To assess the functional outcome of operative and non-operative treatment of distal humeral fractures in the elderly, patients above 75 years of age were studied. Demographic data including associated injuries and co-morbid conditions were recorded. The minimum follow-up was 16 months (range 16–92 months). Elbow function was analysed according to the OTA rating system. Radiographs were monitored for possible predictors of final functional outcome Out of 125 patients with distal humeral fractures, 29 were above the age of 75 years. The mean age at the time of admission was 84.6 years (range 75–100). One patient was lost to follow-up. In total there were 28 patients with 29 fractures. 5 of these were open fractures. As per the AO classification, there were 8 type A, 8 type B, and 13 type C fractures. 8 patients were treated non-operatively (3 type A, 2 type B, 3 type C) and 21 (5 type A, 6 type B, 10 type C) operatively. An olecranon osteotomy was performed in 12 cases, 2 underwent triceps tongue reflection, and 7 had triceps splitting. Local complications included 4 cases (1 deep and 3 superficial) of infection and 3 non-unions (including one at the olecranon osteotomy). In the non-operative group the mean loss of extension and mean flexion achieved were 34.0 and 70.0 degrees respectively, whereas in the operative group the corresponding values were 23.0 and 107 degrees. OTA grading revealed 3 excellent, 9 good, 7 fair and 2 poor results in the operated group whereas in the non-operated group there were 0 excellent, 2 good, 3 fair, and 3 poor results. There was direct correlation between loss of anterior tilt of the distal humerus and adverse outcome.
To evaluate whether in children with knee pathology there is any correlation between clinical diagnosis, magnetic resonance imaging and arthroscopy. Between 1993 and 2001 children age 3–16 years old, who presented in the orthopaedic clinics of our institution with knee pathology were included in this study. All of them underwent MRI investigation. Their history, physical examination and clinical diagnosis were ascertained from their case notes. Some of these children underwent arthroscopic surgery of the knee and findings were also recorded. Clinical data, MRI findings and arthroscopic findings were computerised and analysed. Results were analysed and compared in the following 3 groups: a) clinical data versus MRI findings, b) clinical data versus arthroscopic findings and c) MRI report versus arthroscopic findings. Comparisons were rated in one of three categories: total agreement, partial agreement or total disagreement. Partial agreement was defined as the partial correlation of findings. 130 children (131 knees, one bilateral) were included in this study. The mean age was 8.5 years (range 3–16). 81 were male and 49 were female, ratio 1.7:1. 38 (30%) patients underwent arthroscopy. 43 (33%) of the MRI scans were reported as normal. Lesions reported on MRI included meniscal and ACL tears, osteochondritis dessicans, osteochondral fractures and discoid lateral meniscus. Overall, the results between the comparison of the 3 groups are summarised as follows: In this study 1/3 of the knee MRI was normal and there was only 26% of total agreement between the clinical and MRI findings. Further more in 50% of cases that underwent arthroscopy, there was no correlation of arthroscopic and MRI findings. This study supports the view that knee MRI investigation in children may not provide a reliable diagnosis and guidance in children with knee pathology.