Purpose. To investigate the effect of soft tissue release (STR) and the length of postoperative immobilisation on the long term outcomes of closed reduction (CR) of the hip for developmental dysplasia of the hip. Materials. 77 hips (72 patients) who had undergone closed reduction (CR) between 1977-2005 were studied retrospectively to review their outcome (Severin grade), identify the reasons for failure and to assess factors associated with residual dysplasia. Particular attention was paid to the use of a STR at the time of CR (to improve initial hip stability) and the duration of postoperative immobilisation. Results. The mean age at CR was 10.5 months (5-24months) and mean follow up 97 months. A STR (adductor ± psoas tenotomies) was performed in 65%. Post-operative immobilisation time varied between 3-12 months (mean 6.3 months). 6 hips (all Tonnis grade 3) failed CR within 2-6 weeks. In the remaining 49 hips, 85% were Severin Grade 1 at age 5yrs. Acetabular index (AI) decreased in all patients over time: 80% hips had an AI <20. 0. at age 5yrs. Neither a STR, nor the time of post-operative immobilisation conferred any additional benefit on the final AI. 2/55 hips required a pelvic osteotomy for residual dysplasia. This was not related to initial Tonnis grade, age at reduction or use of STR. Conclusion. A STR is often required for initial hip stability. Once a stable hip is achieved, an excellent long term outcome from CR in infants <24months old can be expected with remodelling of the acetabular dysplasia in ≥95%. Significance. Hip stability is the key to a good outcome. The optimal length of post-operative bracing has not been determined from this study but 3-6months immobilisation of the stable hip is adequate

Introduction: The treatment of stage 3 hallux rigidus is controversial. Cheilectomy, fusion and total joint replacement have all been advocated. No consensus is agreed on the best optimal management. We present our results of a ceramic on ceramic MOJE metatarsophalangeal (MTP) joint replacement. Aim: To find out the medium to long term outcome following MOJE MTP joint replacement. Material and Methods: A sample of 95 patients was identified, between January 1999 to July 2006 from our data base who underwent MOJE metatarsophalangeal joint replacement. We divided these patients into three groups. First group had screw fit ceramic MOJE joint replacement; second group Mark 1 ceramic on ceramic press fit MOJE joint replacement and third group Mark 2. Indications of the surgery were osteoarthritis (primary or secondary), osteochondral defects, inflammatory arthropahty, previous infections and previously failed surgery. The outcome was analysed clinically, radiologically and functionally (using AOFAS and QALY scoring system). Results: This study shows that the early results are promising but the medium and long term results show early radiological loosing. The significance of this is not known but based on these results we would advice caution on the use of these implants and further long term studies are required

Study Design: Retrospective case review. Summary of Background Data: The Chiari malformation is a condition characterised by herniation of the posterior fossa contents below the level of the foramen magnum. Objectives: To present the long term outcome and complication rate following hindbrain decompression for this condition. Methods: We retrospectively analysed the results of patients who underwent hind brain decompression between 1994 and 2003. There were 70 cases with a mean age of 32 years. Follow up was carried out with clinical examination and repeat MRI scans. The mean follow up was 4.7 years. Thirty-six patients had associated syringomyelia. Patients underwent hind brain decompression through a small posterior fossa craniectomy, opening of the foramen magnum with or without removal of arch of C1. Results: One patient died and one had a stroke which resolved except for mild facial weakness. Long term follow up revealed that 50% of the patients were asymptomatic following surgery and another 26% had marked improvement in their symptoms. One patient deteriorated post-operatively and the remainder (23%) had unchanged condition. Of the patients presenting with scoliosis 67% had no further progression in their curve. Conclusion: This is the largest series presented from a single centre with pre- and postoperative MRI fol1ow up. Our results compare favourably with previously published literature

