The 8-plate (Orthofix, SRL, Italy) is a titanium extraperiosteal plate with 2 screws which acts as a hinge at the outer limits of the physis. It has been used for correction of both angular and sagittal deformity around the knee. To our knowledge this is the first study describing the use of 8-plates in leg length discrepancy (LLD) correction.

We aimed to evaluate outcomes of temporary 8-plate epiphysiodesis in LLD, and to assess the complications associated with its usage.

This retrospective study included 30 patients between 2007 and 2010 whom underwent 8-plate epiphysiodesis to address LLD.

Leg length measurements were recorded using erect full leg length scanograms and comparison made between pre-operative, interval and final scanograms. Any deviations of the mechanical axis were also recorded.

During the study period 34 epiphysiodeses were performed on 30 patients. There were 17 males and 14 females. The average age at the time of procedure was 10.7 years (range 3–15). Average time to final follow-up was 24 months (range 52–10). The average pre-operative LLD was 2.5 cm (range 1.5–6 cm). The mean overall rate of correction was 1.0 cm per year. The mean residual LLD at end of treatment was 1.1 cm (range 0–4.5 cm). Two patients experienced genu recurvatum deformity. This was associated with placement of distal femoral plates anterior to the mid-lateral line.

Based on our experience 8-plate epiphysiodesis is a reversible, minimally invasive procedure with reliable results in length correction. However, careful device placement is required to prevent deformity.

Purpose

The evolution of locked anatomical clavicular plating in combination with evidence to suggest that fixation of clavicle fractures yields better outcome to conservative treatments has led to an increasing trend towards operative management. There is no evidence however to compare early fixation with delayed reconstruction for symptomatic non- or mal-union. We hypothesize that early intervention yields better functional results to delayed fixation.

Introduction and Aims: To assess the effects of the various stages of intra-medullary (IM) nailing of the tibia upon intra-compartmental pressure (ICP) measurements, with particular emphasis on factors which reduce the pressure.

Method: Using sensitive transducer-tipped pressure monitors, the anterior compartment pressure was recorded throughout IM nailing of tibial shaft fractures in 34 consenting patients.

Results: Significant peaks in ICP, up to 140mmHg, occurred during reaming and nail insertion, with a sustained elevated pressure phase seen following nail insertion (p< 0.01). In those patients with no fracture distraction visible on fluoroscopy following nail insertion, this pressure was relieved by the release of traction (mean reduction 16.79mmHg, p< 0.01). However, in those with a visible fracture gap, traction release was not sufficient, and impaction of the fracture after distal cross-screw insertion was required to achieve baseline levels in this group (mean reduction 15.29mmHg; p< 0.01).

Conclusions: Using the various pressure criteria for diagnosing ACS, some of our patients either had, or were at considerable risk of developing ACS post-operatively. Furthermore, if fracture impaction had not been performed where necessary, the subsequent sustained increase in ICP would have resulted in additional patients fulfilling the diagnostic criteria for ACS. Clearly, this observation may explain the tendency for some distracted fractures to fail to unite as a result of ischaemia, but of greater significance is the potential for ACS to occur in the post-operative period, leading to significant long-term complications. We recommend that, if traction is used, it is released as early as possible following nail insertion, and that the fracture should be impacted following distal cross-screw insertion if there is visible distraction of the bone ends on fluoroscopy following nail insertion.

Aims: To assess the effects of the various stages of intramedullary (IM) nailing of the tibia upon intracompartmental pressure (ICP) measurements, including new factors such as fracture impaction. Methods: Anterior compartment pressure monitoring was performed on 25 consenting patients undergoing IM nailing for tibial shaft fractures, using a sensitive transducer-tipped pressure monitor. Results: Signiþcant peaks in ICP, up to 130mmHg, occurred during reaming and nail insertion. Although the ICPs recorded post-operatively (32.79mmHg; range 10 to 68mmHg) were higher than the initial recordings (25.83mmHg; range 8 to 61mmHg), the change was not statistically signiþcant. Reduction of ICP was achieved through release of the traction, but the greatest drop in ICP followed impaction of the fracture after distal cross screw insertion (mean drop 21.75mmHg; range 5 to 58mmHg; p< 0.01). Conclusions: Using the various criteria for diagnosing acute compartment syndrome (ACS), some of our patients either had, or were at considerable risk of developing ACS postoperatively. Furthermore, if fracture impaction had not been performed where necessary, the subsequent sustained increase in ICP would have resulted in additional patients fulþlling the diagnostic criteria for ACS. Clearly, this observation may explain the tendency for some distracted fractures to fail to unite as a result of ischaemia, but of greater signiþcance is the potential for ACS to occur in the postoperative period, leading to signiþcant long term complications.