We report the clinical and radiological results of a two- to three-year prospective randomised study which was designed to compare a minimally-invasive technique with a standard technique in total knee replacement and was undertaken between January 2004 and May 2007. The mini-midvastus approach was used on 50 patients (group A) and a standard approach on 50 patients (group B). The mean follow-up in both groups was 23 months (24 to 35). The functional outcome was better in group A up to nine months after operation, as shown by statistically significant differences in the mean function score, mean total score and the mean Oxford knee score (all, p = 0.05). Patients in group A had statistically significant greater early flexion (p = 0.04) and reached their greatest mean knee flexion of 126.5 degrees (95 degrees to 135 degrees ) 21 days after operation. However, at final follow-up there was no significant difference in the mean maximum flexion between the groups (p = 0.08). Technical errors were identified in six patients from group A (12%) on radiological evaluation. Based on these results, the authors currently use minimally-invasive techniques in total knee replacement in selected cases only.

A high rate (12%) of autograft contamination can be expected during autograft preparation for anterior cruciate ligament reconstruction. The contamination rate is almost equal for both bone-patellar tendon-bone and hamstring tendon autografts. We could not identify an association between contaminated grafts implanted in the knee and postoperative inflammatory markers such as the erythrocyte sedimentation rate and the C-reactive protein level.

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Objective: To present our technique and early results using the Masquelet technique. Design: Retrospective cohort study. Patients/Participants: Thirteen patients with 14 open fractures of the femur and tibia were included between November 2013 and December 2014. Intervention: A Masquelet technique was used to manage the open fractures. Main outcome measure: Infection and union rate. Results: The mean follow-up was 17 months. The mean bone defect was 56.6 mm. Eight fractures (57.1%) progressed to union at an average of 42.1 weeks. Infection developed in 3 fractures (21.4%). Overall, the induced membrane technique was abandoned in 5 (35.7%) cases. Conclusions: The induced membrane technique showed a substantial rate of failure in the acute trauma setting in the lower limb. In the absence of sound published evidence, the authors now use the technique in selected cases only. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Bicondylar Hoffa's fractures of distal femur are rare. We report the case of an 18-year-old male who sustained a closed complex fracture of both femoral condyles of the left femur on the sagittal plane (Hoffa fracture), combined with distal metaphyseal fracture. He was treated using parallel plates and interdigitating screws, with our technique based on an extrapolation of the principles of distal humerus fixation. The fracture united clinically and radiologically at 16 weeks. Twelve months postoperatively, the range of movement in the knee was 5°-115°. In this complex case, our technique provided stable fixation of the fragments and a satisfactory final functional outcome.

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