Aim. Up to 34% of fractures of the distal radius in children can ‘re-displace’ early after reduction. Main risk factors are initial displacement (bayonet apposition, > 50% translation, and > 30°angulation), isolated distal radius fracture, associated ulna fracture at the same level, inadequate initial closed reduction and poor casting technique. This study was to identify the rate of ‘re-displacement’ following first successful reduction in distal radius fractures. We also assessed the risk factors associated with initial injury and compared the efficacy of the available indices to assess the quality of casting. Materials & Methods. We performed a case note based radiographic analysis of 90 distal radius fractures treated at our centre from 2005 to 2008. A cohort of 18 patients with re-displacement was compared with 72 patients with maintenance of reduction. Radiological indices were calculated to assess the quality of casting technique. The patient and fracture demographics were compared between the two groups. Statistical analysis was carried out using ANOVA, Fisher's Exact Test and multiple logistic regression analysis. Results. The rate of ‘re-displacement’ in our study was 20 %. A desirable cast index of < 0.7 was achieved in 4 out of 55 cases treated with cast alone. A significant difference (p< 0.008) was observed in the Three Point Index, the degree of comminution (< 0.01) and the quality of the initial reduction (< 0.003). Conclusion. We recommend careful identification of high risk factors and appropriate stabilisation for potentially unstable fractures at first treatment. The magnitude of initial deformity, the comminution, and the amount of remaining skeletal growth must all be considered in the decision making process. Further training to improve the quality of casting technique cannot be over-emphasised. Trainees should be trained to calculate the Three Point Index before accepting the reduction after casting to prevent late displacement and second anaesthesia

The purpose of the study was to identify risk factors that are associated with re-displacement of the hip after surgical reconstruction in cerebral palsy. Retrospective review of children with cerebral palsy who had hip reconstruction with proximal femoral varus derotation osteotomy (VDRO) and Dega-type pelvic osteotomy, between 2005–2012, at a UK and European institution, was performed. Patient demographics, GMFCS, clinical and radiological outcome were assessed as well as the presence of pelvic obliquity and significant scoliosis (Cobb angle > 10 degrees). Redisplacement was defined as Reimer's Migration Index (MI) >30% at final follow-up. Logistic regression analysis was used to assess which factors were predictive of redisplacement and adjusted for clustered variables (α = 0.05). Eighty hips were identified in 61 patients. The mean age at surgery was 8.8 years (± 3.3). Mean MI pre-op was 68% (± 23%) and post-op was 8% (± 12%). At a mean follow-up, of 3.2 years (± 2.0), 23 hips had a MI >30%. Of these; five were symptomatic, and one had required a salvage procedure. Metalwork removal was undertaken in 14 hips. Logistic regression demonstrated that the pre-operative MI and the percentage of acute correction were significant predictors of re-displacement. If the pre-operative MI was greater than 65 percent, the odds ratio (OR) for redisplacement was 5.99 (p = 0.04). If correction of the MI was less than 90% of the pre-operative MI, the OR for re-displacement was 4.6 (p = 0.03). Age at the time of surgery, GMFCS, pelvic obliquity and scoliosis were not predictive of re-displacement. These results, firstly, highlight the importance of hip surveillance in children with cerebral palsy to allow timely intervention to ensure adequate radiological outcomes. Secondly, as in developmental hip dysplasia, full concentric reduction is essential to reduce the risk of re-displacement, with its associated clinical consequences

Introduction. Two randomised trials concluded cast type (above or below elbow) makes no significant difference in the re-displacement rate of paediatric forearm fractures involving the distal third of the radius. This has not, however, led to the universal use of below elbow casts. In particular we noted one trial reported significant re-displacement in 40% or more of cases, which was much higher than we would expect. To review the radiological outcomes and need for re-manipulation of paediatric distal forearm fractures treated with closed manipulation under anaesthesia in our institution, in part for subsequent comparison with published results. All forearm fractures treated at a specialist children's hospital in one year were reviewed retrospectively. Based on the methodology of one trial, we included all fractures involving the distal third of the radius, with or without an ulna fracture, which underwent closed manipulation. Outcomes were radiological alignment using existing radiographs and need for re-manipulation. Cast type was at the discretion of the treating surgeon. The radiological criteria for re-displacement were based on published methodology. 79 children underwent manipulation, 71 receiving above elbow casts and 8 below elbow casts. Radiologically 21% of injuries treated in an above elbow cast re-displaced (15/71) compared to 38% of those in below elbow plasters (3/8). In 2 cases the re-displacement was treated with re-manipulation. The preference in our institution was clearly for above elbow casts in this injury pattern. The small number of below elbow casts in our series limits any comparisons. Our rate of re-displacement using above elbow casts was half that of one of the published studies, so the existing literature is not consistent with our experience

