Introduction:. Displaced and shortened clavicle shaft fractures can be treated operatively by intra- or extramedullary fixation. The aim of the study was to compare the effectiveness of these two treatment modalities. Methods:. Forty seven patients with acute displaced and shortened clavicle shaft fractures were randomly assigned to either an intramedullary locked fixation group or an anatomically contoured locked plating group. All patients were operated by the same surgeon and had identical post-operative treatment regimes. The effectiveness of both treatment regimens were assessed based on; incision length, operative time and union rate. Disabilities of the Arm, Shoulder and Hand Score (DASH) and Constant Shoulder Score were assessed one year post-operatively. Results:. Twenty-five patients were included in the plating group and twenty-two in the intramedullary fixation group. No differences between the two groups were found for age, gender, fracture comminution and/or displacement. Incision size was significantly (p<0.0001) smaller in the nailing group (38±9 mm) than in the plating group (118±19 mm). In line with this the operating time was also shorter in the nailing group than in the plating groups (43±8 min and 60±19 min, respectively (p=0.0029)). One year postoperatively a 100% union rate was achieved in both groups. Lower DASH scores (2±5 vs 16±18 (p=0.0071)) and higher Constant Shoulder scores (96±6 vs. 90 ± 18 (p=0.0122)), were found in the nailing group. Conclusion:. Both anatomically contoured locked plating and locked intramedullary fixation resulted in successful treatment of displaced and shortened clavicle shaft fractures. Intramedullary fixation however was associated with shorter operating times and smaller incision sizes. In addition, better DASH and Constant Shoulder scores were found in the nailing group one year post operatively. Based on these finding and the absence of prominent subcutaneous hardware necessitating removal of the nail, the intramedullary device is a good alternative to treat displaced clavicle shaft fractures

Aim: To report the clinical and radiological outcome of intramedullary fixation following corrective femoral diaphyseal derotational osteotomy, particularly in children with cerebral palsy. Methods: We conducted a retrospective study of all femoral diaphyseal derotational osteotomies with Trigen antegrade intramedullary fixation (TAN system, Smith & Nephew) from April 2005 to June 2006. There were 9 patients with 14 affected limbs. The diagnosis was spastic diplegia in 8 of the 9 children, of whom 5 underwent the osteotomy as part of multilevel surgery. Results: The mean age at surgery was 13.7 years (Range 11.2 – 17.3 years). The mean preoperative femoral anteversion was 43.6 degrees (Range 30 – 50 degrees) with the mean internal & external rotation being 61.6 (Range 50 – 70) & 8.3 (Range 0 – 20) degrees respectively. The average follow-up period was 9.5 months (Range 1.5 – 15 months). All patients mobilised with crutches in an average of 5 days (Range 3 – 12 days) and full weight bearing was achieved by 65 days (Range 45 – 150 days). Marked improvement in gait was noted in all children with postoperative mean internal & external rotation being 42.9 & 52.6 degrees respectively. There have been no instances of avascular necrosis or postoperative complications to date. Correction was maintained at the final follow up in all children with good bony union by 8 – 12 weeks. Conclusion: The key to the success of femoral derotational osteotomy for correction of excessive femoral anteversion in children lies in achieving correction and early mobilisation. Intramedullary fixation following diaphyseal derotational osteotomy in children is a safe, effective, cosmetic and reliable procedure with rapid bony union, attributable to biological fixation and early mobilisation. Good early results have been obtained in children with cerebral palsy undergoing this procedure as a part of multilevel corrective surgery

Introduction: Mid-shaft clavicular fractures that are displaced and shortened are often treated surgically. The standard technique in the past has been to use plate fixation. However, in the last five years intramedullary fixation has been popularised. To our knowledge no recent study has compared the outcomes of intramedullary pinning and plating of displaced mid-shaft clavicular fractures. Method: We retrospectively evaluated 40 patients with mid-shaft clavicular fractures. Twenty patients had plate fixation and twenty patients had intramedullary fixation for exactly the same fracture pattern. Each patient filled out a standardised questionnaire particular to clavicular fractures and was assessed using the Shoulder Score Index of the American Shoulder and Elbow Surgeons and the Constant Score. A physical examination was performed and individual radiographs were assessed to determine the state of union. Results: All fractures that were treated with intramedullary pin fixation went on to union within two to three months. There was one nonunion in the plate fixation group requiring revision surgery. The results revealed no significant difference in the functional outcome scores. There were however fewer complications, less scar related paraesthesia, shorter stay in hospital, and earlier mobilization in the group who underwent intramedullary pinning. Conclusions: Our results suggested that both techniques of intramedullary pinning and plating resulted in good long-term functional outcomes for patients with acute mid-shaft clavicular fractures. Intramedullary pinning, however, resulted in fewer short-term complications. From this study the method of fixation for mid-shaft clavicle fractures should be determined by the surgeon’s preference and expertise

