Introduction: Numerous national joint registries demonstrate a trend towards the use of uncemented femoral components in total hip arthroplasty. While the results of first-generation uncemented, and some of the second-generation uncemented implants have been unacceptably poor, others, including the fully hydroxyapatite (HA) coated femoral stems, have been excellent with survival rates of greater than 95% at 20 years. Component longevity is largely related to robust stem fixation to native bone. Adequate stem fixation to the native bone can be determined by clinical assessment and radiological signs of osteointegration. The absence of these radiological signs might be an indication of early loosening. With this in mind, we performed a radiological analysis of the osteointegration of uncemented fully HA-coated femoral stems inserted at our arthroplasty unit.

A bstract Aim This article aims to describe a novel surgical technique for medial malleolar reconstruction in a young child. Background Severe open ankle injuries that result in bone and soft tissue loss carry a high risk for complications, especially in children who are still growing. These injuries can cause abnormal growth patterns, degenerative diseases, and recurrent instability. Cases of medial malleolar reconstruction have been previously described but none in a child this young. Case description We present a case of an 13-year-old girl who suffered an open injury to the medial distal tibia with traumatic loss of the medial malleolus at the age of 2 and later suffered a Salter-Harris II fracture to the ipsilateral distal fibula. She presented with varus alignment, a leg length discrepancy, premature asymmetrical growth arrest, chronic non-union of the distal fibula physeal fracture, and severe attenuation of the deltoid ligament. Her secondary deformities were managed with distal fibula osteotomy and fixation, distal tibial hemi-plafond corrective osteotomy, and medial malleolus reconstruction with iliac crest autograft. Her leg length discrepancy was corrected by epiphysiodesis of the contralateral distal femur and proximal tibia. At the 2-year follow-up, the alignment was well maintained, the graft was healing well, and the patient reported no pain and being able to walk and play sports without a brace. Conclusion Surgical reconstruction of the medial malleolus with correction for abnormal angulation and leg length discrepancies is critical to promoting healthy growth patterns and quality of life for paediatric patients. This severe open ankle injury can be successfully managed by distal fibula osteotomy and fixation, distal tibial intra-articular osteotomy, and medial malleolus reconstruction with iliac crest autograft. Clinical significance This novel technique is an effective method for the surgical management of paediatric traumatic medial malleolar bone loss in children who are skeletally immature and are at risk of complications due to further growth. How to cite this article Ponton E, Bakkai A, Courtemanche DJ, et al . Late Ankle Reconstruction in a Child with Remote Traumatic Medial Malleolus Loss: Clinical and Radiographic Outcomes. Strategies Trauma Limb Reconstr 2022;17(2):131–135.

Introduction: Death and injury associated with road traffic collisions are global phenomena that require urgent attention. Approximately 1.2 million people worldwide are killed each year. Pedestrian collisions remain one of the single largest causes of injury, disability, and death in the developing world and contribute significantly to trauma centre activity, especially in urban areas. Materials and methods: The study aim was to describe the fracture patterns in pedestrians, and to highlight the epidemiology, spectrum, and outcomes of orthopaedic injuries identified in pedestrian vehicle collision (PVC) victims admitted to a major trauma intensive care unit (TICU). This retrospective analysis of 405 PVC victims, retrieved from an Ethics Approved Trauma Registry (BE360/13 and BE207/09) admitted to the TICU at Inkosi Albert Luthuli Central Hospital, Durban, South Africa, spans a six-year period from 2007 to 2012. Results: Four hundred and five pedestrian-vehicle collision patients were admitted over the six-year study period. Missing data were found in two patients. The mean age was 25.8 ± 17.49 years, with 135 (33.3%) female patients and 270 (66.7%) males. One hundred and eleven patients were referred directly from the scene; the others were inter-hospital transfers. Two hundred and eighty-five patients had fractures and from this group, 63 (22%) patients died in ICU. The most common fracture site was femur (122), followed by tibia (112) and pelvis (95). The mortality was related mainly to the age of the victims; none of the fractures were found to be associated directly with increased mortality. Conclusion: Diverse fracture patterns are seen in PVC patients. The leading cause of death is head injury, followed by chest injury. Increased age of the patients was associated with increased mortality. The predominance of specific fractures, in specific sex and age groups, were noted, and some fractures were found to be associated with more complications; however, none of the fractures were linked directly to mortality.