Displaced fractures of the lateral end of the clavicle in young patients have a high incidence of nonunion and a poor functional outcome after conservative management. Operative treatment is therefore usually recommended. However, current techniques may be associated with complications which require removal of the fixation device. We have evaluated the functional and radiological outcomes using a novel technique of open reduction and internal fixation. A series of 16 patients under 60 years of age with displaced fractures of the lateral end were treated by open reduction and fixation using a twin coracoclavicular endobutton technique. They were followed up for the first year after their injury.

At one year the mean Constant score was 87.1 and the median Disabilities of the Arm, Shoulder and Hand score was 3.3. All fractures had united, except in one patient who developed an asymptomatic fibrous union. One patient had post-traumatic stiffness of the shoulder, which resolved with physiotherapy. None required re-operation.

This technique produces good functional and radiological outcomes with a low prevalence of complications and routine implant removal is not necessary.

The aim was to determine the longterm results of the Oxford unicompartmental knee replacement implanted by a single surgeon in a community hospital setting.

The results of the first 97 cases performed by a single surgeon between Feb 1991 Feb 1999 were retrospectively reviewed. Demographic and operative data were recorded and patients were assessed with Knee Society knee score and x-ray.

Ninety seven operations were performed on 83 patients. Antero-medial osteoarthritis was the predominant preoperative diagnosis present in 96, gout was present in 2 and avascular necrosis in one. The average age was 70, follow-up 104.3 months with maximum 170 months. Kaplan-Meier analysis was performed and survival was 88% at 124 months. 20 patients (21 knees) had died and 10 (9 patients) had required revision leaving 65 knees available for review. No cases were lost to follow-up. Of the 10 revisions 7 had been revised to a total knee, 4 for lateral wear or pain, one for femoral loosening, 1 for tibial subsidence and 1 for infection. Four of these patients had a previous high tibial osteotomy. The remaining 3 revisions included 2 1iner exchanges for fracture and wear in one patient with varus knees at 11 years and 1 liner exchange for dislocation.

The Oxford UKA gives satisfactory longterm results in antero-medial osteoarthritis. We would caution against using this prosthesis where a previous high tibial osteotomy has been performed.