Between 1997 and 2003, five patients with acquired knee flexion contractures were treated by gradual soft tissue distraction using the Ilizarov external fixator.

Two patients presented following burns, two following septic arthritis of the knee and one after poliomyelitis. The mean age was 8.2 years (5 to 12). All patients had a fixed flexion contracture of the knee of 90°. The mean duration of fixator application was 4 months. No soft tissue releases or bony surgical procedures were performed. When the external fixator was removed, the mean residual knee flexion deformity was 2°. Follow-up after removal of the fixator averaged 5 months. The mean loss of correction was 15° (0° to 30°). Two patients developed mild pin-tract sepsis, which was successfully treated with oral antibiotics. Compared to preoperative status, energy-efficient mobility was markedly improved in all patients.

This study was undertaken to identify certain high-risk patient groups admitted following trauma, in an attempt to improve their management.

We retrospective reviewed 207 patients admitted to the ICU with orthopaedic injuries between 1997 and 2003, excluding from the study spinal patients, paediatric orthopaedic patients, and patients having elective surgery. The mean age of the patients was 36.7 years.

The mean duration of stay in the ICU was 8.4 days. In 32% of patients, the only injuries were orthopaedic, with 51% of this group having multiple fractures. Of the patients with associated injuries, 34% had chest injuries. Acute respiratory distress syndrome (ARDS) developed in 46 patients (22%), of whom 33 (71%) had more than one long bone fracture. The incidence of ARDS in patients with no associated injuries was 11%. The overall mortality rate was 13.5% (28 patients), and the mortality rate of patients with only orthopaedic injuries was 5% (10 patients). Death occurred on the day of admission in 28.5% and 70% of the deaths occurred after 8 days in the ICU. Overall, there was a 10% mortality rate in patients admitted to the ICU for more than a day.

We advise close observation of all orthopaedic patients with associated chest injuries and recommend appropriate fracture management within 8 days of admission.