Background: CT scanning is an essential part of the preoperative planning process prior to surgical fixation of acetabular fractures. Considerable disparity exists between the clinical and radiological outcome following open reduction and internal fixation of these fractures. It is suggested that this disparity is due to poor assessment of the quality of reduction using plain radiographs alone.

Aim: To investigate the role of post-operative CT scanning following ORIF of acetabular fractures.

Methods. Prospective study commenced in January 2000 of all patients in our institution undergoing internal fixation of acetabular fractures. Post operative axial CT scans were compared with plain radiographs (AP pelvis and 45 degree oblique Judet views) with regard to the sensitivity to detect articular fracture reduction in terms of gap displacement and step deformity or offset. A simplified binary measurement of radiological outcome was used stratifying radiological result into anatomical and non anatomical. Three observers independently reviewed the plain radiographs and CT scans at two separate time points and categorised the radiographic outcome as described. The interobserver reproducibility and intraobserver reliability of these measurements was expressed as a kappa statistic. In addition in those patients greater than 18 months following surgery we attempted to correlate the radiographic with the clinical outcome using the Harris hip score and the SF-36 score.

Results: 20 patients were recruited. Plain films were equieffective in detecting post-operative articular fragment displacement (p=0.24). The interobserver and intraobserver agreement between the radiological outcome measurements were good with respective kappa values of 0.61 and 0.65. There was a weak association between clinical and radiographic outcome as ascribed by post operative CT scans.

Conclusion: While there may be an argument for the use of post operative CT scanning of acetabular fractures in selective cases, we did not find any significant benefit of CT scans over plain radiographs in the assessment of reduction or radiological outcome following these injuries. Hence we do not routinely advocate their use in the post operative setting.

Background: CT scanning is an essential part of the preoperative planning process prior to surgical fixation of acetabular fractures. Considerable disparity exists between the clinical and radiological outcome following open reduction and internal fixation of these fractures. It is suggested that this disparity is due to poor assessment of the quality of reduction using plain radiographs alone.

Aim: To investigate the role of post-operative CT scanning following ORIF of acetabular fractures.

Methods: Prospective study commenced in January 2000 of all patients in our institution undergoing internal fixation of acetabular fractures. Post operative axial CT scans were compared with plain radiographs (AP pelvis and 45 degree oblique Judet views) with regard to the sensitivity to detect articular fracture reduction in terms of gap displacement and step deformity or offset. A simplified binary measurement of radiological outcome was used stratifying radiological result into anatomical and non-anatomical. Three observers independently reviewed the plain radiographs and CT scans at two separate time points and categorized the radiographic outcome as described. The interobserver reproducibility and intraobserver reliability of these measurements was expressed as a kappa statistic. In addition in those patients greater than 18 months following surgery we attempted to correlate the radiographic with the clinical outcome using the Harris hip score and the SF-36 score.

Results: 20 patients were recruited. Plain films were equieffective in detecting post-operative articular fragment displacement (p=0.24). The interobserver and intraobserver agreement between the radiological outcome measurements were good with respective kappa values of 0.61 and 0.65. There was a weak association between clinical and radiographic outcome as ascribed by post operative CT scans.

Conclusion: While there may be an argument for the use of post operative CT scanning acetabular fractures in selective cases, we did not find any significant benefit of CT scans over plain radiographs in the assessment of reduction or radiological outcome following these injuries. Hence we do not routinely advocate their use in the post operative setting.

Percutaneous wiring is a successful technique for the management of distal radial fractures. Practice differs according to surgeon preference as to whether the wires used are buried or protruding. To assess patient satisfaction with wither technique, we prospectively randomised 52 consecutive patients undergoing percutaneous wiring for distal radius fractures with regard to whether the wires were buried or not.

Patients with a distal radial fracture managed with percutaneous wire fixation and casting only were randomly allocated to have the wires buried or protruding. The fractures were classified according to Frykmn’s classification of fractures of the distal radius, and there were no differences between the groups (p=0.9).

