Introduction. Lower limb immobilisation with full casts is commonly used to manage fractures. There may be the need to split casts in an emergency, such as compartment syndrome, with no current consensus as to which technique is most effective in reducing pressure quickly. Our study aims to compare the reduction in pressure across lower leg compartments using three different cast splitting techniques. Methods. This study was done on a volunteer doctor. Pressure sensors were positioned at the anterior, posterior and lateral compartments. A single plaster technician applied below knee full casts with sequential layering and were allowed to dry as per manufacture instructions. Cast were split utilising three splitting methods; bivalve, tramline and single split and measurements taken when each layer was split. We compared results of ten repetitions for each splitting technique. Results. When the cast was initially cut there were significant reduction in pressure with the bivalve split (20.6 ± 0.76 N) when compared to both the single split (26.8 ± 1.13 N, P < 0.001) and tramline split (26.4 ± 0.90 N, P < 0.001). When the cast was spread there were significant reduction in pressure with the bivalve split (10.7 ± 0.83 units) when compared to both the single split (14.6 ± 0.85 N, P < 0.001) and tramline split (16.6 ± 0.77 N, P < 0.001). When the final layer of wool was released the pressure remained lower (statistically significant) in the bivalve split compared to both single split and tramline split. Conclusion. Our study demonstrates that bivalve cast splitting provided a more rapid reduction in pressure compared to other techniques across all three compartments. Our data shows that once down to skin, bivalve splitting continues to provide the lowest pressure compared to the other techniques. We recommend utilising bivalve when splitting a cast in an emergency

In this retrospective study, using the prospectively collected database of the AO-Documentation Centre, we analysed the outcome of 57 malunited fractures of the ankle treated by reconstructive osteotomy. In all cases the position of the malunited fibula had been corrected, in several cases it was combined with other osteotomies and the fixation of any non-united fragments. Patients were seen on a regular basis, with a minimum follow-up of ten years. The aim of the study was to establish whether reconstruction improves ankle function and prevents the progression of arthritic changes.

Good or excellent results were obtained in 85% (41) of patients indicating that reconstructive surgery is effective in most and that the beneficial effects can last for up to 27 years after the procedure. Minor post-traumatic arthritis is not a contraindication but rather an indication for reconstructive surgery. We also found that prolonged time to reconstruction is associated negatively with outcome.