With increasing numbers of total joint arthroplasties being performed, peri-prosthetic fracture incidence is rising, and operative management remains the gold standard. Short-term survivorship up to 12 months has been well-documented but medium to long-term is almost unknown. We present survivorship review from a district general hospital, undertaking 800 primary hip and knee arthroplasties per year. Patients with peri-prosthetic fractures and background total knee replacements were identified using our computer database between 2006–2011. All patients were operated on our site; methods used include open reduction, internal fixation (ORIF) using Axsos (Stryker Newbury) locking plates (28), intra-medullary nailing (1) or complex revision (6) depending on fracture and patient factors and surgeon's preference. Mortality was assessed at 30 days, 12 months and 5 years. Thirty-four patients were identified with a 7:1 female to male ratio and mean age of 76. 75% of patients had their primary arthrodesis at our hospital. There was only 1 plate failure noted requiring revision plating. Mortality at 30 days, 12 months and 5 years were 3.2, 12.5% and 50% respectively. When compared to the literature our time interval from index surgery to fracture is considerably longer (115 vs 42 months). Further multi-centre reviews are required to further asses this unexpected finding. Overall mortality is better than our hip fracture cohort, suggesting that good results can be achieved in District Hospital. The longer-term results are encouraging and can act as a guide for patients with this injury. We recommend that patients are managed in consultant-led, multi-disciplinary teams.

Introduction

There are a number of options available for surgical management of hallux rigidus. Ceramic implants of the first metatarsophalangeal joint (MTPJ) have been available for years; however there are no published long-term results existing.

Introduction

Aim of our study was to find an association of additional intra-artricular derangements due to the delay in referring a patient with Anterior Cruciate Ligament (ACL) injury to a consultant orthopaedic clinic.

Aims: Evaluation of the clinical and radiological results after primary surgical treatment of CDH in children with late discovered CDH. Methods: We have studied 64 hips of 58 patients (51 female and 7 male), who were between 18 months-8 years old with late discovered CDH. The study was made between 1991–2000. Teratological and neuromuscular cases were excluded. None of the patients have had previous treatment before admission in hospital. Preoperative radiographic evaluation of the cases was made based on the Tšnnis classiþcation system (12-gr.I, 26-gr.II, 19-gr.III, 7-gr.IV). Preliminary traction was used in 5 hips (4 patients). 8 of them were treated by open reduction, 18 by open reduction and pericapsular osteotomy of the ilium described by Pemberton, 38 by combined pelvic osteotomy (29 Pem-berton osteotomy, 9 Chiari osteotomy) and femoral derotation and/or varus osteotomy (with femoral shortening in 8 cases). Postoperatively, a plaster cast was applied for 6 weeks. Average follow-up period was 6.8 years. Results: The radiological results are based on Severin Classiþcation. We obtained in 77.5% of the cases excellent, good and satisfactory results. Using the clinical rating system of Fergusson and Howard, the results were good and satisfactory in 78.8 of the cases. Avascular necrosis occurred in 6 cases, being rated as group II and III according to the Kalamchi and Mac Ewen classiþcation system. Conclusions: In case of late discovered CDH, the results of conservative treatment are not satisfactory, the surgical treatment being recommended. Four years old or elder children can be treated safely with one stage operation consisting of open reduction, pelvic osteotomy with or without femoral derotation and varus osteotomy (with shortening if it is necessary).

Aims: The late effect of intramedullary nailing of the femur on proximal femur growth, particularly on growth plate of the greater trochanter and femoral neck, being known that losing the balance in the growth of the three ossiþcation points of the femurñs proximal extremity, the gap canñt be compensated by the greater trochanterñs remaining growth cartilage. Methods: During 1980–1995 we have performed 55 intramedullary femoral osteosyn-theses using KŸntscher rods in children 5–14 years of age. We have had the opportunity to observe 29 children during their later somatic growth: 25 femoral diaphyseal fractures and 4 non-unions. The average folow-up period has been 8.3 years. The patientñs average age has been 9,5 years. The hips were evaluated clinically for walking, mobility, limb length discrepancy. Radiological evaluation was based, according to Edgren, on following parameters of the joint architecture: cervico-diaphyseal angle (CDA), articulo-trochanteric distance (ATD), intertro-chanteric distance (TTD), femoral neck diameter (FND). Results: Clinical, one child presented 1.3 cm femur shortening. The evaluation of the radiological parameters on coxo-femoral joint showed increased CDA value between 10–30¡ in 8 children, increased ATD value (10–20mm) in 7 children, reduction of the TTD value in 6 patients and reduction of the FND (5–10mm) in 3 children. Conclusions: Insertion of intramedullary nail via the greater trochanter should be avoided in children less than 13–14 years of age, having tardy valgus effect and thinning of the femoral neck. We recommend osteosynthesis with plate and screws or, in little ones, transfragmentar screws, followed by immobilisation in plaster cast.