Background

The traditional Kocher approach for lateral elbow exposure is often complicated by injury to the posterior interosseous nerve (PIN) and the lateral ulnar collateral ligamentous (LUCL). Kaplan approach is less commonly used, due to its known proximity to the PIN. Extensor Digitorum Communis (EDC) splitting approach allows possible wide surgical exposure and low risk of LUCL damage. The comparison of PIN injury during surgical dissection among these 3 common lateral approaches was not previously evaluated. We aim to determine the anatomical proximity of the PIN in these 3 common lateral elbow approaches and to define a safe zone of dissection for the surgical exposure.

The treatment of infected exposed implants which have been used for internal fixation usually involves debridement and removal of the implant. This can result in an unstable fracture or spinal column. Muscle flaps may be used to salvage these implants since they provide soft-tissue cover and fresh vascularity. However, there have been few reports concerning their use and these have concentrated on the eradication of the infection and successful soft-tissue cover as the endpoint. There is no information on the factors which may influence the successful salvage of the implant using muscle flaps.

We studied the results and factors affecting outcome in nine pedicled muscle flaps used in the treatment of exposed metal internal fixation with salvage of the implant as the primary endpoint. This was achieved in four cases. Factors predicting success were age < 30 years, the absence of comorbid conditions and a favourable microbiological profile. The growth of multiple organisms, a history of smoking and the presence of methicillin-resistant Staphylococcus aureus on wound cultures indicated a poor outcome. The use of antibiotic beads, vacuum-assisted closure and dressing, the surgical site, the type of flap performed and the time from primary surgery to flap cover were not predictive of outcome.

Introduction: We present our early results using the Stryker navigated knee system, since March 2003. There have been several papers showing an improvement in alignment of prostheses using navigation but few series have mentioned the problems of introducing this new technology.

Method: 214 consecutive operations were audited retrospectively from operation notes, discharge summaries and clinic notes.

Results: 11 surgeons performed 214 operations on 196 patients. 205 operations were primary knee joint replacements and 9 revisions. Average operation time was 149 minutes. 96% had an excellent outcome (pain free with a good range of motion), 2.6% had a moderate outcome and 1.4% had a poor outcome. 17 patients had superficial wound infections; 4 patients required an MUA for stiffness (with a good outcome); 3 DVTs (all below knee); 1 acute and 3 delayed haemarthroses; 1 temporarily unstable knee; 5 suffered prolonged pain, 1 peri-prosthetic fracture due to anterior notching of the femur requiring revision and there was 1 quads tendon rupture. There were 4 procedures abandoned, 2 because the femoral pin was unstable in osteoporotic bone and because of 2 software errors. Average range of motion was 0–110°. There was one deep infection following pyelonephritis. Average follow up has so far been 20.6 (2–104) weeks.

Conclusion: We have found that our results compare favourably with conventional techniques. We found it particularly useful for revision surgery and those patients who had intramedullary devices for previous fractures of the femur where conventional jigs could not be used.