Purpose of the study: Increasing the number of times the operating room doors open increases the number of airborne bacteria and consequently the rate of postoperative infections with sometimes disastrous results, particularly for prosthesis surgery.

Material and methods: An observer counted the number of times the door to the operating room were opened during orthopaedic operations. The study was conducted in a teaching hospital (hospital A) during scoliosis surgery then repeated for a similar operation after posting dissuasive signs and delivery of information to the personnel concerning the risk of contaminating the patient. A study was then conducted for total hip arthroplasty (THA) in another teaching hospital (hospital B) and in a private clinic (hospital C). The same protocol as used in South Australia was applied for these studies.

Results: The mean rate of door opening in hospital A was 0.52/min. This rate was 0.45/min (13.5% less) in the same hospital A after posting dissuasive signs on the doors and providing information to the personnel. In hospital B, the rate was 0.67/min. In hospital C, the rate was 0.42/min (i.e. 37% less). In Australia, the mean rate was 1/min in hospital A before sign posting and information delivery and 0.65 (−35%) after. In hospital B, the rate was 0.87/min and in hospital C 0.47/min (i.e. 46% less).

Discussion: Nearly 50 years ago Sir John Charnley demonstrated that airborne contamination must be controlled in prosthetic orthopaedic surgery. In France airborne contamination is regulated by a series of standards (NF EN ISO 14644 established in 1999) and partially controlled during the design phase of operating rooms with the installation of laminar flow ventilation. Door opening, and particularly swinging doors, causes turbulent airflow increasing bacterial contamination.

Conclusion: Circulation in the operating room should be limited to necessary organisation (prior transport of instruments and consumables, fluoroscope, nursing staff turnover, etc.) and by information and education of all participants. The presence of observers is inevitable in the operating rooms of teaching hospitals. Their entrance and exit should however be limited and their movement within the room controlled. It is also recommended to use cell phones.

Purpose of the study: Duplication of the thumb is the most common congenital anomaly of the first ray. The characteristic feature of type IV is the diversity of the clinical forms and the presence of certain complex forms particularly difficult to treat (Hung IVD). We propose a new procedure for reconstruction of IVD type thumb duplication.

Material and method: This new procedure was used for thumb reconstruction in two boys with type IVD thumb duplication. Mean age at surgery was 10 months. Surgical technique. The future incisions were traced with a central skin resection removing the most hypoplastic nail entirely (generally the radial nail). At the bone level, a longitudinal osteotomy of the proximal phalanges was made over the entire length to remove the central part and obtain a width for the first phalanx comparable to that of the contralateral thumb. An oblique osteotomy was cut in the base of the distal phalanx of the ulnar hemithumb with resection of a radial corner. The same type of osteotomy was performed at the base of the distal phalanx of the radial hemithumb, but with preservation of the radial corner and resection of the rest of the radial thumb. The proximal hemiphalanges were sutured as were the bases of the distal phalanges. This produced automatic realignment and stabilisation of the interphalangeal joint without an ungueal intervention.

Results: The three children were reviewed at 24, 18 and 12 months. The Horii score was good in all cases.

Discussion: Type IVD duplications of the thumb are difficult to treat and may leave serious sequelae. Our technique is based on the principle of a central resection of the proximal phalanges associated with partial resection of the base of the distal phalanges. This enables realignment and stabilisation of the interphalangeal joint while avoiding the problem of ungueal dystrophy since only one nail is preserved. Our preliminary results are encouraging but must be confirmed with a longer term study.

Purpose of the study: For symptomatic discoid meniscus, the treatment of choice in children is arthroscopic meniscoplasty. The treatment of associated meniscal lesions remains a subject of debate. The purpose of our work was to evaluate our results with arthroscopic meniscoplasty associated with meniscal repair as needed and the findings of the systematic postoperative MRI.

Material and methods: This was a retrospective series of patients treated by one operator. There were 23 discoid menisci (21 patients) treated from 2004 to 2007 with arthroscopic meniscoplasty followed by a complementary procedure depending on the residual meniscus: abstention if there was no associated lesion, suture or reinsertion for reparable lesions, partial meniscectomy for non-reparable lesions. The Lysholm and Tegner scores, plain x-rays, and MRI were obtained systematically.

Results: Mean age at surgery was 9.8 years. The Watanabe classification was I:9, II:9, III:5. Arthroscopy revealed 15 lesions, including 11 longitudinal tears. Meniscoplasty was performed in 9 cases alone, associated with partial meniscectomy in 6 and with repair in 8 (5 cases of disinsertion and 3 tears). Mean follow-up was 37.1 months. The mean postoperative Lysholm was 87.9, the Tegner 5.9. Outcome was considered satisfactory or very satisfactory by 90% of patients. MRI failed to reveal any signs of chondral degeneration or meniscal tear. There were however four cases of high intensity intra-meniscal signals and one meniscal cyst. Mean measurements of the residual meniscus were: anterior segment 8.6 mm thickness and 2.6 mm height; middle segment 5.5 and 2.3 mm; posterior segment 5.8 and 3.0 mm. One case of osteochondritis of the lateral condyle was noted postoperatively.