Paediatric wrist fractures are routinely managed with closed reduction and a molded cast. Gap(GI) and Cast indices(CI) are useful in predicting re-displacement following application of cast. Over 6 months we audited the efficacy of molded cast application following closed reduction of distal radial fractures in paediatric patients. The standard was that proposed by Malviya et al where GI >0.15 and CI >0.8 indicate an increased risk of re-displacement. Age, date and time of operation and surgeon's grade were collected. Pre-op displacement, post-reduction GI and CI and subsequent re-displacement were measured using imaging. Post audit intended changes to practice were presented to all surgeons, a “one-pager” was placed above scrub sinks. Re-audit was conducted at 1 year. The audit and re-audit included 28 and 24 patients respectively. Cast molding (CI) improved minimally following intervention (32% to 29%). Cast padding (GI) improved significantly (82% to 63%). Loss of reduction decreased slightly (14% to 12%), this was not accurately predicted by GI and CI in the re-audit. Audit demonstrated that casts were loose, over-padded and did not hold reduction adequately. Re-audit demonstrated that tighter, less padded but still inadequately molded casts were being applied with minimal change in loss of reduction

Purpose. Distal metaphyseal radial fractures are common in the paediatric population and the management of these fractures is controversial. The incidence of re-displacement in the closed management of these fractures is as much as 30% in some studies. Various methods have been described with the view to predict fracture displacement of distal radial fractures in children. One of these indices is the three point index (TPI). This index seeks to assess the adequacy of 3 point moulding and thus predict fracture displacement. It is a calculated ratio that if above 0.8 states that there is an increased risk of fracture re-displacement. The purpose of this study is to assess the accuracy of this index in predicting displacement of distal radial fractures in children. Methods. This retrospective study included 65 patients of both sexes under the age of 13 for a period of one year from January 2011 to January 2012. All patients with a dorsally displaced fracture of the distal radius were included. 22 patients were excluded because of loss to follow-up or absence of a complete series of x-rays. All patients were taken to theatre for a general anaesthetic and manipulation of their fractures using an image intensifier to confirm reduction. X-rays of initial fracture displacement, post manipulation position and follow-up fracture position at 2 and 6 weeks were assessed. The sensitivity, specificity, negative and positive predictive values of the TPI in screening for fracture re-displacement were calculated. Results. Of the 43 patients included in the study, 93% of patients had an anatomical reduction in theatre with an average TPI of 1. Nineteen patients suffered significant displacement from 2 to 6 weeks postoperatively. We found that the TPI in our study had a sensitivity of 84%, a specificity of 37%, a negative predictive value of 75% and a positive predictive value of 51%. Conclusion. We found the TPI to be a useful screening tool of later displacement for the closed management of distal metaphyseal radius fractures. NO DISCLOSURES