Background: It is well established that unstable fractures of the distal part of the radius may require operative treatment to restore alignment and that failure to restore alignment often leads to wrist and forearm dysfunction. There is ongoing debate in the literature whether or not there is a strict relationship between the quality of anatomical reconstruction and functional outcome. We hypothesize that there is no difference in objective- and subjective functional outcome between patients with AO type B versus more complex AO type C fractures. Methods: Ninety-four patients with an average age of 42 years (range, 20 to 78 years) at the time of injury were evaluated an average of 20 years (range, 8 to 32 years) after treatment of an intra-articular distal radius fracture. At long-term follow-up patients were evaluated using a physician-based evaluation instruments (modified Mayo wrist score; MMWS and an upper extremity-specific health status questionnaire (Disabilities of the Arm, Shoulder and Hand; DASH) questionnaire. Objective and subjective functional outcome of patients with AO Type B and AO Type C fractures were compared. Results: An average of 20 years after injury (average age 62 years, range 35 to 90), all fractures healed without significant loss of alignment. There was no difference in physician based outcome measure according to the Mayo score between 17 patients with 18 AO type B fractures (average, 80,3 points; range 45 to 100) and 27 patients with 31 AO type C fractures (average, 75.9 points; range 10 to 95, p=0.42). Differences in subjective DASH scores were not statistically significant either (p = 0.47); average 13 points for Type B patients (range, 0 to 58 points) and an average of 16 points for Type C patients (range, 0 to 71 points). Groups were statistically comparable. No statistical differences were found in flexion extension arc (average 103 degrees, range 10 to 145 degrees), pronation supination arc (average 150 degrees, range 0 to 180 degrees) or radial ulnar deviation (average 52 degrees, range 0 to 85 degrees), as well as grip strength and osteoarthritis (all p> 0.05). Conclusions: Twenty years after injury 67% of patients have a satisfactory outcome according to physician-based MMWS categorical ratings. There is no difference in functional long term outcome between patient with more extensive intra-articular comminution (type C fractures) and AO type B fractures. This is consistent with previous long term outcome studies with similar methodology; when more complex injuries are not correlated with decreased long term functional outcome, other (subjective) factors are more important determinants of disability

We studied the long term outcome, using the Oswestry Disability Index (ODI), on patients who were managed at our institution between February, 1997, and August, 2004, with a diagnosis of a primary spinal infection, excluding TB or post-operative infection. Patients were identified from databases held within the Departments of Radiology, Orthopaedic Surgery, Neurosurgery and Microbiology. This identified 98 adult patients who fulfilled our inclusion criteria, of who ODIs were calculated on 66, with a mean follow-up of 5 years. There were initially 53 male and 45 female patients with a mean age of 60 years (range 21 0 86) at presentation and symptoms had been present on average for 72 days prior to admission. Back pain was the predominant symptom in 59 and neuropathy in 43. Our figures would suggest a mush higher incidence of primary spinal infection than previously quoted. 75% had significant co-morbidities and 85% of patients under 40 years of age were IV drug users. The causative organisms and their effect were noted. Admission WCC (mean 11.5 ± 8.6) and CRP (mean 128 ± 48) were obtained in the majority of patients (97/98 & 94/98). For those patients who were still available to f/u, the mean ODI was 32 ± 25

We have documented the long term radiological outcome of developmental dysplasia of the hips (DDH) complicated by avascular necrosis (AVN). We have also assessed whether a policy of prolonged post-reduction containment has improved the results. Radiographs of patients with a minimum of 10 years followup wer assessed, and AVN diagnosed accordingly to Crerand and O’Brien’s criteria. Outcome grading was assessed by Severin’s criteria, and head sphericity using Mose’s rings. We identified 35 hips (35 patients) who had developed AVN. Twenty hips had a medial pattern of deformity, and 15 had a valgus pattern. Fifteen hips were Severin grade III, 13 were grade IV, and 3 were grade V. Twenty four patients had more than 6 mm discrepancy in the head of sphericity. Six patients were reviewed clinically: 4 of 5 patients who were < 24 years old have hip symptoms, and the other patient (age 41) has osteoarthritis. These results confirm that AVN is a serious complication with a poor longterm outcome, and that our prolonged containment treatment does not produce better results than those published on patients with shorter containment periods

