Objectives. In this cross sectional study, the impact and the efficacy of a surveillance programme for sarcomas of the extremities was analysed. Methods. All patients who had treatment with curative intent for a high-grade sarcoma and were diagnosed before 2014 were included and followed for a minimum of two years. Results. Of the 909 patients who had a review appointment in 2014, 131 were under review for a high-grade sarcoma of the extremities following treatment with curative intent. Of these patients, three patients died of disease, two patients died of other causes, 12 are alive, with disease, and 114 have no evidence of disease. The surveillance programme accounts for 14% of all review appointments. Four of five patients (80%) who developed local recurrence identified the recurrence themselves. Chest radiographs are adequate in identifying metastatic disease and 11 (73%) of metastases were diagnosed during a routine follow up visit. However, the chance of cure is small and only two patients were referred for a metastatectomy. Of these only one survived for more than two years. The mean time for developing metastatic disease and local recurrence was 2.0 and 3.9 years respectively. Once identified, the mean time to death was 2.1 years for patients with metastatic disease. Conclusions. Surveillance of sarcoma patients makes up a substantial amount of the workload of a sarcoma unit. The chance of cure following identification of local recurrence or metastatic disease, however, is small. Alternative methods of surveillance that allow better evaluation of the patient’s needs are recommended. Cite this article: P. Cool, G. Cribb. The impact and efficacy of surveillance in patients with sarcoma of the extremities. Bone Joint Res 2017;6:224–230. DOI: 10.1302/2046-3758.64.BJR-2016-0253.R1

Aims. The purpose of this study was to determine if clinical and radiological surveillance of cartilage tumours with low biological activity is appropriate. Patients and Methods. A total of 98 patients with an intramedullary cartilage neoplasm in a long bone met our inclusion criteria and were included in the study. These patients had undergone a total of 384 scans. Patients with radiological follow-up of more than three years (46 patients) were divided into two groups: an active group (11 patients) and a latent group (35 patients). Results. Active lesions had a total growth in all three planes that was > 6 mm, whilst latent lesions had < 6 mm of growth. Most latent lesions were heavily calcified: active lesions were calcified less than 50% (p = 0.025). Conclusion. Clinico-radiological surveillance can identify growing cartilage lesions: MRI is the surveillance modality of choice. A CT scan is recommended, in addition, at presentation to assess the amount of calcification within the lesion. A first follow-up MRI is suggested one year from diagnosis. If the total growth in the cartilage lesion is > 6 mm, surgical treatment should be considered. Otherwise, a second surveillance scan can be performed at three years to determine further management. Cite this article: Bone Joint J 2016;98-B:1542–7

Aims. To monitor the performance of services for developmental dysplasia of the hip (DDH) in Northern Ireland and identify potential improvements to enhance quality of service and plan for the future. Methods. This was a prospective observational study, involving all infants treated for DDH between 2011 and 2017. Children underwent clinical assessment and radiological investigation as per the regional surveillance policy. The regional radiology data was interrogated to quantify the use of ultrasound and ionizing radiation for this population. Results. Evidence-based changes were made to the Northern Ireland screening programme, including an increase in ultrasound scanning capacity and expansion of nurse-led screening clinics. The number of infant hip ultrasound scans increased from 4,788 in 2011, to approximately 7,000 in 2013 and subsequent years. The number of hip radiographs on infants of less than one year of age fell from 7,381 to 2,208 per year. There was a modest increase in the treatment rate from 10.9 to 14.3 per 1,000 live births but there was a significant reduction in the number of closed hip reductions. The incidence of infants diagnosed with DDH after one year of age was 0.30 per 1,000 live births over the entire period. Conclusion. Improving compliance with the regional infant hip screening protocols led to reduction in operative procedures and reduced the number of pelvic radiographs of infants. We conclude that performance monitoring of screening programmes for DDH is essential to provide a quality service. Cite this article: Bone Joint J 2020;102-B(4):495–500