Aims:. 1) To determine the predictive value of a simple stability test in children’s wrist fractures treated with simple manipulation and plaster of Paris (PoP) cast immobilisation. 2) To determine the effect of cast quality as reflected in the skin cast distance (distance between the cast and the skin in the plane of major displacement or angulation) and the cast index (the inside diameter of the cast in the sagittal plane divided by the inside diameter in the coronal plane) on re-displacement rates in children’s wrist fractures treated with simple manipulation and plaster of Paris (PoP) cast immobilisation. Methods: This is a prospective study of 57 children aged 4 to 15 with metaphyseal and Salter-Harris II wrist fractures treated with simple manipulation. Under fluoroscopic imaging, a simple stability test involving moving the hand at the wrist in the dorsopalmar, and radioulnar planes was performed following reduction, and x-ray images were saved. We recorded and compared the displacement and angulation on the initial x-rays, during the test, and at one-and 6-week follow-up. We also recorded the skin-cast distance (SCD), and the cast index (CI). Results: 38 patients had isolated radius fractures and 19 had radius and ulna fractures. Four patients needed remanipulation with K-wire fixation. Multiple regression analysis revealed significant correlation between percentage loss of reduction on testing and subsequent re-displacement (relationship between the two sets of values r = 0.6167, (p< 0.001)). This indicates that instability on testing (seen as a significant percentage loss of reduction) is likely to be associated with some loss of reduction on follow-up. There was a significant relationship between the skin cast distance and the cast index, and loss of reduction on one week follow-up. (p=0.006). Isolated radius fractures had a higher risk of re-displacement than radius and ulna fractures (3.9% and 0.9% respectively; p< 0.05%). Conclusion: Stable reduction on stability testing in wrist fractures in children immobilised in a good cast (reflected in a low SCD, and CI) is associated with a good outcome. Isolated radius and ulna fractures are more likely to re-displace than radius and ulna fractures. There is a relationship between instability and loss of position at the 1-week follow-up. Potentially unstable fractures can be prevented from slipping by a good cast. A stable fracture on our stability test rarely slips. We therefore feel that stability test is a useful adjunct in decision-making

Aim: To evaluate the outcome of displaced distal radius fracture in children & review our practice. Methods: A retrospective review of case notes and radiographs of all children requiring orthopaedic intervention under general anaesthetic for displaced distal radius in our hospital over a period of 18 months (January 2005 to June 2006) was carried out. We had treated 72 fractures of the distal radius in same number of children. All but 3 cases were treated by primary closed manipulation & plaster immobilisation. Average age was 11.7 years (range 5 to 16 years). We looked at the re-displacement rate amongst these children that required a second procedure. We also sought predictive factors for redisplacement if any. Results: There were 22 female & 50 male patients. All the fractures were closed injuries with no distal neuro-vascular deficit. Of the 72 cases, 16 cases showed more than 50% initial displacement and 6 were completely displaced (off-ended). 9 cases had volar angulation. Redisplacement of fracture after initial satisfactory reduction was seen in 9 cases (12.7%) & required a second procedure. The secondary procedure involved closed reduction and percutaneous K wire fixation in 4 patients and open reduction in 2 cases. 3 cases had closed remanipulation & change of plaster. We reviewed the factors responsible for re-displacement after a closed reduction such as initial displacement, angulation, adequacy of initial reduction, associated ulna fracture, type of plaster, and initial post-operative images. Average age has been 12.7 years. 3 out of 5 (60 %) completely displaced fractures treated by closed reduction and manipulation required a second procedure. Only 1 in 16 cases of incompletely displaced fracture required a second procedure. Volar angulated fractures tend to redisplace after closed reduction, 3 out of 7cases (42 %) required a second procedure. Associated ulna fracture (22.7%) increased the risks of redisplacement. 5 out of 24 epiphyseal injuries redisplaced but these were either severely displacement or had volar angulation. 3 out of 4 cases (75 %)that were severely displaced had inadequate primary closed reduction & underwent a second procedure. Conclusion: We would like to conclude that despite achieving a very good initial reduction, offended distal radius fractures & those with volar displacement have high risk of re-displacement. Inadequate primary reduction has invariably resulted in requiring a second procedure. It is advisable to treat such cases by primary open reduction and K wire fixation in order to prevent redisplacement. In management of paediatric distal radius fractures, primary reduction with percutaneous Kirschner wire has better outcome and lower incidence of redisplacement in selected cases with features of complete displacement and volar angulation especially in the older age group (> 11 years)

