Introduction. Ankle fractures in the elderly have been increasing with an ageing but active population and bring with them specific challenges. Medical co-morbidities, a poor soft tissue envelope and a requirement for early mobilisation to prevent morbidity and mortality, all create potential pitfalls to successful treatment. As a result, different techniques have been employed to try and improve outcomes. Total contact casting, both standard and enhanced open reduction internal fixation, external fixation and most recently tibiotalocalcaneal (TTC) nailing have all been proposed as suitable treatment modalities. Over the past five years popular literature has begun to herald TTC nailing as an appropriate and contemporary solution to the complex problem of high-risk ankle fragility fractures. We sought to assess whether, within our patient cohort, the outcomes seen supported the statement that TTC has equal outcomes to more traditional open reduction internal fixation (ORIF) when used to treat the high-risk ankle fragility fracture. Materials & Methods. Results of ORIF versus TTC nailing without joint preparation for treatment of fragility ankle fractures were evaluated via retrospective cohort study of 64 patients with high-risk fragility ankle fractures without our trauma centre. We aimed to assess whether results within our unit were equal to those seen within other published studies. Patients were matched 1:1 based on gender, age, Charlson Comorbidity Index (CCI) and ASA score. Patient demographics, AO/OTA fracture classification, intra-operative and post-operative complications, discharge destination, union rates, FADI scores and patient mobility were recorded. Results. There were 32 patients within each arm. Mean age was 78.4 (TTC) and 78.3 (ORIF). The CCI was 5.9 in each group respectively with mean ASA 2.9 (TTC) and 2.8 (ORIF). There were two open fractures within each group. Median follow up duration was 26 months. Time to theatre from injury was 8.0 days (TTC) versus 3.3 days (ORIF). There was no statistically significant difference in 30-day, one year or overall mortality at final follow up. Kaplan-Meier survivorship analysis did however demonstrate that of those patients who died post-operatively the mean time to mortality was significantly shorter in those treated with TTC nailing versus ORIF (20.3 months versus 38.2 months, p=0.013). There was no statistical difference in the overall complication rate between the two groups (46.9% versus 25%, p=0.12). The re-operation rate was twice as high in patients treated with TTC nailing however this was not statistically significant. There was no statistical difference in the FADI scores at final follow up, 72.1±12.9 (TTC) versus 67.9±13.9 (ORIF) nor post-operative mobility status. Conclusions. Within our study TTC nailing with an unprepared joint demonstrated broadly equivalent results to ORIF in the management of high-risk ankle fragility fractures; this replicates findings of previous studies. We did however observe that mean survival was significantly shorter in the TTC group than those treated with ORIF. We believe this may have been contributed to by a delay to theatre due to TTC stabilisation being treated as a sub-specialist operation in our unit at the time. We propose that both TTC and ORIF are satisfactory techniques to stabilise the frail ankle fracture however, similarly to the other fragility fractures, the priority should be on an emergent operation in a timely fashion in order to minimise the associated morbidity and mortality. Further randomised control studies are needed within the area to establish definitive results and a working consensus

