Introduction

Both cross and lateral pinning are common techniques used for displaced supracondylar elbow fractures in children. Our study aims to determine whether there are any radiological differences in outcome between the two techniques. Most recent studies involving radiological evaluation of supracondylar fractures had concentrated on use of Bauman's angle or humerocapitellar angles. Rotational displacement, which has been shown to be critical for stability, is often not adequately addressed. Our evaluation measures both linear displacement using Bauman's angle and rotational displacement through the measurement of the lateral rotational percentage (LRP).

Introduction: Forearm fractures are the most common long bone fracture in the paediatric population. Associated neurological injury is a well recognized complication of these injuries yet is generally considered to beuncommon. This study sought to evaluate the incidence of neurological impairment in children referred for manipulation by the orthopaedics team in this tertiary referral hospital.

Materials & Methods: A retrospective chart analysis was performed of the first 100 children to be referred for orthopaedic assessment. This represented 43% of the total number of children presenting to the emergency department in this time period. Inclusion criteria involved a fracture of any segment of the radius and/or ulna on radiological examination. Exclusion criteria included concomitant ipsilateral upper limb fracture, and compartment syndrome.

Results: A total of 96 cases met the inclusion criteria. The cohort had a mean age of 8.04. Males were more likely to be injured as was the left forearm. The distal metaphysis was the segment most likely to be fractured and compound injuries were uncommon. The incidence of associated neurological impairment was 15.6%. The median nerve was most commonly injured, comprising 60% of nerve injuries. Distal physeal fractures were the most common fracture pattern to be associated with neurological impairment, with a rate of 37%.

Conclusions: Forearm fractures requiring manipulation in the paediatric population are commonly associated with nerve injuries, with distal physeal fractures having a particularly strong correlation. Clinicians require a high index of suspicion for nerve injury when evaluating forearm fractures to avoid underdiagnosis. Failure to recognize neurological injury at the time of initial assessment has the potential to delay time to reduction due to the injury being misclassified as non-urgent. This delay has the potential to cause a prolonged or failed recovery of nerve function.

Introduction: The role of continuous compartment pressure monitoring to detect compartment syndrome associated with tibia fractures is unclear. Our study aims to assess the impact of continuous compartment pressure monitoring in patients with acute tibial fractures.

Method: A randomised controlled trial was performed on 200 consecutive extra-articular tibial shaft fractures presenting to a major metropolitan trauma centre between June 2000 and August 2003. One hundred patients were randomised to continuous compartment pressure monitoring of the anterior compartment for 36 hours. The other group received usual care. The surgical team was alerted if the compartment pressure was within 30mmHg of the diastolic blood pressure. Compartment syndrome was diagnosed on clinical grounds in alert patients. All cases of compartment syndrome were treated with fasciotomy. All patients were followed-up for a minimum of six months.

Result: During the study period, three patients presented with acute compartment syndrome and underwent immediate fasciotomy and, consequently, were not entered into the study. In several cases, monitoring revealed pressures within 30 mmHg of diastolic blood pressure, but compartment syndrome was excluded on clinical grounds. The two groups were comparable with regards to age, mechanism of injury and fracture classification. Of the 100 control fractures, there were three cases of compartment syndrome. Each underwent fasciotomy without significant sequelae. Of the 100 monitored fractures, no cases of compartment syndrome were diagnosed. There were no cases of missed compartment syndrome in this study. Continuous compartment pressure monitoring requires regular nurse education and, despite this, in most patients monitoring was not complete.

Conclusion: We did not find continuous compartment pressure monitoring useful in diagnosing compartment syndrome in patients with acute tibial fractures or preventing missed compartment syndrome. However, this study is underpowered to detect differences in missed compartment syndrome and it may be subject to trial bias as the level of awareness of compartment syndrome was raised by performing the trial. We no longer perform continuous compartment pressure monitoring at our institution.