Treatment for hip displacement in children and youth with cerebral palsy (CP) is dependent upon when the problem is detected. Hip surveillance aims to identify hip displacement early through systematic screening and, together with timely orthopaedic intervention, can eliminate the need for salvage hip procedures. Here we report the impact on surgical practice of 1) hip surveillance program advocacy and knowledge translation efforts and 2) initial population-based program implementation. A retrospective review was completed of all children with CP undergoing surgery for hip displacement at a provincial tertiary pediatric hospital in the years 2004 to 2018. Date and type of surgery, age at surgery, Gross Motor Function Classification System (GMFCS) level, and pre-operative migration percentages (MP) were collected. Surgeries were categorized as soft-tissue release, reconstructive, and salvage procedures. Results were collected for three time periods: historical (September 2004- June 2010), hip surveillance advocacy and knowledge translation (July 2010- August 2015), and post provincial hip surveillance program implementation (September 2015 – December 2018). A total of 261 surgeries on 321 hips were reviewed. The rate of salvage procedures dropped from 29% (24) of surgeries performed in the historical period to 12% (14) during the period that included targeted hip surveillance knowledge translation and development of provincial guidelines. Since implementation of the surveillance program, salvage procedures have accounted for 7% (4) of interventions performed; all of these were in patients new to the province or existing patients. During the three study periods, reconstructive surgeries accounted for 64%, 81%, and 80% of the interventions performed. The mean initial MP at time of reconstructive surgery has decreased from 66% (SD 20%) in the historical time period to 57% (SD 25%) and 57% (SD 22%) in the subsequent time periods. There were a greater number of children at GMFCS levels III and IV in the two more recent time periods suggesting surveillance may assist in identifying children at these levels of impairment. The rate of soft-tissue surgeries was low during all time periods with the number trending higher since program implementation (7%, 7%, 10%). Knowledge translation and use of standardized surveillance guidelines can have a significant impact on the prevalence of salvage hip surgeries. Centers should utilize existing surveillance guidelines and educate key stakeholders about the importance of hip surveillance in the absence of a formal hip surveillance program

This study reports the experience of one treatment centre with routine surveillance MRI following excision of musculoskeletal sarcoma. The case notes, MRI and histology reports for 57 patients were reviewed. The primary outcome was local tumour recurrence detected on either surveillance MRI in asymptomatic patients, or interval MRI in patients with clinical concern. A total of 47 patients had a diagnosis of soft-tissue sarcoma and ten of a primary bone tumour. A total of 13 patients (22%) had local recurrence. Nine were identified on a surveillance scan, and four by interval scans. The cost of surveillance is estimated to be £4414 per recurrence detected if low-grade tumours with clear resection margins are excluded. Surveillance scanning has a role in the early detection of local recurrence of bone and soft-tissue sarcoma

We reviewed the evidence for hip surveillance in children with cerebral palsy from the published literature. Publications were identified using the Cochrane controlled trials register, the MEDLINE, EMBASE and CINAHL databases and by hand searching key journals and their references. Studies were included if they reported the frequency, associated risk factors or surveillance measures undertaken to identify subluxation or dislocation of the hip in children with cerebral palsy. Assessment of the quality of the methodology was undertaken independently by two researchers. Four studies described the natural history, incidence and risk factors for dislocation of the hip. Two reported their surveillance results. Approximately 60% of children who were not walking by five years of age were likely to develop subluxation of the hip, with the greatest risk in those with severe neurological involvement. The introduction of surveillance programmes allowed earlier identification of subluxation and reduced the need for surgery on dislocated hips. Surveillance can identify children most at risk of subluxation using radiological methods which are widely available

