The aims of this study were to review the management of open tibial fractures in our specialist ortho-plastic centre and to assess whether our practice concurred with the BAO/BAPS guidelines. A retrospective note review of patients with open tibial fractures was undertaken. Data was collected on time to referral to the plastic surgery unit and time to definitive soft tissue cover. Return of limb function was assessed using the Enneking score.

Forty five consecutive patients (27M vs. 18F), with an age range of 11–86 yrs (median age of 42 years), were treated using strict protocols. Seventeen cases were referred by the on-site orthopaedic unit, and 28 patients were from 7 neighbouring units. Time from injury to initial plastic surgery assessment ranged from 0 to 19 days, with a median of 4 days. Time from injury to definitive soft tissue cover ranged from 0 to 21, with a median of 5 days. 41/45 cases had definitive surgery within 5 days of initial plastics assessment. 5 patients with definitive treatment at days 4, 4, 7, 7, 12 developed superficial wound infection.

Patients referred from neighbouring units underwent on average 1 extra operation. We failed to detect any significant difference in return of function between the 2 groups indicating that referral to a specialist centre may produce equivalent functional return even if there is a delay in definitive treatment.

Open tibial fractures should be managed in a specialist centre, manned with dedicated lower limb plastic and orthopaedic reconstructive surgeons and followed up in a combined ortho-plastic clinic. However, more emphasis should be put on improved communication between referring units and the specialist centre.

Introduction: To report the results of quadrupled hamstring tendon autograft anterior cruciate ligament reconstruction with bioabsorbable Rigidfix fixation for both femoral and tibial tunnels.

Methods: ninety one patients were retrospectively identified by notes review as having undergone quadrupled hamstring tendon auto graft anterior cruciate ligament reconstruction with Bioabsorbable Rigidfix fixation with a minimum 1 year follow-up[range12 to 34 months] To our knowledge there has been no published results with Rigidfix device used as a method of fixation at both femoral and tibial tunnels

Results: Data were collected on 91 knees in 91 patients (100 %) at an average 13 months (range, 12 to 34) after surgery. They were all asked to fill in a subjective quetionaire. Seventy eight patients returned for clinical evaluation (85.7 % return) and subjective questionnaire was comleted by 78 patients (85.7 %).

The KT-2000 Arthrometer, mean side-to-side difference for manual maximum displacement was 1 mm (range, 0 to 3). Anterior compliance index mean side-to-side difference was1 (range −1 to 3), Quadriceps active displacement tests mean side-to-side difference was.5 [range −1 to 2]. The mean International Knee Documentation Committee knee score was 89 (range, 33.3 to 100).

Conclusions: Quadrupled hamstring tendon auto graft anterior cruciate ligament reconstruction with Bioabsorbable Rigidfix fixation is comparable with other methods of anterior cruciate ligament reconstruction in terms of patient satisfaction, knee stability, and function.

A prospective trial of proximal femoral nail versus dynamic hip screw for unstable intertrochanteric fractures of the femur. Introduction: The proximal formal nail (PFN) is purposed to have superior bio-mechanical properties to the dynamic hip screwwhen use in the treatment of unstable intertrochantric fractures of the femur. Objective: To compare the outcome of PFN and DHS fixation of unstable proximal femoral fractures. Methods: The authors conducted a prospective study of 70 consecutive patients presenting to the orthopaedic department with acute AO/ASIF 31 -A2 and A3 fractures. Patient underwent either PFN or DHS fracture fixation depending on surgeon experience and preference. Patients were all followed up for 6 months. The main outcome measures were operative blood loss, length of hospital stay, radiographic fracture union, com-plication rates, independent mobility and residual hip pain at 6 months. Result: The two groups exhibited similar demographic characteristics, premorbid mobility and fracture severity. Operation duration was similar in the two groups although blood loss was significantly less in the PFN groups (PFN 200mls; DHS 375mls). There was a significant difference in length of hospital stay (PFN 8 days; DHS 14 days). Radiographic signs of fracture healing at 3 months were 88% PFN and 83% DHS. Three patients in the DHS groups suffered failure of fixation with screw cut out There were no implant failures or failure of fixation in the PFN groups. At 3 month PFN follow up mobility was greater in the PFN group (Wheelchair bound/walking frame/stick/no aide: group = 0%/20%/49%/14%). At 6 months both groups showed similar mobility. Persistent sever hip pain at 6 months was PFN 3% and DHS 9%. Conclusion: The proximal femoral nail may be used successfully in the fixation of unstable femoral fractures with similar result to the DHS for mobility at 6 months. There may be advantages over the DHS in term of reduced blood loss and shorter hospital stay.

Aims: To compare the outcome of PFN and DHS þxation of unstable proximal femoral fractures. Methods: The authors conducted a prospective study of 70 consecutive patients with acute AO/ASIF 31-A2 and A3 and complex intertrochantaric fractures. Patients underwent either PFN or DHS fracture þxation depending on surgeon experience and preference. Patients were all followed up for 6months. The main outcome measures were operative blood loss, length of hospital stay, radiographic fracture union, complication rates, independent mobility and residual hip pain at 6 months. Results: The two groups exhibited similar demographic characteristics, premorbid mobility and fracture severity. Operation duration was similar in the two groups although blood loss was signiþcantly less in the PFN group (PFN 275mls; DHS 475mls). There was a signiþcant difference in length of hospital stay (PFN 14 days; DHS 22 days). Three patients in the DHS group suffered failure of þxation, two of them had screw cut out. There were no implant failures or failure of þxation in the PFN group. At 6 months both groups showed similar mobility. Persistent severe hip pain at 6 months was PFN 3% and DHS 9%. Conclusion: The proximal femoral nail may be used successfully in the þxation of unstable femoral fractures with similar results to the DHS for mobility at 6 months. There may be advantages over the DHS in terms of reduced blood loss, shorter hospital stay and less morbidity.