Timely and competent treatment of paediatric fractures is paramount to a healthy future working population. Anecdotal evidence suggests that children travel greater distances to obtain care compared to adults causing economic and geographic inequities. This study aims to qualify the informal regionalization of children's fracture care in Ontario. The results could inform future policy on resource distribution and planning of the provincial health care system. A retrospective cohort study was conducted examining two of the most common paediatric orthopaedic traumatic injuries, femoral shaft and supracondylar humerus fractures (SCH), in parallel over the last 10 years (2010-2020) using multiple linked administrative databases housed at the Institute for Clinical Evaluative Sciences (ICES) in Toronto, Ontario. We compared the distance travelled by these pediatric cohorts to clinically equivalent adult fracture patterns (distal radius fracture (DR) and femoral shaft fracture). Patient cohorts were identified based on treatment codes and distances were calculated from a centroid of patient home forward sortation area to hospital location. Demographics, hospital type, and closest hospital to patient were also recorded. For common upper extremity fracture care, 84% of children underwent surgery at specialized centers which required significant travel (44km). Conversely, 67% of adults were treated locally, travelling a mean of 23km. Similarly, two-thirds of adult femoral shaft fractures were treated locally (mean travel distance of 30km) while most children (84%) with femoral shaft fractures travelled an average of 63km to specialized centers. Children who live in rural areas travel on average 51km more than their adult rural-residing counterparts for all fracture care. Four institutions provide over 75% of the fracture care for children, whereas 22 institutions distribute the same case volume in adults.?. Adult fracture care naturally self-organizes with proportionate distribution without policy-directed systemization. There is an unplanned concentration of pediatric fracture care to specialized centers in Ontario placing undue burden on pediatric patients and inadvertently stresses the surgical resources in a small handful of hospitals. In contrast, adult fracture care naturally self-organizes with proportionate distribution without policy-directed systemization. Patient care equity and appropriate resource allocation cannot be achieved without appropriate systemization of pediatric fracture care

Tibial shaft fractures co-existing with osteoarthritis can increase the challenges for the orthopedic surgeon. The novel Londhe-Shah technique manages both the problems using one-stage total knee arthroplasty with a long stemmed tibial component which has a good diaphyseal fit. Three osteoarthritis patients with fractures of tibial shaft were treated with this technique and were followed up at 6-weeks, 12-weeks and 1-year (figure 1–3). A complete union of the fractured segment was achieved at follow-up without any adverse events such as infection, damage to the implant, and soft-tissue injury during and after surgery. The American Knee Society Score (AKSS) improved and WOMAC pain and stiffness scores reduced at follow-ups suggesting excellent improvement in functionality and patient satisfaction. One-stage TKR with a long-stem extension of the tibial component to bypass the fracture site mends and stabilises the fracture along with the adverse biomechanics at the fracture site while also correcting the arthritis. The single stage procedure allows early ambulation in six weeks. For any figures or tables, please contact the authors directly

Introduction. We have investigated the long-term (minimum follow-up period; 10 years) clinical results of the total hip arthroplasty (THA) using K-MAX HS-3 tapered stem. Materials and Methods. In K-MAX HS-3 THA (Kyocera Medical, Kyoto, Japan), cemented titanium alloy stem and all polyethylene cemented socket are used. This stem has the double tapered symmetrical stem design, allowing the rotational stability and uniform stress distribution. The features of this stem are; 1. Vanadium-free high-strength titanium alloy (Ti-15Mo-5Zr-3Al), 2. Double-tapered design, 3. Smooth surface (Ra 0.4µm), 4. Broad proximal profile, 5. Small collar. Previous type stem, which was made of the same smooth-surface titanium alloy, has the design with cylindrical stem tip, allowing the maximum filling of the femoral canal. Osteolysis at the distal end of the stem had been reported in a few cases in previous type with cylindrical stem tip, probably due to the local stress concentration. Therefore the tapered stem was designed, expecting better clinical results. 157 THAs using HS-3 taper type stem were performed at Kitano Hospital between March 2004 and March 2008. And 101 THAs, followed for more than 10 years, were investigated (follow-up rate; 64.3%). The average age of the patients followed at the operation was 61.7 years and the average follow-up period was 10.9 years. The all-polyethylene socket was fixed by bone cement, and the femoral head material was CoCr (22mm; 5 hips, 26 mm; 96 hips). Results. Two hips were revised, one was due to late infection, and the other due to breakage of the implant in trauma. Japanese orthopaedic association (JOA) score improved from 40 to 86 points. Postoperative complication was three periprosthetic fractures (one femoral shaft fracture and two greater trochanteric fractures) and femoral shaft fracture case was operated. Dislocation was not observed. Socket loosening (Hodgkinson, Type 3, 4) and stem loosening (Harris, definite and probable) were not observed radiographically. Cortical hypertrophy was observed in 7.9%. The survival rate of HS-3 tapered stem was 98% for revision due to any reason and 100% for revision due to aseptic loosening. Discussion. The long-term clinical results of K-MAX HS-3 tapered stem were excellent. The osteolysis at the stem tip was not observed in this type, which was observed in a few cases in previous type. From the X-ray finding, it was suggested that this taperd stem had more uniform stress distribution to the femoral bone than previous type. Moreover, the problems associated with titanium alloy usage were not observed. From the present investigation, good farther long-term results of the tapered titanium stem were expected

