We treated 50 patients with fractures of the waist of the scaphoid in a below-elbow plaster cast for up to 13 weeks. Displacement of the fragments was assessed independently by two observers using MRI and radiographs performed within two weeks of injury. The MRI assessments showed that only the measurement of sagittal translation of the fragments and an overall assessment of displacement had satisfactory inter- and intra-observer reproducibility and revealed that nine of the 50 fractures were displaced. Only three of the 49 fractures with adequate follow-up failed to unite, and all were displaced with more than 1 mm of translation in the sagittal plane. If the MRI assessment of displacement of the fracture was used as the measurement of choice, assessment of displacement on the initial scaphoid series of radiographs showed a sensitivity of between 33% and 47% and a positive predictive value of between 27% and 86%. Neither observer was able correctly to identify more than 33% to 47% of the displaced fractures from the plain radiographs. Although the overall assessment of displacement and gapping and translation in the coronal plane on the plain radiographs influenced the rate of union, none of these parameters identified all three fractures which failed to unite. We conclude that the assessment of displacement of scaphoid fractures on MRI can probably be used to assess the likelihood of union although the small number of nonunions limits the power of the study. In contrast, the assessment of displacement on routine radiography is inaccurate and of less value in predicting union.
We report the results of application of a strategy for deformity correction in hypophosphataemic rickets using careful preoperative planning, multiple osteotomies where appropriate and acute or gradual correction using internal or circular external fixation or a combination. 7 patients with 25 limb segments (14 femur and 11 Tibia) had deformity correction with either intramedullary nailing (10 Femur and 3 Tibia) or llizarov ring fixator (4 femur and 8 Tibia). The average age was 18 years (7–39 years), 5 were female and 2 male, had an average follow up of 36 months (10–77 months). All patients had adequate control of rickets pre operatively. Clinical examination and analysis of pre and post-operative X-rays were carried out by an observer not involved in the surgical procedures. Standardised X-rays were analysed using the method of Paley and Tetsworth ( Satisfactory correction of deformity was achieved in both frontal and sagittal plane. There were total 8 episodes of soft tissue infection with no long-term consequence. Average ankle ROM was 7–44 and knee ROM was 0–128. There is no recurrence of the deformity. All patients were happy with outcome and are prepared to undergo same treatment if required, even though some were restricted in terms of sport and leisure activities. We conclude that satisfactory correction of deformity in VDRR can be achieved and maintained with nailing or llizarov fixator in short term with minimal complications, no recurrence and excellent outcome.
