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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_III | Pages 120 - 120
1 Feb 2012
Nawabi D Mann H Lau S Wong J Andrews B Wilson A Ang S Goodier W Bucknill T
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On 7 July 2005, four bombs were detonated on the London transport system. Three of these bombs exploded almost simultaneously at 08:50h affecting the underground tube network at Aldgate, King's Cross and Edgware Road stations. The fourth bomb exploded at 09:47h on a double-decker bus in Tavistock Square. There were 54 deaths in total at the scenes and over 700 injured.

194 patients were brought to the Royal London Hospital. 167 were assessed in a designated minor injuries unit and discharged on the same day. 27 patients were admitted of whom 7 required ITU care, 1 died in theatre and 1 died post-operatively. The median Injurity Severity Score (ISS) in this group of patients was 6 (range 0-48) and the mean ISS was 12. The general pattern of injury in the critically ill patients was of mangled lower limbs and multiple, severely contaminated fragment wounds. Hepatitis B prophylaxis was administered to those patients with wounds contaminated by foreign biological material. 11 primary limb amputations were performed in 7 patients. 9 limb fasciotomies, 5 laparotomies and 1 sternotomy were carried out. 3 patients had blast lung injury. All patients who underwent primary amputations and debridement received further regular inspections in theatre. These inspections formed the majority of our theatre work. Under no circumstance was initial reconstructive surgery attempted. Delayed primary closure and split skin grafting of all wounds was completed by the end of the second week. There have been no sepsis-related deaths.

Our experience at The Royal London has allowed us to revisit the principles of blast wound management in a peacetime setting. A number of lessons were learned regarding communication and resource allocation. A multi-disciplinary approach with the successful execution of a major incident plan is the key to managing an event of this magnitude.


Orthopaedic Proceedings
Vol. 87-B, Issue SUPP_III | Pages 330 - 330
1 Sep 2005
Hart A Seepaul T Ang S Hewitt R Amis A Hansen U
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Introduction and Aims: Locking plates represent a major change in the way we stabilise fractures. The distal radius Locking Compression Plate (LCP, Synthes) theoretically enables palmar plating of dorsally comminuted and intra-articular wrist fractures. All current methods (Dorsal plates, K wires and external fixators) have considerable disadvantages. This is the first study to assess the clinical and biomechanical results of this new implant.

Method: We created a synthetic bone fracture model to compare three plates (the LCP, Buttress and Pi). We tested 24 plates, eight in each group, using the Instrom biomechanical testing machine, axially loading the model to 200 Newtons for 500 cycles. The results show significantly less displacement for the LCP plate (p< 0.05).

Results: Early clinical results are reported following a prospective study of the LCP plate to stabilise dorsally comminuted and intra-articular. The average age was 32 years. We report our results at an average follow-up of six months (range four to nine months). There were no complications. The Gartland & Werley scores were at least satisfactory in all patients and good in 75%.

Conclusion: Both our biomechanical and early clinical results support the clinical use of the palmarly applied LCP for intra-articular and dorsally comminuted wrist fractures.


The Journal of Bone & Joint Surgery British Volume
Vol. 84-B, Issue 2 | Pages 311 - 311
1 Mar 2002
Ang S