The total number of patients studied was 52, with a mean age of 56.6 years (range 19–84). The female: male ratio was 38:13. Twenty-five (48%) patients had percutaneous wiring of their fracture with the Kirschner wires buried and 27 (52%) had the wires protruding. Cast and wire fixation were removed at a mean duration of 5.8 weeks in an outpatient setting. Patients recorded whether they experienced pain during the period of wire fixation or pain during the removal of wires on a visual analogue scale. Fifteen patients reported pain during the period of fixation (55.5%), the severity ranged between 2–8 (mean 3.8) with no significant difference between the groups (p=0.8). All patients with buried wires compared with 10% of those protruding wires required local anaesthesia in the operating theatre for removal (p=0.03). Superficial infection was diagnosed in 4 patients with no significant difference between groups (p=0.14).

Buried wires are typically advocated to prevent pin site infections and to improve patient comfort and satisfaction. However, we found no difference between the study groups with regard to patient satisfaction, pain during the period of fixation or pin-site infections. Furthermore, all patients in the buried wire group required local anaesthesia for removal with some of these necessitating a visit to the operating theatre. We therefore feel that burying these wires confers no advantage while adding to the complexity, time and cost of removal and recommend leaving wires protruding through the skin.

Abstract: A review study of 40 skeletally immature patients with displaced, diaphyseal both-bone forearm fractures treated with open reduction, internal fixation of radius only, using Mini DCP/one third tubular plate. Forty children (age range 5–13 years), treated between 1987–1999 by one surgeon were evaluated subjectively for pain or restriction of activities at games or school, clinically for range of movements at elbow, wrist and forearm rotation, and radiologically for residual angulation and time at healing. Duration of follow up was 2–12 years. Galeazzi and Monteggia fractures, as well as fractures with metaphyseal involvement were excluded. Among 40 patients, 26 were male and 14 female. Fracture distribution was 4 (10%) upper third, 12 (30%) middle third and 24 (60%) lower third of radius and ulna. Healing time was 2–10 (mean 3.6 months). One patient went into non-union and required further surgery. One patient developed superficial cellulites around the wound, resolved by a week course of oral antibiotics. No other complications were noted. Subjective evaluation showed excellent results in all patients according to our criteria. Clinically all patients had full range of motion at elbow, wrist and forearm rotation, except two patients who were 5 degree short of pronation and one patient 10 degree short of both supination and pronation, as compared to their normal forearm. Radiologically, two patients showed residual angulation of 5 degree in ulna. We conclude that single bone fixation offers a safe and effective way of treating displaced diaphyseal fractures of both radius and ulna, with excellent functional outcome.

The goal of treatment of an intra-articular fracture is anatomic restoration of normal anatomy and rigid internal fixation to allow for early motion. Weber Type ‘B’ ankle fractures (AO Type B and Lauge-Hansen supination-external rotation) are the most common ankle fractures that require internal fixation. Brunner and Weber first described the use of antiglide plate for treatment of these fractures in 1982. The aim of our study was to assess the functional and radiological outcomes of patients who underwent this procedure. This was a retrospective analysis of a consecutive series, reviewing patients over a ten year period, from 1990 to 1999, in a regional orthopaedic and trauma unit. There were 122 antiglide plate fixations performed in total over the period under review. Our group consisted of 64 patients who had an isolated closed lateral malleolor fracture, thereby excluding patients with open injuries and bimalleolar fractures. 6 patients were lost to follow-up. There were 25 males (age 19–64 years) and 31 females (age 13–62 years) with a mean age of 42 years. The patients were assessed by the American Orthopaedic Foot and Ankle Society (AOFAS) Score and the average follow-up was 5.8 years. The implant used was a 3.5mm AO DCP applied along the posterior surface of the lateral malleolus. This was followed by early commencement of postoperative ankle and foot exercises, allowing toe touch weight bearing out of cast until union. Our results (AOFAS Score out of 100) show that 92% (52 patients) had good to excellent result (Score> 80) with only 8% (4 patients) had a satisfactory outcome. We recommend the use of an antiglide plate because of its biomechanical stability especially in osteoporotic bones which allows for early motion and the nearly nil incidence of implant removal.