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Six children with radial club hand had distraction lengthening of the ulna using the Ilizarov technique at the mean age of 10 years. The mean lengthening achieved was 4.7 cm (46% of original ulna length). Complications included nocturnal pain, pin track infection and callus fracture or delayed union. Distraction lengthening of the ulna can enhance the ability to perform normal activities of daily living, such as reaching the perineum or driving a car, but complications are extremely common. The high rate of callus fracture in this series reinforces the need for regular radiographic review during distraction and suggests that after distraction it may take more than 4 weeks for satisfactory callus consolidation before removal of the fixator.

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A retrospective study was undertaken to review the outcomes of a consecutive series of patients treated using pyrocarbon surface replacement arthroplasty by the same surgeon. We analyzed the results of this procedure in 24 proximal interphalangeal (PIP) joints in 19 hands of 16 patients. The minimum follow-up was 3 years. The study showed that pyrocarbon PIP joint replacements provided excellent pain relief and high patient satisfaction. More than two-thirds of patients subjectively rated postoperative range of motion and functional outcomes as better than preoperatively. Objective assessment showed a modest improvement in the active range of motion, which did not achieve statistical significance, although we did observe a statistically significant increase in passive range of motion. The results are encouraging for those surgeons who seek an alternative to silicone implant PIP joint arthroplasty in high-demand patients.

We present three cases of sub-total amputation of the external ear caused by bite avulsion injury. The ears were all successfully replanted despite us being unable to perform a venous anastomosis in one case. These outcomes support attempted microsurgical replantation for total or sub-total amputations of the ear, as successful replantation is the most effective surgical option.