It is widely recognised that pelvic disruption in association with high-energy trauma is a life-threatening injury. The potential morbidity and mortality associated with acetabular injuries are less well understood. Due to chronic underfunding and the absence of a comprehensive and coordinated national approach to the management of acetabular trauma throughout the UK, patients can incur prolonged recumbency. Prompt and appropriate referral for specialist management, thromboprophylaxis and venous thrombosis surveillance are important issues for the referring centre. We performed a postal questionnaire to establish the current clinical practice in the specialist centres throughout the UK in pelvic and acetabular trauma, with respect to time to surgery, thromboprophylaxis, and surveillance. We identified twenty-one units and thirty-seven surgeons in the NHS who deal with pelvic and acetabular injuries. The mean time to surgery from injury in the UK is 8.5 days (range 2-19 days). The larger units that accept and treat patients from outside their region experience the greatest delay to surgery. Mechanical thromboprophylaxis was used in 67% (14) of the units. 24% (5) use arterio-venous boots, 19% (4) use calf pumps, and 52% (11) use TEDS stockings. No unit routinely use prophylactic IVC filters in acetabular trauma. Chemical thromboprophylaxis is routinely used in 100% (21) of the units. 95% (20) used prophylactic doses of unfractionated heparin or low molecular weight heparin. Clinical surveillance alone for thromboembolism is employed in 90% (19) of the units. Only 2 (10%) units routinely perform radiological surveillance with ultrasound Doppler on its acetabular fracture cases pre-operatively. Currently there is no published directory of dedicated pelvic and acetabular surgeons in the UK. There is no general consensus on the approach to thromboprophylaxis and surveillance in acetabular trauma in the UK. There is no consensus approach to thromboprophylaxis and surveillance in the literature

In the UK, surveillance for surgical site infection is mandatory for orthopaedic surgery. NHS trusts must participate for at least one surveillance period (3 months) every year in at least one of four categories:- hip replacement, knee replacement, hip hemiarthroplasty or open reduction of long bone fractures. Surgical site infections (SSIs) are defined as infections related to a surgical procedure that affects the surgical wound or deeper tissues handled during the procedure. Since mandatory surveillance began in 2004, rates of SSIs have markedly decreased. This is postulated to be secondary to increased early detection. Shorter postoperative stays and underestimation are also likely to be influential factors. We reviewed 150 consecutive lower limb arthroplasties performed at a district general hospital from July to September 2007. All inpatient data were collected as part of the Health Protection Agencies mandatory surveillance. We reviewed this data and notes for recorded evidence of infections or complications for minimum of one year after surgery. We reviewed computer records for recorded microbiological evidence of infection preoperatively and postoperatively. The operations performed during the surveillance period were:- 60 primary total knee replacements (TKRs), 37 primary hip replacements (THRs), 25 hip resurfacings, 15 unicondylar knee replacements, 3 patello-femoral joint replacements, 6 revision TKRs and 4 revision THRs. No SSI’s were detected during the mandatory surveillance period (i.e the inpatient stay, mean 5.61 days, Range 2–44 days). Two SSI’s (1.33%) were detected in our follow up period. Both were superficial wound infections. The first, a 53 year old hip resurfacing patient who was discharged 3 days postoperatively and developed Staphyloccocal infection 5 days later. The other was a 76 year old who underwent THR surgery, was discharged at day 6 and presented on day 12 with Pseudomonas wound infection. Both cases were initially diagnosed and treated successfully with oral antibiotic by GPs. One 61 year old patient who underwent hip resurfacing presented at day 62 with pain. X-rays showed loosening. Deep infection was suspected but hip aspirate, and inflammatory markers were negative. He is being monitored in the outpatient department. Our analysis also revealed that 3 patients had urinary tract infections (Coliforms on MSU) on the day of surgery and none have had postoperative complications. Intraoperative soft tissue samples for one patient who underwent one stage revision TKR grew Haemolytic Streptoccocus but there has been no evidence of postoperative complications. Other complications seen were THR dislocations (n=3) for reasons other than infection, 2 were revised. Persistent pain (n=2), common peroneal nerve palsy (n=1). We conclude that detection of SSI during inpatient stay is almost impossible. Mandatory surveillance seems excessive and a waste of resources

