Normal acetabular development in developmental dysplasia of the hip (DDH) depends upon early and maintained congruent reduction. Computed tomography is an accepted method for evaluating this and attempts to quantify hip reduction, by various angular and linear measurements, have been reported.

The aim of this study was to assess initial CT scans, following open reduction in the older child with DDH, with comparison of outcome to evaluate prognostic value.

Method: Thirty consecutive patients underwent open reduction for DDH, with a mean age of 25.9 months at the time of operation. Acetabular morphology and the position of the femoral head were evaluated on the initial CT scan, taken on the first postoperative day, and AP pelvic radiograph taken at the latest follow-up.

Results: The acetabulae of the dislocated hips were found to be significantly more anteverted than the normal. The dislocated hips also had significantly increased lateral displacement both initially and at latest follow-up. Posterior displacement of the proximal femoral metaphysis should raise concern due to an association with the need for further surgical intervention. These results did not however correlate with outcome.

In conclusion, despite the significant differences noted between DDH and normal hips they did not predict acetabular development or persistent acetabular dysplasia.

Introduction: A review of the treatment of 33 open fractures in 29 children over the period 1997 to 2002.

Method: Intravenous antibiotics, debridement and wound irrigation was performed prior to skeletal stabilisation incorporating plaster cast immobilisation (4%), K wire fixation (13%), screw fixation (13%), flexible intramedullary nail fixation (13%) and external fixation (57%). Secondary wound closure was undertaken if appropriate at 48 hours. The tibia was involved in 49% of cases with approximately equal distribution of other long bone extremities. Fractures were classified according to Gustilo et al (22% grade I, 26% grade II, 17% grade III and 35% grade IIIb).

Results: The average age was 10 years in 22 boys and 7 girls. Tibial fracture union was an average of 9 weeks in gradeI and II compared with 20 weeks for grade III. The remaining fractures healed at an average of 10 weeks. Non union occurred in one patient (tibia). There was on case of growth arrest of the distal tibia. There were no cases of osteomyelitis.

Discussion: Open fractures in children most often result from high energy trauma. An increase in fracture and soft tissue severity is associated with a delayed union. Physeal injuries require close observation for potential growth arrest.

Aims: To compare the cost of intra-medullary implants used stabilising paediatric diaphyseal fractures with the clinical outcome. Methods: Between March 1994 and August 2001, at two centres, The Womenñs and Childrenñs Hospital, Adelaide, Australia and The Royal London Hospital, London UK 60 children were surgically treated for diaphyseal forearm fractures using Elastic Stable Intramedullary Nails (ESIN) or 2.5mm Kirschner wires. Having established no difference in the clinical outcome or subjective disability of either technique we compared the implant cost directly. Results: The two treatments both resulted in an excellent outcome with all fractures leading to union with no subjective disability. The Kirscner wires cost £3.00 per wire while the ESI Nails cost between £57.50 and £ 113.30 per wire, depending on the dimensions. Conclusions: We were not able to demonstrate any difference in outcome between ESIN and K-Wiring, although the nails do offer theoretical advantages. The cost implications of using the special implant are twenty fold or more, and as the pressures of cost cutting grow, we wonder if theoretical advantage is Òvalue for moneyÒ.

Introduction: The majority of forearm fractures in children can be managed with a plaster cast alone and manipulation under anaesthetic as required. A small number of cases however require surgical intervention. A variety of methods are available but the use of elastic intramedullary nails is becoming the technique of choice.

Method: We present a two-centre study assessing the outcome of either Elastic StabJe Intramedullary Nails (ESIN) or Kirschner wires as the method of fracture stabilisation in diaphyseal forearm fractures of the radius and ulna.

