IntroductionSimultaneous Monteggia injuries of the elbow and ipsilateral distal radius and ulna fractures are very rare.Case PresentationA unique case of a type I Monteggia fracture equivalent with ipsilateral fracture of the distal radius and ulna (Salter-Harris type II) in a child is reported. We describe the management of this unique fracture and discuss the possible mechanism of injury.ConclusionWe have highlighted a rare combination of injuries. Early recognition and prompt surgical intervention can lead to a satisfactory outcome even in these complex injuries.

A new uncemented acetabular component, the Cambridge cup, has been designed to mimic the anatomy and physiology of subchondral bone in order to minimise stress shielding and enhance long-term component stability. Cambridge cups were implanted in a cohort of 50 women who presented with displaced sub-capital fracture of the femoral neck. The cups were manufactured with an hydroxyapatite (HA) coating. Twenty six cups were implanted after removal of the HA. Twelve Cambridge cups were retrieved post-mortem between two and 84 months after implantation. Histological and histomorphometric testing was undertaken to analyse the residual HA coating thickness, bone apposition to the implant surface and particulate wear debris in the surrounding tissues. The HA-coated implants showed significantly greater bone apposition to the implant surface with significantly less fibrous tissue formation than the uncoated implants. Where HA resorption occurred, bone and bone marrow was seen adjacent to the implant. Excessive wear of the ultra high molecular weight polyethylene liner was not seen. The HA-coated components demonstrated good initial bone implant bonding and the flexible carbon polymer appeared to maintain stability following HA resorption. The uncoated implants showed little or no bony apposition but had a fibrous membrane apposed to the implant surface. This may be explained by a combination of micro-motion at the bone implant interface and having a component surface finish that was poorly suited to osseous attachment. Hydroxyapatite coated acetabular components can provide reliable osseous attachment. Subsequent HA resorption need not compromise medium-term osseous fixation to an appropriate implant surface.

Acetabular fractures are among the most complex and challenging injuries for orthopaedic surgeons. The choice of surgical treatment in acetabular fracture is important for optimal outcomes. It requires an understanding of the precise outline of the fracture by appropriate classification because it is important for decision making. For this purpose, the classification proposed by Judet and Letournel in 1963 remains the gold standard despite its shortcoming, which are attributed to the inclusion of multiple criteria including anatomical, directional and geometrical. This complex classification remains challenging especially to lesser experienced surgeons. In this article, a new method for classification of acetabulum fractures is proposed. It places posterior column with posterior wall fractures to simple fractures instead of complex fractures in Judet and Letournel classification. More importantly the proposed new classification renames “transverse fracture” as “transcolumnar fracture” to better represent anatomical structure rather than morphology. It is expected that by coining the new term “transcolumnar ”it will be easy to understand different types of acetabular fractures. Especially the confusion between “transverse” and “both column fractures” would not be a concern in future.