Background:. There is limited evidence regarding HIV infection as a risk factor for delayed union and implants sepsis in patient with fractures treated with surgical fixation. Most studies have included patient with a variety of different fractures and hence very different risks regarding delayed union and implant sepsis. We have looked at a single fracture, closed femoral shaft fractures treated with intramedullary nailing, to see if HIV infection is a risk factor with for the development of delayed union and implant sepsis. We present a prospective study of 160 patients with closed femoral shaft fractures treated with intramedullary nailing. Primary outcomes were delayed union of more than 6 months and implant sepsis in the first 12 months. Methods:. From February 2011 until November 2012 all patient with closed femoral shaft fractures treated at our hospital were included in the study. Patients were tested for HIV infection and a number of clinical parameters were documented, including: AO fracture score, duration of surgery, level of training of surgeon, comorbidities, CD4 count, high energy injury and number of operations. Results:. Forty (25%) patients were HIV positive. Seven patients had CD4 counts below 350 cells/µL and 12 patients were on ARV's. Four (3%) patients developed implants sepsis and of these 1 (25%) was HIV positive. Two (1%) patients had a delayed union of more than 6 months and both these patients were HIV negative. Conclusion:. HIV is not a risk factor for delayed union and implant sepsis in the first 12 months after surgery. Intramedullary nailing is a safe and effective in the treatment of HIV positive patients with closed femur fractures

Introduction. Failed operated intertrochanteric fractures (with screw cutout, joint penetration, varus collapse, nonunion, or femoral head avascular necrosis) pose treatment dilemmas. The ideal approach is re-osteosynthesis with autologous bone grafting. When the femoral head is unsalvageable, conversion to a prosthetic hip replacement is necessary. Materials/Methods. Thirty-seven patients with failed dynamic hip screw fixation (and unsalvageable femoral heads) were treated with cementless hip arthroplasty (13 underwent Bipolar Arthroplasty, 24 had Total Hip Arthroplasty) over a 5-year period (Dec 2005 to Nov 2010). Seven needed a modified trochanteric split, and the rest were managed by standard anterolateral approach. Abductor mechanism was reconstructed using strong nonabsorbable sutures (ethibond 5) or stainless steel wires. The calcar was partially reconstructed using remnant femoral head and cerclage wiring in a few cases. Results. Clinico-radiological assessment was done at three, six, 12 months and yearly thereafter over an average 36 months (range, three to 60 months). Stem loosening, lysis, subsidence and trochanteric union were studied. At last follow-up, one patient had died, and there were two instances each of stem subsidence and trochanteric nonunion. Clinical results using Harris hip scores were good or excellent. Conclusion. Management of nonsalvageable femoral heads after failed intertrochanteric fracture fixation is possible with cementless hip arthroplasty. Successful outcomes depend on functional abductor reconstruction, fracture and femoral shaft penetration prevention. Autograft, allograft or head/neck replacement components are necessary sometimes

