The management of bone loss in revision replacement of the knee remains a challenge despite an array of options available to the surgeon. Bone loss may occur as a result of the original disease, the design of the prosthesis, the mechanism of failure or technical error at initial surgery. The aim of revision surgery is to relieve pain and improve function while addressing the mechanism of failure in order to reconstruct a stable platform with transfer of load to the host bone. Methods of reconstruction include the use of cement, modular metal augmentation of prostheses, custom-made, tumour-type or hinged implants and bone grafting. The published results of the surgical techniques are summarised and a guide for the management of bone defects in revision surgery of the knee is presented.

Proximal tibial fractures are rare in children, and most are treated conservatively. We report a case of a minimally displaced proximal tibial epiphyseal injury (Salter-Harris type III) in an 11-year-old child. We initially thought to treat this fracture conservatively, but the presence of massive haemarthrosis and considerable pain made us choose arthroscopy under general anaesthetic. During examination under anesthesia no instability could be detected, but the knee was locked in 5 degrees of flexion. On screening the fracture was not reducible anatomically. At arthroscopy the medial meniscus was not visualised as it was displaced into the fracture site. A small medial arthrotomy showed the meniscus trapped in the fracture site without any avulsion in the anterior or posterior horns. The fracture easily reduced once the meniscus was levered out. The importance of this injury is the fact that it could have been easily missed and would have led to serious functional deficit of the knee joint. We present radiographs and intra-operative pictures of this interesting injury.

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Abstracts / Injury Extra 41 (2010) 197-220 201 Fig. 1. Standard AP image.appears to pass vertically makes it easier to visualise the projected direction of the guide wire.Methods: Fifty Specialist Registrars, thirty participating in the London hip meeting 2009, ten from Oxford and ten from Northern deanery orthopaedic rotations were involved in the study. They were presented with standard AP and rotated images of the femoral neck on paper using 135 degree template to replicate the DHS guide.The participants were asked to mark the entry point on the intertrochanteric area of femur on the image where they would have placed the guide wire. They did this on both standard AP and rotated images aiming for the centre of the head of the femur.Results: Thirty-seven Specialist Registrars (74%) were able to accurately mark their entry point on rotated images on their first attempt as compared to eighteen trainees (36%) managing to place it correctly first time on the standard image. Thirteen trainees (26%) were able to mark their entry point correctly on both standard AP and rotated images with equal accuracy.Conclusion: Coren et al. argue that human vision can more easily judge horizontal and vertical lines rather than oblique lines. Thus, rather than use the standard anterior-posterior projected image of the hip, we should routinely rotate the intensifier image so that the guide wire appears to be passing in a vertical direction. By rotating the image (Fig. 2) in this way it becomes significantly easier Fig. 2. Rotated image.to visualise the projected direction of the guide wire and in doing so ensure its accurate final placement thereby minimising possible complications.Background: Management of first-time patellar dislocations in adults has received more attention recently as it mainly affects young adults who have an active lifestyle. These injuries have greatly reduced the level of activity in this group of population. Non-operative treatment has been the traditionally accepted option. Unfortunately the outcomes have not been satisfactory. Recent studies have brought to light, the associated soft tissue injury which could be operatively treated. The results of operative treatment in terms of early recovery to an active lifestyle have been promising.Aims and objectives: Our aim was to know the current practice among the clinicians in the UK who manage first-time patellar dislocations. We have performed a questionnaire survey gathering the opinion of one hundred orthopaedic consultants registered with the British Orthopaedic Association.Method: We used an online questionnaire survey and emailed it to the members of the British Orthopaedic Association.Results: This is a currently ongoing study. The present status of our survey showed that non-operative treatment has still remained the most favoured approach to the initial management among seventy percent of the surgeons. Further investigations with an MRI or diagnostic arthroscopy have been routinely used by more than eighty percent of the surgeons. Skyline views of the ...