Purpose Of The Study: Avulsion fractures of the anterior tibial spine are uncommon injury and we have evaluated the results in-patients who have undergone arthrotomy and fixation of the fracture.

Material & Method: Twenty five patients were followed up between 21–108 months (mean 44 months) after the operation. They were evaluated clinically, radiologically and the residual ACL laxity was measured with KT 1000. Lysholm scoring scale has been used to assess the outcome.

Eight fractures were fixed with a single AO screw; 5 with Herbert screws; 4 with a steel wire loop and 8 with absorbable stitch.

Results: Significant residual anterior laxity despite adequate fracture union was a common finding. The ACL laxity was maximum in adults in whom absorbable stitch had been used to fix the fracture and they had a corresponding lower Lysholm score.

In 2 out of the 5 patients where Herbert screws had been used there was significant migration of the screws.

Additional articular damage was observed in 3 patients who were pedestrians hit by a car. All 3 ended up with restricted knee movements and poor results. Three individuals who had their knee immobilised in 250–500 of flexion developed flexion deformities, which took 12–18 months to recover.

Conclusions: We recommend that use of absorbable stitches as a method of fixation be avoided in adults. Herbert screws in this situation have a tendency to migrate. AO screws or a non-absorbable loop should be used were possible. Immobilisation of the knee in excessive flexion leads to prolonged flexion deformity and we recommend immobilising the knee in no more than 100 of flexion.

Background: Autologous blood from reinfusion drains are commonly used after major joint arthroplasties with a view to decrease the heterologous blood transfusion requirement. The aim of this study is to find the effect of reinfusion drains on the difference in haemoglobin (Hb) level before and after total knee arthroplasties.

Material and Methods: Between January 2001 and October 2003, 158 patients had total knee arthroplasty on one side. The type of thromboprophylaxis used was the same in all the patients. 74 patients had autologous blood transfusion through reinfusion drains (Group I) while 84 patients had no autologous blood transfusion and ordinary suction drains were used to drain the wound in the immediate postoperative period (Group II). The mean age was 72.1 +/− 8.5 in group I and 69.3 +/− 9.1 in group II. In each patient the preoperative Hb level, the amount of autologous blood transfusion, the postoperative Hb level and the amount of heterologous bleed transfusion requirement were noted.

Results: The mean preoperative Hb level was 13.6 +/− 1.4 g/dL (10.4–18.1) in group I and 13.7 +/− 1.3 g/dL (7.9–16.5) in group II. The mean postoperative Hb level was 10.7 +/− 1.5 g/dL (10.4–18.1) in group I and 10.7 + 1.6 g/dL (5.4 +/− 13.6) in group II. The difference in Hb level between the two groups was analysed using t-test and found to be not significant (p = 0.76), with the mean difference between the groups being 0.05 and the 95% CI to the mean difference includes zero (range −0.3 to +0.4). The difference in Hb level before and after surgery was plotted against the amount of autologous blood transfused and it was observed that there was no significant improvement with increased amount of autologous blood transfusion. The cost of reinfusion drain is 36.43 (~ 53.37 Euros) more than the suction drain.

Conclusion: Autologous blood from reinfusion drains did not significantly improve the postoperative Hb level. Further usage of reinfusion drain is not cost-beneficial.

Background Non-weight bearing hip is a common problem in the elderly population after a minor fall. Magnetic reasonance imaging (MRI) is used to diagnose occult fractures in the hip and the pelvic ring in these individuals. The aim of this study is to find the relationship between the incidence of occult fractures in the hip and that in the pelvic ring following low velocity trauma in the elderly.

Material and Methods Between January 2000 and February 2004, 106 elderly patients (mean age = 81.4 years; range = 67–101 years), underwent an MRI scan of the pelvis and hip to rule out fracture neck of femur. All of them presented with a non-weight bearing hip after a history of low velocity injury. All had standard radiographs of the pelvis and the hip which did not reveal a fracture of the femoral neck. However, eight patients had fracture of the pubic rami visible on plain radiographs. MRI scans were subsequently performed in all of them to rule out an occult fracture of the femoral neck.

Results Out of the 106 patients, 17 (16%) had intracapsular neck of femur fracture, 26 (24.5%) had extracapsular neck of femur fracture, 26 (24.5%) had pubic rami fracture, 17 (16%) had sacral fractures, and 37 (34.9%) had no fractures. All the sacral fractures occurred in patients with pubic rami fractures. Further except in one patient where the pubic rami fracture and the sacral fracture were contralateral, the remaining 16 patients had ipsilateral pubic rami and sacral fractures. None of the patients with pelvic ring fracture had associated femoral neck fracture.

Conclusion Inability to weight bear after a fall is a common presentation in the elderly population. Falls can lead to fracture neck of femur or a fracture of the pelvic ring but seldom both. We can also conclude that in an elderly patient with low velocity injury, if a pelvic ring fracture is detected in the plain radiograph there is no indication for further MRI to rule out femoral neck fracture. Further, the fracture in the anterior and posterior pelvic ring commonly involves the same side than the contralateral side, in the elderly after trivial trauma.