Aim: To determine whether operator’s experience and time of operation (MUA) affects the outcome of fractures in paediatric age group as measured by re-MUA rate.

Method: Retrospective analysis of 918 children with fractures requiring MUA over a period of eight years was carried out.

Results: Re-MUA rate for those 910 children was 9.8%(90). There was a significant difference in these fractures requiring re-MUA depending upon the operator’s experience and time. Amongst all (90) who required re-MUA 7(7.7%) had index surgery by consultants and 83(93.3%) had MUA by trainee surgeons. 23(17.4%) patients were operated between 9 to 1700 hours and rest of them had MUA after 1700 hours (82.6%). At repeat procedure 4(4.4%) required some sort of fixation. (K wiring or ORIF)

Conclusion: The current overall re-MUA rate is higher than data published from the specialised centres and surgeons, but is probably more representative of norm, when performed in a general setting. Exact fracture personality should be evaluated carefully to reduce re-MUA rate. Re-MUA rate for trainee needs to be improved.

Purpose

To assess outcomes of manipulating upper extremity fractures with conscious sedation compared with formal reduction and casting in theatre under general anaesthesia and image intensifier control.

Thoracolumbar injury classification systems are not used or researched extensively in paediatric population yet. This systematic review aims to explore the validity and reliability of the two main thoracolumbar injury classification systems in the paediatric population (age ≤ 18). It also aims to explore the transferability of adult classification systems to paediatrics. The Thoracolumbar Injury Classification System (TLICS) published in 2005 and the AO Spine published in 2013 were assessed in this paper because they both provide guidance for the assessment of the severity of an injury and recommend management strategies. A literature search was conducted on the following databases: Medline, EMBASE, Ovid during the period November 2020 to December 2020 for studies looking at the reliability and validity of the TLICS and AO Spine classification systems in paediatric population. Data on validity (to what extent TLICS/ AO Spine recommended treatment matched the actual treatment) and reliability (inter-rater and intra-rater reliability) was extracted.

There is an “almost perfect validity” for TLICS. There is a “strong association” between the validity of TLICS and AO Spine. The intra-rater reliability is “moderate” for TLICS and “substantial” for AO Spine. The intra-rater reliability is “substantial” for TLICS and “almost perfect” for AO Spine.

The six studies show a good overall validity and reliability for the application of TLICS and AO Spine in pediatric thoracolumbar fractures. However, implication of treatment and anatomical differences of the growing spine should be explored in detail. Therefore, AO Spine can be used in absence of any other classification system for paediatrics.

Olecranon fractures are common injuries representing roughly 5% of pediatric elbow fractures. The traditional surgical management is open reduction and internal fixation with a tension band technique where the pins are buried under the skin and tamped into the triceps. We have used a modification of this technique, where the pins have been left out of the skin to be removed in clinic. The purpose of the current study is to compare the outcomes of surgically treated olecranon fractures using a tension-band technique with buried k-wires (PINS IN) versus percutaneous k-wires (PINS OUT).

We performed a retrospective chart review on all pediatric patients (18 years of age or less) with olecranon fractures that were surgically treated at a pediatric academic center between 2015 to present. Fractures were identified using ICD-10 codes and manually identified for those with an isolated olecranon fracture. Patients were excluded if they had polytrauma, metabolic bone disease, were treated non-op or if a non-tension band technique was used (ex: plate/screws). Patients were then divided into 2 groups, olecranon fractures using a tension-band technique with buried k-wires (PINS IN) and with percutaneous k-wires (PINS OUT). In the PINS OUT group, the k-wires were removed in clinic at the surgeon's discretion once adequate fracture healing was identified. The 2 groups were then compared for demographics, time to mobilization, fracture healing, complications and return to OR.

A total of 35 patients met inclusion criteria. There were 28 patients in the PINS IN group with an average age of 12.8 years, of which 82% male and 43% fractured their right olecranon. There were 7 patients in the PINS OUT group with an average age of 12.6 years, of which 57% were male and 43% fractured their right olecranon. All patients in both groups were treated with open reduction internal fixation with a tension band-technique. In the PINS IN group, 64% were treated with 2.0 k-wires and various materials for the tension band (82% suture, 18% cerclage wire). In the PINS OUT group, 71% were treated with 2.0 k-wires and all were treated with sutures for the tension band. The PINS IN group were faster to mobilize (3.4 weeks (range 2-5 weeks) vs 5 weeks (range 4-7 weeks) p=0.01) but had a significantly higher complications rate compared to the PINS OUT group (6 vs 0, p =0.0001) and a significantly higher return to OR (71% vs 0%, p=0.0001), mainly for hardware irritation or limited range of motion. All fractures healed in both groups within 7 weeks.