Results: ESIN group: 24 children underwent ESIN fixation. There were 22 boys and 2 girls, mean age 9.4 years (1.4–15.2 years, p=O.ll). Indications for stabilisation included 21 cases for fracture instability (immediate or delayed,) 2 irreducible fractures and 1 open fracture. 14 children underwent surgery on the day they sustained their fracture. The remainder were operated on an average 6.5 days following injury (1–14 days). In the K wire group: 36 children underwent K-wires fixation with 2.5mrn wires. There were 21 boys and 15 girls, mean age 10.6 years (2.2–15.5 years). Indication for stabilisation included 22 cases for fracture instability , 6 irreducible fractures and 8 open fractures. 32 children underwent surgery on the day they sustained their fracture. The remaining 4 patients were operated on the following day.

Conclusions: All fractures united with no resultant subjective disability. The complication rate following K-wires was 16% and that following nail fixation 9%. Loss of forearm rotation was documented in 4 children in the K-wire group and 3 children stabilised with nails. These results confirm an excellent outcome following intramedullary fixation. We have demonstrated no difference in outcome between K-wires and ESIN, although the elastic nails do offer some theoretical advantages.

The purpose of the study was to perform an independent assessment of the results of open reduction and internal fixation (ORIF) on a selected group of displaced intra-articular calcaneal fractures from two centres.

It still remains controversial whether to manage intraarticular calcaneal fractures conservatively or operatively with few long-term results. The identification of patients who may benefit from the procedure is still undecided.

Fifty fractures in 46 patients with a defined significant displacement of an intra-articular fracture of the calcaneum underwent ORIF by one of the two senior authors. Mean age at operation was 46 years and mean follow-up was 44 months. 88% of the injuries were due to a fall from a height. 30% of the patients had contralateral foot/ankle injuries, and 20% of the patients developed a superficial wound infection. The infection rate was significantly higher in patients whose surgery was delayed more than 14 days.

All patients were independently reviewed after a minimum two-year follow-up. A clinical, radiographic and subjective assessment of the outcome was made. The results were correlated to the original fracture type. The mean Atkins score was 88 (out of 100). Bilateral injuries fared worse. Heel pain at follow-up correlated with a poor score. Atkins scores over 90 occurred in 77% of Saunders Type II, 50% in Type III, and 43% in Type IV fractures. 94% returned to work at a mean of 10 months post-injury. Three patients have undergone a subtalar arthrodesis – two for persistent pain and one for a significant malunion. One patient required a flap but there have been no cases of chronic osteomyelitis.

In patients with significantly displaced fractures, ORIF is a worthwhile procedure with 90% of patients satisfied and 94% returning to work. Gross articular comminution does not preclude a good/excellent result if hindfoot alignment is restored. ORIF after fourteen days should be avoided due to the high risk of infection.

The purpose of the study was to perform an independent assessment of the results of open reduction and internal fixation (ORIF) on a selected group of displaced intra-articular calcaneal fractures from two centres.

It still remains controversial whether to manage intraarticular calcaneal fractures conservatively or operatively with few long-term results. The identification of patients who may benefit from the procedure is still undecided.

Fifty fractures in 46 patients with a defined significant displacement of an intra-articular fracture of the calcaneum underwent ORIF by one of the two senior authors. Mean age at operation was 46 years and mean follow-up was 44 months. 88% of the injuries were due to a fall from a height. 30% of the patients had contralateral foot/ankle injuries, and 20% of the patients developed a superficial wound infection. The infection rate was significantly higher in patients whose surgery was delayed more than 14 days.

All patients were independently reviewed after a minimum two-year follow-up. A clinical, radiographic and subjective assessment of the outcome was made. The results were correlated to the original fracture type. The mean Atkins score was 88 (out of 100). Bilateral injuries fared worse. Heel pain at follow-up correlated with a poor score. Atkins scores over 90 occurred in 77% of Saunders Type II, 50% in Type III, and 43% in Type IV fractures. 94% returned to work at a mean of 10 months post-injury. Three patients have undergone a subtalar arthrodesis – two for persistent pain and one for a significant malunion. One patient required a flap but there have been no cases of chronic osteomyelitis.

In patients with significantly displaced fractures, ORIF is a worthwhile procedure with 90% of patients satisfied and 94% returning to work. Gross articular comminution does not preclude a good/excellent result if hindfoot alignment is restored. ORIF after fourteen days should be avoided due to the high risk of infection.