We present the outcome of the treatment of chronic post-traumatic contractures of the proximal interphalangeal joint by gradual distraction correction using an external fixator. A total of 30 consecutive patients with a mean age of 34 years (17 to 54) had distraction for a mean of 16 days (10 to 22). The fixator was removed after a mean of 29 days (16 to 40). Assessment at a mean of 34 months (18 to 54) after completion of treatment showed that the mean active range of movement had significantly increased by 63° (30° to 90°; p < 0.001). The mean active extension gained was 47° (30° to 75°).

Patients aged less than 40 years fared slightly better with a mean gain in active range of movement of 65° (30° to 90°) compared with those aged more than 40 years, who had a mean gain in active range of movement of 55° (30° to 70°) but the difference was not statistically significant (p = 0.148).

The use of joint distraction to correct chronic flexion contracture of the proximal interphalangeal joint is a minimally-invasive and effective method of treatment.

Although the use of constrained cemented arthroplasty to treat distal femoral fractures in elderly patients has some practical advantages over the use of techniques of fixation, concerns as to a high rate of loosening after implantation of these prostheses has raised doubts about their use. We evaluated the results of hinged total knee replacement in the treatment of 54 fractures in 52 patients with a mean age of 82 years (55 to 98), who were socially dependent and poorly mobile.

Within the first year after implantation 22 of the 54 patients had died, six had undergone a further operation and two required a revision of the prosthesis. The subsequent rate of further surgery and revision was low.

A constrained knee prosthesis offers a useful alternative treatment to internal fixation in selected elderly patients with these fractures, and has a high probability of surviving as long as the patient into whom it has been implanted.

The purpose of this study was to prospectively audit the functional outcome and peri-operative complications associated with the use of a trochantericentry cephalomedullary nail to treat all low-energy subtrochanteric fractures.

Methods: Over a 95 month period, we used the Long Gamma Nail (LGN) to treat a consecutive series of 302 locally-resident patients who sustained subtrochanteric fractures during low-energy trauma. We prospectively assessed the mortality, prevalence of complications and functional outcome during the first year post-injury. We used survivorship methodology to assess the rate of re-operations and implant revision during the first year after surgery.

Results: By one year, 74 patients had died, 10 were untraceable and 7 refused to participate in follow-up. The remaining 211 patients had evaluation of their functional outcome and post-operative complications during the first year post-injury.

The prognosis following an operatively-treated subtrochanteric fracture was similar to other proximal femoral fractures, with a one-year mortality of 24.5%, and an increased level of social dependence, increased use of walking aids and reduction in mobility amongst survivors.

Re-operation was required in 27 patients (8.9%), although only 18 patients required nail revision. On survivorship analysis, 96.8% of fractures had healed by six months post-injury, and only five patients had confirmed non-unions, which were successfully treated with autogenous bone grafting. Lag-screw mechanical failure and fractures distal to the nail were seen in twelve (4%) and five (1.7%) patients respectively; all of these fractures subsequently healed after further treatment. Deep sepsis occurred in only five (1.7%) patients.

Conclusions: Subtrochanteric fractures caused by low-energy trauma have similar prognosis to other proximal femoral fractures. Trochanteric-entry cephalomedullary nails are a versatile treatment option for these injuries, and are associated with an acceptable rate of peri-operative complications and favourable functional outcome.

We present our experience with correction of Madelung’s deformity by the Ilizarov technique. Seven patients (eight deformities) were treated by osteotomy of the radius with subsequent lengthening and angular correction. They were reviewed at a mean of 30 months (1.5 to 5.5 years). At the time of operation their mean age was 19 years (9 to 44).

At follow-up all were free from pain and supination had improved by a mean of 34° and pronation by 9°. Flexion had increased in most cases with a median increase of 15°, but only one patient gained further extension. Radial and ulnar deviation were increased by a mean of 6° and 9°, respectively. Radiographic measurements showed that the mean volar angulation had been reduced from 25° to 11°, ulnar inclination from 45° to 30° and carpal malalignment (volar translation) from 7 to 2 mm. The mean lengthening of the radius was 12 mm (6 to 25). All the patients were satisfied with the functional and cosmetic results.