Fractures of the shaft of the humerus are often treated conservatively in a hanging cast or a humeral brace. The conservative management of this fracture is often prolonged and quite uncomfortable for the patient. Some of the patients will need an operative fixation after a trial of conservative management. We retrospectively looked at 72 consecutive patients with fractures of the shaft of the humerus that presented in our institution over a period of two years. The fracture pattern, treatment modality time to union and the number that needed operative fixation following a trial of conservative treatment was analysed. Of the 72 patients 4 were lost to follow-up. 45 patients had a 1.2.B or 1.2.C type of fracture and 23 had a 1.2.A type of fracture. 29 (41%) were successfully treated conservatively, 11 (16%) patients were operated as the primary procedure and 15 (22%) patients were operated due to delayed or non union. 13 (19%) patients were operated within 4 weeks of the fracture as their alignment was not acceptable on their weekly follow-up. The average time to union in the patients treated conservatively was 22 weeks, while that of the patients treated primarily by open reduction and plating was 14 weeks (p-value<0.05). Patients who needed operation after initial conservative management required prolonged period of rehabilitation and union time was 32.2 weeks. At the time of fracture union 72% of the patients who had been treated conservatively had joint stiffness requiring physiotherapy, while only 18% of those who had an open reduction and internal fixation had stiffness and required physiotherapy. (p-value < 0.05). In conclusion careful consideration should be given before it is decided to treat this fracture conservatively especially in the case of 1.2.A fracture pattern

Successful ORIF of proximal humeral fractures requires a careful assessment of the patient factors (age/osteoporosis/functional expectations), accurate identification the fracture segments (head/shaft/tuberosities) and accessory factors which are of vascular and surgical relevance (length of posteromedial metaphyseal head extension, integrity of medial soft tissue hinge, head split segments, tuberosity/head segments impacted to-gether or distracted apart). Fixation of the fracture can be achieved by a number of techniques because of the multiple factors that often apply—numerous techniques are usually required of the surgeon. The principles of fixation require accurate restoration of the head and tuberosity orientation, fixation of the metaphyseal segments (tuberosities) results in a stable circular platform on which the head segment rests. Thus, the fixation of choice acts as a load sharing device not a load bearing device. This fixation is often augmented with tension band and circlage suture fixation. These concepts are especially applicable to the osteoporotic patient. The order of fixation requires that the medial hinge not be disrupted. If it is disrupted in the younger patient it requires fixation first. All tuberosity segments are tagged with ethibond sutures. The head and the largest tuberosity segment are reduced and held with k-wire or canulated scews, avoiding the central medullary canal entry point. If the head tuberosity segment is unstable in relation to the shaft, the fixation implant of choice (plate/intramedullary) is chosen and the head/tuberosity complex is reduced to the shaft. Depending on the fracture segments and the degree of comminution this may require compression of distraction. Post-op the patient is immobilised in external rotation to balance the cuff forces. If very rigid fixation is achieved then early mobilisation is undertaken to minimise the adhesions due to opening of the subdeltoid space. If fixation is tenuous movement is commenced a 3–4 weeks. AVN of the humeral head with good tuberosity head architecure can be salvaged. The diagnosis of AVN is determned at three months with a MRI and consideration given to Zolidronate therapy. Post-traumatic stiffness with good architecture can be salvaged with an arthroscopic capsular release

Introduction. Primary wound closure in open tibial fractures has not been recommended. Traditionally initial debridement with fracture stabilisation and delayed wound closure was the accepted treatment. However this practice was developed before the use of prophylactic intravenous antibiotics and improved techniques for fracture stabilisation. Studies suggest that infections are not caused by the initial contamination but the organisms acquired in the hospital. Subsequent primary wound closure after adequate wound care and fracture stabilisation should be a safe concept and should not increase the rate of complications. Material/methods. In a retrospective study we analysed 95 patients with open tibial fractures Gustilo-Anderson Type 1-3a treated at two different teaching hospitals with primary fracture stabilisation and delayed wound closure as group I and primary fracture stabilisation and primary wound closure as group II. Exclusion criteria to the study were the following conditions: Grade 3b and 3c fractures, polytrauma, other fractures, significant medical history, previous surgery 6 months prior to admission. In group I 46 patients (38 males, 8 females) with a mean age of 30.2 years (16-56) were included. 19 sustained Grade 1 open, 16 Grade 2 open, 4 Grade 3a open and 7 gunshot fractures to the shaft of the tibia. In group II 49 patients (36 males, 13 females) with a mean age of 33.4 (18-69) were included. 19 sustained Grade 1 open, 19 Grade 2 open, 3 Grade 3a open and 8 gunshot fractures. The mean follow-up in group 1 was 11.5 (9-18) and 11.7 (8-16) months. The criteria for post-operative infection were clinical/radiological. Results. The mean operating time in group 1 was 96 (45-180) minutes, in group II 101 (40-170) minutes. The hospital stay in group 1 was 8.6 (3-20) days and in group 2 15.4 (4-52) days. One infectious case in group 1 was seen (2%) and two cases in group 2 (4.3%) were found. On further analysis one case in group 2 in our opinion should not have been treated with primary fixation and wound closure. He only had 3 doses of a first generation cephalosporin and was operated 20 hrs after admission to hospital. The corrected sepsis rate in group 2 should therefore should be calculated without that case and then is 2.1%. Discussion. Our results support recent findings that primary wound closure after thorough debridement in Grade 1+2 open fractures does not increase the infection rate in comparison to the standard treatment. It shortens hospital stay and is cost effective treatment. We conclude that primary wound closure is safe. Prospective multicentre studies are needed to further evaluate and result in change of the current practice