Aim: The use of volar plates in the management of distal radius fractures has increased dramatically over the last decade. Our aim was to ascertain if long term outcome could be predicted at clinical review four months following operation. Patients and Methods: Between January 2003 and January 2005, all patients presenting with unilateral distal radius fractures and treated with volar locking plate fixation (Synthes) were invited to participate in long-term follow up. The decision to use a volar plate and the operative procedure itself was undertaken by the on-call consultant and his team. Patients who agreed to enter the study were evaluated at 4, 6 and 12 months following operation. Patient demographics, hand dominance and fracture type were recorded. Assessment of grip strength and wrist movements were undertaken and expressed as a percentage of the contralateral, uninjured side. Results: A total of 76 out of 100 eligible patients agreed to participate in the study. Of those patients, 23 (30%) failed to attend all their follow-up appointments, leaving a dataset of 53 patients (70%) available for analysis. There were 28 females (53%) and the mean patient age was 55 years (range 28–83). Grip strength, pinch grip, wrist flexion, wrist extension, radial deviation, ulnar deviation, pronation and supination all showed graded improvement in the year following fracture, achieving a mean range of 73% to 95% of function compared to the contralateral side at 12 months. Wrist flexion and ulnar deviation showed near maximum improvement by 6 months, whereas the other variables continued to show significant improvement between 6 and 12 months. Logistic regression analysis suggested that improvement in wrist extension at four months was the best predictor of a good outcome at one year. Discussion: Use of volar plate fixation is an increasingly common method of managing distal radius fractures. Our study suggests that good functional results can be achieved by this method of treatment. Failure to regain reasonable wrist extension by four months appears to predict higher risk of poor outcome and therefore patients in this group should be followed up more closely

We present the clinical and radiological outcome of a prospective series of 22 Buechel-Pappas Total Ankle Replacements (TAR) implanted in 19 patients with a mean follow-up of 9 years (range 6 to 13). The only published long term results of this prosthesis in the literature are from the originators' unit.

Patients have been prospectively reviewed yearly since 1991. None was lost to follow-up. The primary diagnosis was rheumatoid arthritis in 11 and osteoarthritis in 8 patients. 12 patients were female. Mean patient age was 64 (range 39 to 81). At the time of review 4 patients (6 ankles) had died between 12 and 69 months post-operatively of unrelated causes with their prostheses in situ. One patient had a below knee amputation for chronic venous ulceration 11 years after a TAR which until that point had continued to function well. One patient with severe rheumatoid arthritis had the implant removed at 8 weeks for deep infection. Another patient with rheumatoid arthritis had the TAR revised to a tibio-talar-calcaneal fusion 59 months post-operatively for talar avascular necrosis. One patient has pain from impingement and another patient with rheumatoid arthritis has intermittent pain at 8 years following her TAR. Every other implant continues to function well. The New Jersey LCS ankle assessment scores increased from a mean of 35 pre-operatively to 82 post-operatively. The increases were largely due to pain relief and improved function with the pre-operative range of motion being preserved. These scores have been maintained in the long term. No surviving implant is radiologically loose.

Our results suggest that the Buechel-Pappas TAR offers good clinical and radiological long-term results to patients with often disabling ankle arthritis

Introduction The Buechel-Pappas Total Ankle Replacement (BP TAR) has been used in Cornwall since 1991. The early results were presented to the Foot Society in 1997. The only published long term results of this pros-thesis are from the designer’s unit.

Method We present the clinical and radiological outcome of a prospective series of 22 BP TARs implanted in 19 patients with a mean follow-up of 9 years (range 6–13). The primary diagnosis was rheumatoid arthritis (RA) in 11 and osteoarthritis in eight patients. Twelve patients were female. Mean patient age was 64 years (range 39–81). Patients were reviewed at yearly intervals. None were lost to follow-up.