Management of acetabular fractures in the elderly population remains somewhat controversial in regards to when to consider is open reduction internal fixation (ORIF) versus acute primary total hip. study aims to (1) describe outcome of this complex problem and investigate predictors of successful outcome. This retrospective study analyzes all acetabular fractures in patients over the age of 60, managed by ORIF at a tertiary trauma care centre between 2007 and 2018 with a minimum follow up of one year. Of the 117 patients reviewed, 85 patients undergoing ORIF for treatment of their acetabular fracture were included in the analysis. The remainder were excluded based management option including acute ORIF with THA (n=10), two-stage ORIF (n=2), external fixator only (n=1), acute THA (n=1), and conservative management (n=1). The remainder were excluded based on inaccessible medical records (n=6), mislabelled diagnosis (n=6), associated femoral injuries (n=4), acetabular fracture following hemiarthroplasty (n=1). The mean age of the cohort is 70±7 years old with 74% (n=62) of patients being male. Data collected included: demographics, mechanism of injury, Charlson Comorbidity Index (CCI), ASA Grade, smoking status and reoperations. Pre-Operative Radiographs were analyzed to determine the Judet and Letournel fracture pattern, presence of comminution and posterior wall marginal impaction. Postoperative radiographs were used to determine Matta Grade of Reduction. Outcome measures included morbidity-, mortality- rates, joint survival, radiographic evidence of osteoarthritis and patient reported outcome measures (PROMs) using the Oxford Hip Score (OHS) at follow-up. A poor outcome in ORIF was defined as one of the following: 1) conversion to THA or 2) the presence of radiographic OA, combined with an OHS less than 34 (findings consistent with a hip that would benefit from a hip replacement). The data was analyzed step-wise to create a regression model predictive of outcome following ORIF. Following ORIF, 31% (n=26) of the cohort had anatomic reduction, while 64% (n=54) had imperfect or poor reduction. 4 patients did not have adequate postoperative radiographs to assess the reduction. 31 of 84 patients undergoing ORIF had a complication of which 22.6% (n=19) required reoperation. The most common reason being conversion to THA (n=14), which occurred an average of 1.6±1.9 years post-ORIF. The remainder required reoperation for infection (n=5). Including those converted to THA, 43% (n=36) developed radiographic OA following acetabular fracture management. The mean OHS in patients undergoing ORIF was 36 ± 10; 13(16%) had an OHS less than 34. The results of the logistic regression demonstrate that Matta grade of reduction (p=0.017), to be predictive of a poor outcome in acetabular fracture management. With non-anatomic alignment following fixation, patients had a 3 times greater risk of a poor outcome. No other variables were found to be predictive of ORIF outcome. The ability to achieve anatomic reduction of fracture fragments as determined by the Matta grade, is predictive of the ability to retain the native hip with acceptable outcome following acetabular fracture in the elderly. Further research must be conducted to determine predictors of adequate reduction in order to identify candidates for ORIF

Failed open reduction internal fixation (ORIF) of the proximal femur can render patients severely disabled. This study analyzed the short-term functional results and complications of total hip arthroplasty (THA) for complications of ORIF of the proximal femur. Using the Hamilton Arthroplasty Database, thirty-six patients treated with a THA for complications of ORIF of the proximal femur were compared to a matched cohort. Analysis showed that THA for complications of ORIF of the proximal femur is a successful procedure despite increased intraoperative difficulty that results in comparatively lower short-term Harris Hip Scores. No statistically significant differences in intraoperative or postoperative complications were noted. Open reduction internal fixation (ORIF) of the proximal femur is a common, successful orthopedic procedure. However, failed ORIF of the proximal femur can render patients severely disabled. The purpose of this study is to analyze and compare the short-term functional results and complications of total hip arthroplasty (THA) for complications of ORIF of the proximal femur. After ethics approval, the Hamilton Arthroplasty Registry, a prospective database, was used to identify thirty-seven patients treated with THA for complications of ORIF of the proximal femur. From September 1998 to the present a group consisting of sixteen males and twenty females, with a mean age of sixty-seven, were matched to a cohort of patients treated with a primary THA. Using Wilcoxon Test and Chi-Square Tests, the two groups were compared (p< 0.05). Initially, ORIF was used to treat thirty-six patients for proximal femur fracture. The mean follow-up was 13.5 months. The experimental group had a significantly lower (p=0.035) Harris Hip Score at the one year follow-up, however both groups showed a significant improvement from preoperative scores (p=0.0001). A significant difference was noted between the two groups in estimated blood loss (p=0.01) and operative time (p=0.01). There was no significant difference in complication rate. THA for complications of ORIF of the proximal femur is a successful procedure improving patient’s pain and functional status. This is a more complicated procedure than primary THA, at times requiring the use of a revision stem, which results in significantly lower Harris Hip Scores. Nonetheless, there appears to be no comparative increase in short-term complications

