The use of the Direct Scheduler module of the web-based TSF software allows the complete correction of complex deformities without the need for obtaining complex mounting and frame parameters. We achieved successful closure of soft tissue defects and restored the anatomical tibial alignment in all our cases.

Objective: This cross-sectional survey aimed to assess the prevalence of depression, anxiety, post-traumatic stress disorder (PTSD), and drug and alcohol dependence in a limb reconstruction population and examine associations with demographic and functional variables.Methods: As part of routine clinical care, data were collected from 566 patients attending a tertiary referral centre for limb reconstruction between April 2012 and February 2016.Depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol and drug dependence were measured using standardised self-report screening tools.Results: 173 patients (30.6% CI 26.7-34.4) screened positive for at least one of the mental disorders assessed. 110 (19.4% CI 16.2-22.7) met criteria for probable major depression; 112 (19.9% CI 16.6-23.2) patients met criteria for probable generalised anxiety disorder; and 41 (7.6% CI 5.3-9.8) patients met criteria for probable PTSD. The prevalence of probable alcohol dependence and probable drug dependence was 1.6% (CI 0.6-2.7) and 4.5% (CI 2.7-6.3), respectively. Patients who screened positive for depression, anxiety and PTSD reported significantly higher levels of pain, fatigue, and functional impairment. Depression and anxiety were independently associated with work disability after adjustment for covariates (OR 1.98 (CI 1.08-3.62) and OR 1.83 (CI 1.04-3.23), respectively).Conclusion: The high prevalence and adverse associations of probable mental disorder in limb reconstruction attest to the need for routine psychological assessment and support.Integrated screening and management of mental disorder in this population may have a positive impact on patients" emotional, physical and occupational rehabilitation. A randomised controlled trial is needed to test this hypothesis.

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Proximal femoral varus and derotation osteotomy is a common procedure performed in the management of developmental dysplasia of the hip. This procedure imposes high shear stress on the femoral epiphysis, depending on the degree of varus obtained. We report two cases of proximal femoral epiphyseal slip after varus derotation osteotomy and discuss the management and outcome. Such epiphyseal slip may or may not be symptomatic, and a careful radiologic examination should be carried out in suspected cases. Management should be individualised. Surgical correction of varus may be required.

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Triplane ankle fractures typically occur in the adolescent age group. Although many are minimally displaced and can be managed nonoperatively, some are displaced and difficult to reduce by closed methods and need open reduction and internal fixation. Traditionally satisfactory articular reduction is achieved through an open approach, which can be extensive. We describe our experience of treating displaced triplane fractures in four patients, assisted by ankle arthroscopy to ensure anatomical reduction and minimal soft tissue disruption. We achieved excellent reduction and stable fixation in all four cases. All patients regained full range of movement within 6 weeks.

A 13-year-old boy fell off his bicycle and landed on his outstretched left hand, sustaining a Salter-Harris type II fracture of the lower radial epiphysis with volar displacement, and an undisplaced fracture across the waist of the left scaphoid. After manipulation, and immobilisation for six weeks, he made a complete recovery and has no residual deformity. We hypothesise that the fracture was caused by the weight of the body being taken by the relatively stiff and immobile hand, and could find no report of a similar case.

A bstract Aim To present a novel technique developed in our institution to remove incarcerated and broken intramedullary (IM) tibial and femoral nails. Background IM nails are commonly used to treat diaphyseal fractures in both the tibia and femur. These nails can become problematic for the orthopaedic surgeon when they need to be removed, especially in the rare event that the nail has failed and broken. This can leave part of the nail deep in the bone and incarcerated. Multiple techniques have been described to remove a broken nail but we present a novel technique developed based on our experience. Technique After all other methods to remove the broken nail have failed, a window technique can be employed. This requires a small window of bone to be removed from the cortex overlying the remaining IM nail. A carbide drill is then used to drill a hole into the nail to gain purchase. The edge of an osteotome is placed in the hole in the nail through the window and gently hammered upwards to push the nail towards the over-reamed nail entry point. The nail is repeatedly drilled and pushed until the nail can be removed. The bone window is then replaced. Conclusion This is a novel technique that works when all other options including hooks, wire stacks and specialist nail removal techniques have failed. It is simple, efficient and effective for both the tibial and femoral nails. How to cite this article Somerville CMB, Hanschell H, Tofighi M, et al. A Novel Surgical Technique for Extraction of a Firmly Integrated Broken Intramedullary Nail. Strategies Trauma Limb Reconstr 2022;17(1):55–58.