We undertook a prospective randomised trial to determine the outcome of locked intramedullary fixation vs. plating of displaced shortened mid-shaft clavicle fractures. The primary outcome measure was the Constant shoulder score, while secondary outcome measures included the Oxford shoulder score, union rate, and complication rates. Thirty-two patients were recruited to the trial; 17 randomised to locked intramedullary fixation and 15 randomised to plating. Mean age was 29.3years (13 to 53 years). Mean follow-up was 12.4 months (5 to 28 months). There was no significant difference in Constant scores (p = 0.365) and no significant difference in Oxford scores (p = 0.686). There was 100% union in both groups. In the intramedullary group, there was one case of soft tissue irritation that settled after the pin was removed, one pin backed out and had to be revised with another pin. There were three superficial wound infections resulting in plate removal and 8 plates (53%) were removed. Locked intramedullary fixation and plating are equally effective in the management of shortened displaced mid-shaft clavicle fractures

The reliability of the radiological assessment of the healing of tibial fractures remains undetermined. We examined the inter- and intraobserver agreement of the healing of such fractures among four orthopaedic trauma surgeons who, on two separate occasions eight weeks apart, independently assessed the radiographs of 30 patients with fractures of the tibial shaft which had been treated by intramedullary fixation. The radiographs were selected from a database to represent fractures at various stages of healing. For each radiograph, the surgeon scored the degree of union, quantified the number of cortices bridged by callus or with a visible fracture line, described the extent and quality of the callus, and provided an overall rating of healing. The interobserver chance-corrected agreement using a quadratically weighted kappa (κ) statistic in which values of 0.61 to 0.80 represented substantial agreement were as follows: radiological union scale (κ = 0.60); number of cortices bridged by callus (κ = 0.75); number of cortices with a visible fracture line (κ = 0.70); the extent of the callus (κ = 0.57); and general impression of fracture healing (κ = 0.67). The intraobserver agreement of the overall impression of healing (κ = 0.89) and the number of cortices bridged by callus (κ = 0.82) or with a visible fracture line (κ = 0.83) was almost perfect. There are no validated scales which allow surgeons to grade fracture healing radiologically. Among those examined, the number of cortices bridged by bone appears to be a reliable, and easily measured radiological variable to assess the healing of fractures after intramedullary fixation

Aims. Custom-made partial pelvis replacements (PPRs) are increasingly used in the reconstruction of large acetabular defects and have mainly been designed using a triflange approach, requiring extensive soft-tissue dissection. The monoflange design, where primary intramedullary fixation within the ilium combined with a monoflange for rotational stability, was anticipated to overcome this obstacle. The aim of this study was to evaluate the design with regard to functional outcome, complications, and acetabular reconstruction. Methods. Between 2014 and 2023, 79 patients with a mean follow-up of 33 months (SD 22; 9 to 103) were included. Functional outcome was measured using the Harris Hip Score and EuroQol five-dimension questionnaire (EQ-5D). PPR revisions were defined as an endpoint, and subgroups were analyzed to determine risk factors. Results. Implantation was possible in all cases with a 2D centre of rotation deviation of 10 mm (SD 5.8; 1 to 29). PPR revision was necessary in eight (10%) patients. HHS increased significantly from 33 to 72 postoperatively, with a mean increase of 39 points (p < 0.001). Postoperative EQ-5D score was 0.7 (SD 0.3; -0.3 to 1). Risk factor analysis showed significant revision rates for septic indications (p ≤ 0.001) as well as femoral defect size (p = 0.001). Conclusion. Since large acetabular defects are being treated surgically more often, custom-made PPR should be integrated as an option in treatment algorithms. Monoflange PPR, with primary iliac fixation, offers a viable treatment option for Paprosky III defects with promising functional results, while requiring less soft-tissue exposure and allowing immediate full weightbearing. Cite this article: Bone Jt Open 2024;5(8):688–696