Results At the time of review, four patients (six ankles) had died between 12 and 69 months post-operatively of unrelated causes with their prostheses in situ. One patient had a below knee amputation for chronic venous ulceration, 11 years after a BP TAR which was functioning well. One patient with severe RA had the implant removed at 8 weeks for deep infection. A second patient with RA had the TAR revised to a tibiotalocalcaneal fusion 59 months post-operatively for talar avascular necrosis. One patient has pain from impingement and another patient with RA has intermittent pain at 8 years following TAR. Every other implant remains asymptomatic. The New Jersey LCS ankle assessment scores increased from a mean of 35 pre-operatively to 82 post-operatively. The increases were largely due to pain relief and improved function with the pre-operative range of motion being preserved. These scores have been maintained in the long term. No surviving implant is radiologically loose.

Conclusion Our results suggest that the BP TAR offers good clinical and radiological long-term results to patients with often disabling ankle arthritis.

Clinical and radiographic data on 47 hips in 45 patients with Developmental Hip Dysplasia who underwent either a Salters Innominate Osteotomy or a Femoral Derotation Varus Osteotomy by a single operator were reviewed. The average age of patients at the time of osteotomy was 21 months (range 12–108 months). Clinical evaluation was performed with use of the lowa hip rating score and the Harris hip score. Radiographs were evaluated pre=operatively, post-operatively and at final review.

The mean duration of follow-up was 15 years 9 months (range 10–21 years). Thirty-five patients had a Salter innominate osteotomy, 11 a derotation varus osteotomies and one a Klisic.

Al last follow-up examination the Iowa hip rating averaged 96.6 (range 62 to 100) and the modified Harris Hip Score averaged 96.8 (range 48 to 100). Forty seven percent of patients reported abductor fatigue after sport. Forty-one patients had excellent result with a Severin class I hip on radiographic evaluation. All of these patients had an Iowa index > 95 and a mean Centre-Edge angle of 35.5 (range 25–40).

Six patients had a poor radiological outcome with 5 Severin class IV hips and one class V. Clinical outcome scores did not correlate with poor radiological outcome; Iowa hip score 92 (range 62–100). One patient required a Ganz periactabular osteotomy. The age at which primary osteotomy was performed was significantly higher in the poor outcome group with a mean of 50.8 months.

When the anatomy of the hip is restored to normality at an early age with out the development of avascular necrosis excellent long-term results can be expected.

Eighty-nine patients (8 males, 81 females) with an average age of 52 years had 119 high dislocations (Crowe IV, 30 bilateral and 59 unilateral). The patients underwent 118 total hip arthroplasties between 1970 and 1986 using original or modified Charnley prostheses. Only 39 patients had not had a previous operation. Pain in the hip associated with stiffness and limitation in activity was the main indication for surgery. Back or knee pain was the chief complaint of 11 patients. Pre-operatively and post-operatively, a thorough assessment of the patients was made including hips, pelvis lumbosacral spine, knee, leg length discrepancy and static body balance.

The operation was performed through a transtrochanteric approach. A small socket was always inserted and cemented into the true acetabulum augmented by an autogenous graft, and a straight femoral component implanted at the level of the lesser trochanter. Muscle releases and tenotomies were not performed. Twenty-nine patients (35 hips) had died or were lost to follow-up. Sixty patients were still alive at the last examination in 1996, and regularly seen with a mean follow-up of 16 years. The mean follow-up of the whole series was 12.8 years.

At the last examination, clinical results according to the d’Aubigne rating system were classified as excellent 59.3%, very good 15.2%, good 15.2%, fair 5.1%, and poor 5%. Only 10 patients had a persistent waddling gait and a positive Trendelenburg sign. The results were slightly less good when a major femoral angulation needed an alignment osteotomy.

One femoral and seven acetabular loosenings were revised. In addition, five hips were revised for severe polyethylene wear and osteolysis before definite loosening, and two hips for heterotopic ossifications. The rate of revision was 12.7%. At twenty years, the survival rate was 99% for the femoral component and 87% for the socket, cemented fixation as end point, whereas the cumulative survival rate of the prosthesis was 78%, revision as end point.

