External fixation is an important aspect of complex fracture management. Ilizarov fixation is a specialised type of external fixator consisting of numerous wires that penetrate the limb and are attached to a circular metal frame. Ilizarov fixation is used for fracture fixation and stabilisation, limb reconstruction, deformity correction and limb lengthening. The external fixator can be in place for many months and patients will need to adapt to the device and demonstrate an understanding of the principles of pin site care. Psychosocial issues also need to be considered.

No abstract

We have undertaken a prospective clinical and radiological analysis of 124 shoulder arthroplasties (113 patients) carried out for osteoarthritis. The clinical results showed improvement in the absolute Constant score and the American Shoulder and Elbow Surgeons score of 22 and 43, respectively. Both were statistically significant (p < 0.001). There was no significant difference in the scores after hemiarthroplasty and total arthroplasty in those patients with an intact rotator cuff.When revision was used as the end-point for survival at ten years, survival of 86%, or 90% if glenoid components made of Hylamer sterilised in air were omitted, was obtained in primary osteoarthritis. The most common cause for revision in the hemiarthroplasty group was glenoid pain at a mean of 1.5 years; in the total arthroplasty group it was loosening of the glenoid at a mean of 4.5 years. Analysis of pre-operative factors showed that the risk of gross loosening of the glenoid increased threefold when there was evidence of erosion of the glenoid at operation. Shoulder arthroplasty should not be delayed once symptomatic osteoarthritis has been established and should be undertaken before failure of the cuff or erosion of the glenoid are present.The number of shoulder replacements for osteoarthritis has been increasing over the past 40 years with various changes being made to the earlier designs of prosthesis. However, many questions remain about the most appropriate procedure to be performed. While good functional improvement is usually gained, 1-4 this may be related more to relief from pain than improved movement. Relief from pain is generally expected although a few patients continue to have discomfort. The reason for this is not always clear.There is still uncertainty as to whether replacement of the glenoid is associated with improved functional results. 1,2,5 There is a high incidence of radiological lucency and loosening of the glenoid component, despite improved techniques of fixation, which gives concern as to the long-term survival of the component. When only replacement of the humeral head is performed there is concern about adequate relief from pain and the potential for progressive erosion of the glenoid.We have analysed these factors in a consecutive series of operations performed for osteoarthritic conditions using a single type of prosthesis since 1992, with at least a two-year follow-up period. Patients and MethodsBetween 1992 and 2002 the Global Shoulder replacement (DePuy International Ltd, Leeds, United Kingdom) was used in 124 shoulders in 113 patients for osteoarthritis. During this period no other type of prosthesis was used and no patient was excluded. The indications for surgery were increased levels of pain and reduced function of the shoulder. Radiological assessment included standard anteroposterior (scapular plane) and axillary views. Scanning was not routinely performed. Glenoid erosion was assessed on the radiographs and at surgery.All the operations were performed by the senior authors (IAT, JFH) or unde...