We have reviewed the intermediate term results of 56 out of 61 consecutive Wagner revision stems implanted without bone graft. After a mean of 5 years (range 4 to 7 years) 49 out of 56 hips were graded as excellent or good based on the Harris Hip Score. The clinical result was not related to the degree of femoral bone defect prior to revision.

49 Out of 56 hips were seen to subside, but this did not affect the hip score at final review. The mean subsidence was 4.8mm (range 0 – 19mm).Only one stem showed continued subsidence after 12 months post-operatively, and this stem achieved a stable position by 24 months. All osteotomies of the femur united with reconstitution of the femoral bone stock. There was a low incidence of complications; one stem showed catastrophic subsidence within 48 hours of surgery, requiring re-revision to a larger Wagner stem. There was one sciatic nerve palsy. 3 hips dislocated on one occasion in the early post-operative period, but were stable at latest follow-up.

In conclusion, the Wagner stem can bypass major proximal femoral bony defects and achieve initial axial and rotational stability in intact diaphyseal bone. Subsequent stem subsidence does not affect clinical outcome, and proximal femoral bony reconstitution is achieved without the need for bone grafting.

This paper describes the outcome of type III pilon fractures of the distal tibia treated primarily with an llizarov ring fixator.

Only patients with intra-articular fracture of the tibial plafond on plain radiographs that corresponded to type III pattern of Ruedi and Allgower were included. There were thirteen patients with a mean age of 45 (range 29–65), twelve males and one female. The mechanism of injury in all the patients was high-speed road traffic accident. Operative fixation consisted of fracture reduction and stabilisation using the Ilizarov circular frame external fixator and olive tipped wires. Further insult to the already damaged soft tissues was avoided.

Bony union was achieved in all cases. Treatment in the frame lasted between 3 and 10 months (average of 6.3 months). Neither deep infection nor soft tissue complications occurred. Outcomes measured using the Olerud ankle score, modified Ovadia and Beals radiological criteria, and the SF-36 Health Questionnaire and our results compare well with other fixation techniques.

The use of the llizarov circular frame external fixator without any additional internal reduction or fixation procedures is a definite option for the treatment of these high-energy injuries.

To investigate the use of the Ilizarov circular fixator in treating diaphyseal non-union following previous intra-medullary nailing. The stability of each non-union was augmented using an Ilizarov fixator with nail retention.

We retrospectively reviewed nine consecutive patients (mean age 31 years, range 24–53 years) who were treated in our institution between 1993 and 1997 (mean follow up 19.2 months, range 6–33 months). Two femoral, three tibial and four humeral non-unions were included in the study. All patients were referred from other centers after failure to achieve bone union with intramedullary nailing. Patients who had non-union with other fixation devices in situ, those with active infection and those who had their non-unions explored at the time of fixator application were excluded from the study. The patients had undergone an average of 2.4 operations (range 1–5 operations) prior to fixator augmentation.

The circular fixator was applied over the nail as a closed procedure (non-union not surgically explored) in all nine patients. The non-union was manipulated either by compression or oscillation during fixator treatment. The mean duration of fixator treatment was 6.2 months (range 3–11 months).

Outcome measures assessed were bone union, deformity, shortening and functional outcome. Bone union was achieved in all nine patients. The bone results were graded as six excellent, one good and two fair. All patients reported a reduction in pain and satisfaction with their final outcome.

We recommend the use of the Ilizarov fixator with nail retention in resistant long bone union in carefully selected patients. This technique is particularly useful in the humerus where it avoids the morbidity associated with nail removal and plating. The augmentation method can shorten the fixator time and has the advantage of a simpler frame construct.

Avascular necrosis is an iatrogenic complication of the treatment of congenital dislocation of the hip. In order to assess the incidence of this and other complications, we have reviewed a consecutive series of 211 children treated at some stage with the modified Denis Browne splint used in Adelaide. In 173 children treated with this splint alone for 238 subluxed or dislocated hips which were stable when reduced, six hips (2.5%) developed radiographic avascular necrosis, though there was progressive growth deformity in only one. There was a much higher incidence among cases treated for unstable reduction by tenotomy, plaster spica and then the splint, 20 of 33 hips (60.6%) showing radiographic signs, though only one led to progressive abnormality. Of seven patients treated by adductor tenotomy and the splint no case of avascular necrosis was encountered. In the whole series the incidence of significant long-term growth disturbance in children treated in this splint was 0.7%. The great majority of our cases of avascular necrosis were attributable to manipulation and plaster, not to the subsequent use of a splint.

The term "congenital scoliosis" contributes little to our understanding of aetiology, for "congenital" simply means "to be born with" and is applicable to deformities present at birth whether these are genetically determined or acquired in utero. The presentation of monozygotic twins, one of whom has congenital scoliosis (vertebral anomalies) while the other is normal, provides a rare opportunity to study the cause of this deformity. Three pairs of monozygotic twins, previously unreported, are presented with a review of the previous literature. These cases add weight to the argument that congenital scoliosis may be acquired in utero rather than being genetically determined.