Childhood obesity is an epidemic of growing concern. There has been a dramatic increase in childhood obesity in the United Kingdom in the recent years. Previous studies demonstrated that this cohort of paediatric population demonstrated poorer balance with increased risk of falling during daily activities and with weight related increase in force, more likely to sustain a fracture. The goal of present investigation is to assess the incidence of fractures in paediatric population and if there is a role of socio economic status as a confounding factor.

We prospectively looked at attendance of children at out-patient fracture clinics over a period of 8 months. The BMI is calculated and the centiles are determined on the charts using Cole’s LMS method which adjusts body mass index distribution for different degrees of skew ness at different ages. Children over 98 centile were considered as obese. The musculoskeletal injuries were documented. The social status was determined from the areas where they lived using the Neighbourhood Renewal Fund.

A total of 405 children presenting to the trauma clinics with musculoskeletal injuries were measured. There were 252 boys and 153 girls. The mean age is 10.5 years with a median age of 12 years (range 2–16 years). The prevalence of obesity is 14.8% compared to the national average of 13.6%. Children from deprived areas had an increased prevalence of 17.3%. The incidence of fractures remains equal in obese and normal weight children. The most common anatomical region involved is wrist and hand. Upper limb injuries were significantly more common in the obese group (p< 0.05, Chi-square test)

Parents should be educated regarding the adverse effects of obesity. Strategies should be in place to identify high risk groups. Local programmes should be developed involving parents, schools authorities and health services to provide targeted care and necessary education.

Aim: This study was undertaken to assess the incidents of Deep Vein Thrombosis (DVT) and/or Pulmonary Embolus (PE) in orthopaedics outpatients who were immobilised in lower limb casts.

Materials and Methods: We retrospectively analysed the incidents of DVT/PE in a district general hospital over a one year period in orthopaedic outpatients who had their lower limb immobilised. Only patients who were no already on anti-coagulants were included and patients with co-morbidity associated with a higher risk of thrombosis were excluded. The diagnosis of DVT was made by ultrasound scan and PE confirmed with a CT pulmonary angiogram. The details of patients who were found to have a clot were cross checked with the outpatient plaster room register. The relevant case notes were then studied.

Results: There were three hundred and eighty patients who had lower limb casts, six of whom developed a blood clot during the period of immobilisation. All patients were male -and four patients presented with a DVT and two patients presented with a pulmonary embolism, all patients survived.

There were two smokers and one patient was very overweight.

Discussion: Incidents of DVT among patients with lower limb casts are low. At present there is no guideline on the use of DVT prophylaxis in orthopaedic outpatients. Our results show that even though the number of proven DVTs is low, the potential of developing a fatal pulmonary embolus in these patients is present.

Conclusion: DVT prophylaxis could be considered for orthopaedic outpatients who are treated with lower limb casts and who have additional risk factors. A larger prospective survey is required before guidelines regarding prophylaxis can be drawn up.

Between 1982 and 1997, twenty-six children between the age of 2 and 15 (mean age 10. 6 years) underwent proximal femoral replacement. Twenty have survived and all but three have reached skeletal maturity.

Sequential radiographs have been reviewed with particular reference to acetabular development and fixation of the prostheses. Initially a cemented acetabular component was inserted, but recently uncemented implants and unipolar femoral heads that exactly fit the acetabulum have been used.

In older children the acetabulum develops normally and the components remain well fixed. One of nine children over thirteen years with a cemented acetabulum needed revision for loosening and one suffered recurrent dislocations.

In younger children the acetabulum continues to develop at the triradiate cartilage, so a cemented acetabulum grows away from the ischiopubic bar. As the component is fixed proximally, it becomes increasingly vertical and will almost inevitably loosen. In our study six of eight children under 13 years of age with a cemented acetabulum needed revision for loosening.

Unipolar replacements in younger children tend to erode the superior acetabular margin. Femoral head cover is difficult to maintain, and of four unipolar implants in children under thirteen, two required acetabular augmentation.

Cemented cups may be unsuitable for children under thirteen years but our results are not statistically significant. In this age group, unipolar implants may be more appropriate but they have serious potential complications. In children over thirteen, cemented implants survive longer. The number of uncemented implants in our study is too small to comment on long-term survival.