Triplane fractures of the adolescent ankle commonly require operative management. A number of classification systems exist showing a variety of fracture patterns, making fixation planning complex. Our institute has previously presented a classification system that simplifies the fracture pattern. Our aim was to find a fixation method that could be used in all cases.

We devised a universal screw trajectory for the epiphyseal fracture based on a partially threaded screw placed medial-to-lateral at 20 degrees to the inter-malleolar axis of the ankle. We retrospectively reviewed the axial CT images of 59 consecutive operatively managed triplane fractures from a single institute to simulate the placement of the screw.

In all 59 subjects, the simulated universal screw placement was in a satisfactory position to adequately, and safely, reduce the fracture. Two cases were classified as ‘Tillaux variants’, which are classically managed with a lateral-to-medial screw, but they were deemed to be potentially suitable for the universal screw, indeed in one case the treating surgeon used a medial-to-lateral screw and had a successful outcome.

Our classification system demonstrates a reproducible fracture line that is amenable to a universal screw fixation method in the world's largest published triplane series. It offers a low-tech solution to a difficult problem. This could simplify the preoperative plan and obviate the need for a CT scan, which is relevant to departments treating populations without access to such resources.

We present a review of our Specialist Physiotherapy clinic for normal physiological variations of the lower limb (SPNV) clinics, demonstrating them to be clinically effective and cost effective.

Children with normal variation of rotational profile and limb angulation present much anxiety to parents and primary care. Providing consultation: to eliminate significant pathology and reassure families, is an important service that a Paediatric Orthopaedic department provides. In our tertiary referral department we have a Specialist Physiotherapy led clinics into which primary care practitioners refer children with whom there are concerns about lower limb development variation.

The (SPNV) Clinic was first set up by a Consultant and Senior Physiotherapist in 1999. The aim of the clinic was to reduce the waiting times for incoming referrals but ensuring they are seen in an appropriate environment by an experienced health care professional. Clinics are run by Senior Specialist Physiotherapists, alongside Consultant clinics who are available for advice and direction. This provides security for the physios, the Trust and the patient.

Over 15 years there have been more than 4000 patient visits to this clinic. Over 80% were new patient visits. 70% of these visits were discharged in one or two reviews. 97.4% of new referrals were discharged without subsequent review by an orthopaedic surgeon. The most common conditions reviewed were Genu valgum (25%), Genu Varum (16%), intoeing (17%) and flexible flat feet (11%).

The clinic has proven to be cost effective as well in drawing in up to £500,000 revenue into the trust in a single year. The department has been approached by other trusts to assist in the implementation of similar clinics.

We present this review of the patients, as a template for supporting the work of Paediatric Orthopaedic Departments. This service has facilitated the streamlining of our Consultant Paediatric Orthopaedic clinics.

The aim of this study is to discuss the results of intramedullary devices in the management of paediatric radial neck fractures and to suggest methods to avoid the pitfalls of the technique.

30 patients with isolated Judet III and IV fractures were included in this retrospective study. The method of reduction was reviewed. The final results were graded using the Metaizeau functional scoring system and Oxford Elbow score.

Intramedullary K wires were used in 10 patients and blunt tipped TENS nails in 20 patients. The complications seen were radiocapitellar joint penetration-6 cases at mean 4.87 weeks, redisplacement − 6, radial epiphyseal sclerosis − 5 and heterotopic ossification − 1 case. The functional result was good to excellent in 24 of 30 cases(80%). The mean Oxford Elbow score was 44.32. The mean follow-up was 40.11 months.

Intramedullary K wires may result in radiocapitellar joint penetration. Blunt tipped devices should not be used as purely fixation devices as they may not prevent redisplacement. Minimal redisplacement does not affect the functional outcome.

Regular follow-up until atleast 6 weeks is essential. Patients who have a Judet IV fracture and need open reduction should be closely followed up and given a guarded prognosis.

Aim

To use Patient Reported Outcome Measures (PROMs) to determine the effectiveness of lumbar spinal surgery at a single UK institution.

Aim

Debate remains over the optimal treatment for severe unstable SCFE. AVN is the principle problem; current thinking suggests this can be minimized by emergent reduction and fixation within 24 hours. If emergent treatment is not possible, open osteotomy with a variable delay of 10–21 days has been advocated. We present our experience of delayed intracapsular cuneiform osteotomy (ICO)

Purpose

Plating remains the most widely employed method for the fixation of displaced diaphyseal clavicle fractures. The purpose of this study was to assess the efficacy and outcomes of diaphyseal clavicle fractures treated with intramedullary fixation using the Rockwood clavicle pin.

Introduction: A learning curve is a recognised phenomenon in surgery. It implies that the frequency of peri-operative adverse events will decrease with the increase in experience of the surgeon. Evidence shows increased instruction and experience in a specific surgical task leads to improved performance. There is conflicting evidence as to whether there is a learning curve for total ankle replacement, and a paucity of evidence for foot and ankle surgery as a whole. Current evidence is centered on perioperative complications, rather than functional outcome.

Aim: To determine whether a learning curve effect is present during the first year of independent practice by measuring patient outcome.

Materials and Methods: 150 patients underwent elective foot or ankle surgery during the first 12 months of a newly appointed consultant’s practice. Preoperative and six month postoperative functional scores were recorded, together with perioperative complications. Two patients died of unrelated causes in the first 12 months. 121 patients (81.8%) were followed up for a minimum of six months by telephone. Functional outcome was assessed with a modified American Orthopaedic Foot and Ankle Society midfoot Score (85 points). Outcome was compared between the first and second six-month periods using the student’s t-test.

Results: Eighty procedures were undertaken during the first six months compared to 70 in the second. Total ankle replacements were only undertaken in the latter period. Otherwise there was no statistical difference in the caseload. One wound infection occurred during each period and other perioperative complications were equivalent. Functional improvement was greater in the group from the second 6 months (+23.86 v’s +18.69). This difference did not reach statistical significance (p = 0.061).

Discussion and Conclusion: There is a trend, approaching significance, towards a learning curve during a foot and ankle consultant surgeon’s first year of practice. Collating data from other new consultants may demonstrate a learning curve with statistical significance.