Purpose: Many surgeons are now performing hip arthroplasty using a minimally invasive technique with the aim of reducing muscle damage and improving rehabilitation. We compared the learning curve of two MIS THA approaches: the two-incision mini and a modified Watson-Jones (G3) approach.

Methods: A retrospective review of 47 consecutive patients who underwent a THA using an MIS approach was conducted. All patients received an uncemented acetabular cup (Trilogy–Zimmer) fixed with 1 or 2 screws, and an uncemented femoral stem (ML taper, fiber metal taper, fully porous coated–Zimmer). Note was made of BMI, surgical time, incision length, blood loss, component positioning, hospital stay and perioperative complications.

Results: Twenty-one patients received a G3 and 26 received a 2 incision mini approach. The average BMI was 29.7 and 26.1 respectively. Average acetabular inclination was 37 for the G3 and 42 for the 2-incision mini. On average, the femoral component was positioned in neutral in the coronal plane for both approaches. Average surgical time was 121minutes for the G3 and 166 minutes for the 2-incision which also includes fluoros-copy time. Hospital stay averaged 5.4 and 6.8 days respectively. The skin incision averaged 8.9 cm for G3 a total of 9.8cm for 2-incision. Perioperative complications for the G3 included 1 lateral femoral cutaneous nerve palsy, 1 DVT, 1 PE and 1undisplaced intraoperative acetabular fracture. Complications for the 2-incision mini included 5 intraoperative fractures, 7 nerve injuries, 1 wound infection, 1 infection requiring revision and 1 PE.

Conclusions: The G3 minimally invasive approach for THA has advantages over the 2-incision mini: shorter operative time, no need for fluoroscopy, fewer days in hospital, shorter total incision length and lower complication rate. The G3 approach also offers the opportunity to bail out to a traditional approach, by extending the incision, should this be necessary.

We undertook a prospective, single blinded, randomized, controlled trial of one hundred children treated with either an above or below elbow cast for treatment of closed, distal third forearm fractures requiring reduction. The re-manipulation rate in the below elbow group was 2% (95%CI: 0–11%) compared to 6% (95%CI: 2–15%) in the above elbow group, p=0.62. Above elbow casts do not appear to improve fracture immobilization nor reduce the requirement for re-manipulation in pediatric distal third forearm fractures.

Debate exists regarding the benefits of using below elbow casts instead of above elbow casts for maintaining reduction in pediatric distal third forearm fractures. The literature indicates a loss of reduction rate of 14.6% of children treated in an above elbow cast and 2.5% in those treated with a below elbow cast.

We undertook a prospective, single blinded, randomized, controlled trial of one hundred children treated with either an above or below elbow cast for treatment of closed, distal third forearm fractures requiring reduction. Outcome measures included re-manipulation rate, fracture displacement during cast wear, and cast complications. One hundred patients were suitably enrolled; fifty-four received an above elbow cast, forty-six received a below elbow cast. The two groups were similar in terms of age and gender. The above elbow group contained a higher proportion of both bone fractures (41/54) than the below elbow group (27/46).

There were no significant differences between the two cast groups in initial, post-reduction or cast-off fracture angulation; nor any difference in the amount of fracture displacement during cast wear. The number of cast complications was similar between the two groups. The re-manipulation rate in the below elbow group was 2% (95%CI: 0–11%) compared to 6% (95%CI: 2–15%) in the above elbow group, p=0.62.

Above elbow casts do not appear to improve fracture immobilization nor reduce the requirement for re-manipulation in pediatric distal third forearm fractures.

Funding Hip Hip Hooray, Saskatoon