To assess the efficacy of the current surveillance programme for patients with sarcoma we undertook a prospective analysis of all patients with sarcoma treated between 1990 and 1995. The patients routinely enter a surveillance programme which consists of regular clinical evaluation, CXR and radiological imaging. We reviewed 643 cases of sarcoma with mean follow up 8. 4 years (range 6. 2–11. 3). Local recurrence occurred in 14% of cases and 34% developed metastases. The cumulative survival at 10 years was 59%. 46% of the deaths were directly attributable to metastases. For the soft tissue sarcomas 15% of the local recurrences were picked up at surveillance appointment and 70% were picked up early by the patient. For the sarcomas of bony origin 36% were picked up at surveillance and 57% were picked up early by the patient. Pulmonary metastasis was by far the common metastasis with 82% developing these. 78% were identified by surveillance CXR of which 83% were asymptomatic and 34% went on to thoracotomy and metastectomy. Of the other metastases a third were picked up during surveillance and all were symptomatic. Surveillance programmes have a role in the management of patients with sarcoma, allowing the earlier identification of local recurrence and metastasis. Clinical evaluation and CXR were found to be, in particular, valuable tools, but patient education and open access to clinics is also important

To detect early signs of infection infrared thermography has been suggested to provide quantitative information. Our vision is to invent a pin site infection thermographic surveillance tool for patients at home. A preliminary step to this goal is the aim of this study, to automate the process of locating the pin and detecting the pin sites in thermal images efficiently, exactly, and reliably for extracting pin site temperatures. A total of 1708 pin sites was investigated with Thermography and augmented by 9 different methods in to totally 10.409 images. The dataset was divided into a training set (n=8325), a validation set (n=1040), and a test set (n=1044) of images. The Pin Detection Model (PDM) was developed as follows: A You Only Look Once (YOLOv5) based object detection model with a Complete Detection Intersection over Union (CDIoU), it was pre-trained and finetuned by the through transfer learning. The basic performance of the YOLOv5 with CDIoU model was compared with other conventional models (FCOS and YOLOv4) for deep and transition learning to improve performance and precision. Maximum Temperature Extraction (MTE) Based on Region of Interest (ROI) for all pin sites was generated by the model. Inference of MTE using PDM with infected and un-infected datasets was investigated. An automatic tool that can identify and annotate pin sites on conventional images using bounding boxes was established. The bounding box was transferred to the infrared image. The PMD algorithm was built on YOLOv5 with CDIoU and has a precision of 0.976. The model offers the pin site detection in 1.8 milliseconds. The thermal data from ROI at the pin site was automatically extracted. These results enable automatic pin site annotation on thermography. The model tracks the correlation between temperature and infection from the detected pin sites and demonstrates it is a promising tool for automatic pin site detection and maximum temperature extraction for further infection studies. Our work for automatic pin site annotation on thermography paves the way for future research on infection assessment using thermography

Objectives. The clinical utility of routine cross sectional imaging of the abdomen and pelvis in the screening and surveillance of patients with primary soft-tissue sarcoma of the extremities for metastatic disease is controversial, based on its questionable yield paired with concerns regarding the risks of radiation exposure, cost, and morbidity resulting from false positive findings. Methods. Through retrospective review of 140 patients of all ages (mean 53 years; 2 to 88) diagnosed with soft-tissue sarcoma of the extremity with a mean follow-up of 33 months (0 to 291), we sought to determine the overall incidence of isolated abdominopelvic metastases, their temporal relationship to chest involvement, the rate of false positives, and to identify disparate rates of metastases based on sarcoma subtype. Results. A total of four patients (2.9%) exhibited isolated abdominopelvic metastatic disease during the surveillance period. In all cases of concomitant chest and abdominopelvic disease, chest involvement preceded abominopelvic involvement. There was a significant false positive rate requiring invasive workup. Conclusions. In the setting of a relative paucity of evidence concerning a rare disease process and in difference to recently published investigations, we add a clinical cohort not supportive of routine cross sectional imaging of the abdomen and pelvis. Cite this article: Bone Joint Res 2015;4:45–9

