Aims: To discover how the management of traumatic anterior shoulder dislocation in the young patient (17–25) has changed, if at all, over the past six years.

Methods: The same postal questionnaire was used in 2003 and 2009, sent out to 164 members of British Elbow and Shoulder Society. Questions were asked about the initial reduction, investigation undertaken, timing of any surgery, preferred stabilization procedure, arthroscopic or open, detail of surgical technique, period of immobilization and rehabilitation programme instigated in first-time and recurrent traumatic dislocators.

Summary of Results: The response rate were 92% (n=151) – 2009, 83% (n=131) – 2003 The most likely management of a young traumatic shoulder dislocation in the UK would be:

Reduction under sedation in A& E by the A& E doctor (80% of respondents).

Conclusions: There has been a remarkable change in practice compared to the previous survey. A significant proportion of Orthopaedic Surgeons would consider stabilisation in young first time dislocators instead of conservative management. Arthroscopic stabilisation is now the preferred technique compared to open stabilisation whenever possible. Surgeons are using more investigations prior to listing the patient for surgery namely the MR arthrogram. There is also an increased use of bio-degradable anchors as compared to metallic bone anchors in 2003.

A comprehensive postal questionnaire was sent to 164 orthopaedic consultants, all members of the Brit-ish Elbow and Shoulder Society. Questions were asked about the initial reduction, investigations undertaken, timing of any surgery, preferred stabilization procedure, arthroscopic or open, detail of surgical technique, period of immobilization and rehabilitation programmes instigated in first-time and recurrent traumatic dislocators. The response rate was 83% (n=136)

The most likely treatment of a young traumatic shoulder dislocation:

It will be reduced under sedation in A& E by the A& E doctor.

On the other hand, 54% of surgeons indicated they would investigate prior to surgery, 16% said their first choice operation would be arthroscopic stabilisation, the number of dislocations normally permitted before surgery ranged from 1 to more than 3, and the period of immobilisation post operation from nil to 6 weeks.

The results reveal a wide variation in practice and no clear consensus on how to best manage these patients. Open stabilisation remains the firm favourite. Does this mean arthroscopic stabilisation is regarded as an experimental procedure?

To discover how traumatic anterior shoulder dislocation in the young patient (17–25) is managed by shoulder surgeons in the UK.

A comprehensive postal questionnaire was sent to 164 orthopaedic consultants, all members of BESS. Questions were asked about the initial reduction, investigations undertaken, timing of any surgery, preferred stabilization procedure, arthroscopic or open, detail of surgical technique, period of immobilization and rehabilitation programmes instigated in first-time and recur- rent traumatic dislocaters.

The response rate was 82% (n=135)

The most likely treatment of a young traumatic shoulder dislocation:

It will be reduced under sedation in A& E by the A& E doctor.

On the other hand, 54% of surgeons indicated they would investigate prior to surgery, 18% said their first choice operation would be arthroscopic stabilisation, the number of dislocations normally permitted before surgery ranged from 1 to more than 4, and the period of immobilisation post operation from nil to 6 weeks.

We now know how shoulder surgeons in the UK are treating this common injury. The results reveal that in Britain, we do not have a consistent approach, raising many discussion points. Open stabilisation remains the firm favourite. Does this mean arthroscopic stabilisation is regarded as an experimental procedure?

To investigate whether children with fractures have a low bone mineral density, 109 children (46 female and 63 male) aged 10.5 ± 2.9 years (range 5–16) sustaining either a single fracture (n=60 patients) or multiple fractures (n=49 patients) had Bone Mineral Density measurements [BMD] (Hologic QDR4500A) of L2 to L4. The Z score {(Patient’s BMD – mean aged related BMD)/ standard deviation of that age group)} was calculated using two previously published data from Shropshire children and American children. A z score of zero indicates that the patients’ BMD is exactly on the mean. The proportion above and below zero and was compared using the binomial theorem. Comparison of frequencies between the groups was undertaken using the Chi 2 test.

In a scatter plot of z score against age, low z scores were frequent in girls under 8yrs using both reference data. In this group BMD z score was more likely to be below zero (p< 0.05). A low z score was more frequent in boys less than 8 years using American reference data but not Shropshire data. Girls and boys above 8 years did not show any evidence of low BMD. There was no difference in the frequency of low BMD in patients with multiple compared with single fracture.

Girls and possibly boys below 8 years who have sustained a fracture show evidence of low BMD. Boys at any age and girls over 8 years did not show any evidence of having low bone density. Further work is needed to establish whether this risk continues into later life. Multiple fractures do not appear to confer additional risk of low bone density.

The changes in serum adjusted ionised calcium and parathyroid hormone (PTH) were prospectively studied in 32 patients with isolated tibial fractures, treated conservatively. We measured serum albumin, adjusted total calcium, phosphate, pH, adjusted ionised calcium and PTH at intervals until the fractures had healed. The mean ionised calcium adjusted for pH fell within 24 hours of injury, and then rose to a peak at between four and six weeks. These changes cannot be explained by changes in serum pH or PTH. The restoration of normal ionised calcium levels after fracture coincided with the period when the callus was being calcified. Analysis of the changes in ionised calcium, phosphate and PTH suggests that PTH levels alter in response to changes in ionised calcium levels. PTH is highest immediately after fracture and lowest, often not recordable, at six weeks. The cause of the changes in the ionised calcium level has yet to be elucidated.