This study identified variables which influence the outcome of surgical management on 126 ununited scaphoid fractures managed by internal fixation and non-vascular bone grafting. The site of fracture was defined by a new method: the ratio of the length of the proximal fragment to the sum of the lengths of both fragments, calculated using specific views in the plain radiographs. Bone healing occurred in 71% (89) of cases. Only the site of nonunion (p = 1 × 10⁻⁶) and the delay to surgery (p = 0.001) remained significant on multivariate analysis. The effect of surgical delay on the probability of union increased as the fracture site moved proximally. A prediction model was produced by stepwise logistic regression analysis, enabling the surgeon to predict the success of surgery where the site of the nonunion and delay to surgery is known.

Purpose: We present a 12 year follow up of a patient who presented with a multiple plexiform schwannoma of the median nerve with multiple recurrences, where it was possible to salvage the limb.

Patients and Methods: Multiple plexiform Schwannomas are rare nerve sheath tumours. In this case the tumour presented as a soft non-tender swelling in the palm of a child. On exploration the lesion was found to involve the median nerve from the digital nerves to the antecubital fossa. Histology confirmed a plexiform schwannoma.

The tumour was locally very aggressive with multiple recurrences initially in the median nerve and ulnar nerves and later in the nerve grafts used following excision of the primary tumour.

We present a pictorial review of the mode of presentation of the tumour; discuss different modalities used for limb salvage and the differential diagnosis of this rare tumour.

Conclusion: There are very few reports of PS involving main nerve trunks and none describe the long term follow-up. We report a twelve year follow up of a PS involving the main nerve trunks of the upper limb with salvage despite multiple recurrences. The clinical course of the tumour is presented up to the age of sixteen where the growth tumour appears to have regressed.

Distal tibial physeal fractures are the second most common growth plate injury and the most common cause of growth arrest and deformity. This study assesses the accuracy of pre-operative planning for placement of the screws in these fractures using either standard radiographs or CT scans.

We studied 62 consecutive physeal fractures over a period of four years. An outline of a single cut of the CT scan was used for each patient. An ideal position for the screw was determined as being perpendicular to and at the midpoint of the fracture. The difference in entry point and direction of the screw between the ideal and the observers’ assessments were compared using the paired Student’s t-test. There was a statistically significant improvement (p < 0.0001) in the accuracy of the point of insertion and the direction of the screw on the pre-operative plan when CT scans were used rather than plain radiographs.

We would, therefore, recommend that CT scans are routinely used in the pre-operative assessment and treatment of distal tibial physeal fractures.

Introduction; Distal tibial physeal fractures are the commonest cause of growth arrest and deformity secondary to failure to achieve and maintain an accurate reduction. Our study compared assessment of displacement and screw placement using X-ray alone compared to CT scans. Methods; 62 consecutive fractures over a 4 year period were used. Displacement was measured on 18 Salter Harris III and IV fractures by 7 surgeons separately using X-rays alone. These measurements were compared to those made from the CT scans. Screw placement was drawn onto tracings of outlines of of single cuts of CT scans by 4 surgeons seperately for all 62 fractures using X-rays alone. This was repeated one week later using the CT scans. Ideal screw placement was considered to perpendicularly bisect the fracture line. Differences between the ideal and observer measurements were analysed using the paired t-test. Results; The surgeons were incorrect in determining whether there was more or less than 2mm of displacement in 33.3 Ð 50% of cases (mean = 38.9%) . There was a statistically signiþcant difference (p < 0.0001) in accuracy of screw insertion point and direction between using X-rays and Ct scans for all surgeons and fracture types. Conclusions; We recommend that CT scans are essential for accurate pre-operative assessment of distal tibial physeal fractures.

Introduction

Distal tibial physeal fractures are the commonest cause of growth arrest and deformity secondary to failure to achieve and maintain an accurate reduction. Our study compared assessment of displacement and screw placement using X-Ray alone compared to CT scans.

Method

Sixty-two consecutive fractures over a four-year period were used. Displacement was measured on 18 Salter Harris III and IV fractures by seven surgeons separately using X-rays alone. These were compared to measurements from the CT scans. Screw placement was drawn onto outlines of single cuts of CT scans by four surgeons for all 62 fractures using X-Rays alone. This was repeated one week later using the CT scans. Ideal screw placement was considered to perpendicularly bisect the fracture line. Differences between the ideal and observer measurements were analysed using the paired t-test.

Results

The surgeons were incorrect in determining whether there was more or less than 2mm of displacement in 33.3 – 50% of cases (mean = 38.9% ). There was a statistically significant difference (p < 0.0001) in accuracy of screw placement between using X-Rays and CT scans for all surgeons.

Conclusions

We recommend that CT scans are essential for accurate pre-operative assessment of distal tibial physeal fractures.

To ascertain the optimum number, thickness and configuration of K-wires needed to prevent displacement of distal radial fractures.

Synthetic and cadaver bones were used. A transverse osteotomy was performed 1. 5 cm proximal to the articular surface of the distal radius. Different numbers and configurations of 1. 1mm or 1. 6mm K-wires were used to hold the bone reduced. Dorsoradial and distraction forces were applied using a tensiometer. The endpoint was a displacement of 3mm at the osteotomy site.

We demonstrated a statistically significant increase in the force required to displace the osteotomy site a) when using thicker wires and b) when using three crossed wires compared with two wires either crossed or parallel.

When balancing ease of insertion with maximum stability, we would recommend two parallel 1. 6mm wires inserted through the radial styloid process, with 1 wire inserted from the dorsoulnar corner of the radius crossing at approximately 90 degrees. All wires should pass into the opposite cortex. This configuration resisted forces of over 300 Newtons and there was little benefit in using additional wires.