Pediatric olecranon fractures treated with a suture tension-band technique and k-wires left percutaneously is a safe and alternative technique compared to the traditional buried k-wires technique. The PINS OUT technique, although needing longer immobilization, could lead to less complications and decreased return to the OR due to irritation and limited ROM.

Introduction

Femoral shaft fractures in children is a serious injury that needs hospitalization, with a high prevalence in the age group 6–8 years old. Various treatment options are available and with a comparable weight of evidence. Submuscular plating provides a dependable solution, especially in length-unstable fractures and heavier kids. We present a novel technique to facilitate and control the reduction intraoperatively, which would allow for easier submuscular plate application.

Supracondylar fractures of the humerus (SCH) are the most common fractures sustained following a fall among children. The majority of these fractures are mild, but the most severe injury types can result in a disruption to the nerves and blood supply resulting in limb threatening injuries and potential life-long disability. Better understanding of mechanisms of injury and child-related factors that influence injury, especially for severe cases, is crucial to identifying best practices and informing policy. We aim to stratify fractures and examine the associated mechanisms and circumstances of injury to identify best practices and inform supportive policy. In doing so, we plan to investigate why some children sustain more severe fractures than others by exploring mechanisms and locations of injury, and risk-taking behaviours.

A prospective, mixed-methods pilot study employing a child-led research design. Our approach links narratives from qualitative photo elicitation interviews (PEI) to mapped images of the locations of injury using geotagged photographs children have taken themselves, complications and injury outcomes, and an assessment of overall risk-taking tendencies.

Participants aged six-12, with the help of their photographs, were able to lay out the events leading up to, including, and following their injury. Much of this information was either not included in their medical charts or was markedly different. Themes included not being able to prevent the injury and being adventurous, as well as becoming more cautious afterwards. These can have applications to the necessity of exploration as well as possibilities to prevent injury or not. Thus, the in-depth, first-person retelling of injury mechanism illustrated the need for mechanistic data and statistics beyond injury location alone. Risk-taking behaviours, as scored by the Sensation Seeking Scale for Children, correlated to injury severity, which is known to be associated with poorer outcomes and long-lasting complications.

PEI of children sustaining SCH fractures in Vancouver reveals mechanisms of injury beyond those previously reported in literature and suggest the feasibility of a large-scale study. PEI in this age group allows for clarifications and a clearer picture of injury mechanism as well as context of injury. These aspects significantly affect our ability to determine the relationship between injury mechanism and injury severity. Mixed-methods analysis of child-directed data as well as quantitative injury demographics reveals unique translational knowledge which can be shared with clinicians, patients/care-givers, community-based health teams, and local policy makers to make timely and impactful improvements in injury prevention, clinical practice, and play structure safety.

Paediatric femoral fractures are a common result of significant trauma, and always require intervention. Hip spica casting, traction, and surgical fixation can all be used to treat these fractures. This variety in treatment options leads to a vast potential for variability in management decisions among surgeons and has prevented effective comparative studies to show which treatment methods provide optimal outcomes for patients. The purpose of this study was to identify practice variability in management and follow-up and assess patient outcomes to aid in the development of a comprehensive, prospective, evidence-based pathway for the management of paediatric femoral fractures.

A retrospective chart review was performed of all patients treated surgically for isolated femoral fractures during a six year period at a single tertiary care paediatric centre. Patients were identified from a surgical database and were included if there was no pre-existing pathology and no history of previous femoral fracture. Demographic data, operative details, post-operative management, and clinical outcomes were collected. Radiographic images and reports were analyzed to determine fracture classification and imaging parameters. Variability in treatment among eight surgeons was assessed, including number of follow-up appointments and length of follow-up. Patient demographics and follow up measures were summarised for each surgeon and between surgeon variability was assessed with linear models.

