Aim

To compare outcomes for children treated for idiopathic clubfeet with the Ponseti regimen before (2002–2004) and after (2005–2006) implementation of a dedicated Ponseti service.

Aim

10 years after the introduction of the Ponseti casting regimen as standard treatment for idiopathic clubfoot at Alder Hey Children's Hospital, we reviewed the mid-term outcomes of the initial 2-year cohort (treated from 2002–2004)

Introduction: It is common practice to screen the hips of infant with a family history of DDH clinically and ultra-sonographically in selective screening programmes. The practice of regular radiographic follow-up of infants with a positive family history of Developmental Hip Dysplasia (DDH) is based on the widespread belief that Primary Acetabular Dysplasia is a genetic disorder that can occur in the absence of frank hip subluxation or dislocation¹. It has been our practice to obtain a 6 – 12 month screening radiograph in such patients but this practice is not conclusively supported in the literature.

Materials and Methods: We reviewed all such infants who had a normal clinical and ultrasound examination of the hips at the 6–8 week screening examination but who, because of the family history underwent further radiographic screening after a 6–12 month interval. The radiographs of all such infants (n=77) were analysed for any signs of late hip dysplasia.

Results and Discussion: Sixty six infant had normal X rays at the 6–8 month assessment and were discharged. The remaining eleven patients had acetabular angles at the upper end of the normal range for age and were reviewed again with further radiographs at 12 months. At this stage ten patients were normal and were discharged. The remaining patient was reviewed again at 18 months and 24 months and finally proved to be normal and was discharged. The result of a postal survey has suggested that majority of BSCOS members do not get follow up x-ray done if the clinical and ultrasound scan is normal at screening visit.

Conclusion: All of the seventy seven patients eventually developed normal radiographs and we question the need for radiographic follow up of infants with a family history of DDH but who have a normal clinical examination and ultrasound scan at 6–8 weeks.

Aim: A retrospective study to analyse the treatment of paediatric diaphyseal forearm fractures over the preceding 6 years and to assess if there was any difference in outcome between plate and elastic stable intra-medullary nailing (ESIN).

Material and Methods: Between January 1997 and December 2002, 144 unstable fractures required surgical fixation. 59 patients were treated with both-bone plate fixation, 55 patients were treated with single-bone plate fixation and 30 patients were treated with ESIN.

The mean age of surgery was approximately 12 with peaks at age 8 and 13 years.

In the plate group, 70% to 80% were undertaken by the SpRs and in the nailing group, approximately 50% were undertaken by staff grades; 30% by Consultants and 20% by SpRs.

Results: Between each group there was no difference in time spent in plaster, clinic attendance, time to clinical union and time to restoration of normal movements. On radiographic reviews, single-bone plate fixation patients united quicker than the both-bone plate fixation or ESIN groups. Average anaesthetic times became more prolonged from single-bone to ESIN to both-bone plate fixation.

Compound fractures were approximately 10% in both groups. There were hyper-trophic scars in approximately 10% in the plate group and 3% in the nail group. There were 3 compartment syndromes in the plate group and 2 compartment syndromes in the nail group.

In the plating groups, there was a higher rate of peri-prosthetic fracture, mal-union, hyper-trophic scarring, infection and neuro-vascular complications.

Conclusion: ESIN is superior to plating in relation to surgical complications. It is therefore recommended that elastic stable intra-medullary nailing should be used for displaced paediatric diaphyseal forearm fractures.

This paper presents the results of forearm fractures in twenty children treated with flexible intramedullary nailing, over a period of 3 yrs.

Forearm fractures in children are an extremely common injury and excellent results are obtained in the majority of cases by closed reduction and plaster immobilisation. If adequate reduction cannot be achieved or maintained by conservative means or if it fails, some form of internal fixation will be required. Flexible nails are an extremely effective way for addressing this problem.

Twenty children had flexible intramedullary nailing done following forearm fractures over a 3-year period from 1997–2000 [failed reduction (10), unstable post MUA(3), slipped in plaster(6) and open fractures(1)]. There were 15 male and 5 female patients, the mean age being 10. 9. The nature of the injury were radial neck (3); proximal radius (1), galeazzi (1) and both bone fractures (15). Nine patients had closed nailing, while 11 required a mini open approach of which, 5 needed exposure only on one side. Patients were protected post surgery until signs of union were seen. The patients had regular clinical and radiological assessment and nails were removed on an average of 6–8 months, though in patients with radial neck fractures it was removed much earlier [4–5 weeks].

All patients went on to full bony union in excellent position, the average time to union being 5. 8 weeks. All but one patient regained full prono-supination, elbow and wrist motion, though none had any functional disability. There were a few minor complications especially following implant removal, including superficial wound infections (3), transient hypoasthesia in the distribution of the superficial radial nerve (2) and one patient in whom one nail had to be left behind as it could not be removed. There were no long-term sequelae.

Several methods of internal fixation are available, and the very diversity of choice demonstrates the lack of an ideal solution. K-wires are not applicable at all levels and plates have the disadvantage that they require extensive exposure of the fracture site. Removal of the plates is just as, if not more, fraught with complications.

Flexible nails can often be inserted closed, leave cosmetically more acceptable scars, provide excellent alignment of the fracture and can be removed easily without requiring any postoperative immobilisation. In our opinion it should be considered as the method of choice in treating forearm fractures in children, when some form of internal fixation is required.