Purpose:. Paediatric forearm fractures are commonly seen and treated by closed reduction and plaster cast application in theatre. Historically, cast application has been subjectively evaluated for its adequacy in maintaining fracture reduction. More recently emphasis has been placed on objectively evaluating the adequacy of cast application using indicators such as the Canterbury index (CI). The CI has been used in predicting post-reduction, re-displacement risk of patients by expressing the casting and padding indices as a ratio. The CI has been criticized for not including cast 3 point pressure, fracture personality and lack of standardization of X-ray views as well as practical requirement of physical measurement using rulers. The aim of this study was to determine whether subjective evaluation of these indices, on intra-operative fluoroscopy and the day 1 to 7 postoperative X-ray, was accurate in predicting a patient's ultimate risk of re-displacement, following reduction and casting. Materials and Methods:. In total, 22 X-rays from 11 patients were evaluated by 20 orthopaedic registrars and 8 consultants, before and after a tutorial on the Canterbury index. Results:. Formal tutorial did not show an increased subjective predictive accuracy. No clear correlation could be demonstrated between CI and the clinical outcome. Conclusion:. Value of the CI in clinical practice is doubtful due to various confounding factors. The CI has been used due to lack of other available systems, and ideally a system should be sought which incorporates fracture personality, cast 3 point pressure and standardisation of X-Rays

Introduction. To investigate if the gap index measured in the follow-up X-rays predicts the reduction of swelling in the plaster cast thereby increasing the risk of re-displacement of fracture treated by manipulation alone. Materials/Methods. We selected for this study a cohort of children who presented with a traumatic displaced fracture of distal radius at the junction of metaphysis and diaphysis who were treated with manipulation alone. This cohort was chosen because of the high risk of re-displacement following closed manipulation of this unstable fracture and to maintain uniformity of the fracture type. Cast index and Gap index was measured in the intra-operative radiograph and at two-weeks to note the change in these indices. Gap index which is measured by summing radial and ulnar translation/inner diameter of cast in the AP X-ray and similar translation on the lateral x-ray/inner diameter of cast, with a measure of <0.15 considered to be a satisfactory cast. Results. Forty-one children with a mean age of 9 years (mode-8, range 4–15 yrs) admitted between Jan 2008 and Feb 2010 with the above described fracture and were treated with manipulation alone were included in this study. Serial radiographs show a gradual loss of reduction in 34 (83%) children and 17 (41%) of these children required re-manipulation. As the plaster cast was not changed the cast index remained same while the gap index increased in the follow-up x-rays as the swelling subsided. In those children whose reduction remained satisfactory, the initial gap index was 0.14 which changed to 0.18 (n=7, p>0.05) while in children in whom the fracture lost reduction, the initial gap index was 0.18 and changed to 0.25 (n=34, p=0.0092) at two weeks. Conclusion. Gap index can easily be calculated on follow-up radiographs and can be used to assess the adequacy of plaster cast. From this study we can conclude that it is effective in assessing the adequacy of plaster cast as the swelling subsides

Distal radius fractures are the most common osteoporotic fractures among women. The treatment of these fractures has been shifting from a traditional non-operative approach to surgery, using volar locking plate (VLP) technology. Surgery, however, is not without risk, complications including failure to restore an anatomic reduction, fracture re-displacement, and tendon rupture. The VLP implant is also marked by bone loss due to stress-shielding related to its high stiffness relative to adjacent bone. Recently, a novel internal, composite-based implant, with a stiffness less than the VLP, was designed to eradicate the shortcomings associated with the VLP implant. It is unclear, however, what effect this less-stiff implant will have upon adjacent bone density distributions long-term. The objective of this study was to evaluate the long-term effects of the two implants (the novel surgical implant and the gold-standard VLP) by using subject-specific finite element (FE) models integrated with an adaptive bone formation/resorption algorithm. Specimen: One fresh-frozen human forearm specimen (female, age = 84 years old) was imaged using CT and was used to create a subject-specific FE model of the radius. Finite element modeling: In order to simulate a clinically relevant (unstable) fracture of the distal radius, a wedge of bone was removed from the model, which was approximately 10 mm wide and centered 20 mm proximal to the tip of the radial styloid. Bone remodeling algorithm: A strain-energy density (SED) based bone remodeling theory was used to account for bone remodeling. With this approach, bone density decreased linearly when SED per bone density was less than 67.5 µJ/g and increased when it was more than 232.5 µJ/g. When it was in the lazy zone (67.5 to 232.5 µJ/g), no changes in density occurred. Boundary conditions: A 180 N quasi-static force representing the scaphoid, and a 120 N quasi-static force representing the lunate was applied to the radius. The midshaft of the radius was constrained. FE outcomes: To examine the effects of stress shielding associated with each implant, the long-term changes of bone density within proximal transverse cross-sections of radius were inspected. The regional density analysis focused on three transverse cross-sections. The transverse cross-sections were positioned proximal to the subchondral plate, and were distanced 50 (cross-section A), 57 (cross-section B), and 64 mm (cross-section C) from the subchondral endplate. For both implants in all three cross-sections, cortical bone was reserved completely at the volar side. On the dorsal side, the cortical bone was completely resorbed in the VLP model. In all cross-sections, the averaged resultant density was higher for the “novel implant”. The difference ranged from 33% (cross-section A) to 36% (cross-section C) in favor of the “novel implant”. On average, the density values of the novel implant were 34% higher in transverse cross-sections (A, B, and C). This study showed that the novel implant offered higher density distributions compared to the VLP, which suggests that the novel implant may be superior to the VLP in terms of avoiding stress shielding