Introduction: Local recurrence of tumour following definitive treatment of bone or soft tissue sarcoma is a predictor of increased morbidity. Early detection of local recurrence may affect outcome. The role of magnetic resonance imaging (MRI) screening following definitive treatment is controversial. This study investigates the experience of one treatment centre with routine surveillance MRI following treatment of sarcoma. Methods: Patients were identified from the records of the Regional Sarcoma Group. With Local Ethics Committee approval the casenotes, MRI and histology reports for sixty-five patients who had routine surveillance MRI scans following definitive treatment of sarcoma in a single treatment centre were reviewed. The minimum follow up period was 24 months. The primary outcome was the presence of local tumour recurrence and whether this was identified on surveillance or interval scanning. Results: There were sixty-four patients identified with a bone or soft tissue sarcoma. All had undergone surveillance scanning biannually for the first year then annually. Six patients with Ewing’s sarcoma were excluded because they had not had surgical excision. Fifty-eight patients (59% men) with a bone or soft tissue sarcoma without metastasis between 1996 and 2003 were available for study. The median age at diagnosis was 53 years (range 6–78 years). Eighty three percent had a diagnosis of soft tissue sarcoma. Ten patients had a primary bone tumour. Fourteen patients had local recurrence (24%). Six were identified on surveillance scan, and the remaining eight required interval scans because of clinical suspicion of tumour recurrence. There were no statistical differences in gender, age, or tumour characteristics between those identified on surveillance or interval scans. All those detected on surveillance had intra-lesional or marginal resections. Conclusions: Surveillance scanning has a role in the early detection of local recurrence of bone and soft tissue sarcoma. Whether this results improvements in prognosis require longer-term follow up studies

Aims: To determine the rate of orthopaedic wound infection using ASEPSIS and compare this to the rate of infection as defined by the US Centres for Disease Control (CDC) and the UK Surgical Site Infection Surveillance Service (SSISS). Background: It is a common misconception that reported rates of orthopaedic wound infection are accurate, reliable and reproducible. Most definitions of infection, including CDC and SSISS, are subjective and depend on the interpretation of the surgeon. ASEPSIS. 1. is a method of wound scoring which grades wounds as uninfected, disturbed healing, minor infection, moderate infection and severe infection. ASEPSIS scoring has been proven to be both objective and repeatable. 2. . Method: Over 4 years, 1113 orthopaedic wounds were prospectively evaluated using the CDC definition for surgical site infections, the SSISS definition and the ASEPSIS scoring method. Patients were seen pre-operatively and at 3 and 5 days post-operatively. They also completed a wound surveillance questionnaire at 2 months post-discharge. Results: The overall infection rates were 8% as defined by CDC, 4% as defined by SSISS and 3% as defined by ASEPSIS. Further classification of the wounds as defined by ASEPSIS revealed that 91% of wounds showed no evidence of infection (score < 10), 6.6% showed a disturbance of healing (score 11–20), 2.3% had a minor infection (score 21–30), 0.4% had a moderate infection (score 31–40) and 0.3% had severe infection (score > 40). Conclusion: This study illustrates that accurate wound surveillance is not simple. Different wound infection definitions give very different rates of infection and make comparisons between surgeons and hospitals impossible. We propose that ASEPSIS provides the most accurate and reproducible results and also provides more information with the grading of wound infection. The overall rate of orthopaedic wound infection using the ASEPSIS method is 3%. If all hospitals used this scoring method, more accurate comparisons of infection rates could be made

Introduction. The purpose of this study was to use patient generated digital surveillance PROM's to track outcomes of TKA, Medial PKA, Lateral PKA. Methods. From Aug 2018 until June 2019 we performed 873 knee arthroplasties. Of these, 41 were fixed bearing lateral partial knee replacements (5%), 309 medial partial knee replacements (35%), and 523 total knee replacements (60%). The average age was 65 years old and 59% were female. KOOS-Jr scores were recorded preoperatively, and 6, 12 months postoperatively using digital surveillance technology with a greater than 90% response rate. Results. Baseline, 6 month, and 12 month KOOS-JR scores for TKR (54, 76, 79) were not different than baseline, 6 month, and 12 month KOOS-JR scores for medial PKA (56, 78, 82) [p values of 0.23, 0.32, 0.20 respectively]. Baseline and 6 month KOOS-JR scores for TKR were not different than baseline and 6 month KOOS-JR scores for lateral PKA (55, 77) [p values of 0.35 and 0.50 respectively). Where as, the 12 month KOOS-JR scores for TKR (79) were significantly less than 12 month KOOS-JR scores for lateral PKA (84)[p value of 0.04]. Baseline, 6 month, and 12 month KOOS-JR scores for medial PKR were not different than lateral PKR (55, 77, 84) [p values of 0.49, 0.39, 0.20]. Conclusions. Prospective digital surveillance of PROM following knee arthroplasty has proven to be a cost-effective strategy. Short term improvements in PROM's following TKA and medial PKA were not different. Lateral PKA demonstrated statistically significant higher 1 year PROM but unlikely clinically significant. Longer-term follow-up is needed for determination of implant and unreplaced compartment survivorship. For figures, tables, or references, please contact authors directly

