Background

Vitamin D deficiency may increase predisposition to a number of paediatric orthopaedic conditions and the prevalence of vitamin D deficiency is increasing in children in developed countries. The aim of this study was to determine the epidemiology of vitamin D deficiency and insufficiency in children presenting to a regional paediatric orthopaedic service. We also examined the relationships between vitamin D status, social deprivation and ethnicity

Purpose: To determine if patients randomized to a knee immobilizer following a primary hamstring tendon anterior cruciate ligament (ACL) reconstruction have lower visual analog scale (VAS) pain scores at day two postoperative than patients who do not wear a knee immobilizer.

Method: Patients aged 18–40 with symptomatic ACL deficiency as determined by MRI or physical exam who met the study inclusion criteria were eligible. Patients meeting intra-operative inclusion critiera were randomized (immobilizer or no immobilizer) during wound closure. The immobilizer used was a soft unhinged brace with velcro straps and three metal bars (Breg). Pre, intra and post operative protocols were standardized. Analgesic use and VAS scores were recorded at: one hour after surgery, 8am and 8pm for the first two days postoperative, and 5pm for days 3–14 postoperative. Patients were examined by the surgeon within 14–28 days postoperative. Based on a published survey and the literature, the primary outcome was patient self-assessed pain using a 0–100mm VAS (no pain-worst pain) at day 2 postoperative. Secondary outcomes included: analgesic use, complications, and range of motion. A sample size estimate was calculated resulting in 44 patients per group. A total of 102 patients were enrolled; 88 randomized and 14 excluded intra-operatively. Recruitment was achieved within 11 months.

Results: There was no difference in mean VAS pain scores at 2 days post-operative between immobilized and non-immobilized patients (32.6 and 35.2, respectively; p=0.59, 95% CI −6.99, 12.3). Regardless of group allocation, the greatest pain reported was on the evening of day 1 post-operative. Throughout the first week, patients medicated to a pain level of approximately 30/100. There were no differences between groups in medication consumed, range of motion or complications. At 2 days post-operative all patients randomized to the immobilizer group reported that they worn their brace 76–100% of the time.

Conclusion: No differences in pain were detected between immobilized and non-immobilized patients at any point during 14 days post ACL reconstruction. Based on these findings, a knee immobilizer is not recommended post-operatively for pain control. This study does not address other reasons for immobilizer use such as graft protection or range of motion.

Management of comminuted, intra-articular distal radius fractures remains a challenge. Basic principles are to obtain anatomic reduction, maintain the reduction, and rehabilitate the injured joint and the patient as soon as possible. This report presents fragment specific fixation as a method for maintaining fractures reduction and allowing early otion.

This was a retrospective consecutive series of AO classified C2 and C3 distal radius fractures treated with fragment specific fixation. Patients were included if their age was between eighteen and sixty years. Part one was a radiographic assessment of seventy-two patients after fracture union. Part two was a comprehensive functional assessment, carried out by a blinded observer in the first twenty-three patients, six months post op.

Mean patient age was thirty-nine years. The most common combination of fixation was a radial pin plate with an ulnar pin plate, although twenty-eight different combinations were found. Part one (radiographic) results were mean final radial inclination angle 21°, mean final palmar tilt 3.7°, mean final ulnar ariance +0.7mm, mean final intra-articular gap 0.9mm, mean final intra-articular step 0.7mm. Part two (functional) results were mean grip 21kg; mean key pinch 10kg; mean ranges of motion pronation 74°, supination 69°, extension 59°, flexion 48°, radial deviation 17°, ulnar deviation 22°; and mean return to work twenty-one weeks. Mean scores in Patient Rated Wrist Evaluation and Disabilities of the Arm, Shoulder, and Hand were twenty and fourteen, respectively.

In the short term, the functional results of ragment specific fixation of ifficult distal radius fractures produced results similar to other methods described in the medical literature. The technique, however, allowed early wrist motion, and produced long term radiographic results well within Cooney’s criteria for optimal reduction. It is expected, therefore that long-term results will prove to be superior to other management techniques.