Objective. We reviewed clinical results with minimally invasive method and using a new developed plate for unstable pelvic ring fractures, especially vertically unstable sacral fractures. Materials & Methods. Between 2002 and 2010, 35 patients with vertically unstable sacral fractures were treated with minimally invasive method and using an M-Shaped transiliac plate which was developed by the author. This plate is anatomically designed for posterior pelvic ring, and achieved rigid fixation. Patients included 19 male and 16 female, with the mean age of 46.2 (range, 17∼79) years old. According to the AO classification, 23 patients had a C1 injury, 9 had a C2 fracture, and 3 patients sustained a C3 injury of the pelvic ring. Functional outcome was assessed using the Majeed's functional evaluation and radiography. Minimum follow-up was one year. Results. All patients were not fixed anterior of pelvic ring. The average of surgical time was 85 minutes (range: 45∼150), and intraoperative blood loss was 332.8 ml (range: 35∼1055). Postoperative functional results were excellent and good in 30 patients (85.7 %), and fair in four cases due to infection or sciatic nerve paralysis, and one case of poor was nonunion. Three patients complicated wound healing delayed, but there were no residual pain and re-displacement. Conclusion. Using an M-Shaped transiliac plate can be achieved significant outcome and rigid fixation with minimal invasion for vertically unstable sacral fractures

Aims

The primary aim of this study is to quantify and compare outcomes following a dorsally displaced fracture of the distal radius in elderly patients (aged ≥ 65 years) who are managed conservatively versus with surgical fixation (open reduction and internal fixation). Secondary aims are to assess and compare upper limb-specific function, health-related quality of life, wrist pain, complications, grip strength, range of motion, radiological parameters, healthcare resource use, and cost-effectiveness between the groups.

Introduction. Displaced distal radius fractures in children have been treated in above elbow plaster casts since the last century. Cast index has been calculated previously, which is a measure of the sagittal cast width divided by the coronal cast width measurement at the fracture site. This indicates how well the cast was moulded to the contours of the forearm. We retrospectively analysed the cast index in post manipulation radiographs to evaluate its relevance in redisplacement or reangulation of distal forearm fractures. Study Design. Consecutive radiographic analysis. Materials and methods. 156 consecutive paediatric patients (114M : 42F), with a mean age of 9.8 years (range 2-15 years), presenting with forearm fractures were studied. All patients were manipulated in OR and a moulded above elbow cast was applied. The cast index was measured on immediate post manipulation radiographs. Results. Displacement of the fracture within the original plaster cast occurred in 30 patients (19%), 22/114 males; 8/42 females. The cast index in the 30 patients requiring a second procedure (mean 0.92, SD=0.08) was significantly more than the cast index (mean 0.77, SD=0.07) in the others (p< .001). Discussion. A high cast index in post manipulation radiographs indicates increased risk of re-displacement of the fracture and these patients should be kept under close review. Conclusion. Cast index is a valuable tool to assess the quality of moulding of the cast following closed manipulation of distal radius fractures in children. The maximum acceptable cast index should be 0.82

