Introduction: We conducted a prospective study on 29 patients comparing the medium-term outcome between intramedullary nail fixation and plate fixation in paediatric forearm fractures.

Materials and Methods: The criteria were patients who had a nail (10) or plate fixation (19) for a single or both bones forearm fracture between 2004 and 2006. All these patients were recalled following ethical approval for assessment of their grip strength using a hand dynamometer, forearm and elbow range of movements, scar assessment, POSNA outcome questionnaire and new radiographic views of the forearms.

Results: Mean age of 10.4 years for both groups (4–16), All fractures were caused by low velocity falls. Grip strength is reduced in 83% of patients, comparable in both groups. Elbow flexion is more reduced in the plating group but more reduction in extension in the nailing group. The reduction in forearm pronation (69% of patients) and supination (61%) were comparable in both groups. Using the ‘Manchester scar proforma’; the plating group scored worse with 14/21; nail 11/21. ‘POSNA outcome questionnaire’ score showed the nailing group had 90% excellent or good result and plating group 74%. The moderate and poor POSNA outcome (26% plate, 10% nail) were associated with pain, restricted rotation, bad scarring and difficulty lifting heavy objects. Nails were removed after bony healing but all plates were left in situ. Complete remodeling of forearm bones were seen in all radiographs in both groups. One case of non-iatrogenic ulnar nerve injury and two cases of wound infection were noted; all made full recovery.

Conclusion: The medium-term outcome at 2.5 years following either fixation method is generally comparable and good. The obvious differences were; a higher (better) POSNA score in the nailing group, larger scar formation in plating, elbow extension restriction in nailing and elbow flexion restriction in plating group. Factors that were comparable were grip strength, forearm rotation and radiographic remodeling and outcome.

Introduction: The concept of cell senescence has been described as the mechanism responsible for the ageing of tissues, that is a finite ability to replicate and produce new tissue. The senescent cell population is separate and distinct from the cells which are undergoing programmed cell death (apoptosis), and those which are necrosing acutely. Cells reaching the senescent state have an increase in β-galactosidase activity, which is detectable using an established technique for soft tissues including fibroblasts and epithelial tissues. Senescence has not previously been investigated in bone. We have investigated this and hypothesise that new bone formed by distraction osteogenesis will have fewer senescent cells than the adult cortical “old” bone.

Methods: Eight New Zealand white rabbits underwent application of a M100 Orthofix external fixator to the tibia and creation of a mid-diaphyseal osteotomy, using a hand saw. After a seven day latency period, distraction was commenced (0.5mm twice daily) to twenty percent lengthening. After 3 weeks consolidation, the tibae were harvested for histological analysis.Senescent Staining:The sections were stained using a technique described by Faragher, using an X-gal based stain. Sections were incubated for 16 hours at 37 degrees centigrade before counter staining with DAPI. Sections underwent histological analysis and total cell and senescent cell counts performed.

Results: Surprisingly, large numbers of cells within the bone regenerate stained for cell senescence. A mixture of multinucleate and mononucleate cells were present. The location and appearance of the multinucleate cells prompted the use of TRAP staining. This provided support for these cells being osteoclasts.

Discussion: Previously, a high percentage of apoptotic cells and a high rate of cell division has been reported in bone regenerate. The surprisingly high numbers of cells within the newly formed bone staining positively for senescence suggest that there may also be a high senescent cell population. Alternatively, the positive TRAP staining may indicate that the stain is less specific than reported and may be staining osteoclasts and mature macrophages within the bone regenerate.