In a prospective randomised controlled trial, 51 patients who did not receive a bone plug during total knee replacement surgery were compared to 49 patients who received a bone plug. The primary outcome measure was the need for allogenic blood transfusion requirement and the secondary outcome was the post-operative blood loss and decline in haemoglobin levels. The patients had autologous re-transfusion from their closed drainage system. The two groups did not differ in the demographics. The mean intra-operative blood loss was slightly more in the no plug group (difference of 41.25 millilitres), which was not statistically significant. There was no statistically significant difference in total post-operative blood loss and drop in haemoglobin levels. Only one patient had two units of allogenic blood transfusion in the no bone plug group while none required allogenic blood in the bone plug group. There was no statistically significant difference in the amount of blood re-transfused from the drain between the two groups. Our findings did not show any statistically significant difference in post-operative blood loss, decline in haemoglobin levels and the need for allogenic blood transfusion in total knee replacement surgery.

The study was to ascertain if parents/carers could be effective screeners in the detection of infant hip dysplasia.

Infants have been screened for developmental hip dysplasia (DDH) since the late 1960's. The recognition of the importance for early identification of the condition has been well documented. However, the changes to the national screening programme in 2008 have reduced the surveillance of DDH following the removal of the 8 month infant hip check, leaving only the 6–8 week hip check as standard.

A self-check guide for DDH has been developed to enlist parents as screeners for the condition. The guide highlights common signs used to alert to the possibility of hip dysplasia or dislocation. The guide was disseminated by the Royal Berkshire Hospital NHS Trust between 2008 – 2013 within West Berkshire through the maternity services and Health Centres. The guide provided parents with information on classic signs associated with DDH which they were asked to check for.

Of those infants referred to our specialist clinic as a result of parental screening, 73% were “abnormal” of these 33% went on to treatment with splintage. The mean age of these infants was 5.36 months. 20% of positive findings were in infants aged 7 month or over at the time seen. None went on to open surgery. These patients represented between 5 and 10% of our overall group of DDH positive patients. If left undiagnosed, they may have gone on to late presentation of hip dislocation requiring surgery as a child or undiagnosed acetabular dysplasia and possible surgical treatment in relatively early adult life.

Therefore we concluded that given the right guidance parents/carers would be ideal screeners to assist in detecting possible later presenting DDH in their baby.

Aim

Paediatric fractures are common but those occurring in non-ambulant children are associated with higher rates of Non Accidental Injury (NAI). There is little published on the mechanisms of injury associated with accidental fracture in young children. This study explores the aetiology of long bone fractures in non-ambulant children.