Introduction. A recent retrospective study of distal femoral physeal fractures (DFPFs) suggested closed manipulation alone has a high incidence of re-displacement, malunion or physeal bar formation. The paper concluded that all displaced DFPFs require internal fixation, and breaching the physis with k-wires is safe. We agree that hyper-extension/flexion injuries need stabilisation using k-wires but, in our experience, purely valgus/varus deformities can be successfully managed by manipulation under anaesthesia (MUA) and a moulded cylinder cast. Method. We prospectively observed DFPFs presenting over 12 months. Departmental policy is to treat varus/valgus deformities by MUA, with cylinder casting providing 3 point fixation. Hyper-extension/flexion injuries are reduced on a traction table. 2mm cross k-wiring is performed, leaving the wires under the skin, and a cylinder plaster applied. A post-operative CT scanogram accurately assesses limb alignment. Patients are mobilised immediately using crutches and weight-bearing as pain allows. Plaster and k-wires are removed after 4–5 weeks. Scanogram is then repeated, and again at 6 months and 1 year. Results. 17 cases presented over 1 year. 16 were male, with a median age of 15. 13 were injured playing soccer, 1 in a motor vehicle accident and 3 by other mechanisms. Internal fixation supplemented reduction in 13 cases. 1 patient required repeat MUA and k-wiring when post-operative scanogram identified significant varus mal-alignment. In all cases, cylinder casting was unproblematic and range of movement quickly recovered after plaster/wire removal. To date none have developed significant malunion or growth arrest requiring intervention. Conclusion. DFPFs are uncommon, almost always occurring in teenage males. Accurate reduction and stabilisation is vital to restore and maintain a correct mechanical axis. MUA and cylinder casting is adequate in appropriate cases. Early imaging with CT scanogram can detect mal-alignment. Growth arrest is unusual and unlikely to be significant in most patients, who are approaching skeletal maturity. NO DISCLOSURES

Aims. To evaluate the results of Elastic Stable Intramedullary Nailing (ESIN) for displaced, unstable paediatric forearm diaphyseal fractures. Method. A retrospective, consecutive series study of 60 patients treated with ESIN between February 1996 and July 2005. Results. There were 43 (72%) boys and 17 (28%) girls with median age of 11.5 years (range: 2.6-15.9). 54 (90%) patients had a closed injury and 6 (10%) sustained a Grade I open injury. Seven patients had an isolated radius fracture. 49 (82%) fractures were stabilised with both bone ESIN, 10 (16%) with radial and one with isolated ulnar ESIN by standard technique under tourniquet control. All but two patients were protected with an above elbow cast. Thirty-six cases (60%) were primary procedures and 24 (40%) were performed due to re-displacement following a MUA. 36 patients (60%) required a minimal open reduction. Average hospital stay was 1.8 days (1-8 days). Average length of immobilisation was 5.4 weeks (3-9 weeks). Average time for clinical fracture union was 5.7 weeks (3-13 weeks). ESIN were removed after mean period of 33.8 weeks (approx: 7.9 months). One patient had a forearm compartment syndrome and required formal fasciotomy. One patient had ulnar delayed union and one had ulnar non-union. Five patients had transient superficial radial nerve neuropraxia. Ten had soft tissue irritation leading to early nail removal in two patients and two had superficial wound infection. Three patients sustained a re-fracture with the nail in situ following a new injury. 53 (88%) patients had full elbow and wrist movements on discharge. Seven patients had restriction of forearm rotations of less than 15°. Conclusion. Good clinical outcome, transitory and modest complications; quick and safe nail removal; and better cosmesis compared to plating makes ESIN an attractive treatment option for displaced, unstable paediatric forearm diaphyseal fractures

For a long time treatment of all forarm fractures was coservatively in principle. Retrospective analysis of more than 1000 fractures showed that 97,8% were treated orthopedically, 22% finished consolidation with an axial malalignment of more than 10∞ and 6,9% showed bad functional results 3–13 years later. Most bad results were found in shaft fractures of both bones on the same level or in oblique fractures with convergent displacement. The introduction of elastic stable intramedullary nailing (ESIN) gave the opportunity to stabilize instable diaphy-seal fractures with less [Aufwand], with an implant adequate for children and with the possibility of immediate postoperative movement. Within three years, 161 diaphy-seal forearm fractures were managed by cast (27%), reduction (32%) or osteosynthesis (41%). In 14 cases (8,7%), secondary osteosynthesis took place because of secondary or re-displacement during orthopedic treatment. The functional results following ESIN are very good. In radial neck fractures with severe displacement of more than 60° an open reduction and fixation by K-wires was the preferred method for a long time. After open reduction, radial head necrosis was the result in a significant part of cases independent of the quality of reduction. Closed reduction with the tip of the nail without touching the fracture region improved the results extremely. Seldom a transcapsular reduction manoever is necessary. In a multicentric study of proximal radius fractures including 67 cases, 27 fractures with a relevant displacement were managed surgically (24 ESIN, 3 K-wire). 3 [Verplumpung] of the radial head, two of them combined with premature closure of epiphyseal plate, and one radial head necrosis took place, but only in one case with ESIN, whereas all cases with open reduction and K-wire use showed problems during the healing course

