Success treating AIS with bracing is related to time worn and scoliosis severity. Temperature monitoring can help patients comply with their orthotic prescription. Routinely collected temperature data from the start of first brace treatment was reviewed for 14 patients. All were female with an average age of 12.4 years (range 10.3–14.6) and average 49o Cobb angle (30–64).

Our current service recommendation is brace wear for 20 hours a day. Patients complied with this prescription 38.0% of the time, with four patients averaging this or more. Average brace wear was 16.3 hours per day (3.5–22.2).

There were 13 patients who had completed brace treatment. The majority had surgery (7/13; 54%) or were considering surgery (1/13; 8%). There were 5 who did not wish surgery at discharge (5/13; 38%); 1 achieved a 40o Cobb angle, with 4 larger (53o;53o;54o;68o). The Bracing in AIS Trial (BrAIST) study measured “success” as less than a 50o Cobb angle, so using this metric our cohort has had a single “success”.

Temperature monitors allowed an analysis of when patients were achieving their brace wear. When comparing daywear (8am-8pm) to nightwear (8pm-8am), patients wore their brace an average of 7.6 hours a day (2.5–11.2) and 8.7 hours a night (0.4–11.5).

We conclude the minority of our patients comply with our current 20 hour orthotic prescription. The “success” of brace treatment is lower than comparison studies despite higher average compliance but starting with a larger scoliosis. Brace wear is achieved during both the day and night.

To audit adherence to the British Orthopaedic Association and British Association of Plastic, Reconstructive and Aesthetic Surgeons 2009 review of the acute management of severe open lower limb fractures (BOAST4).

Audit: Retrospective study of adherence to BOAST4 standards of 37 cases treated at Derriford Hospital between March 2010 and 2011.

Intervention: a multidisciplinary approach towards the management of such injuries. Assigning department-specific roles across all specialities involved and establishing an early patient transfer pathway from non-specialist centres in the region.

Re-audit: Prospective data collection of adherence to BOAST4 of 18 cases between October 2011 and April 2012.

Eleven of 15 standards were comparable. Statistical analysis was performed using Fisher's exact test (p≤0.05). Six standards showed statistically significant improvement: antibiotic therapy; regular assessment of neurovascular status; urgent surgery for contaminated wounds; initial wound care; appropriate splinting and early patient transfers. One standard was adhered to in all cases. 3 standards showed improvement, although not statistically significant and 1 standard remained consistently low in adherence.

Although doctors are familiar with BOAST4, many are not aware of the specific details. A coordinated and informed multidisciplinary team has enabled the successful application of an evidenced-based approach to the management these injuries.

Plymouth Hospitals NHS Trust developed a pelvic and acetabular service in 2008, with the aim to provide a tertiary service for Devon and East Cornwall.

We describe the demographics of the patients, referral and fracture patterns, the operative management undertaken and complications seen in a newly developed tertiary pelvic and acetabular service in the South West.

Over 150 patients have been referred and treated, with follow up in a specialised tertiary clinic. Clinical scoring and radiological follow up were performed, and complications recorded.

Several difficulties and problems were encountered in the development of the service including training issues, equipment availability, surgeon availability, referral pathways and theatre time.

The presentation will describe the clinical results of the service, along with the logistical obstacles encountered in setting up a new service.

Purpose: To evaluate the Cable-Ready Cable Grip System in the treatment of peri-prothetic femoral fractures. Materials and Methods: Twenty cases of treated with Cable-Ready Cable Grip System were reviewed retrospectively. Outcome was measured using clinical and radiological observations. Mechanism of injury, fracture types and complications were noted.

Results: Eighteen of the twenty cases reviewed had good or excellent results. One case required re-operation for implant failure, complications included continued pain and mal union.

Conclusions: The cable-ready cable grip system is a simple and secure fixation system for peri-prosthetic femoral fractures. The system functions optimally in situations where the prosthesis remains stable and the correct length of plate is employed.

Achilles Tendon lengthening was carried out on six patients for the treatment of long standing neuropathic plantar ulcers in the diabetic foot. The results were reviewed after an average of 13 months. Alteration in gait pattern, mobility & resolution of ulcers were assessed. At the time of review, all patients showed complete ulcer healing, none reported any difficulty in mobilisation, despite off loading of the forefoot in each case.

Achilles Tendon Lengthening gives good results in selected patients, particularly those who have not responded to mechanical off loading techniques. The surgical principles & mechanisms of action of the procedure are discussed.