Introduction. Lateral humeral condyle fractures account for 17% of the distal humeral condyle fractures. They affect children between 5 and 10 years of age. Recent reports advocate closed reduction and internal fixation for the less displaced fractures. Methods. We retrospectively reviewed children treated with open reduction internal fixation of these fractures at a single institution over a period of 13 years. All cases of lateral humeral condyle fractures treated with ORIF were identified through the trauma register. Case notes and radiographs were retrieved. Fracture classification, mode of fixation, time to union, and clinical examination at latest follow up were reviewed. Results. 105 lateral condyle fractures were identified. 76 (72%) in boys and 29 (28%) in girls. Average age was 6.2 years. 92 were Milch type 2 and 13 Milch type 1. According to the Jacobs classification for displacement 9 were type I, 33 Type II and 63 type III. All fractures were treated with open reduction and fixation with K-wires. Average time to union (radiologic) was 34 days. Mean follow up was 39 months. Hypertrophy of the lateral condyle in follow up radiographs was documented in 45 cases (42%). Cubitus Varus was documented in 7 cases (7%). None of the children complained of painful range of movement at latest follow up. There was one case of superficial infection of the K-wires and one case of delayed union. Discussion. Open reduction internal fixation is the established management of lateral humeral condyle fractures. This series confirms the consistently good results of open reduction. Compared to recent reports of closed reduction internal fixation, this series demonstrates good results with no complications directly relating to the open reduction technique

The primary aim of this study was to identify risk factors for developing neuritis and its impact on outcome following open reduction internal fixation (ORIF) of distal humerus fractures. Patients were identified from a prospective trauma database (1995–2010). All fractures of the distal humerus (OA-OTA Type A, B, C) managed with ORIF were included. Prospective long-term follow up was collected by telephone. Demographic data, fracture classification, intraoperative details (time to surgery, tourniquet, approach, fixation technique, nerve transposition), subsequent surgeries, presence of postoperative nerve palsy, complications and range of motion were collected. The Broberg and Morrey Elbow Score and DASH score were used as functional outcome measures. Eighty-two patients, mean age 50(range, 13–93) were included. 16% (13/82) developed post-operative ulnar neuritis, 7% (6/82) radial neuritis and 5% (4/82) longterm nonspecific dysaesthesia. Short-term (mean 10 months, range 1–120, collected in 82 patients) and long-term (mean 6 years, range 4–18, collected in 45%, 34/75, of living patients) was completed. In patients with nerve complication: average Broberg and Morrey score was 86 (76% good/excellent), average DASH was 24.7(range, 3.3–100) and Oxford Elbow Score was 39.5(range, 18–48). Compared to: 94 (96% good/excellent), 17.7(range, 0–73.3) and 43.8(range, 17–48) in patients without. Mean pain score was 3.7 in patients with nerve complication compared to 2 without. Nerve complications were seen with increased frequency in young, male patients with high energy and Type C injuries. Nerve complication following ORIF of distal humerus fractures is relatively common. They have detrimental impact on functional outcome. Certain groups appear to be at increased risk

We conducted a prospective randomised controlled trial to compare functional outcomes, complications and reoperation rates in elderly patients with displaced intra-articular distal humerus fractures treated with open reduction internal fixation (ORIF) or primary semi-constrained total elbow arthroplasty (TEA). Twenty-one patients were randomised to each treatment group. Two patients died prior to follow-up and were excluded from the study. Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) scores were collected at six weeks, three months, six months, twelve months and two years. Complication type, duration, management, and treatment requiring reoperation were recorded. Five patients randomised to ORIF were converted to TEA intraoperatively because of extensive comminution and inability to obtain fixation stable enough to allow early ROM. This resulted in fifteen patients (three male, twelve female) with an average age of seventy-seven years in the ORIF group and twenty-five patients (two male, twenty-three female) with an average age of seventy-eight in the TEA group. MEPS was significantly improved at three months (82 vs 65, p=0.01), six months (86 vs 66, p=0.003), twelve months (87 vs 72, p=0.03) and two years (86 vs 73, p=0.04) in patients with TEA compared with ORIF. DASH scores showed a significant improvement for TEA compared with ORIF between six weeks (43 vs 77, p=0.02) and six months (31 vs 50, p=0.01) but not at twelve months (32 vs 47, p=0.1) and two years (34 vs 38, p=0.6). Reoperation rates for TEA (3/25) and ORIF (4/15) were not statistically different (p=0.2). TEA for the treatment of comminuted intra-articular distal humeral fractures provides improved functional outcome compared with ORIF