Background: Long bone fractures and intramedullary stabilisation can result in the extravasation of fat and marrow emboli into the venous circulation. The effects of these emboli can become systemic causing neurological features. Aim: To establish the cerebral microembolic load following femoral and tibial diaphyseal fractures treated by intramedullary fixation and to specify any neurological impairment with the application of a series of cognitive tests and a serum marker of neuronal injury. Methods: 20 femoral and tibial fractures treated with intramedullary fixation had intra-operative transcranial doppler ultrasound monitoring of the middle cerebral artery with emboli detection software set to established guidelines. Cognitive testing (day 3), following surgery with an I.Q. assessment (PFSIQ) allowing comparison with age specific normative data. This included: verbal fluency and speed (COWAT – Control Oral Word Association Test); working memory with assessment of immediate and delayed recall; mini-mental state examination; executive function, attention and mental processing speeds (Colour Trails 1& 2). Beta S-100 levels measured pre-operatively, 0, 24 and 48 hours following surgery as a marker of neuronal injury. Statistical Analysis: One sample Wilcoxon signed rank test to compare median of the cognitive scores with age matched normative data. Multiple regression analysis used to correlate embolic load with cognitive function. Results: Mean age (SD) for the group is 32 (5.8). Mean PFSIQ of 52.8%, SD 21.4 [median 59.5, IQ range 28.3, 71.3]. No significant difference detected in cognitive testing compared with normative data. Cerebral microemboli detected in 17 of 20 patients with a count median (range) of 6 (0, 29). The mean pre-operative beta S-100 level was 0.36 micro g/l (normal range 0–0.15). This increased to a peak mean of 0.88 micro g/l immediately following surgery with a poor correlation to cerebral embolic load. Discussion: Detailed clinical testing indicates no significant deterioration in cognitive function following intramedullary stabilisation of these fractures. A variable cerebral micro-embolic load was seen but with no detectable clinical effect. No direct correlation was found between the elevated levels of Beta S-100 seen following surgery and cerebral embolic load. This appears to correlate with previous concerns in the literature regarding the specificity and sensitivity of this established marker of neuronal injury

Purpose. Plating remains the most widely employed method for the fixation of displaced diaphyseal clavicle fractures. The purpose of this study was to assess the efficacy and outcomes of diaphyseal clavicle fractures treated with intramedullary fixation using the Rockwood clavicle pin. Methods. We conducted a retrospective analysis of all diaphyseal clavicle fractures treated with intramedullary fixation using the Rockwood pin between February 2004 and March 2010. Sixty-eight procedures were carried out on 67 patients. Functional outcome was assessed using the Disability of the Arm, Shoulder and Hand (DASH) questionnaire and an overall patient satisfaction questionnaire. Results. There were 52 (77.6%) male and 15 (22.4%) female patients with an average age of 35.8 years. In 35 (51.5%) cases the injury was located on the dominant side. Fractures were classified according to the Edinburgh system with the commonest configuration being the Type 2B1 (47, 69.1%). The indications for fixation were; acute management of displaced fractures (56, 82.4%), delayed union (2, 2.9%), nonunion (8, 11.8%) and malunion (2, 2.9%). The average time to pin removal was 3.7 months and the average follow-up prior to discharge was 6.9 months. Sixty-six (97.1%) fractures united without consequence. Two (2.9%) cases of non-union were treated with repeat fixation using a contoured plate and bone graft. The most common problem encountered postoperatively was discomfort due to subcutaneous pin prominence posteriorly (12, 17.6%) which resolved following removal of the metalwork. The average DASH score was 6.04 (0–60) and 96.4% of patients rated their satisfaction with the procedure as good to excellent. Conclusion. Due to its minimally invasive technique, cosmetically favourable scar, preservation of periosteal tissue, avoidance of stress risers associated with screw removal and good clinical outcomes, the use of this device is the preferred method of treatment for displaced diaphyseal clavicle fractures in our hospital

