Distal radius fractures are commonest injury managed by junior doctors in accident and emergency department. Technique of manipulation is very well described and doctors are prepared from the days of medical school. Though manipulation is done in good position at initial management many patients require re-manipulation and surgical stabilisation due to loss of position on subsequent examination. Many Senior surgeon thinks this is due to inadequate plastering and moulding technique.

Material and methods: We retrospectively, randomly selected 50 patients from 210 manipulations done in one year at District General Hospital. All these patients x-rays were reviewed and data collected for classification of fracture (Frykmann’s classification), radial height, ulnar varience, radial angulation, and Radial inclination measurements. Three Senior Orthopaedic Surgeons reviewed pre and post manipulation x-rays and asked for acceptability of initial reduction, plaster position and moulding signs on x-rays and asked to predict those requiring re-manipulation or loss of position.

Results: 70% of the fractures were frykmann I or II as intra articular fractures Prediction of senior surgeon was right for more than 60 percent of the cases. Average radial angulation was 14 degree on post manipulation films. Radial height and inclination was average 6 mm and 18 degrees respectively.

Discussion: Post manipulation is very important factor for maintaining reduction and poor moulding can lead to loss of position and require unnecessary additional operative procedure for initially well reduced fracture. Teaching of Plastering and moulding technique is very important skill development for junior doctors to improve outcome of these simple injuries

Internal fixation of ankle fractures should be undertaken either before or after the period of critical soft tissue swelling. As part of the clinical governance in our unit, an audit was undertaken to examine the interval between admission and surgery and net inpatient stay of patients with ankle fractures over a 6 month period.

Thirty four patients fulfilled the inclusion criteria of having an acute closed fracture of the ankle requiring open reduction and internal fixation (ORIF). There were 16 unimalleolar, 10 bimalleolar and 8 trimalleolar fractures. 10 Patients underwent surgery on the day of admission, 9 patients had surgery within 24 hours, 15 patients had surgery after 24 hours of admission. The average in patient stay was 9 days (1–61 days).

If surgery was undertaken within 24 hours the average inpatient stay was 9 days (1–14). If surgery was delayed beyond 24 hours the average inpatient stay was 15 days (3–61 days).

Delayed surgery of closed ankle fractures increases the risk of soft tissue complications and prolongs hospital stay with profound cost implications. Long-term disability resulting from ankle fractures can be reduced by optimal early management procedures.