Introduction:- We reviewed 69 patients with subcapital fracture neck of femur treated with two hole plate DHS and parallel de-rotation screw into the cranial part of the femoral head between January 2000 to January 2005. Methods:- Patients were selected for fixation by having Garden 1 to 4 fractures, being younger, more active and mobile. Reduction was classified as “good” when residual angulation in the lateral projection was less than 15 degrees, no varus angulation and good alignment in the calcar area. Screw position was considered “good” when there was less than 10 degrees deviation in the direction of screws, screw threads not bridging the fracture site, screw tips less than 5mm from subchondral bone and no signs of intra-articular penetration. The fracture was considered healed when bridging of trabecular bone was present. Patients were reviewed until they were pain free at rest or on walking and had radiological healing of fracture. Results:- 13 had Garden 3 & 4, 46 had Garden 1 & 2 and 10 had impacted fractures. Sixty eight patients had operation within 24 hours in the next available trauma list. Average age at operation was 70 years (range 21– 89) and hospitals stay 13 days (range 2–52). Good reduction was achieved in 61 patients, 54 of these had good screw position, 8 patients (11%) had combination of poor reduction and poor screw position; five of them had loss of fixation within 6 to 12 weeks postoperatively, one each had segmental collapse and avascular necrosis between 12 to 24 months of operation. Conclusion:- Their was no re-displacement, non-union, avascular necrosis or segmental collapse when fractures were well reduced and had good screw position. Two hole plate DHS and a parallel de-rotation screw has high rate of fracture union. We recommend its use for treatment of subcapital femoral neck fractures

Aims: The purpose of this study was to investigate the number and type of complications following external þxation of pelvic fractures. Methods: We carried out a retrospective review of all patients treated at Frenchay Hospital with external þxation for fractures of the pelvic ring between August 1996 and September 2002. Patientsñ details were collected prospectively; outcome data was collected by casenote review. Results: 74 patients were treated with external þxation for pelvic fractures. In 41 patients, the þxator was used to achieve pelvic stability temporarily, whilst in 33 it was retained as part or all of the deþnitive treatment. 30 patients were haemodynamically unstable when the þxator was applied. Of these patients, two patients died of retroperitoneal haemorrhage, three had pelvic angiography and arterial embolisation and þve required a laparotomy, of which three were negative. Of the þxators used temporarily, four (10%) had pin-site infections. In only one case did this change the plan for the deþnitive treatment. Two of the temporary þxators required revision; one for loss of reduction secondary to pin loosening and one for pin penetration of the femoral head after using the low anterior approach. Six (8%) of all the þxators required repositioning due to impingement on the skin. Of the deþnitive þxators, 53% required antibiotics and 18% required pin removal for sepsis. Three (9%) of the deþnitive þxators required revision; there was one loss of reduction, one re-displacement after removal and one non-union of the pelvic fractures. Conclusions: Temporary application of external þxation to the fractured pelvis, using high iliac crest pin placement to restore pelvic stability, is a safe procedure with few complications. Haemodynamic stability is restored in the majority of patients. When used as part of the deþnitive treatment, pin site infection is common and may require pin removal but rarely leads to loss of fracture reduction or revision of þxation

Aims

Describe a statistical and economic analysis plan for the Distal Radius Acute Fracture Fixation Trial 2 (DRAFFT2) randomized controlled trial.

The February 2013 Children’s orthopaedics Roundup³⁶⁰ looks at: ABC treated with suction and curettage; peri-acetabular osteotomy; cast index; Perthes’ disease associated with accidental injury; brachial plexus birth palsy; MRI assessment of DDH; total meniscectomy; and paediatric septic arthritis.