Open talus fracture are notoriously difficult to manage and they are commonly associated with a high level of complications including non-union, avascular necrosis and infection. Currently, the management of such injuries is based upon BOAST 4 guidelines although there is no suggested definitive management, thus definitive management is based upon surgeon preference. The key principles of open talus fracture management which do not vary between surgeons, however, there is much debate over whether the talus should be preserved or removed after open talus fracture/dislocation and proceeded to tibiocalcaneal fusion.

A review of electronic hospital records for open talus fractures from 2014-2021 returned foureen patients with fifteen open talus fractures. Seven cases were initially managed with ORIF, five cases were definitively managed with FUSION, while the others were managed with alternative methods. We collected patient's age, gender, surgical complications, surgical risk factors and post-treatment functional ability and pain and compliance with BOAST guidelines. The average follow-up of the cohort was four years and one month. EQ-5D-5L and FAAM-ADL/Sports score was used as a patient reported outcome measure. Data was analysed using the software PRISM.

Comparison between FUSION and ORIF groups showed no statistically significant difference in EQ-5D-5L score (P = 0.13), FAAM-ADL (P = 0.20), FAAM-Sport (P = 0.34), infection rate (P = 0.55), surgical times (P = 0.91) and time to weight bearing (P = 0.39), despite a higher proportion of polytrauma and Hawkins III and IV fractures in the FUSION group.

FUSION is typically used as second line to ORIF or failed ORIF. However, there are a lack of studies that directly compared outcome in open talus fracture patients definitively managed with FUSION or ORIF. Our results demonstrate for the first time, that FUSION may not be inferior to ORIF in terms of patient functional outcome, infection rate, and quality-of-life, in the management of patients with open talus fracture patients. Of note, as open talus fractures have increased risks of complications such as osteonecrosis and non-union, FUSION should be considered as a viable option to mitigate these potential complications in these patients.

PURPOSE OF STUDY: We report our experience with multiple flexible intramedullary nailing (Ender nailing) of fractures of shaft of the femur in paediatric age group.

METHODS: We did a prospective review of 20 children (mean age- 8.8 years; range- 6.5 to 15 years) treated with Ender nailing. Fall from height was the predominant mechanism of injury (18 children). The mean follow-up period was 16.3 months (range- 4 to 28 months).

RESULTS: 18 fractures united by 6-8 weeks and 2 fractures united by 8-10 weeks. Minor limb length discrepancies were seen in this series (range, -5mm to +10mm). 2 children had shortening of 5mm while 4 children with upper third fractures had 10mm lengthening. All patients were able to squat on floor and sit cross-legged. All but one patient had full hip and knee range of motion. Varus angulation of 15 degree was seen in 2 patients who were non-compliant and had started early weight bearing. Backing out of 1 nail was seen in 1 patient and the nail was extracted. TEN outcome scoring system was used to critically analyse the results. 16 children had excellent outcome, 2 children had satisfactory outcome and 2 children (with varus malunion) had poor outcome.

CONCLUSION: Ender nailing is a safe and effective method for treatment of femoral shaft fractures in children between the age of 6 and 15 years. Patient compliance is crucial for a satisfactory outcome since early full weight bearing can predispose to varus malunion.