Discussion: To our knowledge, there is no other study evaluating the outcome of discoid meniscus surgery with postoperative MRI. There have been few reports concerning meniscoplasty then repair. This approach spares meniscal tissue, essential for children. We obtained good clinical results and patient satisfaction. At the MRI, the residual meniscus had a morphology close to normal. There were no signs of tears. The high intensity signals occurred in patients with good outcome.

Conclusion: Arthroscopic meniscoplasty associated with repair or partial meniscectomy as needed appears to be a good therapeutic solution for discoid meniscus in children.

Introduction: Slipped Capital Femoral Epiphysis (SCFE) is the most common hip problem of adolescence. Obesity and African and Pacific Islander races have been associated with increased susceptibility. In the setting of increasing rates of obesity in Australian adolescents over the last twenty years, it is unknown whether the incidence of this condition is increasing. There are no studies to date on the Australian population and it is unknown whether there is an increased incidence in the local Aboriginal population.

Aims: The demographics of SCFE patients presenting to the Women’s and Children’s Hospital (W& CH) in Adelaide were studied, from 1988 to the present, with particular emphasis on weight and race. This was then compared to weight for age percentiles data in the Australian population. The issues of prophylactic pinning of the contralateral side and the efficacy of the department protocol of “pinning in situ” were also studied.

Method: Systematic chart review, statistical analysis, and comparison with data from the Australian Bureau of Statistics and the Centre for Applied Anthropometry, University of South Australia, pertaining to weight and racial mix in South Australia.

Results: SCFE was associated with obesity. Over 45% of the cohort was above the 95th percentile for weight. The mean weight was in the 85th percentile and the median weight was in the 94th percentile.

As an example, the average weight of children aged 12 to 14 years was 13kgs more than the median value of children in this age group.

There was a clear increase in incidence of this condition over the last twenty years which corresponds with increasing obesity rates in the community.

There was a higher incidence in the indigenous population as compared with the non-indigenous population.

Out of the 236 patients enrolled, 5 cases were complicated by avascular necrosis. The overall complication rate was low.

Rate of progression to contralateral slip was low as was the rate of prophylactic pinning.

Conclusions: Our complication rate when compared to other centres is relatively low and would seem to support our consistent protocol of “pinning in situ”. The low rate of progression to contralateral slip also supports our protocol of watchful surveillance rather than mandatory prophylactic pinning of the contralateral side.

We have shown that SCFE is associated with obesity in Australia when compared with general population data. Obesity is also more common in the Aboriginal population and we postulate that this explains the higher incidence of SCFE in this group. In keeping with increasing rates of obesity amongst Australian adolescents, the increasing incidence of this condition further highlights the importance of public health initiatives to tackle obesity in the community.

Purpose: Reaming is classically contraindicated for open leg fractures. For certain authors, reaming can favour bone healing without increasing the risk of infection (Court-Brown JBJS 90B and 91B, Wiss Coor 95). The aim of this retrospective analysis of patients treated in a single centre was to validate these notions and determine the role of locked centromedullary nailing (LN) with reaming for the treatment of open leg fractures.

Material and methods: Between 1989 and June 2000, 141 open leg fractures were fixed with locked centromedullary nailing without reaming in 103 men and 38 women, mean age 34 years, who were mainly accident victims (2-wheel vehicles 43%, 4-wheel vehicles 22%). Multiple trauma was present in 18.7% of the cases and multiple fractures in 28%. Skin wounds were (Gustilo classification): type I 81 (57%), type II 38 (27%), type IIIA 14, and type IIIB 8. There was a simple fracture in 50% of the cases, a wedge fracture in 32%, and comminution in 18% with bifocal fractures in 10 cases. Osteosynthesis was performed within a mean 5.5 hours (2–18) and deferred in six cases. The Grosse and Kempf nail was used in all cases with reaming (man 11). Static locking was used in 88% of the cases. type I, II and IIA skin wounds were sutured after debridement. Three aponeurotomies were performed as preventive measures. Type IIIB wounds were treated by early plasty. A brief antibiotic prophylaxis was given in all cases.

Results: There was one aggravation of the comminution, two dismantelings subsequent to unauthorised weight-bearing, three compartment syndromes and one lateral sciatic popliteal paralysis. Two patients died from their multiple injuries. Four patients developed infection: two healed without removing the nail, one was amputated (free flap failure). One patient consulted another unit. Ten patients who were not residents of our area were lost to follow-up. Dynamisation was performed in 31 patients (25.6%) at a mean 4.4 months. Four patients with delayed healing cured after a new nailing with secondary reaming. Delay to bone healing was related to the type of fracture (p < 0.01): 4.2 months for type A (AO classification), 5.2 months for type B and 5.9 months for type C. Bone healing was correlated with Gustilo type (p < 0.05): 4.5 months for types I, 4.6 months for type II, 5.8 months for types III. Six patients developed nonunion: four were revised with success after a new nailing and secondary reaming (two lost to follow-up). Delayed healing and non-union were related to type of fracture (A = 3.8%, B = 15.6%, C = 18%) and soft tissue damage (Gustilo I: 4.1%; II: 10.7%; III: 15.8%).

Discussion conclusion: Locked centromedullary nailing with reaming is appropriate when the skin wound is minimal; dynamisation and/or replacement of the nail with secondary reaming should be discussed early in case of delayed healing.