Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

This study aimed to determine the long-term functional, clinical and radiological outcomes in patients with Schatzker IV to VI fractures of the tibial plateau treated with an Ilizarov frame. Clinical, functional and radiological assessment was carried out at a minimum of one year post-operatively. A cohort of 105 patients (62 men, 43 women) with a mean age of 49 years (15 to 87) and a mean follow-up of 7.8 years (1 to 19) were reviewed. There were 18 type IV, 10 type V and 77 type VI fractures. All fractures united with a mean time to union of 20.1 weeks (10.6 to 42.3). No patient developed a deep infection. The median range of movement (ROM) of the knee was 110(°) and the median Iowa score was 85. Our study demonstrates good long-term functional outcome with no deep infection; spanning the knee had no detrimental effect on the ROM or functional outcome. High-energy fractures of the tibial plateau may be treated effectively with a fine wire Ilizarov fixator.

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Chondrosarcoma is most frequently present in the pelvis and long bones and rarely seen in the bones of the hand. Traditionally the treatment of choice for involvment of the hand is ray amputation, however this causes significant functional deficit if there is thumb involvement. There are limited cases in literature of resection of thumb chondrosarcoma with restoration of function. We present a case of high grade chondrosarcoma of the first metacarpal treated with resection and free fibular graft reconstruction. We report excellent functional outcome with this procedure.

Background:Instability of the knee joint, after anterior cruciate ligament (ACL) injury, is contraindication to osteochondral defect repair. This prospective study is to investigate the role of combined autologous chondrocyte implantation (ACI) with ACL reconstruction.Materials and Methods:Three independent groups of patients with previous ACL injuries undergoing ACI were identified and prospectively followed up. The first group had ACI in combination with ACL reconstruction (combined group); the 2nd group consisted of individuals who had an ACI procedure having had a previously successful ACL reconstruction (ACL first group); and the third group included patients who had an ACI procedure to a clinically stable knee with documented nonreconstructed ACL disruption (No ACL group). Their outcomes were assessed using the modified cincinnati rating system, the Bentley functional (BF) rating system (BF) and a visual analog scale (VAS).Results:At a mean followup of 64.24 months for the ACL first group, 63 months for combined group and 78.33 months for the No ACL group; 60% of ACL first patients, 72.73% of combined group and 83.33% of the No ACL group felt their outcome was better following surgery. There was no significant difference demonstrated in BF and VAS between the combined and ACL first groups. Results revealed a significant affect of osteochondral defect size on outcome measures.Conclusion:The study confirms that ACI in combination with ACL reconstruction is a viable option with similar outcomes as those patients who have had the procedures staged.

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Intramedullary nailing of tibial fractures is commonplace, and freehand operative techniques are increasingly popular. The standard freehand method has the knee of the injured leg flexed over a radiolucent bolster. This requires the theatre fluoroscope to swing from antero-posterior to lateral position several times. Furthermore, guide wire placement, reaming and nail insertion are all performed well above most surgeons' shoulder height. Alternatively the leg is hung over the edge of the table, and the assistant must crouch and hold the leg until the nail is passed beyond the fracture. We describe a freehand figure 4 position technique for tibial nailing which is easier both for the surgeons and the radiographer, and present a series of 87 consecutive cases utilising this method.

identified as having had revision ACL reconstruction at a single stage under a single surgeon. The case notes were retrospectively reviewed and patients were contacted by telephone interview where patient reported outcome measures were recorded in the form of Tegner Activity Scale, Tegner Lysholm Knee Scoring Scale, Cardiff ACL Satisfaction Index and EQ5D Euroqol. Results: 20 patients were contactable (59%), with the average follow-up of 3.8 years [range 1-10 years]. None of the revisions had failed. The mean Tegner score was 84.4 [range 45-100], which correlated well with the EQ5D Euroqol. One patient had proceeded to TKR at 6 years but the graft was functioning at the time of surgery. Eight of the revisions used bone patella tendon bone (BPTB) as a graft material. Fixation was possible in all but one case where a femoral post and suspensory fixation was required. Tegner score was higher in revisions using hamstrings [n¼8, mean 83.4] than BPTB [n¼11, mean 82.6]. Conclusions: Single stage revision ACL reconstruction can yield good results, where hamstring and BPTB grafts yield similar results on functional outcome scores.