Background: The best treatment for displaced distal radius fracture is still debated. The aim of our study is to use the PRWE and Euroqol questionnaires to look at patients function at a minimum of 1 year following distal radius fracture. Method: 32 consecutive patients with a Colles-type fracture were treated surgically. 16 were treated with K wires and 16 underwent an open reduction and internal fixation. At a minimum of one year the PRWE and Euroqol questionnaires were filled in. Results: Intra articular and extra articular fractures were equally distributed between the 2 groups. The Euroqol the EQVAS and PRWE scores showed no statistical difference between the 2 groups (respectively p=0.7 CI 95% -0.23 to 0.17; p=0.05 CI -30 to 0.6 and p=0.5 CI 95% -18 to 9.4). Conclusion: Using PRWE and Euroqol, there is no short term functional difference between patients treated with closed reduction and percutaneous wire fixation or open reduction and internal fixation following a distal radius fracture

Determine the infection risk of nonoperative versus operative repair of extraperitoneal bladder ruptures in patients with pelvic ring injuries. Pelvic ring injuries with extraperitoneal bladder ruptures were identified from a prospective trauma registry at two level 1 trauma centers from 2014 to 2020. Patients, injuries, treatments, and complications were reviewed. Using Fisher's exact test with significance at P value < 0.05, associations between injury treatment and outcomes were determined.

Of the 1127 patients with pelvic ring injuries, 68 (6%) had a concomitant extraperitoneal bladder rupture.

All patients received IV antibiotics for an average of 2.5 days. A suprapubic catheter was placed in 4 patients. Bladder repairs were performed in 55 (81%) patients, 28 of those simultaneous with ORIF anterior pelvic ring. The other 27 bladder repair patients underwent initial ex-lap with bladder repair and on average had pelvic fixation 2.2 days later. Nonoperative management of bladder rupture with prolonged Foley catheterization was used in 13 patients. Improved fracture reduction was noted in the ORIF cohort compared to the closed reduction external fixation cohort (P = 0.04).

There were 5 (7%) deep infections. Deep infection was associated with nonoperative management of bladder rupture (P = 0.003) and use of a suprapubic catheter (P = 0.02). Not repairing the bladder increased odds of infection 17-fold compared to repair (OR 16.9, 95% CI 1.75 – 164, P = 0.01).

Operative repair of extraperitoneal bladder ruptures substantially decreases risk of infection in patients with pelvic ring injuries. ORIF of anterior pelvic ring does not increase risk of infection and results in better reductions compared to closed reduction. Suprapubic catheters should be avoided if possible due to increased infection risk later. Treatment algorithms for pelvic ring injuries with extraperitoneal bladder ruptures should recommend early bladder repair and emphasize anterior pelvic ORIF.

To compare the long-term outcomes of fibular nailing and plate fixation for unstable ankle fractures in a cohort of patients under the age of 65 years.

Patients from a previously conducted randomized control trial comparing fibular nailing and plate fixation were contacted at a minimum of 10 years post intervention at a single study centre. Short term data were collected prospectively and long-term data were collected retrospectively using an electronic patient record software.

Ninety-nine patients from one trauma centre were included (48 fibular nails and 51 plate fixations). Groups were matched for gender (p = 0.579), age (p = 0.811), body mass index (BMI)(p = 0.925), smoking status (p = 0.209), alcohol status (p = 0.679) and injury type (p = 0.674). Radiographically at an average of 2 years post-injury, there was no statistically significant difference between groups for development of osteoarthritis (p = 0.851). Both groups had 1 tibio-talar fusion (2% of both groups) secondary to osteoarthritis with no statistically significant difference in overall re-operation rate between groups identified (p = 0.518,). Forty-five percent (n=42) of patients had so far returned patient reported outcome measures at a minimum of 10 years (Fibular nail n=19, plate fixation n=23). No significant difference was found between groups at 10 years for the Olerud and Molander Ankle Score (p = 0.990), the Manchester-Oxford Foot Questionnaire (p = 0.288), Euroqol-5D Index (p = 0.828) and Euroqol-5D Visual Analogue Score (p = 0.769).

The current study illustrates no difference between fibular nail fixation and plate fixation at a long-term follow up of 10 years in patients under 65 years old, although the study is currently under powered.

Advancements in treating distal humerus fractures. We will review and discuss approaches to the elbow to treat different types of fractures. We will discuss the role of soft tissue structures and how they affect elbow function. During this session, we will review the latest techniques for treating the complex articular fractures of the distal humerus to include capitellar and trochlear fractures. Techniques presented will address fixation, reconstruction, and salvaging of complex distal humerus fractures.