The leg shortening, mean 4.84 cm (range 3-8 cm), was accurately corrected 63 times and within 1 cm 42 times. The lengthening was an average of 3.80 cm (2 to 7 cm). Leg length discrepancy was, on the whole, reduced as much as possible (mean 2.6 cm pre-operatively, 0.4 cm post-operatively). Of the 18 pre-operative painful knees, 10 were greatly improved, but four of these needed an operation.

Lateral pelvic tilt was corrected in more than 50%, pelvic frontal asymmetry was substantially reduced, as well as lordosis and lateral curve of the lumbar spine. As a result, low back pain has been relieved in 40 patients, but two required a laminectomy for a lumbar canal stenosis.

Total hip arthroplasty on high riding hips may be a wonderful operation, but this operation is full of pitfalls, technically demanding, and may represent a serious risk of complication. A successful result depends on a complete pre-operative assessment of the patient, a perfectly performed surgical procedure, and a reasonable selection of its indications.

Primary total hip arthroplasty in patients with osteoarthrosis secondary to developmental hip dysplasia is often more complex due to anterolateral acetabular bone deficiency. Femoral head (shelf) autograft provides a non-immunogenic, osteoconductive lateral support with the potential for enhanced bone stock should revision surgery be required. The technique has been shown in other series to give reliable early results but may be complicated by graft revascularisation and collapse. As yet, no study has assessed shelf grafts long term or quantified the need for further bone graft at revision surgery.

This study aims to assess initial graft union rate; quantify long term graft resorption and; quantify the need for further bone graft in the patients requiring revision surgery.

A retrospective analysis of a single surgeon's series of 31 THR in 25 patients was conducted. Post-operative, biplanar radiographic analysis was performed at 3 and 6 months and annually thereafter for a mean of 14 years (range 8-18). Grafts were assessed for union, resorption and displacement. Intra-operative necessity for bone graft at revision surgery was recorded.

Union, osseous 93%, fibrous 7%. No grafts displaced. In 71% less than one-third of the graft resorbed, in 29% one-third to one-half resorbed and in no grafts did greater than a half resorb. Of 10 patients revised, 2 required bone graft for inadequate bone stock.

Femoral head autograft allows effective acetabular coverage with excellent rates of union, minimal graft resorption in the long term and improves bone stock in revision surgery.

Purpose: Resection elbow arthroplasty is a salvage procedure typically considered as a last resort when other reconstructive options have failed. It was the intent of this study to evaluate the long-term outcome of patients following resection elbow arthroplasty.

Method: Fifty-four elbow resections performed between 1975 and 2005 were retrospectively reviewed. Pre and post-operative elbow function was evaluated with the Mayo Elbow Performance Score (MEPS) and additional follow-up data was compiled using the Disability of Shoulder and Hand (DASH) score. All patients in this study had a resection following a failed total elbow arthroplasty (TEA). Nineteen patients had died at time of follow-up, and 5 patients were lost to follow-up, leaving 30 of the surviving 34 patients (88%) available for long-term evaluation.

Results: The main indication for resection in this study was infection (50 of 54 elbows). The average MEPS prior to resection was 36. The long-term results in 30 patients at an average of 11 yrs (range 2.7–28 yrs) demonstrated an average MEPS score of 60, and a DASH score of 71. Complications were common including persistent infection requiring re-operation (44%), intra-operative fracture (32%), transient (11%) or permanent (5.5%) nerve damage, and one case of vascular injury requiring amputation. Achieving a stable resected elbow correlated strongly with a good long-term MEPS score (r=0.75).

Conclusion: This study emphasizes the difficulty in treating patients with a failed total elbow arthroplasty. Resection arthroplasty is a salvage procedure indicated primarily for persistently infected TEA and results in satisfactory outcomes in this population.

