Aims

High-quality clinical research in children’s orthopaedic surgery has lagged behind other surgical subspecialties. This study used a consensus-based approach to identify research priorities for clinical trials in children’s orthopaedics.

The aim was to assess contemporary management of slipped capital femoral epiphysis (SCFE) by surveying members of the British Society of Children's Orthopaedic Surgery (BSCOS).

A questionnaire with 5 case vignettes was used. Two questions examined the timing of surgery for an acute unstable SCFE in a child presenting at 6 hours and at 48 hours after start of symptoms. Two further questions explored the preferred method of fixation in mild and severe stable SCFE. The final question examined the management of the contralateral normal hip. Responses were entered into an Excel spreadsheet and the data w analysed using a chi-squared test.

The response rate was 56% (110/196). 88.2% (97/110) responded that if a child presented with an acute unstable SCFE within 6 hours, they would treat it within 24 hours of presentation, compared with 40.9% (45/110) for one presenting 48 hours after the onset of symptoms (P<0.0001). 52.6% (58/110) of surveyed BSCOS members would offer surgery for an unstable SCFE between 1 and 7 days after onset of symptoms. Single screw fixation in situ was advocated by 96.4% (106/110) and 70.9% (78/110) while corrective osteotomy was preferred by 1.8% (2/110) and 26.4% (29/110) of respondents for the mild and the severe stable slips respectively (P<0.0001). Surgeons preferring osteotomy are more likely to perform an intracapsular technique. Prophylactic fixation of the contralateral normal hip was performed by 27.3% (30/110) of participants.

There are significant differences in opinions between BSCOS members as to the optimal management of SCFE in children. This reflects the variable recommendations and quality in the current scientific literature. Further research is therefore required to determine best practice and enable consensus to be reached.

The long term results of closed reduction of the hip for DDH were reviewed to determine if the presence of the ossific nucleus had an effect on outcome.

The clinical and radiological outcome of a single-surgeon series of closed reduction for DDH was assessed in a strictly defined group of 48 hips in 42 patients with an average of 11.1 years follow up.

In 50% of cases, the ossific nucleus was absent. 100% of patients had an excellent or good result (Severin classification) at final follow-up. 8.3% (4 hips) demonstrated evidence of avascular necrosis. Three were Kalamchi & MacEwen Type I and one was type II. Two of the AVN cases did not demonstrate an ossific nucleus at closed reduction, and both developed type I AVN. 6 hips underwent further surgery. The acetabular index and center-edge angle were not significantly different between the affected and unaffected hip at final follow-up.

There was no relationship between the presence or absence of an ossific nucleus at the time of closed reduction and the final outcome.

In this well defined group, closed reduction is safe and provides excellent results in the long-term. The absence of an ossific nucleus is not detrimental to the final outcome.

Firearm injury is a potentially increasing public health problem worldwide. It is increasingly the subject of media and public attention. We aim to analyze the epidemiology, pattern and outcome as experienced.

Data such as age, sex, race, scene and nature of injury, firearm used, alcohol and drug factors, anatomy involved, surgical requirements, transfusion details, ICU/HDU stay, complications, deaths, and outcome were collected from medical notes, WYMAS and Coroners office of all patients who presented with firearm injuries from January 1995 to December 2001. Seventy-eight cases presented to our institution. There were 19 fatalities at the scene of injury. 69 were male. 51 sustained injuries in public places, 20 at their homes and 7 in outdoor areas. Low velocity firearms were involved in 49 cases. 50 were crime related. Alcohol was identified in 34 patients and illicit drugs in 6 cases. 19 cases had bony injury with associated vascular injury in one case. Primary neurological injury was diagnosed in 5 cases. Lower extremities and upper limb injuries accounted for 59% and 26%. 3 had head and neck wounds. 4 patients had thoracic trauma and 5 had abdominal injury. 86% required surgical intervention. 11 patients had a total of 16 complications, the most common being secondary infection. 6% of patients died at the emergency department and 3 after. Chest injuries caused 5 deaths and head wounds caused 3 deaths illustrating criminal intention to cause fatal body harm.

Conclusion: Males in younger age groups are disproportionately affected and the majority were crime- related injuries. Alcohol and other drugs were identified as a significant factor. There has been no significant decrease in the reported cases of firearm injuries or firearm-related deaths after the amendment made in the Firearm Rules in September 1998 (No:1941). The incidence of non-fatal firearm injury is comparable to centres involving similar population.

Aims: Firearm injury is a potentially increasing public health problem worldwide. It is increasingly the subject of media and public attention. We aim to analyse the epidemiology, pattern and outcome as experienced. Methods: Data such as age, sex, race, scene and nature of injury, þrearm used, alcohol and drug factors, anatomy involved, surgical requirements, transfusion details, ICU/HDU stay, complications, deaths, and outcome were collected from medical notes, WYMAS and Coroners ofþce of all patients who presented with þrearm injuries from Jan 1995 to Dec 2001. Results: 78 cases presented to our institution. There were 19 fatalities at the scene of injury. 69 were male. 51 sustained injuries in public places, 20 at their homes and 7 in outdoor areas. Low velocity þrearms were involved in 49 cases. 50 were crime related. Alcohol was identiþed 34 patients and illicit drugs in 6 cases. 19 cases had bony injury with associated vascular injury in one case. Primary neurological injury was diagnosed in 5 cases. Lower extremities and upper limb injuries accounted for 59% and 26%. 3 had head and neck wounds. 4 patients had thoracic trauma and 5 had abdominal injury. 86% required surgical intervention. 11 patients had a total of 16 complications, the most common being secondary infection. 6% patients died at the emergency department and 3 after. Chest injuries caused 5 deaths and head wounds caused 3 deaths illustrating criminal intention to cause fatal body harm. Conclusions: Males in younger age groups are disproportionately affected and the majority were crime related injuries. Alcohol and other drugs were identiþed as a signiþcant factor. There has been no signiþcant decrease in the reported cases of þrearm injuries or þrearm related deaths after the amendment made in the Firearm Rules in Sep 1998 (No:1941). The incidence of non-fatal þrearm injury is comparable to centers involving similar population.