Neglected fractures of the femoral neck, common in young adults in underdeveloped countries, may be complicated by nonunion or avascular necrosis (AVN). We treated 52 cases by open reduction, fixation by compression screw and a free fibular graft. The mean delay between injury and operation was 5.1 months. Of 40 fractures assessed at a mean of 58.8 months (24 to 153), 38 were found to be united and two, owing to surgical errors, were not. Seven of eight heads which were avascular before operation revascularised without collapse, while seven others developed AVN after the procedure. At the last follow-up considerable collapse was apparent in five femoral heads, and 11 hips had developed coxa vara. The fibular graft had fractured in four cases. The hip had been penetrated by the screw in six cases and by the graft in three. Hip function was excellent in seven patients, good in 21 and fair in seven. Five patients had poor results. Incorporation of the fibular graft was seen after four years: in many cases the graft had been almost completely resorbed.

We recommend this procedure for the treatment of neglected fractures of the neck of the femur in young adults to reduce resorption of the neck, AVN and nonunion.

Aim: This retrospective study presents the results of humeral pseudarthrosis management, in our clinic, during the period 1997–2002. Material: 21 patients with humeral pseudarthrosis were treated during this period. 7 were men, with an average age of 48, 6 (range 22–63) and 14 were women, with an average age of 63, 3 (range 42–80). The initial treatment in 19 cases was conservative and in 2 cases surgical (internal fixation with plate – screws or intramedullary nailing). The average time of the humeral pseudarthrosis management was 5,9 months (4–10 months).3 pseudarthrosis were oligotrophic and 18 atrophic. Method: All patients underwent an open reduction, internal fixation and bone grafting (autografts and/or allografts).In humeral shaft pseudarthrosis a wide plate was applied, while in superior humeral metaphysis pseudarthrosis, a T-plate. In all cases impaction of the fracture edges was achieved. Results: The average follow-up was 40,2 months (range 4–68 months).Union was achieved in all cases in an average of 2,8 months (range 2–8 months). Direct postoperative mobilisation and physical therapy was applied in 20 cases and only in 1 case a “Sarmiento” splint was applied for 3 weeks. In 2 cases a postoperative haematoma presented. In 1 case a pre-existed paresis of the radial nerve after the initial treatment of the fracture with internal fixation, came back 3 months after the management of pseudarthrosis and the release of the nerve. All patients’ revealed good functional rehabilitation, about 85–90% compared with the normal arm. Arm shortening in no case was greater than 2 cm. Conclusion: Open reduction and internal fixation is the treatment of choice in the management of the humeral pseudarthrosis. The impaction of the fracture edges into each other strengthens significantly the stability of the fracture and promotes union

Background. Studies have compared open reduction internal fixation (ORIF) with fibular nail fixation (FNF) and shown reduced wound complications with minimal difference to PROMS in the short term. Our aim is to compare long-term outcomes for unstable ankle fractures at 10 year follow up. Methods. Patients from a previously conducted RCT were contacted at a minimum of 10 years post intervention at a single study centre. Case notes were reviewed, and patient reported outcome measures acquired at 10 years. Results. Ninety-nine patients were included (48 FNF and 51 ORIF). After 10 years 75% (33/44) of patients in the FNF group required no further follow up versus 81% (39/48) in the ORIF group. Radiographically at 2 years post-injury, there was no statistically significant difference between groups for development of osteoarthritis (p=0.851). There was one tibio-talar fusion in each group secondary to osteoarthritis, but no statistically significant difference in overall re-operation rate (p=0.518). Fifty-one percent (n=50) of patients have so far returned patient reported outcome measures at a minimum of 10 years (Fibular nail n=23, plate fixation n=27). No significant difference was found between groups for the mean scores of Olerud and Molander Ankle Score (FNF 84.78 vs ORIF 84.07; p=0.883), the Manchester-Oxford Foot Questionnaire (MOXFQ) (FNF 89.54 vs ORIF 96.47; p=0.112), Euroqol-5D Index (FNF 0.88 vs ORIF 0.87; p=0.701) and Euroqol-5D Visual Analogue Score (FNF 77.30 vs ORIF 77.52; p=0.859). Conclusion. The current study illustrates that both methods of treatment result in a satisfactory long-term outcome with no difference in late complications or PROM scores at up to 10 years in patients under 65 years old, although the study is currently under powered