Aims. The aim of this study was to examine perioperative blood transfusion practice, and associations with clinical outcomes, in a national cohort of hip fracture patients. Methods. A retrospective cohort study was undertaken using linked data from the Scottish Hip Fracture Audit and the Scottish National Blood Transfusion Service between May 2016 and December 2020. All patients aged ≥ 50 years admitted to a Scottish hospital with a hip fracture were included. Assessment of the factors independently associated with red blood cell transfusion (RBCT) during admission was performed, alongside determination of the association between RBCT and hip fracture outcomes. Results. A total of 23,266 individual patient records from 18 hospitals were included. The overall rate of blood transfusion during admission was 28.7% (n = 6,685). There was inter-hospital variation in transfusion rate, ranging from 16.6% to 37.4%. Independent perioperative factors significantly associated with RBCT included older age (90 to 94 years, odds ratio (OR) 3.04 (95% confidence interval (CI) 2.28 to 4.04); p < 0.001), intramedullary fixation (OR 7.15 (95% CI 6.50 to 7.86); p < 0.001), and sliding hip screw constructs (OR 2.34 (95% CI 2.19 to 2.50); p < 0.001). Blood transfusion during admission was significantly associated with higher rates of 30-day mortality (OR 1.35 (95% CI 1.19 to 1.53); p < 0.001) and 60-day mortality (OR 1.54 (95% CI 1.43 to 1.67); p < 0.001), as well as delays to postoperative mobilization, higher likelihood of not returning to their home, and longer length of stay. Conclusion. Blood transfusion after hip fracture was common, although practice varied nationally. RBCT is associated with adverse outcomes, which is most likely a reflection of perioperative anaemia, rather than any causal effect. Use of RBCT does not appear to reverse this effect, highlighting the importance of perioperative blood loss reduction. Cite this article: Bone Joint J 2022;104-B(11):1266–1272

Introduction: The majority of forearm fractures in children can be managed with a plaster cast alone and manipulation under anaesthetic as required. A small number of cases however require surgical intervention. A variety of methods are available but the use of elastic intramedullary nails is becoming the technique of choice. Method: We present a two-centre study assessing the outcome of either Elastic StabJe Intramedullary Nails (ESIN) or Kirschner wires as the method of fracture stabilisation in diaphyseal forearm fractures of the radius and ulna. Results: ESIN group: 24 children underwent ESIN fixation. There were 22 boys and 2 girls, mean age 9.4 years (1.4–15.2 years, p=O.ll). Indications for stabilisation included 21 cases for fracture instability (immediate or delayed,) 2 irreducible fractures and 1 open fracture. 14 children underwent surgery on the day they sustained their fracture. The remainder were operated on an average 6.5 days following injury (1–14 days). In the K wire group: 36 children underwent K-wires fixation with 2.5mrn wires. There were 21 boys and 15 girls, mean age 10.6 years (2.2–15.5 years). Indication for stabilisation included 22 cases for fracture instability , 6 irreducible fractures and 8 open fractures. 32 children underwent surgery on the day they sustained their fracture. The remaining 4 patients were operated on the following day. Conclusions: All fractures united with no resultant subjective disability. The complication rate following K-wires was 16% and that following nail fixation 9%. Loss of forearm rotation was documented in 4 children in the K-wire group and 3 children stabilised with nails. These results confirm an excellent outcome following intramedullary fixation. We have demonstrated no difference in outcome between K-wires and ESIN, although the elastic nails do offer some theoretical advantages