In total, 138 femoral fractures in 134 patients (101 male, 33 female) were included in analysis. Of these patients, 55 had right femoral fractures, 76 left, and three bilateral (one bilateral patient had three distinct femoral fractures). Of 138 total fractures, 131 were of the diaphysis of the femur. 14 patients sought initial surgical treatment at our institution but received follow-up management elsewhere. Across all patients, median follow-up time was 32.8 weeks (0–201.4) with a median of three follow-up visits (0–26) in that period. Mean number of follow-up clinic visits ranged from 3 to 4.8 among surgeons, and mean length of follow-up ranged from 31.8 to 62.3 weeks.

No significant differences in follow-up between surgeons were found, but small sample sizes are a likely contributing factor. Summary statistics show large ranges in most variables and differences in patient demographics between surgeon groups. The large ranges in follow-up time and visit number suggest a lack of consensus on optimal management for paediatric femoral fractures. Further prospective study examining long-term functional and quality of life outcomes will be required to identify and develop optimized management guidelines.

Fractures through the physis account for 18–30% of all paediatric fractures, leading to growth arrest in 5.5% of cases. We have limited knowledge to predict which physeal fractures result in growth arrest and subsequent deformity or limb length discrepancy. The purpose of this study is to identify factors associated with physeal growth arrest to improve patient outcomes.

This prospective cohort study was designed to develop a clinical prediction model for growth arrest after physeal injury. Patients < 1 8 years old presenting within four weeks of injury were enrolled if they had open physes and sustained a physeal fracture of the humerus, radius, ulna, femur, tibia or fibula. Patients with prior history of same-site fracture or a condition known to alter bone growth or healing were excluded. Demographic data, potential prognostic indicators and radiographic data were collected at baseline, one and two years post-injury.

A total of 167 patients had at least one year of follow-up. Average age at injury was 10.4 years, 95% CI [9.8,10.94]. Reduction was required in 51% of cases. Right-sided (52.5%) and distal (90.1%) fractures were most common. After initial reduction 52.5% of fractures had some form of residual angulation and/or displacement (38.5% had both). At one year follow-up, 34 patients (21.1%) had evidence of a bony bridge on plain radiograph, 10 (6.2%) had residual angulation (average 12.6°) and three had residual displacement. Initial angulation (average 22.4°) and displacement (average 5.8mm) were seen in 16/34 patients with bony bridge (48.5%), with 10 (30.3%) both angulated and displaced. Salter-Harris type II fractures were most common across all patients (70.4%) and in those with bony bridges (57.6%). At one year, 44 (27.3%) patients had evidence of closing/closed physes.

At one year follow-up, there was evidence of a bony bridge across the physis in 21.1% of patients on plain film, and residual angulation and/or displacement in 8.1%. Initial angulation and/or displacement was present in 64.7% of patients showing possible evidence of growth arrest. The incidence of growth arrest in this patient population appears higher than past literature reports. However, plain film is an unreliable modality for assessing physeal bars and the true incidence may be lower. A number of patients were approaching skeletal maturity at time of injury and any growth arrest is likely to have less clinical significance in these cases. Further prospective long-term follow-up is required to determine the true incidence and impact of growth arrest.

To analyse the management of open paediatric tibial fractures treated at a children's Major Trauma Centre (MTC), comparing fixation methods, union and complications.

We retrospectively identified all patients admitted to RMCH with an open tibia fracture between 2008 – 2016. Demographics, mechanism, inpatient stay and follow-up management were reviewed. There were a total of 44 patients, with an average age = 10 years (3–15). 93% of cases were caused by road traffic accidents, commonly pedestrian versus car. Older children were more likely to sustain higher grade injuries, requiring increased length of stay. 35 patients had primary / delayed wound closure, 1 patient required fasciotomies and 4/44 needed skin grafts and/or flap. 7 patients were treated in plaster, 9 by elastic nailing, 15 had mono-lateral fixators and 12 with circular frame. The average number of surgeries = 3 (1–7) with older children having increased risk of revision surgery. Monolateral fixators were the most common primary fixation method (n=15), however 60% required revision to ring fixator due to displacement or delayed union. The main risk factor for displacement was inadequate fracture reduction in theatre, as well as those fracture patterns involving butterfly fragments. Union (defined as RUST score = 3 on >3 cortices) was achieved in all patients (ave 6 months). Delayed union was associated with higher grade injuries, those treated with elastic nails demonstrated the longest union time (ave 7.3 months). 21/44 (47.7%) patients had complications, with pin site infection being the most commonly seen. 18% patients suffered a major complications needing further surgery.