Background: Extra-articular fractures of the distal radius in children are most often treated with closed reduction and cast immobilization. The purpose of this retrospective study was to evaluate long term (> 12 years follow-up) objective and subjective outcomes in a consecutive series of pediatric patients treated with closed reduction with standardized outcome instruments. We hypothesized that children treated with closed reduction and cast immobilization have little or no objective functional impairment in later life and therefore subjective factors are the strongest determinants of outcome.

Methods: Twenty-seven patients with an average age at time of injury of 9 years (range, five to sixteen years) were evaluated at an average of twenty-one years (range, twelve to twenty seven years) after injury (patients aged 21 to 39) after closed reduction of an extra-articular distal radius fracture. Patients were evaluated using 2 physician-based evaluation instruments (modified Mayo wrist score; MMWS, and the Sarmiento modification of the Gartland and Werley score; MGWS) and an upper extremity-specific health status questionnaire (Disabilities of the Arm, Shoulder and Hand; DASH) questionnaire. Radiographic measurements were also made. Multivariable analysis of variance and multiple linear regression modelling were used to identify the degree to which various factors affect variability in the scores derived with these measures.

Results: All fractures had healed without significant loss of alignment. Final functional results according to the MGWS were rated as excellent or good in all patients. The average MMWS score was 90 points, and the median DASH score was 0 points. Twenty patients (74%) considered themselves pain free. Bivariate analysis revealed pain -as rated according to scales used in the MMWS- and age at time of injury to be correlated with DASH scores, with pain as the only independent predictor of patient-based outcome in multivariable analysis. This explains almost three quarters of the variability in DASH scores. Pain, range of motion, and radiographic measurement of radial length correlated with the physician based scoring system MMWS;

Conclusions: Twenty-one years after injury 96% of patients have a satisfactory outcome according to physician-based MMWS categorical ratings and patient-based DASH scores. It is remarkable that pain explained 74% of the variation in DASH scores. Perhaps when there is very little impairment, subjective factors are more important determinants of disability.

Objectives: Fresh osteochondral allografts are well-established treatment for patients who have posttraumatic osteochondral defects over 3cm in diameter and 1cm in depth of the knee. The objective of our study was to investigate the long-term outcome of these grafts and how long they may delay need for arthroplasty in patients with mal-united tibial plateau fractures.

Method: A prospective cohort study of patients who had received fresh osteochondral allografts of the tibial plateau was conducted. 118 patients were identified and survivor ship analysis was performed using conversion to total knee arthroplasty as the end point for graft failure. The Modified Hospital for Knee Surgery Scoring System (MHKSS) was used to clinically assess each patient who had more than five years of follow up. Radiographs were assessed for mechanical axis as well as using the Tonis grade for degenerative change.

Results: 29 of 118 (25%) experienced graft failure and underwent conversion to total knee arthroplasty, at a mean of 12 years (range 3–23) after the index procedure. The remaining 52 patients with a successful graft, and follow up over five years, had a mean MHKSS score of 83 (range 49–100) with a mean follow up of 11.7 years (range 5–34). Kaplan-Meier survivorship analysis of all 118 patients showed that graft survivorship was 94% at 5 years (std err 2.7), 83% at 10 years (std err 4.6), 62% at 15 years (std err 7.4) and 45% at 20 years (std err 8.5). Factors that predicted a successful graft were, using a meniscal allograft in conjunction with the osteochondral graft, and a lateral tibial plateau defect. The age at the time of surgery was no different between the patients that had a successful graft or those that failed.

Conclusion: Fresh osteochondral allografting works well in providing long term treatments for patients with tibial plateau damage. The concurrent use of meniscal allografts is also recommended.

There is little published data concerning long-term outcome in pyogenic spinal infection. Previous studies have used either neurological outcome in isolation, or non-validated quality of life measure instruments yielding data that is difficult to interpret.

To assess long-term outcome following pyogenic spinal infection through standardised outcome measures, Oswestry Disability Index (ODI) and Short Form-36 (SF-36) were utilised.

All cases of pyogenic spinal infection presenting to a single institution over the period 1993–2003 were retrospectively identified. Inclusion in each case was based on consistent clinical, imaging and microbiology criteria. The follow-up was by clinical review, American Spinal Injury Association (ASIA) classification, ODI and SF-36. The outcome was compared to normative data for the Irish population.

