Femoral shaft fractures are usually the result of high energy trauma and are often associated with poly-trauma. Inappropriate treatment results in prolonged morbidity and disability. The treatment of choice for fixation is an interlocking intramedullary nail inserted by closed technique. This study reviewed the perioperative difficulties associated with late nailing of femoral fractures at a busy trauma unit.

Thirty four consecutive femoral nails were reviewed retrospectively. Delay to surgery, operative time and peri-operative morbidity was assessed. There were 27 males and 7 females. The average age was 30.5 years. Eleven patients were referred from a peripheral hospital. Motor vehicle collisions accounted for 22 fractures, and gun shot wounds for 7. There were 29 mid shaft injuries, 2 subtrochanteric and 3 distal femurs (Retrograde nails). Preoperative immobilization was by Thomas splint or skin traction. Six operations were done by a consultant, 17 by a senior registrar and 10 by a junior registrar.

The average delay to theatre was 32 days (range 10–63). Nineteen femurs required open reduction. Open reduction resulted in increased operating time: 117 minutes versus 82 minutes for closed reduction. Nine patients required perioperative blood transfusion and 2 patients were admitted to high care post operatively. Leg length discrepancy post operatively ranged from 0 to 4cm. Early knee range of motion was limited.

Delay to surgery was due to insufficient theatre availability, and delay in referral from peripheral hospitals. We found that the delay to surgery resulted in increased operative difficulty, operative time and perioperative morbidity. Late nailing of fractures requires meticulous preoperative planning by the entire theatre team, and careful, experienced surgical technique.

The tibia is the most commonly fractured long bone and is susceptible to open injuries. Open fractures are difficult to manage despite advances in medical care and result in high rates of non union, delayed union and sepsis. Concerns with delay in surgical debridement resulted in our review of open tibial fractures at out institution.

We did a retrospective review of 27 open tibial fractures with a follow up of 6 to 18 months. There were 20 males and 7 females. Sixteen fractures were incurred as pedestrians. There were 12 associated injuries. Eleven patients were referred from peripheral hospitals. There were 9 Gustilo grade 1 injuries, 8 grade 11 and 10 grade 111. Fracture patterns were a range from simple 42 A1 to C3 (AO). Eleven patients were managed by wash-out in casualty, and admission for intravenous antibiotics. Sixteen patients were debrided in theatre. Delay to theatre ranged from 6 hours to 19 days. This was a combination of referral delay and insufficient theatre availability. Nine patients had an external fixator applied, 2 intramedullary nails and 5 plaster casts.

Five patients required repeat procedures, 3 redebridements, and 2 skin grafts. Average hospital stay for patients managed non-operatively was 3 days and operatively 22 days. Union was documented clinically and radiologically in 22 patients at between 12 weeks and 6 months. Eight patients united after 5 months. There were 5 nonunions, 6 cases of superficial sepsis, and 2 deep sepsis. Early complications included one compartment syndrome, and one peroneal nerve palsy.

This study showed a high complication rate for open tibial fractures. We concluded that an improvement in the referral system and local availability of theatre facilities would improve our complication rate.

This pilot study was undertaken to assess the prevalence of low back pain among nurses. Fifty-two women (mean age 44.28 years) working at a provincial hospital completed a questionnaire about low back pain and other health conditions. The duration of pain, number of episodes a year, duration of each episode and treatment were assessed.

Twenty-nine professional, three staff and 17 enrolled nurses responded. Their mean length of service was 18.32 years. Their mean weight was 78.55 kg, with a body mass index (BMI) of 32.2. They commuted a mean distance of 29.02 km (1 to 80), taking 37.12 mins (10 to 90). On average they had 2.18 dependents and 24 had help with household chores. Seventeen respondents participated in sports such as tennis, soccer and swimming.

Forty-six reported episodes of pain lasting five or more days. Symptoms had been present for 6.62 years. Twenty-three had fewer than eight episodes a year. Thirty-eight patients (82.6%) required treatment, including rest, medication and physiotherapy. Seven were admitted to hospital and one had surgery. Sick leave accounted for 751 lost work days. Forty-one nurses (78.8%) wanted to participate in a back care programme.