Aims. Slipped capital femoral epiphysis (SCFE) is one of the most common hip diseases of adolescence that can cause marked disability, yet there is little robust evidence to guide treatment. Fundamental aspects of the disease, such as frequency, are unknown and consequently the desire of clinicians to undertake robust intervention studies is somewhat prohibited by a lack of fundamental knowledge. Methods. The study is an anonymized nationwide comprehensive cohort study with nested consented within the mechanism of the British Orthopaedic Surgery Surveillance (BOSS) Study. All relevant hospitals treating SCFE in England, Scotland, and Wales will contribute anonymized case details. Potential missing cases will be cross-checked against two independent external sources of data (the national administrative data and independent trainee data). Patients will be invited to enrich the data collected by supplementing anonymized case data with patient-reported outcome measures. In line with recommendations of the IDEAL Collaboration, the study will primarily seek to determine incidence, describe case mix and variations in surgical interventions, and explore the relationships between baseline factors (patients and types of interventions) and two-year outcomes. Discussion. This is the first disease to be investigated using the BOSS Study infrastructure. It provides a robust method to determine the disease frequency, and a large unbiased sample of cases from which treatment strategies can be investigated. It may form the basis for definitive robust intervention studies or, where these are demonstrated not to be feasible, this may be the most robust cohort study

This study investigates the experience of one treatment centre with routine surveillance MRI following excision of sarcoma. Casenotes, MRI and histology reports for fifty-nine patients were reviewed. The primary outcome was the presence of local tumour recurrence and whether this was identified on surveillance or interval scanning. Forty-eight patients had a diagnosis of soft tissue sarcoma, the remaining 11 a primary bone tumour. Fifteen patients had local recurrence (25%). Eight were identified on surveillance scan, and the remaining 7 required interval scans. Surveillance scanning has a role in the early detection of local recurrence of bone and soft tissue sarcoma

We studied prospectively the impact of a hip surveillance clinic on the management of spastic hip disease in children with cerebral palsy in a tertiary referral centre. Using a combination of primary clinical and secondary radiological screening we were able to detect spastic hip disease at an early stage in most children and to offer early surgical intervention. The principal effect on surgical practice was that more preventive surgery was carried out at a younger age and at a more appropriate stage of the disease. The need for reconstructive surgery has decreased and that for salvage surgery has been eliminated. Displacement of the hip in children with cerebral palsy meets specific criteria for a screening programme. We recommend that hip surveillance should become part of the routine management of children with cerebral palsy. The hips should be examined radiologically at 18 months of age in all children with bilateral cerebral palsy and at six- to 12-monthly intervals thereafter. A co-ordinated approach by orthopaedic surgeons and physiotherapists may be the key to successful implementation of this screening programme

We report the follow-up at 12 years of the use of the Elite Plus total hip replacement (THR). We have previously reported the results at a mean of 6.4 years. Of the 217 patients (234 THRs), 83 had died and nine had been lost to follow-up. The patients were reviewed radiologically and clinically using the Oxford hip score. Of the 234 THRs, 19 (8.1%) had required a revision by the final follow-up in all but one for aseptic loosening. Survivorship analysis for revision showed a survival of 93.9% (95% confidence interval (CI) 89.2 to 96.5) at ten years, and of 88.0% (95% CI 81.8 to 92.3) at 12 years. At the final follow-up survival analysis showed that 37% (95% CI 37.3 to 44.7) of the prostheses had either failed radiologically or had been revised. Patients with a radiologically loose femoral component had a significantly poorer Oxford hip score than those with a well-fixed component (p = 0.03). Radiological loosening at 6.4 years was predictive of failure at 12 years. Medium-term radiographs and clinical scores should be included in the surveillance of THR to give an early indication of the performance of specific implants