Twenty-nine cases of pyogenic spinal infection were identified. Nineteen patients (66%) had an adverse outcome at a median follow-up of 61 months, despite only 5 patients (17%) who had persistent neurological deficit according to ASIA classification. A significant difference in SF-36 PF (physical function) scores was observed between patients with adverse outcome and those who recovered (p=0.003). SF-36 scores failed to reach those of a normative population, even after apparent full recovery. A strong correlation was observed between ODI and SF-36 Physical Function scores (rho=0.61, p< 0.05). Seventeen percent (n= 5) of admissions resulted in acute sepsis-related death. Delay in diagnosis of spinal infection (p= 0.025) and neurological impairment at diagnosis (p< 0.001) were associated with neurological deficit at follow-up examination. Previous spinal surgery was a significant predictor of adverse outcome in patients requiring readmission < 1 year (p= 0.018).

The finding of high rates of adverse outcome and using SF-36 and ODI suggests under-reporting of poor outcome in other series. We advocate use of validated standardised spinal outcome questionnaires to accurately assess long-term outcome and facilitate comparison between case series.

We prospectively studied 29 patients with distal femoral fractures stabilised using the less invasive stabilisation system [LISS]. Four patients were excluded from the final follow up [3 deaths and 1 case of quadriplegia]. The mean age of the remaining 25 patients [9 males] was 60.9 years and the mean follow up 18 months [12–24]. Eleven patients were tertiary referrals from other hospitals [7 cases were referred due to failure of primary fixation]. Overall, there were 12 cases of high-energy trauma [7 open fractures]. According to the AO classification there were 5 Type 33A, 2 Type 33B and 12 Type 33C fractures and 4 Type 32A, 1 Type 32B, 1 Type 32C fractures. Functional assessment was performed using the Modified HSS and the Schatzker and Lambert scores. The average time to union in 22 cases was 3.5 months [range, 2–5]. None of the acute cases required bone grafting with a 100% union rate. There were 3/7 cases of non-union in the salvage group still undergoing treatment. The overall results in the acute cases were good and in the salvage cases fair. While this is a small series of patients, our preliminary data indicate favourable results using the LISS in stabilizing acute distal femoral fractures. However, when the LISS is used as a revision tool despite the concept of preserving the bone biology, the results seem to be less satisfactory. The system appears to be user friendly and no technical difficulties were encountered.

Introduction

Displaced fractures in the sacrum are associated with other intra-pelvic organ injuries. There are some reports on short term outcome, however there is little knowledge about the long-term morbidity after these severe injuries.

Introduction

Young, high-demand patients with large post-traumatic tibial osteochondral defects are difficult to treat. Fresh osteochondral allografting is a joint-preserving treatment option that is well-established for such defects. Our objectives were to investigate the long-term graft survivorships, functional outcomes and associated complications for this technique.

The long term results of closed reduction of the hip for DDH were reviewed to determine if the presence of the ossific nucleus had an effect on outcome.

The clinical and radiological outcome of a single-surgeon series of closed reduction for DDH was assessed in a strictly defined group of 48 hips in 42 patients with an average of 11.1 years follow up.

In 50% of cases, the ossific nucleus was absent. 100% of patients had an excellent or good result (Severin classification) at final follow-up. 8.3% (4 hips) demonstrated evidence of avascular necrosis. Three were Kalamchi & MacEwen Type I and one was type II. Two of the AVN cases did not demonstrate an ossific nucleus at closed reduction, and both developed type I AVN. 6 hips underwent further surgery. The acetabular index and center-edge angle were not significantly different between the affected and unaffected hip at final follow-up.

There was no relationship between the presence or absence of an ossific nucleus at the time of closed reduction and the final outcome.

In this well defined group, closed reduction is safe and provides excellent results in the long-term. The absence of an ossific nucleus is not detrimental to the final outcome.