Although there is strong evidence that bisphosphonates prevent certain types of osteoporotic fractures, there are concerns that they may be associated with rare atypical femoral fractures. 1480 patients of proximal femur and shaft fractures over a period of 2 years from Jan 2014 to Jan 2016 were retrospectively reviewed in Gloucestershire Hospitals NHS trust. Hospital trauma database was used.195 patients had fractures in subtrochancteric and femoral shaft area. 11 patients had atypical femur fractures as defined by American society for bone and mineral research (ASBMR) task force 2013, revised criteria. Ten were female, one was male. Patients were aged from 68 to 97. In 6 patients, fractures were in the shaft, 5 in subtrochancteric area and 4 patients out of these had bilateral fractures. 10 out of 11 patients were on bisphosphonates. 4 patients had delayed diagnosis. 5 out of 11 patients did not have contralateral femoral x-rays. Treatment, 9 patients had intramedullary nail, one blade plate, and one treated conservatively. One patient in the IM group, had bilateral nailing. Average follow up was 7.6 months (range 1 to 16 months). At the end of the study, only 4 had united, 6 had not united and one not followed up. 4 out of 7 had low Vitamin D levels, 3 out of 7 had their bisphosphonate treatment stopped and 2 had histology which showed necrotic bone with trabeculae surrounded by fibrosis. Increasing number of patients are on bisphosphonates for osteoporosis. Atypical femur fractures from bisphosphonates are often occult, often bilateral, with delayed healing. Patients on bisphosphonatetreatment should be advised to report any thigh or groin pain. Painful incomplete fractures need treatment with cephalomedullary nailing. Bone biology needs correcting by stopping bisphosphonatesand administering calcium & vitamin D supplements. Implications: We need to raise awareness amongst treating clinicians and have national guidelines

Introduction. Internal fixation of pertrochanteric fractures is evolving as newer implants are being developed. Proximal Femoral Nail Antirotation (PFNA) is a recently introduced implant from AO/ASIF designed to compact the cancellous bone and may be particularly useful in unstable and osteoporotic hip fractures. This study is a single and independent centre experience of this implant used in management of acute hip fractures. Methods. 68 patients involving 68 PFNA nailing procedures done over a period of 2 years (2007–09) were included in the study. Average follow-up period of patients was 1 year. AO classification for trochanteric fractures was used to classify all the fractures. Radiological parameters including tip-apex distance and neck shaft angle measurement were assessed. Results. Average age of patients included in the study was 80 years. 18 patients died during the follow up period due to non-procedure related causes. Average tip-apex distance was 12.7 mm and radiological fracture union time was 5 months. Revision of short to a long PFNA was needed for periprosthetic fracture of shaft of femur in two patients. Two patients needed a complex total hip replacement eventually and further two patients had removal of the implant due to PFNA blade penetration through the femoral head. Discussion. PFNA is a technically demanding procedure and has a learning curve. Our experience shows that it is a useful implant in unstable pertrochanteric fracture fixation. A close radiological and clinical follow up is recommended due to the risk of late fracture and implant related complications