Over a seven-year period we treated a consecutive series of 58 patients, 20 men and 38 women with a mean age of 66 years (21 to 87) who had an acute complex anterior fracture-dislocation of the proximal humerus. Two patterns of injury are proposed for study based upon a prospective assessment of the pattern of soft-tissue and bony injury and the degree of devascularisation of the humeral head. In 23 patients, the head had retained capsular attachments and arterial back-bleeding (type-I injury), whereas in 35 patients the head was devoid of significant soft-tissue attachments with no active arterial bleeding (type-II injury). Following treatment by open reduction and internal fixation, only two of 23 patients with type-I injuries developed radiological evidence of osteonecrosis of the humeral head, compared with four of seven patients with type-II injuries. A policy of primary treatment by open reduction and internal fixation of type-I injuries is justified, whereas most elderly patients (aged 60 years or over) with type-II injuries are best treated by hemiarthroplasty. The best treatment for younger patients (aged under 60 years) who sustain type-II injuries is controversial and an individualised approach to their management is advocated

Background: Complex anterior fracture-dislocations of shoulder are rare injuries and little is known about the functional outcomes following operative treatment. The aim of our study was to evaluate the functional outcomes following open reduction and internal fixation for these injuries. Methods: Over a ten and a half year period, we studied thirty-two consecutive patients who presented to shoulder injury clinic at the Royal Infirmary of Edinburgh with an acute Type-I complex anterior fracture-dislocation of the shoulder. The average age of the 19 men and 13 women was 58 years (range 21–81 years). All patients were treated with open reduction and internal fixation and were followed up for at least two years. The functional outcomes were assessed by three scoring systems (Disabilities of the Arm, Shoulder and Hand questionnaire, the Constant questionnaire, and the Short Form-36 general health questionnaire). Results: At two years post injury, the median DASH score was 26 points and the median Constant score was 83.5 points. The range of motion of the shoulder joint showed significant improvement throughout the two year period and degree of forward flexion and abduction continued to show significant improvement at five years. At two years, the mean forward flexion was 162°, mean extension was 152°, mean internal rotation was 109° and mean external rotation was 73°. All but one patient returned to their job at two years. Conclusions: Type I complex anterior fracture-dislocations of the shoulder are rare and occur in the middle age and elderly group of population. Following open reduction and internal fixation, the functional outcomes have been shown to be satisfactory. We recommend that open reduction and internal fixation should be the first choice of treatment in Type-I complex anterior fracture-dislocation of shoulder

Abstract. Background. The incidence of periprosthetic fractures of the femur around a total knee arthroplasty (TKA) is rising and this is owed to the increased longevity that today's TKA implants allow for, as well as an aging population. These injuries are significant as they are related to increased morbidity and mortality. Methods. We retrospectively reviewed all periprosthetic fractures around a TKA that presented to our NHS Trust between 2011 to 2020. Medical records were reviewed. Treatment, complications and mortality were noted. Results. 37 patients (34 females) with an average age of 84 (range 65–99) met the inclusion criteria for this study. 17 patients (45.9%) underwent open reduction and internal fixation (ORIF), eight patients (21.6%) underwent revision arthroplasty to a distal femoral replacement (DFR) and 12 patients (32.4%) were treated non-operatively. 10 (58.8%) of the 17 patients that were treated with ORIF were discharged from hospital to a rehabilitation facility rather than their usual residence. In comparison, 3 (37.5%) of the patients that were treated with a DFR were discharged to a rehabilitation facility. one-year mortality rate in the ORIF group was 29.4 compared to 12.5% in those that had a DFR. Conclusion. Revision arthroplasty using a DFR should be considered in patients with periprosthetic fractures around a TKR, as it is associated with lower mortality rates and higher immediate post-operative function

We have previously reported that fibular nailing in the elderly is associated with a significantly reduced complication rate and greater cost-effectiveness when compared to ORIF. The aim of this study was to compare the outcomes of fibular nailing to ORIF in patients under the age of 65.

100 patients aged 18 to 64 were randomly allocated between groups. Outcomes assessed over two years post-operatively included: development of wound complications or radiographic arthritis, the accuracy of reduction and patient satisfaction. The mean age was 44, 25% of patients were smokers and 35% had some form of comorbidity of whom three were diabetic. 27 injuries occurred after sport and two after assault the remainder occurred after a simple fall from a standing height.

