The databases of the Picture Archiving and Communication Systems of two hospitals were searched and all children who had a lateral radiograph of the ankle during their attendance at the emergency department were identified. In 227 radiographs, Bohler’s and Gissane’s angles were measured on two separate occasions and by two separate authors to allow calculation of inter- and intra-observer variation. Intraclass correlation coefficients were used to assess the reliability of the measurements.

For Bohler’s angle the overall inter-observer reliability, the intraclass correlation coefficient was 0.90 and the intra-observer reliability 0.95, giving excellent agreement. This reliability was maintained across the age groups. For Gissane’s angle, inter- and intra-observer reliability was only fair or poor across most age groups.

Further analysis of the Bohler’s angle showed a significant variation in the mean angle with age. Contrary to published opinion, the angle is not uniformly lower than that of adults but varies with age, peaking towards the end of the first decade before attaining adult values. The age-related radiologic changes presented here may help in the interpretation of injuries to the hindfoot in children.

Recombinant Bone Morphogenetic Protein 7 (OP-1) has been available in the UK since 2001, but there has been little published data on its use in the upper limb. In our institution OP-1 has been used in the management of 23 upper limb patients between 2001–2005, including 10 humeral non-unions. We believe this represents one of the largest single-unit cohorts of humeral fractures treated with OP-1.

We reviewed the 10 humeral patients, who were all tertiary referrals with established non-unions. Two had been treated non-operatively before referral. The remaining eight had undergone a mean of 2.1 operations before OP-1 was used, with autologous bone grafting used in the majority of cases. Surgery occurred at a mean of 70.5 months following initial fracture. Seven patients underwent revision of the fracture fixation, and autologous bone graft was used with the OP-1 in 8 cases. Clinical union was established in 8 patients (80%) within a mean of 7.4 months. Radiological union was achieved in 8 patients (80%) within a mean of 9.1 months. No complications or adverse effects from the use of OP-1 were encountered.

Both cases which failed to unite had a definite history of deep infection prior to index surgery, despite initial treatment with a staged revision procedure before OP-1 use.

This study shows that OP-1 can be used successfully in the treatment of recalcitrant non-unions of the humerus following failure of traditional fracture management methods.