Various fixation methods can be successfully used to treat these fractures. They demonstrate a high complication rate and often require multiple surgeries, with union taking an average of 6 months. Mono-lateral fixators demonstrate a high revision rate, particularly if the fracture is not well reduced.

Supracondylar fractures of the humerus (SCH) are the most common fractures sustained following a fall on an outstretched hand in healthy children, and one of the leading causes of hospital admission and surgical intervention. With increasing severity of injury, treatment options become more invasive and the potential for long lasting complications increases. The aim of this study is to examine the causes and circumstances surrounding SCH in public play spaces particularly to determine whether or not the playground equipment implicated in injurious falls is compliant with Canadian Standards Association (CSA) standards.

Children aged 6–12 years who sustained SCH while playing at a public play space between 2017 and 2019 were recruited from the paediatric orthopaedic clinic. Public playgrounds within a 50 km radius of the clinic were visited by research assistants. Using GPS coordinates from photographs taken by the children at the site of injury or play structures identified by the children using Google Maps, play structure type, dimensions, height of fall, and the type and depth of the surface material were collected from each site and compared to the relevant CSA standard.

Of the 89 SCH injuries reported during the recruitment period, 49 (55%) occurred on public play structures. Thirty-nine injury sites, representing 42 SCH cases, were accessible to conduct site visits and were included in the analysis. Thirteen children (31%) sustained Type One, 19 (45%) were Type Two, and 10 (24%) were Type Three SCHs. The mean child age at injury was 7.13 years. Of the 42 SCH cases, 37 sites had woodchips surfacing (88%); three had rubber (7%), one had cement (2%), and one had sand (2%). Of the 36 sites where woodchip depth measurements could be obtained, only seven (19%) met the minimum CSA depth. Out of the 42 SCH cases, 29 injuries (69%) involved upper body equipment (i.e. monkey bars or similar) and track rides. Fourteen of these 29 injuries (48%) occurred on structures that did not meet CSA standards for fall height. All rotating play structures had less than half of the required clearance between the components.

Eighty-six percent of SCH cases occurred in playgrounds where at least one of the required CSA standards was not met. Woodchip surfacing was of particular concern because 81% of woodchip surface depths failed to meet CSA standards. Of the 14 injuries where fall height did not meet CSA standards, 11 (79%) also did not meet minimum CSA surface depth. Field investigation into the characteristics of playgrounds in which children sustain SCH can guide preventative policy and practice measures. Municipalities and school boards should be alerted to the need for regular maintenance of woodchip playground surfacing, in order to remain compliant with the minimum surface depth and prevent serious injuries. Additionally, compliance with minimum surface depths can also decrease fall heights to meet CSA standards. By minimizing the prevalence of SCH injuries occurring on play structures and the need for emergency department visits, the burden to healthcare systems and families of injured children can potentially be reduced.

Technology within medicine has great potential to bring about more accessible, efficient, and a higher quality delivery of care. Paediatric supracondylar fractures are the most common elbow fracture in children and at our institution often have high rates of unnecessary long term clinical follow-up, leading to an inefficient use of healthcare and patient resources. This study aims to evaluate patient and clinical factors that significantly predict necessity for further clinical visits following closed reduction and percutaneous pinning.

A total of 246 children who underwent closed reduction and percutaneous pinning following supracondylar humerus fractures were prospectively enrolled over a two year period. Patient demographics, perioperative course, goniometric measurements, functional outcome measures, clinical assessment and decision making for further follow up were assessed. Categorical and continuous variables were analyzed and screened for significance via bivariate regression. Significant covariates were used to develop a predictive model through multivariate logistical regression. A probability cut-off was determined on the Receiver Operator Characteristic (ROC) curve using the Youden index to maximize sensitivity and specificity. The regression model performance was then prospectively tested against 22 patients in a blind comparison to evaluate accuracy.

