Thoracolumbar injury classification systems are not used or researched extensively in paediatric population yet. This systematic review aims to explore the validity and reliability of the two main thoracolumbar injury classification systems in the paediatric population (age ≤ 18). It also aims to explore the transferability of adult classification systems to paediatrics. The Thoracolumbar Injury Classification System (TLICS) published in 2005 and the AO Spine published in 2013 were assessed in this paper because they both provide guidance for the assessment of the severity of an injury and recommend management strategies. A literature search was conducted on the following databases: Medline, EMBASE, Ovid during the period November 2020 to December 2020 for studies looking at the reliability and validity of the TLICS and AO Spine classification systems in paediatric population. Data on validity (to what extent TLICS/ AO Spine recommended treatment matched the actual treatment) and reliability (inter-rater and intra-rater reliability) was extracted.

There is an “almost perfect validity” for TLICS. There is a “strong association” between the validity of TLICS and AO Spine. The intra-rater reliability is “moderate” for TLICS and “substantial” for AO Spine. The intra-rater reliability is “substantial” for TLICS and “almost perfect” for AO Spine.

The six studies show a good overall validity and reliability for the application of TLICS and AO Spine in pediatric thoracolumbar fractures. However, implication of treatment and anatomical differences of the growing spine should be explored in detail. Therefore, AO Spine can be used in absence of any other classification system for paediatrics.

Background

A recent Cochrane review has shown that total shoulder arthroplasty (TSA) seems to offer an advantage in terms of shoulder function over hemiarthroplasty, with no other obvious clinical benefits. This is the first study to compare complication rates on a national scale.

The diagnosis of musculoskeletal infection is an ongoing problem. Multiple specimens and histology peri-operatively have been used to increase the accuracy of the diagnosis. However, to determine antibiotic resistance profiling it is essential to grow bacteria from the patient. The aim of this prospective study was to evaluate whether there is an increase in the rate of isolation of micro-organisms from musculoskeletal tissue samples sent directly in broth culture or whether there is an over-diagnosis due to false positive contaminants.

Samples were taken from patients undergoing planned orthopaedic surgery (some with and some without suspected infection). Each specimen was harvested with separate instruments. The specimens were placed into universal containers without broth according to our standard protocol and also into containers with broth. These samples were cultured and the results analysed for any difference in culture growth. A total of 72 specimens were taken in the operating theatre (36 in broth, 36 without broth). The results of culture were compared to a diagnosis of infection from clinical and histological data.

Overall there were 24 true positive samples in the study (sensitivity of 66.7%) and 32 true negative samples (specificity of 88.9%). The isolation of bacteria from the culture of samples sent in broth had a sensitivity of 77.8% and a specificity of 83.3%. Whereas, the sensitivity and specificity of musculoskeletal specimens sent without broth were 55.6% and 94.4%, respectively.

The results of the study show that there is an increase in the rate of isolation of micro-organisms from musculoskeletal tissue samples sent directly in broth culture, compared to specimens sent without broth. However, the broth samples resulted in a higher rate of false positives. This study concludes that placing musculoskeletal specimens directly in broth in the operating theatre for culture improves the rate of microbiologial diagnosis. However, a larger study with more patients would be of use to confirm this.

We are presenting a prospective study of 25 patients with clavicle fracture treated with Rockwood Intramedullary pin fixation. Operative management is required for open fractures, neurovascular injury or compromise, displaced fractures with impending skin compromise and displaced middle third fractures with 20mm or more shortening. Plate osteosynthesis or intramedullary fixation devices are used for operative management.

Patients and Methods: 25 patients with clavicle fractures underwent fixation of clavicle fractures with threaded intramedullary Rockwood pin. The indications for internal fixation were persistent wide separation of fracture with interposition of soft tissue in 12, symptomatic non-union in 3, associated multiple injuries in 3,one of them had a floating shoulder, impending open fracture with tented skin in 4 and associated acromioclavicular joint injury in 3 and one of whom had bilateral fracture clavicle.. All patients underwent open reduction through an incision centred over the fracture site along the Langer line. Intramedullary pin was inserted in a retrograde manner. Autologous bone grafting from iliac crest was done in all patients with nonunion. Radiographic and functional assessment conducted using DASH scores.

Results: There were 21 male and 4 female patients with a mean age of 34 yrs (range 17 to 64 yrs). Mean follow up was 12 months (range 5 months to 30 months). Radiographic union occurred in all patients within 4 months. In our study the commonest indication for Rockwood pin fixation was displaced middle third clavicle fracture followed by impending open fractures. Commonest complication was skin irritation at the distal end of the pin with formation of a tender bursa occurring in 9 patients, 3 of whom had skin breakdown. Fracture union occurred in all these patients with no further intervention and wounds healed completely after removal of the pin. One patient developed non-union and was later treated with ORIF with DCP and bone-graft. There were no deep infections, pin breakage or migration or re-fractures after pin removal. At the time of last follow up the average DASH score was 25 with a range of 18 to 52.

Conclusion: Open reduction and intramedullary fixation of clavicle fractures with Rockwood pin is a safe and effective method of treatment when surgical fixation of displaced or non-union of middle third clavicle fracture is indicated. This technique has an advantage of minimal soft tissue dissection, compression at the fracture site, less risk of migration and ease of removal, along with early return to daily and sports activities.

Introduction Vitamin D deficiency has been reported widely in various community groups but especially in the osteoporotic/fracture population. We decided to investigate the incidence in an elective female population undergoing hip or knee arthroplasty as this has not been previously reported.

Methods Data was collected prospectively from a group of female patients who were undergoing hip or knee arthroplasty for osteoarthritis. Patients with rheumatoid or inflammatory arthritis were excluded, as were patients on Vitamin D supplements. Serum 25-hydroxyvitamin D (25 OHD) levels were measured as part of routine pre-operative work-up. A total of 40 female patients over a 12 month period were checked, with average age 66 years (range 15 to 93 years). Average height was 151 cm and weight 67 kg. Thirty total hips and 10 total knee replacements were performed. Vitamin D deficiency was classified as either marginal (25 OHD levels ranging from 25 to 50 nmol/L or frank (25 OHD levels, < 20–25 nmol/L).

Results Eleven patients out of 40 (27.5%) had marginal deficiency and four of those patients (10%) had frank vitamin D deficiency. There was no correlation with height or weight or age.

Conclusions This small study suggests that a significant percentage of patients undergoing elective lower limb arthroplasty for osteoarthritis have low Vitamin D levels.