Application of recombinant BMP-7 on persistent upper and lower limb non-unions.

The purpose of this study was to evaluate the efficacy and safety of recombinant bone morphogenetic protein 7 (rhBMP-7 or OP-1) as a bone-stimulating agent in the treatment of persistent fracture non-unions. Twenty-five consecutive patients [19 males, mean age 39.4 years (range: 18-79)] with 26 fracture non-unions were treated with rhBMP-7. There were 10 tibial non-unions, eight femoral, three humeral, three ulnar, one patellar, and one clavicular non-union. The mean follow-up was 15.3 months. The mean number of operations performed prior to rhBMP-7 application was 3.2, with autologous bone graft and bone marrow injection being used in 10 cases (38.5%). Both clinical and radiological union occurred in 24 (92.3%) cases, within a mean time of 4.2 months and 5.6 months, respectively. Of the remaining two cases, one patient ultimately underwent a below knee amputation, secondary to recurrence of deep sepsis. The other patient with recalcitrant ulnar non-union although the radiological union was incomplete, declined further intervention, as he was asymptomatic. No complications or adverse effects from the use of rhBMP-7 were encountered. This study supports the view that the application of rhBMP-7 as a bone-stimulating agent is safe and a power adjunct to be considered in the surgeon's armamentarium for the treatment of these challenging clinical conditions.

Nonunion of fracture of the neck of the radius: a report of three cases.

Nonunion of a radial neck fracture is uncommon. Our report of three cases aims to highlight the fact that this complication is possible following such a fracture in adults. Appropriate clinical and radiologic follow-up is necessary to make sure such nonunion not missed. Surgical fixation (when nonunion of radial neck fracture is suspected) or excision of the radial head may be necessary if the complication is symptomatic. When associated with an ulna fracture, the threshold for internal fixation of both fractures must be lower.

A review of the quality of trauma protocols on the Internet.

A review of trauma protocols found on the Internet was performed in September 1997 to evaluate the content, presentation and usefulness of these resources. A wide variation was found in the nature of these 'protocols', the educational content and the academic strengths of the web pages. We attempted to define a protocol and a scoring system to assess these documents and reviewed each accordingly.

Cemented versus uncemented Thompson's prostheses: a functional outcome study.

One hundred and one elderly patients (90 female and 11 male) with a mean age of 83.5 years (range 69-100) were treated for intracapsular femoral neck fracture by Thompson's prosthesis. The prosthesis was fixed in the femoral shaft using Palacos cement in 23% and was inserted uncemented in 77%. We compared the following pre and postoperative variables in each group; mobility of the patient, their activity, walking aids and postoperative thigh pain. We also studied the pre and postoperative hip X-rays. Our patients did well in both groups. We conclude that there is no statistically significant difference between the variables in the two groups. Thompson's prosthesis can be inserted uncemented. Patients with radiological loosening of the prosthesis are not necessarily symptomatic. Intra and postoperative complications were similar to other published series of hip prostheses. The femoral neck osteotomy for Thompson's prosthesis can be performed safely well above the calcar femoris without detrimental complications. The original inter-trochanteric cut Thompson described is not necessary for acute fractures. This consequently makes revision of failed Thompson's prosthesis easier.

Motorcyclists, full-face helmets and neck injuries: can you take the helmet off safely, and if so, how?

Injured motorcyclists may have a damaged and unstable cervical spine (C-spine). This paper looks at whether a helmet can be safely removed, how and when should this be done? The literature is reviewed and the recommendations of the Trauma Working party of the Joint Colleges Ambulance Liaison Committee are presented.