246 paediatrics patients were collected, with 29 cases requiring further follow up past the three month visit. Significant predictive factors for follow up were residual nerve palsy (p < 0 .001) and maximum active flexion angle of injured elbow (p < 0 .001). Insignificant factors included other goniometric measures, subjective evaluations, and functional outcomes scores. The probability of requiring further clinical follow up at the 3 month post-op point can be estimated with the equation: logit(follow-up) = 11.319 + 5.518(nerve palsy) − 0.108(maximum active flexion). Goodness of fit of the model was verified with Nagelkerke R2 = 0.574 and Hosmer & Lemeshow chi-square (p = 0.739). Area Under Curve of the ROC curve was C = 0.919 (SE = 0.035, 95% CI 0.850 – 0.988). Using Youden's Index, a cut-off for probability of follow up was set at 0.094 with the overall sensitivity and specificity maximized to 86.2% and 88% respectively. Using this model and cohort, 194 three month clinic visits would have been deemed medically unnecessary. Preliminary blind prospective testing against the 22 patient cohort demonstrates a model sensitivity and specificity at 100% and 75% respectively, correctly deeming 15 visits unnecessary.

Virtual clinics and automated clinical decision making can improve healthcare inefficiencies, unclog clinic wait times, and ultimately enhance quality of care delivery. Our regression model is highly accurate in determining medical necessity for physician examination at the three month visit following supracondylar fracture closed reduction and percutaneous pinning. When applied correctly, there is potential for significant reductions in health care expenditures and in the economic burden on patient families by removing unnecessary visits. In light of positive patient and family receptiveness toward technology, our promising findings and predictive model may pave the way for remote health care delivery, virtual clinics, and automated clinical decision making.

Paediatric supracondylar fractures are the most common elbow fracture in children, and is associated with an 11% incidence of neurologic injury. The goal of this study is to investigate the natural history and outcome of motor nerve recovery following closed reduction and percutaneous pinning of this injury.

A total of 246 children who underwent closed reduction and percutaneous pinning following supracondylar humerus fractures were prospectively enrolled over a two year period. Patient demographics (age, weight), Gartland fracture classification, and associated traumatic neurologic injury were collected and analyzed with descriptive statistics. Patients with neurologic palsies were separated based on nerve injury distribution, and followed long term to monitor for neurologic recovery at set time points for follow up.

Of the 246 patient cohort, 46 patients (18.6%) sustained a motor nerve palsy (Group 1) and 200 patients (82.4%) did not (Group 2) following elbow injury. Forty three cases involved one nerve palsy, and three cases involved two nerve palsies. No differences were found between patient age (Group 1 – 6.6 years old, Group 2 – 6.2 years old, p = 0.11) or weight (Group 1 – 24.3kg, Group 2 – 24.5kg, p = 0.44). A significantly higher proportion of Gartland type III and IV injuries were found in those with nerve palsies (Group 1 – 93.5%, Group 2 – 59%, p < 0 .001). Thirty four Anterior Interosseous Nerve (AIN) palsies were observed, of which 22 (64.7%) made a full recovery by three month. Refractory AIN injuries requiring longer than three month recovered on average 6.8 months post injury. Ten Posterior Interosseous Nerve (PIN) palsies occurred, of which four (40%) made full recovery at three month. Refractory PIN injuries requiring longer than three month recovered on average 8.4 months post injury. Six ulnar nerve motor palsies occurred, of which zero (0%) made full recovery at three month. Ulnar nerve injuries recovered on average 5.8 months post injury.

Neurologic injury occurs significantly higher in Gartland type III and IV paediatric supracondylar fractures. AIN palsies remain the most common, with an expected 65% chance of full recovery by three month. 40% of all PIN palsies are expected to fully recover by three month. Ulnar motor nerve palsies were slowest to recover at 0% by the three month mark, and had an average recovery time of approximately 5.8 months. Our study findings provide further evidence for setting clinical and parental expectations following neurologic injury in paediatric supracondylar elbow fractures.

Purpose of study

To review the treatment and outcomes of paediatric pelvic ring injuries in the UK

Introduction: Chance fractures in children are rare the mechanism of injury is a flexion-distraction inertial force created during a motor vehicle accident when wearing a two-point seat belt or lap belt. High velocity paediatric Chance fractures are frequently associated with intra-abdominal injuries, although this may not be appreciated at the time of initial presentation.

Methods: The cases of two brothers who sustained Chance fractures with complete neurological deficits and intra-abdominal injuries from a motor vehicle accident are presented.

