Our aim was to investigate the incidence and outcome of chest injuries after blunt trauma in patients admitted in a level I trauma centre over a 6-year period. This is a review of prospectively collected data (1996–2002); part of the (TARN-UK) data. Patients divided in 6 subgroups based on the chest AIS. Univariate analysis identified factors predicting mortality and a backward stepwise logistic regression multivariate analysis determined relationships with outcome.

There were 1,164 patients with chest injuries. The mean overall severity of chest injuries was 3.15+/−1.01. The commonest mechanism of injury was RTAs (57.01%). Rib fractures were the most common injuries (395 patients, 34%) associated with lung contusions in 12.9%. Admission GCS was highest in chest-AIS subgroup 2 and was significantly higher in groups 1 and 3. Complications, invasive operations, and investigations were more common with increasing chest-AIS. The ICU-admissions and the mean length-of-stay were similar for chest-AIS1 and 2, but significantly higher for the rest. Half of the AIS1 patients had associated head injuries; the lowest percentage was in subgroup 2 (18.8%). There was a variable correlation of abdominal injury severity with severity of chest injury. There was a significant difference in mortality rates between group 2 and group 1 and -3. The average time to death in those with chest-AIS1 was significantly lower than the average time in those with AIS4 and 5.

Patients in the higher AIS groups had both a higher overall ISS and mortality rate. Minimal chest injury severity (AIS1) showed higher ISS and significantly higher mortality compared with chest-AIS2,3. This has been attributed to the fact that the chest is spare as most of the impact during the course of the accident is been absorbed by the head (head injury). This theory also explains the shorter time period of death seen in patients belonging to the chest AIS1 group.

Introduction: The use of extendible endoprosthetic implants in the skeletally immature has been used for just under 30 years. Limb salvage has become a realistic alternative to those children presenting with primary bone sarcomas. We aim to review the use of an implant which uses a non-invasive mechanism of adjusting the length of the prosthesis, during the growth phase.

Method: A retrospective review of consecutive patients undergoing primary or revision endoprosthetic replacement with non-invasive extensible implants, was undertaken. Between January 1993 and February 2008, 34 children were treated with non-invasive extensible endoprosthetic replacements, 26 distal femur, 5 total femurs, 3 proximal tibias and 1 proximal femur.

Results: The underlying pathology, requiring excision, was Ewings sarcoma in 4 patients and osteosarcoma in the remaining 30 patients. Most underwent pre-operative chemotherapy and 2 patients died of their disease.

Four operations were secondary procedures following previous non-grower implant failures (1 infection of previous EPR, 1 IM nail non-union, 1 failed allograft and a revision of a proximal femoral EPR to a total femoral prosthesis). Five patients required revision of the primary prosthesis (2 with motor failures, 3 due to prosthesis infections).

Mean time to start lengthening from surgery was 12.2 months. The mean number of lengthenings was 4 with an average total length of 30 mm achieved, mean leg length difference was 0.8 cm. All lengthenings were undertaken with the patient fully alert, no adverse incidents occurred at the time or after lengthening.

Discussion: The non-invasive prostheses show promise in handling the difficult problem of limb preservation in a growing child, with similar complication rates to that of an invasive type, but without the need for multiple anaesthetics for lengthening.

Introduction: Current practice in the UK is to perform clinical follow up on patients with soft tissue sarcoma (STS) and only to request cross sectional imaging if there is clinical suspicion. We aimed to assess the effectiveness of this policy by investigating the patients who developed a local recurrence (LR) after previous treatment for STS and whether the size and extent at diagnosis of LR affected their subsequent management

Method: We reviewed the clinical records and imaging of all patients with diagnosed LR of STS to investigate the site and size of the LR and its management.

Results: 35 patients were diagnosed with LR over a 3 year time period. The average time from previous definitive treatment was almost 19 months. The suspicion was made by the patient in 18 patients, by a doctor in 16 and a district nurse in 1. The patients had MRI to confirm the diagnosis followed by biopsy or excision biopsy. 31 of the tumours were high grade, 2 low and 2 were not excised. The size at time of LR was 5.6 cm (range 0.5–15). 12 of the patients had concomitant metastases. 16 were treated by local excision and 5 by amputation whilst 14 patients had palliation. It was felt that with earlier diagnosis the clinical management would have been different in:

those 7 whose LR was inoperable due to size,

Discussion: Earlier diagnosis could have led to simpler surgery in a third of the affected patients. This study raises the question as to whether a more aggressive policy of follow up with regular imaging (either MRI or ultrasound) could detect LR earlier and lead to improved outcomes.