid associated with comminuted fracture of the proximal humerus. She was treated by internal fixation of the fractured glenoid by 2 screws, followed by hemi-arthroplasty of the shoulder. All patients were evaluated by the Constant’s Shoulder Score and by radiographs. Results: Overall results were excellent and good in 27/33 Pts (82%). They were almost free of pain and most of them had almost complete ROM of the affected shoulder. In the group of the patients treated conservatively for undisplaced or minimal displaced fractures of the glenoid 22/26 (85%) had satisfactory results. Five of the patients treated surgically (71%) had excellent and good results, with some better results in less comminuted fractures. The remaining 2/7 Pts treated surgically had fair results. One of them had a comminuted fracture of the glenoid and the other patient had an associated compound fracture of the proximal humerus and a shoulder hemiarthroplasty. Conclusions: Based on this study it seems that most fractures of the glenoid – undisplaced or minimally displaced – can be treated conservatively. However, for patients with displaced glenoid fractures, best results can be obtained with open reduction and internal fixation by screws or by plates. This should be followed by intensive physiotherapy

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The aim of this study was to identify the origin and development of the threshold for surgical intervention, highlight the consequences of residual displacement, and justify the importance of accurate measurement.

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Carpal malalignment after a distal radial fracture occurs due to loss of volar tilt. Several studies have shown that this has an adverse influence on function. We aimed to investigate the magnitude of dorsal tilt that leads to carpal malalignment, whether reduction of dorsal tilt will correct carpal malalignment, and which measure of carpal malalignment is the most useful.

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Our aim in this study was to describe the long-term survival of the native hip joint after open reduction and internal fixation of a displaced fracture of the acetabulum. We also present long-term clinical outcomes and risk factors associated with a poor outcome.

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The degree of displacement of a fracture of the distal radius is an important factor which can be assessed using simple radiographic measurements. Our aim was to investigate the reliability and reproducibility of these measurements and to determine if they should be used clinically.

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The treatment of late presenting fractures of the lateral humeral condyle in children remains controversial.

The databases of the Picture Archiving and Communication Systems of two hospitals were searched and all children who had a lateral radiograph of the ankle during their attendance at the emergency department were identified. In 227 radiographs, Bohler’s and Gissane’s angles were measured on two separate occasions and by two separate authors to allow calculation of inter- and intra-observer variation. Intraclass correlation coefficients were used to assess the reliability of the measurements.

For Bohler’s angle the overall inter-observer reliability, the intraclass correlation coefficient was 0.90 and the intra-observer reliability 0.95, giving excellent agreement. This reliability was maintained across the age groups. For Gissane’s angle, inter- and intra-observer reliability was only fair or poor across most age groups.

Further analysis of the Bohler’s angle showed a significant variation in the mean angle with age. Contrary to published opinion, the angle is not uniformly lower than that of adults but varies with age, peaking towards the end of the first decade before attaining adult values. The age-related radiologic changes presented here may help in the interpretation of injuries to the hindfoot in children.

Heterotopic ossification occurring after the use of commercially available bone morphogenetic proteins has not been widely reported. We describe four cases of heterotopic ossification in patients treated with either recombinant bone morphogenetic protein 2 or recombinant bone morphogenetic protein 7. We found that while some patients were asymptomatic, heterotopic ossification which had occurred around a joint often required operative excision with good results.

Between 1998 and 2007, 22 patients with fractures of the scapula had operative treatment more than three weeks after injury. The indications for operation included displaced intra-articular fractures, medialisation of the glenohumeral joint, angular deformity, or displaced double lesions of the superior shoulder suspensory complex.

Radiological and functional outcomes were obtained for 16 of 22 patients. Disabilities of the Arm, Shoulder, Hand (DASH) and Short form-36 scores were collected for 14 patients who were operated on after March 2002. The mean delay from injury to surgery was 30 days (21 to 57). The mean follow-up was for 27 months (12 to 72). At the last review the mean DASH score was 14 (0 to 41). Of the 16 patients with follow-up, 13 returned to their previous employment and recreational activities without restrictions. No wound complications, infection or nonunion occurred.

Malunion of the scapula can be prevented by surgical treatment of fractures in patients with delayed presentation. Surgery is safe, effective, and gives acceptable functional results.