Results: The two brothers were rear seat passengers in car involved in a head-on collision with a tree. They were both wearing three point seat belts but had removed the chest straps, thus effectively converting them to a two-point harness.

Case 1. Boy age 3 years 10 months sustained a bony Chance fracture through the L3 vertebrae with a complete neurological deficit at the L1 level. There was an associated closed head injury and severe abdominal bruising. He underwent a CT scan of his abdomen on day of admission and posterior stabilisation of the spinal fracture on day 4. Seven days post-admission he was diagnosed with pancreatitis. He continued to have abdominal pain and vomiting. Further repeat abdominal CT scans, ultrasound examinations and abdominal contrast studies were performed. Ten weeks following admission he underwent laparotomy and a section of ischaemic small bowel was removed.

Case 2. Boy age 2 years 8 months presented with a ligamentous Chance fracture of L2 / L3 with a complete neurological deficit at T12. He had a closed head injury and severe abdominal bruising. He underwent CT scan on the day of admission and a diagnostic peritoneal tap on day two with aspiration of straw coloured fluid. The spinal fracture was stabilised 10 days post-admission with posterior instrumentation. On day 14 he underwent a laparoscopy and subsequent laparotomy with drainage of an abscess secondary to a perforated caecum.

Discussion: Chance fractures or flexion-distraction fractures of the spine are rare occurrences in children with few cases reported. They represent severe trauma and are often related to the wearing of two-point seat belt fixation. There is a high associated incidence of abdominal injuries which may be difficult to diagnose. The authors support the view of Beaunoyer¹ that a diagnostic laparoscopy or laparotomy should be considered strongly in patients with lumbar Chance fractures. Abdominal bruising and neurological defi cit are cardinal signs, reflecting severe trauma.

Osteotomy of ulna with fractional distraction maintains ulnar length and reduced position of radial head via interrosseous membrane.

We reviewed 9 patients, 5:M, 4:F, aged 2–14 years. Interval between injury and surgery ranged 2–36months but in seven patients the repositioning was performed within 6 months. All had elbow deformity with radial head prominence. 6 patients had restricted movements of elbow. 3 had pain on movements.

2 x 2mm k-wires each, proximal and distal to ulnar osteotomy. Distal k-wires were transfixed in radius in complete supination (during distraction of ulna, radius is pulled down). ‘Z’/‘Transverse’ osteotomy was then performed subperiosteally. Ulna lengthened by fractional distraction. Axial k-wire in ulna was used in selected patients to prevent any angular deformity from developing at osteotomy site during distraction. Latency period was 7 days, Distraction rate was 0.8mm/day. Radial head position was monitored by weekly x-rays. Static fixator time was 2 x (distraction time) so as to allow time for consolidation of new-bone. Total fixator time was 6weeks followed by fixator removal and brace for 2weeks with elbow-joint physiotherapy.

Distraction corrected ulnar deformity, restored ulnar length and repositioned radial head in anatomical position. Average ulnar length gained was 14mm. Duration of distraction was 17 days. Average follow-up was 2 years (1.5 – 4years). We achieved full, painless, stable elbow flexion, extension, pronation and supination movements in eight but one patient. Pronosupination movement did not deteriorate over four years of our study. No patient developed myositis ossificans or neurodeficit. 2 patients had minor pin-tract infection, which responded to basic treatment.

Safe, effective and fully controlled method. This technique may be considered before open procedures for radial head is undertaken.

Purpose

This study evaluated the acceptability of performing manipulations with intranasal diamorphine and inhaled Entonox to parents of children presenting to our Emergency Department.

Introduction

Trauma is the leading cause of death and disability in children. Pelvic fractures although rare, with a reported incidence of one per 100,000 children per year are 2^nd only to skull fractures with respect to morbidity. The objectives of this study were to improve understanding of paediatric pelvic fractures through a concise review of all aspects of these fractures and associated injuries. Understanding the patterns in which paediatric pelvic fractures and their associated injuries occur and the outcome of treatment is vital to the establishment of effective preventative, diagnostic and therapeutic interventions.

Forearm fractures are a common paediatric injury. This study was aimed to describe the epidemiological of paediatric forearm fractures in the urban population of Glasgow.

