Aims: The purpose of this study was to investigate the number and type of complications following external þxation of pelvic fractures. Methods: We carried out a retrospective review of all patients treated at Frenchay Hospital with external þxation for fractures of the pelvic ring between August 1996 and September 2002. Patientsñ details were collected prospectively; outcome data was collected by casenote review. Results: 74 patients were treated with external þxation for pelvic fractures. In 41 patients, the þxator was used to achieve pelvic stability temporarily, whilst in 33 it was retained as part or all of the deþnitive treatment. 30 patients were haemodynamically unstable when the þxator was applied. Of these patients, two patients died of retroperitoneal haemorrhage, three had pelvic angiography and arterial embolisation and þve required a laparotomy, of which three were negative. Of the þxators used temporarily, four (10%) had pin-site infections. In only one case did this change the plan for the deþnitive treatment. Two of the temporary þxators required revision; one for loss of reduction secondary to pin loosening and one for pin penetration of the femoral head after using the low anterior approach. Six (8%) of all the þxators required repositioning due to impingement on the skin. Of the deþnitive þxators, 53% required antibiotics and 18% required pin removal for sepsis. Three (9%) of the deþnitive þxators required revision; there was one loss of reduction, one re-displacement after removal and one non-union of the pelvic fractures. Conclusions: Temporary application of external þxation to the fractured pelvis, using high iliac crest pin placement to restore pelvic stability, is a safe procedure with few complications. Haemodynamic stability is restored in the majority of patients. When used as part of the deþnitive treatment, pin site infection is common and may require pin removal but rarely leads to loss of fracture reduction or revision of þxation.

Aims: The purpose of the study was to analyse the early experience of the technique of transitory percutaneous pinning to manage three and four part proximal humeral fractures. Methods: An independent review of 66 consecutive patients with proximal humeral fractures treated in our unit over a three-year period was carried out. The patients underwent closed reduction under image intensiþer guidance with percutaneous pinning using an average of 3.5 wires (range 3–4). A standard three dose prophylactic antibiotic regime was used. A protective collar and cuff was the used for 4 weeks, and a physiotherapy program of pendular movements going on to assisted active exercises started after this. The wires were typically removed in an outpatient setting at 4 to 6 weeks. Results: The postoperative radiographs were deemed satisfactory with good overall alignment by two external observers in all cases. Our þndings were however remarkable for a very high early complication rate. This included pin migration (50%), stiffness (41%), pain (33%), infection (25%), nonunion (8%) and radial nerve palsy (8%). The complication rate increased dramatically in those over the age of 50 or those with osteopenia. Conclusions: The technique of transitory percutaneous humeral pinning is technically demanding. Our early experience would suggest high rates of early complications and readmissions. This technique should be applied with caution in older patients with osteopenia.

The long term outcome of open debridement for the treatment of anterior impingement in the ankle in 27 patients was assessed. Using pre-operative radiographs, patients were grouped according to both the McDermott and the van Dijk scoring systems for anterior impingement. The accuracy of these classifications in predicting outcome was assessed. Clinical outcome was evaluated using the Ogilvie-Harris scoring system, a visual analogue of patient satisfaction, time to return to full activities, and the ability to return to sports at the pre-morbid level. Follow-up radiographs were used to assess the recurrence of osteophytes. The incidence of talar osteochondral lesions at surgery was assessed.

At a mean follow-up of 7.3 years, 23 of 25 (92%) patients without joint space narrowing had a good or excellent result. Improvement in the Oglivie-Harris score was seen in all patients. In athletes, 19 of 24 (79%) were able to return to sports at the pre-morbid level. Two patients with pre-operative joint space narrowing had poor results.

Recurrence of osteophytes was the norm and most patients did not feel their range of dorsiflexion ever returned to normal, but symptomatic relief enabled most patients to return to high level sport.

Our results for non-arthritic joints suggest that this is a safe and successful procedure.

Shoulder active range of flexion, abduction and external rotation was measured with three devices in 33 subjects using a blinded protocol. The aim was to compare the accuracy and interobserver reliability of the goniometers. The devices used were the routine clinical goniometer as used clinically with and without the elbow flexed to 90 degrees, differential goniometers incorporated into a tightly fitting brace holding the elbow at 90 degrees flexion, and the Isotrak II electromagnetic coupling laboratory equipment which was used as the reference tool and in addition was used to make simultaneous measurements of trunkal movements.

For the measurement of flexion and external rotation, there was no significant difference in interobserver reliability between the goniometric methods. There was a small difference when measuring abduction with the brace mounted differential goniometers being the most accurate. The striking finding was the poor accuracy and over-measurement error of both goniometric methods, over-measuring by 34 degrees for flexion, 43 degrees for abduction, and 15 degrees for external rotation. Trunkal movements are shown to account for part of this error but humeral rotation was also noted.