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Reperfusion injury by the abrupt restoration of circulation after the prolonged ischemia has been remained unsolved problem in the reconstructive microsurgery. We tested the hypothesis that a procedure of intermittent interruption of reperfusion, i.e., postconditioning (post-con) attenuates ischemia/reperfusion (I/R) injury of rat epigastric skin flap. A complete 4 hours of ischemia was generated by occlusion of the pedicle of dissected flap. The post-con procedure was started at the end of ischemia. A cycle of 15 seconds of full reperfusion, followed by 15 seconds of complete reocclusion was repeated six times (3 min of total intervention) prior to the unlimited reperfusion. Flap necrosis area of post-con group was compared with sham (no ischemic exposure) and control (4 hours of ischemia followed by full reperfusion without intervention) groups at postreperfusion day 5. Histology and MPO activities of flaps were evaluated. The post-con group showed significantly reduced flap necrosis at the end of 5 days of reperfusion compared with the control. Decreased inflammatory cell infiltration and MPO activity indicated post-con attenuated acute inflammatory reaction caused by I/R. This study reports for the first time that ischemic post-con effectively attenuates skin flap I/R injury. With further study, post-con may eventually be clinically applicable for the I/R injury as an "after-injury strategy."

We reviewed 22 children with cubitus varus who had been treated by a reverse V osteotomy and fixation by cross-pinning and wiring. The mean pre-operative humeral-elbow-wrist angle was -16.9 degrees (-25 degrees to +9 degrees ) and at the latest follow-up it was +7.3 degrees (-2 degrees to +14 degrees ). No child had a lateral prominence greater than 5 mm after correction. An excellent result was achieved in 20 children and a good result in two. We believe that this osteotomy has the advantages of better inherent stability, the avoidance of a prominent lateral condyle after correction and firm fixation allowing early movement.

Minimally invasive plate osteosynthesis (MIPO) has been used for humeral shaft fractures, but concerns exist about soft tissue injuries. The purpose of this study was to report the surgical technique and clinical outcomes of MIPO using a helical plate for metadiaphyseal complex humeral shaft fractures. Twelve patients with acute displacement involving proximal and middle third humeral shaft fractures (AO type C) were treated using the MIPO technique with a helical plate. Fracture union, complications, and functional outcomes were evaluated using the Constant-Murley score and Mayo Elbow Performance Score (MEPS) at final follow-up. All fractures united at an average of 17.9 weeks. No major complications, such as neurovascular injury, infection, and nonunion, were observed. Mean Constant-Murley and MEPS scores at final follow-up were 88.6 and 97.9, respectively. A MIPO technique using a helical plate can be a useful surgical option for metadiaphyseal complex fractures of the humeral shaft.

PA screw placement was biomechanically superior to AP screw placement. Together with the fact that it is clinically easier to insert and remove screw from the posterior ulna, these data indicate that optimal screw orientation for fixation of coronoid tip fracture is posterior to anterior direction.

INTRODUCTIONThe orientation of acetabular component is influenced by pelvic tilt, body position and individual variation in pelvic parameters. Most post-operative adverse events may be attributed to malposition of the component in the functional position. There is evidence that orientation of the pelvis changes from the supine to standing position. Authors report a case of recurrent dislocation after total hip arthroplasty due to excessive pelvic tilting.PRESENTATION OF CASE A 69-year old female with coxarthrosis had undergone total hip replacement with recurrent dislocation of the hip on bearing weight in spite of using constrained acetabular component.DISCUSSIONOur case report substantiates the influence of pelvic tilt, incurred by a sagittal deformity of spine, on dynamic orientation of the acetabular cup which was positioned in accordance with the anatomic landmarks alone. If the reference is only bony architecture and dynamic positions of the pelvis are not taken into account, improper functional orientation of the acetabular cup can result in sitting and standing positions. These can induce instability even in anatomically appropriately oriented acetabular component.CONCLUSIONThe sagittal position of pelvis is a key factor in impingement and dislocation after total hip arthroplasty. Pelvic tilting affects the position of acetabular component in the sagittal plane of the body as compared with its anatomic position in the pelvis. We suggest a preoperative lateral view of spine-pelvis, in upright and supine position for evaluation of a corrective adaptation of the acetabular cup accordingly with pelvic balance.

Although silicone radial head arthroplasty has been successful in many patients, it has been associated with complications such as fractures of the prosthesis and silicone synovitis. Synovectomy and removal of the failed silicone radial head, with or without reimplantation of a metallic radial head, is indicated in such complications. In an effort to perform minimally invasive surgery, we performed arthroscopic removal of the silicone head combined with synovectomy in a series of such patients. The silicone prostheses were cut into two or three pieces and then removed. After a median follow up of 26 months, all patients reported excellent pain relief and there were no residual loose bodies. Removal of a failed silicone radial head can be successfully performed arthroscopically. This arthroscopic technique has the advantage of being minimally invasive and can be combined with other procedures including capsulectomy, if necessary.