BackgroundPosterior wall fractures are the most common of all acetabular fractures, and there is universal consensus that displaced fractures are best treated with anatomical reduction and stable internal fixation. Though early and mid term results for such studies are available, few shed light on long term results. This study was performed to evaluate long term functional and radiological outcomes in patients with posterior wall acetabular fractures and to determine factors that may contribute adversely to a satisfactory final outcome.Materials and methods We retrospectively analysed the hospital records for patients who underwent open reduction and internal fixation (ORIF) for posterior wall acetabular fractures. Twenty-five patients (20 men, five women), including one with bilateral posterior wall fracture, with a mean age of 41.28 ± 7.16 years (range 25–60 years) and a mean follow-up of 12.92 ± 6.36 years (range 5–22 years) who met the inclusion criteria formed the study cohort. Matta’s criteria were used to grade postoperative reduction and final radiological outcome. Functional outcome at final follow-up was assessed according to d’Aubigné and Postel score.ResultsAnatomic reduction was achieved in 22 hips, imperfect in four and poor in none. Radiological outcome at final follow-up revealed excellent results in ten hips, good in eight, fair in five and poor in three. The final d’Aubigné and Postel scores were excellent in 14 hips, good in six and fair and poor in three each. Patients with anatomical reduction had a favourable functional and radiological long term outcome. However, the presence of associated injuries in lower limbs and a body mass index (BMI) >25 adversely affected the final functional outcome. Osteonecrosis was seen in three patients, heterotopic ossification in two and Morel Lavallee lesion in one. One patient had postoperative sciatic nerve palsy, which recovered 6 weeks after surgery.ConclusionAnatomic postoperative reduction leads to optimal functional and radiological outcome on long term follow-up; however, the presence of associated lower-limb injuries and BMI >25 adversely affects a satisfactory final outcome in patients with posterior wall acetabular fractures.Level of evidence(Level 4) Retrospective case series.

BackgroundManagement of distal tibial tumours with limb salvage surgery poses a challenge for the orthopaedic surgeon. This study was done to evaluate the results of fibular centralisation as a technique to reconstruct defects that occurred after resection at this site.Materials and methodsNine patients with a mean age of 23.2 years (range 17–34) with diagnosis of osteosarcoma in four patients, Ewing’s sarcoma in two, giant cell tumour in two and chondrosarcoma in one patient underwent surgical treatment for tumour in the distal tibia. All patients had wide resection of the tumour and ankle arthrodesis with centralisation of the fibula. Patients were assessed clinico-radiologically for bone union, infection and complications. The final functional outcome was estimated according to Musculoskeletal Tumor Society (MSTS) scores.ResultsThe mean age at the time of surgery was 23.2 years (17–34). There were five females and four males. The mean follow-up was 37 months (range 28–54 months). One of the patients with osteosarcoma had a recurrence a year after limb salvage surgery, underwent above-knee amputation, and died 18 months later due to metastasis. One patient developed leg length discrepancy. The mean MSTS score was 22.75 (range 17–27).ConclusionFibular centralisation is a durable reconstruction tool for defects of the distal tibial metaphysis with an acceptable functional outcome. It is an inexpensive and simple procedure, with a low rate of late complications, and reproducible results.Level of evidenceIV Retrospective case series.

Purpose. To report the outcome of fixation for delayed union or non-union posterior cruciate ligament (PCL) avulsion fractures. Methods. Seven men and 4 women aged 24 to 35 (mean, 28) years underwent lag screw or suture fixation for non-union or delayed union of avulsion fracture of PCL tibial attachment after a mean delay of 8.6 (range, 4-14) months. Patient satisfaction was assessed using a visual analogue scale (VAS). Functional outcome was evaluated using the Lysholm scale.Results. The mean follow-up period was 17 (range, 8-36) months. The mean Lysholm score improved from 82 preoperatively to 92 at the final follow-up (p=0.34), the mean range of knee motion improved from 82º to 87º (p=0.008), and the mean VAS score for patient satisfaction improved from 4.3 to 7.4 (p=0.0004). All patients but one achieved bone union after a mean of 7.5 (range, 7-9) weeks. Functional outcome was excellent for 6 patients, good for 4, and fair for one. Posterior drawer test was positive (grade I laxity) in 3 patients whose outcome was good for 2 and fair for one. The latter had non-union after Ethibond suture repair for a communited fracture. There were no instances of wound complications or implant loosening. Conclusion. Fixation with lag screw or suture combined with bone grafting for delayed union or non-union of PCL avulsion fractures achieves acceptable functional outcome.

Distal radius fracture is usually associated with ulnar styloid fracture. Whether to fix the ulnar styloid or not remains a surgical dilemma as some surgeons believe that their repair is imperative while others feel that they should be managed conservatively. This prospective study involved 47 patients with unilateral fracture of the distal radius who met the inclusion criterion and underwent open reduction and internal fixation with volar locking plates; 28 patients (12 males and females = 16) had an associated ulnar styloid fracture (Group A) while 19 (7 males; 12 females) did not have any ulnar styloid fracture (Group B). At the time of final evaluation both the groups were compared clinically by measuring the grip strength and range of motion around the wrist and the radiologically by measuring radial angle, radial length, volar angle and ulnar variance. Subjective assessment was done using DASH score and final assessment using Demerit point system of Saito. In Group A, average time for consolidation was 9.4 weeks, 17 patients developed non-union of the ulnar styloid, average DASH scores was 4.4 and according to Demerit point system of Saito, there were 78.5 % excellent, 17.9 % good and 3.6 % fair results; there were 2 cases of loss of reduction out of which one had persistent ulnar sided wrist pain. In Group B the average time for consolidation was 10.2 weeks, average DASH score was 3.8.and Demerit point system of Saito yielded 78.9 % excellent, 15.8 % good and 5.3 % fair results. There was one case of loss of reduction and one case of carpal tunnel syndrome which was managed conservatively. Both groups attained excellent range of motion, grip strength and well maintained the post operative radiological parameters. The comparison of clinico-radiological parameters in both groups was found to be statistically insignificant. To conclude, ulnar styloid fracture or its non union does not affect the outcome of an adequately fixed distal end radius fracture. We urge caution in electing operative treatment of non-united fracture of the ulnar styloid until better scientific report for treatment of pain associated with these fracture is available.

Internal fixation of paediatric subtrochanteric fractures using the proximal humeral locking plate of the ipsilateral side appears to be a good treatment option for the age group of 10-16 years, though comparative studies with a larger sample size are required to further support this observation.