Current health economics forces the clinician to consider the cost of treatment. Currently in Fife Hospitals, all lower limb injuries likely to require operative treatment are admitted from the Accident and Emergency department on the day of injury. The aim of this investigation was to see if non-emergency trauma cases could be managed pre-operatively as outpatients to reduce costs. We prospectively recorded all patients admitted with lower limb trauma excluding neck of femur fractures, requiring operative treatment over an eleven-week period. The senior author reviewed all patients and a clinical judgment was made as to whether the patient could have been safely managed as an outpatient pre-operatively. 61 patients met the inclusion criteria. Average age 41.8 (Range 8-66). The three most common fractures were 23(38%) ankle fractures, 15(25%) tibial fractures and 8(13%) femoral shaft fractures. 28(46%) fractures were deemed safe to have been managed preoperatively on an outpatient basis. 14/23(61%) ankle fractures were deemed safe to be discharged home. The average pre-operative stay was 1.38 nights (Range 1-4 nights). By initiating a simple policy of allowing uncomplicated ankle fracture patients to wait at home and return on the morning of surgery it is possible to reduce inpatient occupancy by 64 nights per year in our department. At a cost of £518 per patient per night, this could result in a saving of around £33,000 in unnecessary overnight inpatient stays. In order to achieve this, clear clinical guidance for admitting doctors is necessary and further prospective research should be conducted into the risk/benefit of implementing this policy

Aim. The aim of this study was to compare the results of humerus intramedullary nail (IMN) and dynamic compression plate (DCP) for the management of diaphyseal fractures of humerus. Material & methods. 47 patients with diaphyseal fracture of shaft humerus were randomised prospectively and treated by open reduction and internal fixation with IMN or DCP. The criteria for inclusion were Grade 1.2a compound fractures; Polytrauma; Early failure of conservative treatment; Unstable fracture. Patients with pathological fracture, Grade 3 open fracture, refracture or old neglected fracture of humerus were excluded from the study. 23 patients underwent internal fixation by IMN and 24 by DCP. Reamed antegrade nailing was done in all cases. DCP was done through an anterolateral or posterior approach. Results. The outcome was assessed in terms of union time, union rate, functional outcome and incidence of complications. Functional outcome was assessed using the American Shoulder and Elbow Surgeons Score (ASES). On comparing the results by independent samples t test, there was no significant difference in ASES score between the two groups. The average union time was found to be significantly lower for IMN compared to DCP(P<.05). The union rate was found to be similar in both the groups. Complications like infection were found to be higher with DCP compared to IMN, while shortening of the arm (1.5-4cm) and restriction of shoulder movements due to impingement of the nail were found to be higher with DCP compared with IMN. However, this improved in all patients following removal of the nail once the fracture healed. Conclusion. This study proves that IMN can be considerd as a better surgical option for these fractures as it offers shorter union time and less incidence of serious complications like infection. However, there appears to be no difference between two groups in union rate and functional outcome

Background. Identification of novel therapeutics to accelerate acute fracture healing remains critical. A prostaglandin EP-2 receptor agonist (CP-533,536) has demonstrated acceleration of fracture healing in preclinical models. The objective of this study is to assess the efficacy of a single dose of CP-533,536 in subjects with a closed fracture of the tibial shaft using radiographic measurements compared to placebo treatment. Methods. In a phase II randomised, blinded, placebo-controlled trial, the efficacy of a single local injection of three doses of CP-533,536 (0.5mg, 1.5mg and 15mg) was compared to a placebo and a standard of care arm in patients with closed tibial shaft fractures. The tibial fractures were treated with reamed inter-locked intramedullary nails. Patients were followed at two week intervals to six months with a final evaluation at one year. Fracture healing was independently adjudicated by a radiologist panel and an orthopaedic surgeon panel. Results. Ninety-nine patients were enrolled ranging from 17-76 years in age. Baseline characteristics were comparable across treatment groups. No statistically significant differences in median healing time between any of the CP-533,536 treatment groups and placebo were observed based on the radiology panel assessment; however, significant differences were demonstrated by an orthopaedic panel. At weeks 8, 10, 12, 14 and 16 a higher percentage of subjects in the CP-533,536-1.5 and 0.5 mg groups were considered healed compared to the placebo and the 15 mg groups by the orthopaedic panel assessment. Moreover, the CP-533,536- 0.5 mg group showed a statistically higher (p=0.05) mean radiographic healing score than placebo treated group at weeks 8, 14, 16, 18, and 24. Conclusion. CP-533,536 demonstrated accelerated healing in patients with acute tibia fractures by an orthopaedic panel. Confirmatory trials are required to assure validity of the observed treatment effects