We reviewed of all the forearm fracture treated by the orthopaedic service in Yorkhill Children's Hospital in 2008. Datum gathered from case notes and radiographs using the prospective orthopaedic database to identify patients with forearm fractures. The age, sex, side and type of fracture, the timing and mechanism of the injury and treatment were documented for the 436 fractures. Census data were used to derive absolute age-specific incidences.

Distinction was made between torus and other types of fractures. Torus fractures require no specific orthopaedic treatment and were segregated out. For the remaining 314 fractures, the age and sex distribution, seasonal variation of fractures and treatments for each type of fracture were examined. The incidence of forearm fractures in our population is 411 fractures per 100,000 population per year. An increased number of fractures occurred during the months of May and August. A fall from less than one metre was the commonest mechanism of injury, sporting injuries were the second commonest with football the most common sport associated.

This study identifies some features which are in good agreement with studies from elsewhere in Britain, such as incidence and seasonality. However, there are also interesting differences – such as the Glasgow peak incidence for forearm fractures being at age 8, with a marked decline by 12 years. Furthermore, our findings have been extended to consideration of type of intervention, and likelihood of successful treatment.

Introduction: Ankle fractures accounts for 25% to 38% of all physeal fractures. An accurate diagnosis is the key to the appropriate management of these fractures. Traditionally the management decisions have been based on x-ray findings. We have used computed tomograpy (CT) scans in additon to x-rays in the management of these fractures.

Objective: To determine the usefulness of computed tomograpy (CT) scans in the management of ankle fractures in children.

Materials and Methods: Between 2001 to 2005, 53 patients with ankle fractures who were managed in our unit had CT scans in addition to plain radiographs. The mean age was 12.3 years (+/− 2.1). The radiographs were reviewed by senior paediatric orthopaedic surgeon who classified the fractures and formulated treatment plans (operative/non-operative). The CT scans were then reviewed by the respective surgeon and a similar exercise undertaken. A Radiologist confirmed that the fractures were classified accurately.

Results: In 47% (25 fractures) the x-ray diagnosis/classification tallied with the CT scans whilst in 53% (28 fractures) the CT scans showed the fractures were more extensive/serious than noticed on the x-rays. The management was changed in 34% after reviewing the CT scans, In 9 from operative to non-operative treatment and in the other 9 from non-operative to operative treatment.

Conclusion: We have found CT scans to be more useful than plain radiographs in making an accurate diagnosis of ankle fractures in children and thus planning appropriate management.

Purpose: The purpose of this study was to assess the clinical, radiological, and functional outcomes following the treatment of a lumbar Chance fracture and to analyze the spectrum of associated abdominal injuries as seen in the Seat Belt Syndrome.

Methods: All patients diagnosed with L1 to L4 Chance fractures were included in this study. Patient data, injuries, treatment and complications were collected from hospital charts. A review of all available spinal radiology was done to measure pre-treatment, post-treatment and follow-up kyphosis angles. We have also described and calculated a Chance Fracture Deformity Index. Patients were seen in follow-up to assess for range of motion, tenderness and neurological status. A functional outcome questionnaire by the AAOS Pediatric Instruments was completed by the patients.

Results: Between December 1984 and February 2001, 27 patients aged 3 to 17 were treated for lumbar Chance fractures. The mean age at injury was 11.1 years. There were 17 females and 8 males. All injuries occurred as a result of a motor vehicle accident. Of the 25 patients, 17 were treated surgically. 12 patients had abdominal injuries. 3 cases involved abdominal arterial vascular trauma. Significant improvement in intra-vertebral kyphosis, segmental kyphosis, and vertebral kyphosis redmodelling (6.5 vs. 4 degrees) was noted in the operative group compared to the non-operative group. The disease specific AAOS Lumbar Spine Questionnaire scores were poor for pain and disability, 29.22, (26.41–31.98), but the SF-36 scores for both MCS and PCS were within the normal range, 47.79 (44.03–51.54) and 47.71 (42.59–52.82), respectively.

Conclusions: An abdominal and spinal CT must be taken when presented with a Chance fracture with abdominal symptoms. Injury type and kyphosis angle are the main factors that aid in treatment planning in paediatric lumbar chance fractures. A purely soft-tissue injury or a kyphosis angle greater than 20 requires surgical intervention.