Elevated fat pads on a paediatric elbow radiograph may represent an intraarticular fracture. If no obvious fracture is visible, the injury may be treated with a collar and cuff until discomfort resolves. In some centres these patients are discharged directly from A&E, easing the load on fracture clinics and reducing the number of visits required by the patient. A retrospective study was carried out to review patient journey for children referred to clinic with elevated fat pads only and to investigate whether such a protocol could be established locally. Notes for all children attending fracture clinic in May 2018 were reviewed. X-rays for patients with any elbow injury were then reviewed. Patients with raised fat pads only were included in the study. Outcome following clinic review was recorded. 818 patients (315 new referrals) attended 15 clinics. 31 were referred with raised fat pads only. Mean age was 7.7 years with mean time to clinic of 4 days. 74.2% required no further treatment and were discharged at first clinic appointment. 8 patients were kept in cast for another 1–2 weeks due to parental apprehension, patient apprehension or patient being uncomfortable without cast. None of our patients required surgical intervention or re-attended following discharge. This study showed that patients with raised fat pads only can be treated with collar and cuff, analgesia and discharged from A&E with an advice leaflet. This would reduce the number of patients unnecessarily attending clinics thereby reducing patient distress and enabling more efficient use of clinic appointments

Tibial plateau fractures are common intraarticular fractures. The principal long-term complication is post-traumatic osteoarthritis (PTOA) with the usual salvage procedure being total knee arthroplasty (TKA). Our aim was to define the incidence of PTOA requiring TKA following tibial plateau fractures and identify the risk factors. We looked at all tibial plateau fractures between 1995 and 2008. There were 888 tibial plateau fractures. 23% were Schatzker I, 25% II, 14% III, 22% IV, 8% V and 8% VI. To date 25 have undergone TKA (2.8%). The mean age of patients at time of fracture was 56 in the overall cohort and 65 in those requiring TKA; this was statistically significant (p=0.04). 4% of females with tibial plateau fractures required TKA in comparison to 2% of males. The Schatzker I fractures were the least likely to require TKA at 1% with the most likely requiring arthroplasty surgery being type III at 6%. Only 1% of the patients treated non-operatively later underwent TKA. The overall incidence of TKA after tibial plateau fractures was 3%. For displaced fractures requiring internal fixation this rose to 4%. Risk factors were increasing age, split depression fractures and female gender. Although tibial plateau fractures are commonly associated with degenerative radiographic changes, we concluded that the incidence of symptomatic OA severe enough to require TKA is low