Hip fractures accounts to about 86000 cases per annum in UK. AP and Lateral radiographs form an essential investigation in planning the management of these fractures. Recently it has been suggested that lateral view doesn't provide any additional information in majority of the cases. We looked retrospectively at 25 consecutive radiographs with intracapsular and extracapsular fracture neck of femur each presenting to our department between May 2010 and January 2011. These radiographs were put on the CD in 2 folders as AP and Lateral. It was reviewed by 2 Observers who suggested their preferred treatment. The results were compared for the intra observer agreement to assess the necessity of the lateral view of the radiographs. We also compared the treatment options with the gold standard and looked at the interobserver agreement. Of the 50 set of radiographs that were reviewed, Observer 1 had disagreed with himself on one occasion (98%agreement) compared to the Observer 2 who had two disagreements (96% agreement). When analyzing the intracapsular fractures, we found 100% agreement of OBSERVER 1 with himself when proposing treatment on AP and Lateral View. Whereas, OBSERVER 2 had only one disagreement. It gave us a Free marginal kappa value of more than 0.70 indicating excellent agreement. One difference doesn't have any statistical significance. In the extracapsular fractures, Kappa values ranged from 0.413 to 0.88. OBSERVER 1 did change his opinion after reviewing the lateral view but generally had good outcome (K=0.88). Whereas, the opinion of OBSERVER 2 was unaffected by the Lateral view. The X-ray diagnoses by OBSERVER 1 and OBSERVER 2 had only moderate agreement (K=0.52 (AP) and 0.57 (Lat). Comparing the observer opinion to the gold standard (operation performed) showed moderate agreement both on AP and Lateral view (OBSERVER 1 AP and Lat both K=0.64, OBSERVER 2 AP and Lat both K=0.41). The Lateral view failed to change the opinion of the observers (K > 0.7) but there was moderate to excellent agreement between the observers and observer vs operation (The Gold Standard) with kappa value of more than 0.52. We feel that the Lateral view doesn't make any difference in most of the cases as shown by a good intra-observer agreement. However, we cannot completely rule out their importance and they should be performed in occult fractures, pathological fractures, fractures extending into the shaft, young patients, and on the request of physician

Tibial shaft fractures have a high incidence of delayed and non-union, often requiring multiple procedures. Pulsed electromagnetic field (PEMF) stimulation is a safe and effective treatment for tibial non union but little is known about the efficacy of PEMF in preventing non-union in acute fractures. Between August 2005 and December 2008, eligible patients presenting at six major metropolitan hospitals with acute tibial shaft fractures (AO classification 4-2) were included. Participants were randomised by an independent allocation centre to identical active or inactive PEMF devices, both prescribed to be worn ten hours daily for twelve weeks. Baseline data were collected, and patients and surgeons were surveyed serially via post and/or phone at three, six and twelve months. Participants, data collectors and data analysts were blinded. The main outcome was any surgical intervention for delayed/non union. Data from 150 patients (76 active and 74 inactive) were available for analysis (12 month follow up 78%). There was no between-group difference in age, gender, mechanism of injury, open grade, smoking status, or compliance with the device (hours of use). Overall compliance was moderate (5.7 hours daily use). Fifteen of 76 (20%) of active device patients required surgery for delayed/non-union vs. 8 of 74 (11%) in the placebo group; odds ratio of surgery=2.03, p=0.13, 95% CI 0.80 to 5.12. An intention to treat analysis adjusted for open grade and hours the device was used showed an odds ratio of requiring surgery of 1.78 (p=0.24, 95% CI 0.68 to 4.64). A sub-group analysis of 80 compliant patients (defined a priori as a minimum average of six hours daily use) was performed. Nine of 35 (26%) patients with an active device required surgery for delayed/non-union vs. 3 of 45 (7%) in the placebo group; odds ratio of surgery=7.60 (p=0.017, 95% CI 1.43 to 40.24). Based on these unexpected initial results, PEMF stimulation does not prevent revision surgery for delayed/non-union in acute fractures of the tibial shaft

Magnification of anteroposterior radiographs of the pelvis is variable. To improve the accuracy of templating, reliable and radiographer-friendly methods of scaling are necessary. We assessed two methods of scaling digital radiographs of the pelvis: placing a coin of known diameter in the plane of interest between the patient’s thighs, and using a caliper to measure the bony width of the pelvis. A total of 39 patients who had recently undergone hemiarthroplasty of the hip or total hip replacement were enrolled in the study. The accuracy of the methods was assessed by comparing the actual diameter of the head of the prosthesis with the measured on-screen value. The coin method was within a mean of 1.12% (0% to 2.38%) of the actual measurement, the caliper group within 6.99% (0% to 16.67%). The coin method was significantly more accurate (p < 0.001). It was also reliable and radiographer friendly. We recommend it as the method of choice for scaling radiographs of the pelvis before hip surgery.