There is little data regarding the epidemiology of childhood injury in Ireland. This is difficult to obtain retrospectively. The aim of this study was to prospectively evaluate paediatric trauma referrals to our department, describe their epidemiology, and identify potentially preventable injuries in children. Our unit at the National Childrens Hospital is located in a growing suburban area in South Dublin. Injury surveillance was conducted on orthopaedic referrals by distributing a form to parents of children attending fracture clinics or admitted acutely for surgery. Parents were asked for demographic information, and a brief description of the injury in terms of location, mechanism and circumstance of injury. Diagnosis was completed by the attending doctor and data was transferred to a computerised database. We analyzed data from the 397 referrals in the first month of this study. The mean age of injury was 9.1 years and the male: female ratio was 1.3:1. The peak hour of injury was 7 – 8 pm. Only 33% of injuries occured during the weekend. 62% of injuries were due to falls, usually form the standing position. The most common location for injury was in or about the home (39%), and other notable locations were school (16%) and sportsfield (14%). 61% of falls greater than 1 metre occurred at home, mostly from walls and childrens slides. 20% of injuries occurred while participating in organized sport, including Gaelic football, soccer and hurling. Injuries occuring during unsupervised sport were more likely to need surgery. Domestic ‘bouncing castles’ and trampolines, increasingly popular in our area, were a notable cause of significant trauma to the upper limb. 7% of injuries occurred by falling from a bicycle, but vehicular road traffic accident was an uncommon cause of injury. 263 children had confirmed fractures, other injuries consisting largely of sprains to the ankle, elbow and wrist. Predictably, the bones most commonly fractured were the radius (41%), phalanges (15%) and humerus (11%). 20% of fractures needed operative management, mostly forearm manipulation under anaesthesia. 63% of operative cases were performed outside of normal working hours. Several countries utilise injury surveillance as a means of development and evaluation of injury prevention strategies. In our initial study, basic surveillance has outlined local characteristics of chilhood trauma, and some trends were noted. In particular, we suggest home injuries need further attention in out catchment area

Purpose of the study. We report the problems associated with setting up an electronic arthroplasty surveillance plan and suggest some solutions which are appropriate to the modern NHS setting. Methods and Results. In 2006, the lower limb arthroplasty surgeons at UHCW NHS Trust decided to set up a ‘virtual’ arthroplasty surveillance plan to provide long-term radiographic and patient reported clinical outcomes for all patients undergoing hip and knee arthroplasty. In the face of increasing pressure upon outpatient waiting time and funding issues, this system was designed to replace the routine clinical review of patients in the outpatient department. While simple in principle, the virtual arthroplasty surveillance plan required input from surgeons and allied health professionals, hospital management, PCT clinicians, PCT finance, hospital finance, IT services and of course patients. However, in 2009 we were able to provide an electronic record of functional outcome scores and associated radiographs for over 1000 patients who had primary hip and knee arthroplasty surgery in our unit. Response rates for the first 6 months of 2009 for hip arthroplasty were 85.2% for functional outcomes and 84.2% for radiographic review. The subsequent clinical input is managed through ‘virtual’ clinics which provide a means to track patient outcomes and also an automated mechanism for financing the system. There are several areas which can still be improved, but early qualitative feedback suggests that this system provides high levels of satisfaction for both patients and surgeons. Conclusion. We believe that the long-term follow-up of patients undergoing arthroplasty surgery is important to both surgeons and patients. An electronic surveillance system using ‘virtual clinics’ offers one possible solution, but implementing such a system in the modern NHS requires a great deal of persistence