Introduction and Aims: To evaluate the results of humeral nailing with the new Fixion inflatable humeral nail.

Method: We retrospectively studied 42 patients with acute humeral fractures (20), delayed and non-union (12) and pathological fractures (10), who where treated with an inflatable humeral nail and had a minimum follow-up of six months. Our primary outcome measures were clinical and radiological union. Secondary outcome measures were revision of the nail, screening time and operative time. We made a clinical assessment of the patients using the Constant score of the shoulder and a measure of health-related quality of life, using the EuroQol EQ-5D questionnaire.

Results: In patients with acute fractures 16/19 (84%) went on to clinical and radiological union (1/20 patients died four weeks post-operatively from bronchopneumonia). All of the patients with delayed and non-union of humeral fractures went on to clinical and radiological union. In the patients with pathological fractures, the nail provided good palliative symptom relief. Average screening time was 40.5 seconds (21–107). Average operative time was 71 minutes (26–142). Constant score of the shoulder had a median of 67 (SIQ 46.5–77.5) in the affected arm and 87 (SIQ 74–89) in the normal arm.

Conclusion: The treatment of humeral fractures using the inflatable intramedullary nail is a simple and safe technique, avoiding the time and complications associated with distal locking. Its seems to be an appropriate technique with excellent results in those patients with delayed and non-union of humeral fractures, and provides effective palliation in patients with pathological fractures. Its efficacy in patients with acute fractures is comparable to other intramedullary nails. In our experience, it is particularly effective in the multiply injured and the infirm because of the speed and ease of insertion.

Anterior knee pain attributable to the patellofemoral joint and extensor mechanism dysplasia is a common presentation to Orthopaedic surgeons. Plain radiology is likely to remain the primary investigation of the knee in most centres, but most of the radiological features of extensor mechanism dysplasia are time consuming and difficult to measure reproducibly. 137 consecutive symptomatic knees aged under 30, referred to an Orthopaedic surgeon were studied in order to identify a rapid and reproducible marker for those knees worthy of further in-depth analysis.

Overall, 67 knees (49%) had at least one radiological abnormality and 70 (51%) were considered ‘normal’. There were 5 Dejour Type3 dysplasias of the femoral trochlea, 9 Type2 and 12 Type1. There were 49 cases of patella alta and 5 of patella infera. Four knees had an abnormal lateral patellofemoral (patellar tilt) angle. 15 knees had more than one abnormality. The classification of trochlear dysplasia was difficult and showed poor reproducibility. This was also true for the measurement of lateral patellofemoral angles. Patellar height was more easily measured but took time. The sulcus angle emerged as an easily and rapidly measurable feature that was reproducible and was closely related to the other features of extensor mechanism dysplasia.

The sulcus angle offers a rapid and reliable ‘screening’ measurement on knee radiographs. A normal sulcus angle suggests that seeking the other radiological markers of extensor mechanism malalignment is unlikely to reveal additional useful information. Other diagnoses can then be sought. The more abnormal the sulcus angle, the more severe the other features of extensor mechanism dysplasia are likely to be. Further detailed measurements can then help to define the most appropriate surgical correction.

We describe the use of MRI to establish the exact diagnosis in a swollen elbow in a neonate. Urgent diagnosis was needed for medical and social reasons. We accomplished this without the use of an invasive procedure or anaesthesia for a fracture that is recognised to be difficult to diagnose in patients of this age group.