Introduction: Intramedullary fixation is a recognised method of fracture fixation in fifth metacarpal fractures. We describe a new technique for fixation of fractures of the middle three metacarpals. Patients and Methods: We reviewed a single surgeon’s series of 16 male patients (mean age 27.9 years, range 18–46) with 20 displaced transverse midshaft fractures of the 2nd, 3rd and 4th metacarpals treated by antegrade intramedullary Kirschner wiring. Work related and domestic accidents constituted the mode of injury in 8 patients and in the remaining 8 as a result of an assault, fall or road traffic accident. Twelve patients were in employment at the time of injury including four heavy manual labourers. A single pre-bent 1.6 millimetre Kirschner wire was inserted into the medullary canal through a drill hole in the metacarpal base and passed across the reduced fracture into the metacarpal head. The proximal end of the wire remained protruding percutaneously. Following stabilisation of the fracture, early mobilisation was commenced. Results: All of the study group had satisfactory clinical and radiological outcomes. All of the fractures united clinically and radiologically. There was one case of delayed union, with union at 35 weeks. In the remaining patients fracture union had occurred radiologically at an average of 5.4 weeks (range 4–12 weeks). Radiologically there was a mean angular deformity of 4.05° (range 0–11°) in the coronal plane and 0.75° (range 0–9°) in the sagittal plane. Postoperatively 2 patients developed a pin tract infection requiring treatment with antibiotics and early removal of the K-wire. All patients on questioning by telephone questionnaire were satisfied with their resulting hand function and appearance. All patients had returned to normal activities of daily living by 8 weeks. Of those patients in employment all had returned to work by 6 weeks (mean 3.3. weeks). Conclusion: Antegrade intramedullary single K wiring is a useful technique for managing unstable midshaft metacarpal fractures producing excellent clinical and radiological results

Aims

Bone turnover markers (BTMs) follow distinct trends after fractures and limited evidence suggests differential levels in BTMs in patients with delayed healing. The effect of vitamin D, and other factors that influence BTMs and fracture healing, is important to elucidate the use of BTMs as surrogates of fracture healing. We sought to determine whether BTMs can be used as early markers of delayed fracture healing, and the effect of vitamin D on BTM response after fracture.

Aim: To compare two implants, the Gamma Nail and the ACE Trochanteric Nail in the treatment of pertrochanteric femoral fractures. Patients and methods: Sixty patients were randomized on admission to two treatment groups. Thirty patients were treated with the Gamma nail implants , and thirty had intramedullary fixation with ACE Trochanteric NailI . The average age of these patients was 79 years. 22 patients were men and 38 women. 11 fractures were stable and 49 unstable. Patients were followed for 1 year and had a regular clinical and radiological review at 1, 3 and 6 months postoperatively. Operation time, intra-operative blood loss and blood transfusion and complications were recorded. The mobility score was used to assess the preinjury and postoperative mobility status. All the patients were operated within 24 hours after their accident and 39 of them within the first 6 hours. Results: There were no complications during the surgery. All the patients were mobilized the first 24 hours post operatively irrespectively of the fracture’s type, and weight bearing was permitted as tolerated. The mean follow up time was 8 months (range 6 to 12 months). 3 patients were lost at the follow up and 2 died. Union of the fracture was achieved in all 55 patients. There was no statistically significant difference between the two groups with regard to intraoperative blood loss and the duration of the surgery. There was no mechanical failure of the implants despite the early patients mobilization. All the patients achieved mobility status similar to the preoperative at the latest follow up. Conclusions: Based on our study, intramedullary nailing of pertrochanteric hip fractures represents a reliable method of treatment. We did not observe any differences in the two patient groups concerning the operation time, the intraoperative blood loss, the postoperative complications and the patients functional status at the latest follow up

Aims and methods. To compare the mechanical stability of an intramedullary (IM) screw with two crossed interfragmentary compression screws for fixation of the 1st MTPJ in ten pairs of cadaveric feet. One foot underwent fixation with two crossed 4.0-mm cannulated cancellous screws. The contralateral foot was fixed with an IM 1.6-mm Kirschner wire and an IM 6.5-mm partially threaded cancellous lag screw. A plantar-to-dorsal load was applied to the distal end of the proximal phalanx at a rate of 1 mm/sec. Failure was defined as gross actuator displacement of 5 mm. Stiffness was defined as the slope of the force versus deformation curve between 10 and 60 N. Strength was defined as the load at failure. The differences in stiffness and strength parameters between the two fixation techniques were checked for significance (P < 0.05) with a paired t-test. Results. The intramedullary MTP joint fixation was significantly stiffer (18.7 ± 10.1 N/mm) than control group fixation (10.2 ± 6.1 N/mm). Similarly MTP joint fixation in the IM group was stronger (149.2 ± 88.2 N) than that of the control group (100.2 ± 70.8 N), but this was not significant (P = 0.07). Conclusions. The IM technique resulted in a stronger stiffer fixation when compared with the standard crossed lag screw technique

Tip-apex distance (TAD) has long been discussed as a metric for determining risk of failure in fixation of peritrochanteric hip fractures. This study seeks to investigate risk factors including TAD for hospital readmission one year after hip fixation surgery.

