We compared two management strategies for the perfused but pulseless hand after stabilisation of a Gartland type III supracondylar fracture. We identified 19 patients, of whom 11 were treated conservatively after closed reduction (group 1). Four required secondary exploration, of whom three had median and/or anterior interosseus nerve palsy at presentation. All four were found to have tethering or entrapment of both nerve and vessel at the fracture site. Only two regained patency of the brachial artery, and one patient has a persistent neurological deficit.

In six of the eight patients who were explored early (group 2) the vessel was tethered at the fracture site. In group 2 four patients also had a nerve palsy at presentation and were similarly found to have tethering or entrapment of both the nerve and the vessel. The patency of the brachial artery was restored in all six cases and their neurological deficits recovered completely.

We would recommend early exploration of a Gartland type III supracondylar fracture in patients who present with a coexisting anterior interosseous or median nerve palsy, as these appear to be strongly predictive of nerve and vessel entrapment.

100 fibula fractures sustained at or below the syndesmosis were studied retrospectively. They were consecutive trauma clinic referrals with an initial conservative treatment plan. All initial radiographs studied were taken prior to application of below knee plaster splintage. Weber A and B classification was n=47 and 53 respectfully. Serial radiographs showed that none of the 100 ankles developed further displacement during their treatment. There was 5.6 and 6.6 individual radiographs and 4.2 and 4.3 clinic reviews for Weber A and B respectfully. We conclude that Weber A and B fractures without talar shift are stable injuries. Once the decision has been made to treat them conservatively, no further radiographs need be requested. This will result in reduction to two clinic reviews and one single initial anteroposterior and lateral radiograph. Significant cost savings to the health service and reduction in ionising radiation exposure to the patient will result.