Superficial wound infections occurred in two patients in each group. Six patients requested removal of the nail, and six patients requested plate and screw removal. Patient reported outcome scores were comparable for the two groups. Two failures of fixation occurred in the fibular nail group; one in a patient with neuropathy. One failure of fixation occurred in the ORIF group. All other patients went on to an anatomical union without complication. Patient satisfaction with the surgical scar was higher after fibular nailing (visual analogue scale mean 0.75, range 0–5) than for ORIF (mean 1.5, range 0–7).

The fibular nail allows accurate reduction and secure fixation of ankle fractures with comparable radiographic and patient-reported outcomes to ORIF at two years and a greater patient satisfaction with the appearance of the surgical scars.

Purpose: Fractures of the calcaneus remain a significant clinical challenge. Little study has been done to investigate the potential benefit of bone graft in the treatment of these fractures. The purpose of this study is to compare the clinical outcome of calcaneus fractures treated with and without ICBG.

Method: In an ongoing study at a Level I Trauma Center 45 patients with calcaneus fractures requiring operative management were enrolled in a prospective, randomized study. 24 patients were randomized to ORIF without graft (control) and 24 patients were randomized to ORIF with ICBG (study group). Demographic, intra-operative and long term clinical outcome data was collected. Outcome measures included pain scores, Creighton-Nebraska Foot Scores, time to weight bearing, return to work and wound complications.

Results: The groups showed no differences in gender, age, mechanism of injury, fracture classification or time to surgery (avg. 12 days). Tscherne scores at presentation differed, with higher average scores in the control group. There were 2 open fractures in each group. The groups showed no statistically significant differences in any of the clinical outcome measures. There was no difference in pain scores (control mean 2.6 vs. study mean 4.1, p = 0.1), Creighton-Nebraska Scores (control 71 vs. study 55, p = 0.1), time to weight bearing (control 2.6 months vs. study 2.7 months, p = 0.9). At 6 months 38% of controls had returned to work (with 87% of those returning to the some occupation) while 39% of the study group returned to work (71% to same occupation). An overall wound complication rate of 27% was seen with 30% of controls and 24% of study patients exhibiting wound issues.

Conclusion: In this prospective randomized study, patients treated with ORIF for calcaneus fractures showed no difference in clinical outcomes with or without the addition of ICBG. No clear benefit is demonstrated to warrant the additional operative time, pain and possible complications that have been previously documented to be associated with ICBG.

Background. Outcome of Type II and III (Sander's CT classification) fracture of the calcaneum who underwent open reduction and internal fixation was assessed. Methods. Thirty-three type II and III fractures of the calcaneum (all unilateral) underwent open reduction and internal fixation using the ‘extensile lateral approach’. There were twelve Type II and twenty-one Type III fractures. Patients were followed up for a mean of 40.81 months (Range 28 to 62 months). Patients were assessed clinically by the Creighton Nebraska Health foundation score for assessment of fractures of the calcaneum. Radiologically assessment was done comparing the pre and post operativeBohler's and Gissane angles and measuring the calcaneal width on the axial xrays. Results. Nineteen patient were classified as excellent and 14 as good. There were no poor or fair results. The mean correction of Bohler's angle was 5.6 +/− 7.2 and the Gissane'sanglecorrected by 7.8 +/−5.8 °. Superficial skin necrosis was the most common complication encountered (3 patients). Two patients preferred removal of the implant after fracture union due to prominent hardware. Conclusion. Open reduction Type II and III intra – articular calcaneal fractures is associated with minimal complications and gives reproducible results, especially in young adults

A total of 179 adult patients with displaced intra-articular fractures of the distal radius was randomised to receive indirect percutaneous reduction and external fixation (n = 88) or open reduction and internal fixation (n = 91). Patients were followed up for two years. During the first year the upper limb musculoskeletal function assessment score, the SF-36 bodily pain sub-scale score, the overall Jebsen score, pinch strength and grip strength improved significantly in all patients. There was no statistically significant difference in the radiological restoration of anatomical features or the range of movement between the groups. During the period of two years, patients who underwent indirect reduction and percutaneous fixation had a more rapid return of function and a better functional outcome than those who underwent open reduction and internal fixation, provided that the intra-articular step and gap deformity were minimised