A retrospective review of proximal hip fractures treated with single screw intramedullary devices between 2016 and 2020 was performed at a 327 bed regional medical center. Patients included had a postoperative follow-up of at least twelve months or surgery-related complications developing within that time.

44 of the 67 patients in this study met the inclusion criteria with adequate follow-up post-surgery. The average TAD in our study population was 19.57mm and the average one year readmission rate was 15.9%. 3 out of 6 patients (50%) with a TAD > 25mm were readmitted within one year due to surgery-related complications. In contrast, 3 out of 38 patients (7.9%) with a TAD < 25mm were readmitted within one year due to surgery-related complications (p=0.0254). Individual TAD measurements, averaging 22.05mm in patients readmitted within one year of surgery and 19.18mm in patients not readmitted within one year of surgery were not significantly different between the two groups (p=0.2113).

Our data indicate a significant improvement in hospital readmission rates up to one year after hip fixation surgery in patients with a TAD < 25mm with a decrease in readmissions of over 40% (50% vs 7.9%). This result builds upon past investigations by extending the follow-up time to one year after surgery and utilizing hospital readmissions as a metric for surgical success. With the well-documented physical and financial costs of hospital readmission after hip surgery, our study highlights a reduction of TAD < 25mm as an effective method of improving patient outcomes and reducing financial costs to patients and medical institutions.

Introduction

The use of vascularised fibula grafts is an accepted method for reconstructing the distal femur following resection of malignant childhood tumours. Limitations relate to the mismatch of the cross-sectional area of the transplanted fibula graft and thel ocal bone, instability of the construct and union difficulties. We present midterm results of a unique staged technique—an immediate defect reconstruction using a double-barrel vascularised fibula graft set in in A-frame configuration and a subsequent intramedullary femoral lengthening.

Purpose: Many surgical techniques have been described for the treatment of pathological fractures due to aggressive unicameral bone cysts in order to varying rates of success and incomplete healing or recurrence. Many Authors suggested curettage and bone grafting as effective treatment in case of active lesion in children 8 – 12 years old, adjacent to the physis with width of the lesion exceeds that of the adjacent physis and recurrence or persistence. Due to invasive nature of operation this method non is preferred by several Authors : we preferred minimally invasive treatment consisting closed reduction and flexible with titanium rod (Nancy)intramedullary fixation for low operative morbidity whether for the fracture or for the cyst; in case of recurrence of the cyst the closed curettage of the cyst with arthroscopic technique can be applied successful. Methods: Between 2002–2004 40 aggressive unicameral cysts were observed as pathologic fractures in patients between 5–15 years old in these cases there was a significant loss of bone stock. The site of involvement was in 33 patients the metadiaphysis of humerus, in 7 the femur; radiograms reveal expanding lesion in metaphyseal-diaphyseal site with cortex tinned from its inner surface and erosion with infraction with displacement. The parents were informed about contextual presence of two lesions: the fracture and cyst. The proposed internal fixation with Nancy titanium rods heals the first and might heal the second lesion ; in case of failure this method do not exclude another possibility of treatment as arthroscopic curettage. The Nancy flexible intramedullary fixation was performed with retrograde access 3 0 4 mm. diameter. Two nails with “ Eiffel Tower” construction were inserted by two miniportals 1 centimetres far from the physis. Follow up of treated lesion was made with periodic x rays performed every 45 days. Results: In 36 patients after a 2-year period of observation the cyst has completely or incompletely healed but with a sufficient bone stock in the remainder four cases the arthroscopic procedure was performed. Curettage of cystic wall by trimmer blade and multiple miniportals 4,5 millimetres is the best way to treat all the cyst. In all the cases we used the standard optical cannula 30°. Conclusions: In conclusion minimally invasive treatment by Nancy rods and artrhoscopy can be effective because assure high incidence of favourable results by decompression-scaffolding of the lesions, the patient quickly recover natural life and school attendance

