Background and Aims:

Forearm fractures are common in the paediatric population and most are treated in a moulded plaster of Paris (POP) cast. It is our concern that many casts applied by our registrars are sub-optimal and that we need to improve our training process. The aim of our study was to review the adequacy of forearm cast application in paediatric patients at our institution and to identify if there is a need for a more formal training program with regard to plaster cast application.

Introduction Malunion of radial head fractures can lead to pain, stiffness and early development of osteoarthritis. While the operative management of acute displaced radial head fractures is well described there is only one published case study of treatment of radial head mal-union by an osteotomy.

Methods Four patients aged between 22 to 51 years with a displaced intra-articular radial head fracture were initially treated non-operatively in this series. They subsequently developed a malunion resulting in loss of motion and pain. Each of these cases were treated with an intra-articular osteotomy and internal fixation within two to six months of their injury. The procedure was performed via a Kochers approach, preserving the lateral ligament complex. An osteotomy was then performed through the site of malunion, with the depressed fragment being elevated, grafted and internally fixed using two compression screws to re-establish the original anatomy. In some cases a capsular release was also performed. They were followed-up for a period of six to 12 months to assess for union, range of motion and pain.

Results All patients reported a marked improvement in elbow movement with significantly reduced pain and better function. On average there was an increase of 40° of elbow flexion and 50° of forearm rotation. There was clinical and radiographic evidence of union in all cases. All four patients were satisfied with the result and were able to resume their pre-injury employment.

Conclusions Malunion of the radial head can be treated successfully by a radial head osteotomy and grafting technique as described in this paper. Each of these cases was performed within six months of the injury before arthritic change of the radiocapitellar joint was irreversible.

Aim: To examine the effect of the anterior and posterior approaches for the surgical correction of scoliosis on pulmonary function, curve correction and patient satisfaction.

Methods: Thirty-five patients with adolescent idiopathic scoliosis undergoing surgical treatment were evaluated with spirometry, assessing volume (FVC) and flow (FEV1) pre and post-operatively . They were followed for a minimum of two years and their results were compared with the normalised data for their age group. The patients were divided into three groups based on the surgical approach and the amount of correction. The patients in group one underwent posterior spinal fusions and had greater than 60% correction of pre-operative Cobb angles. Those in group two underwent posterior spinal fusions and had less than 60% correction of their pre-operative Cobb angles. A combined anterior and posterior spinal fusion was used for the patients in group three with greater than 60% correction in their pre-operative Cobb angles.

Results: The patients in group one had significantly improved pulmonary function values at follow-up. The patients in group two all returned to pre-operative pulmonary function values and the patients in group three had improved pulmonary function values but this was not significant.

Conclusions: Patients with purely posterior surgery and large Cobb angle corrections demonstrated a statistically significant increase in lung function values. Large corrections greater than 60 degrees in combined anterior/posterior procedures increased lung function values but not significantly. We suggest that large corrections can be achieved with posterior surgery alone using pedicle screws for caudal fixation and question the need for a thoracotomy.

Introduction: Labelled leukocyte scintigraphy has been shown to be a sensitive and specific technique for the detection of pedal osteomyelitis in patients with diabetes mellitus. There has however been little data relating the efficacy of the technique to outcomes.

Aim: To examine the prognostic value of sequential 99m Tc labelled leukocyte scans at diagnosis and after 3–4 weeks of appropriate antibiotic therapy.

Method: Twenty-three patients with proven pedal osteomyelitis or persistent uptake on the sequence of scans were studied.

Results: Five additional episodes of osteomyelitis developed in the group over the period of the study. Eleven patients demonstrated persistent uptake in the sequential scans. Nine progressed to amputation. The remaining two patients were biopsy negative for infection, did not have cutaneous ulceration and were thought to have rapidly progressive arthropathy.

Conclusion: Sequential leukocyte scintigraphy accurately predicted the need for amputation and circumvented ineffective prolonged antibiotic therapy.