Purpose: We present 10 cases of long bone fractures in children (femur, tibia, forearm) that were treated with internal fixation (flexible intramedullary rods).

Material and Methods: The patients were 10 children (9 boys and 1 girl), 6 to 15 years of age (mean 10.4 years) suffering of 6 femoral, 3 forearm and 1 tibial fracture, treated with flexible intramedullary rods. The femoral fractures healed between 3 to 4.5 months (mean, 14.7 weeks), the tibial frtacture in 3 months (12.8 weeks) and the forearm fractures in between 1 to 2.2 months (mean 7.6 weeks). Removal of the rods was performed 7.1 to 10 months (mean 39 weeks).

Results: The advantages of intramedullary fixation of long bone fractures in children, with flexible rods are: The earlier mobilization of the patient and return to his usual daily activities, the shorter period of hospitalization, the anatomic reduction of the fracture in comparison with conservative treatment (traction-cast) and external fixation and the smaller amount of complications than external fixation ( delayed union, refracture, etc.).

Conclusion: In conclusion intramedullary fixation with flexible rods has excellent results under the following conditions: the appropriate fracture (diaphyseal transverse or oblique femoral and tibial fractures and unstable fractures of the forearm) and the correct surgical technique while inserting the rods.

The aim of surgery in the treatment of tumours of the distal radius is to achieve satisfactory clearance whilst best preserving function of the hand and wrist. Since 1992 a technique of distal radial tumour excision with reconstruction by autologous free fibula strut grafting has been employed in the treatment of thirteen patients at our unit. The procedure employs fixation of the non-vascularised fibula shaft to the proximal radius by step-cuts and a dynamic compression plate. The fibula head substitutes for the distal limit of the radius and articulates with the carpus.

We have treated 10 cases of primary or recurrent giant cell tumour and cases of osteosarcoma, chondrosarcoma and Ewings’ sarcoma by this technique. The patients were reviewed at a mean of 50 months post surgery, with assessment of their functional outcome and measurement of the range of wrist movement and grip strength.

The patient with Ewings tumour had died of meta-static disease 62 months post grafting. Three patients treated for giant cell tumour had required further surgery, two of these had forearm amputation for malignant transformation. In comparison to the unoperated wrist, range of movement was well preserved. The power of grip strength was 57% of the contralateral wrist and hand.

These results compare well with published rates of recurrence of benign giant cell tumour treated by other methods. This technique would seem to offer an acceptable functional result without compromise of the tumour prognosis.