400 patients with a trochanteric hip fracture were randomised to fixation with either a 220mm long Targon PF (proximal femoral) nail or a Sliding Hip Screw. All surgery was undertaken or supervised by one surgeon. All patients were followed up for a minimum of one year by a blinded observer. The mean age was 82 years (range 27 to 104 years), 20% were male. Mean length of surgery was slightly increased for the nail (44 versus 49 minutes, p=0.002). Fluoroscopic screening time was increased in the nail group (0.3 versus 0.6 minutes, p< 0.0001). Intra-operative complications were more common with the nailing. There was no difference in blood transfusion requirement between groups. Postoperatively there was no difference in the occurrence of medical complications or mortality. Deep wound infection requiring removal of the implant occurred in one case in the SHS group. In addition there were two cases of cut-out, three of plate detachment from the femur and one non-union in the SHS group, requiring secondary surgery. There were only once compilations in the nailed a case of cut-out which required secondary surgery. At follow-up there was no difference in pain scores between groups but there was a tendency to improved mobility in the nailed group (p=0.004). These results suggest that with improved designs and surgical technique, the newer versions of short nails for proximal femoral fractures may not suffer from the complications of the earlier short intramedullary nails. Intramedullary fixation can result in a lower re-operation rate (3.5% versus 0.5%) and improved mobility in comparison to the sliding hip screw

The Sliding Hip Screw (SHS) is currently the treatment of choice for all trochanteric hip fractures. An alternative treatment is the short femoral nail. Earlier designs of these nails were associated with an increased fracture healing complication rate in comparison to the sliding hip screw. The new designs of nails (third generation nails) may however be as good as or even superior to sliding hip screw fixation. We conducted a large randomised trial to compare the Targon Proximal Femoral Nail with the Sliding Hip Screw. Patients with trochanteric hip fractures as per the AO classification (A1–A3) were randomised to either implant. All surgery was supervised by one surgeon. All patients were followed up for a minimum of one year months by a blinded observer. The mean age was 82 years, range 27 to 104 years), 20% were male. Length of surgery was slightly increased for the nail (44 versus 49 minutes, p=0.002). Fluoroscopic screening time was increased in the nail group (0.3 versus 0.6 minutes, p< 0.0001). Intra-operative complications were more common with the nailing. There was no difference in blood transfusion requirement between groups. Postoperatively there was no difference in the occurrence of medical complications or mortality. Deep wound infection requiring removal of the implant occurred in one case in the SHS group. In addition there were two cases of cut-out, three of plate detachment from the femur and one non-union in the SHS group, requiring secondary surgery. There was only one compilation in the nailed a case of cut-out which required secondary surgery. At follow-up no difference in pain scores but there was a tendency to improved mobility in the nailed group (p=0.004). These results suggest that with improved designs and surgical technique, the newer versions of short nails for proximal femoral fractures may not suffer from the complications of the earlier short intramedullary nails. Intramedullary fixation can result in a lower re-operation rate (3.5% versus 0.5%) and improved mobility in comparison to the sliding hip screw

Introduction and Aims: The ‘Boxer’s fracture’ is a common injury. Often these fractures are treated conservatively with acceptable functional results, leaving the patient with a residual deformity. A minimally invasive technique of treating these fractures was investigated.

Method: Twenty-three consecutive patients with a fractured neck of the fifth metacarpal with a volar angulation exceeding 40 degrees were offered treatment with a prograde intramedullary K-wire. All 23 patients accepted this treatment with informed consent. A 1.6 mm pre-bent K-wire was inserted via the base of the fifth metacarpal in each case. Time to regaining full function, time to union and final functional and radiological outcome were looked at.

Results: All 23 patients went on to full clinical and radiological union within six weeks. In 18 patients the reduction was anatomical with no residual angulation. In five, the residual angulation ranged from five to 15 degrees with an average of eight degrees. Two patients suffered a transient sensory neuropraxia.

Conclusion: The presented technique is a simple, cost-effective and reliable method of treating a ‘Boxer’s fracture’. Although this type of injury can often be treated without surgery, this procedure ensures a rapid return to full function with little or no residual deformity.