Introduction: Large numbers of studies have been conducted to help the decision making of appropriate management of an ankle fracture.

Aim: To assess intra-observer and inter-observer agreement of treatment for ankle fracture based on plain radiographs.

Materials and Methods: Fifty patients with ankle fracture were randomly selected. Antero-posterior and lateral view ankle radiographs were blinded by the first author and then reviewed by five orthopaedic surgeons with varying clinical experience. The observers were asked for their opinion about how they would like to treat the fracture? They were provided with additional basic information of patient age, sex, mechanism of injury and associated comorbidities. This exercise was repeated again after four weeks. The kappa coefficient and observed agreement values were used for statistical analysis.

Results: The kappa values on both occasions were 0.41(SE: 0.084, 95% Confidence interval: 0.248–0.576, P< 0.00001) and 0.29(SE: 0.099, 95% confidence interval: 0.098 TO 0.487, P< 0.00001). These results show only fair inter-observer agreement.

The kappa values for intra-observer agreement were from 0.34 to 0.69 (P< 0.001) for different observers. The observed agreement for these observers was from 70% to 94%. Only two most senior observers had good agreement.

Conclusion: These results show that there is only fair inter-observer agreement of the treatment for ankle fracture based on plain radiographs and only senior clinicians were consistent about their preferred mode of treatment on both occasions. There is a need of clear guidelines and better understanding of biomechanics of Ankle Fractures to minimize the ‘grey’ zone of when to intervene.

Trampoline was used by British & American fighter pilots as a training device during World War II. It became popular among Civilian as a recreational sports during 50s and 60s. Trampoline related injuries including quadriplegia and death have been reported from United States and Europe. We are reporting the incidence, type and distribution of trampoline-related injuries in children in a District General Hospital in United Kingdom.

Recently we treated three serious injuries – proximal tibial fracture associated with popliteal artery injury, subtrochanteric fracture of femur and cervical fracture-dislocation leading to quadriplegia, that lead to an audit study. This is a retrospective analysis of trampoline-related injuries in children seen in the Accident & Emergency Department over three months period. The casualty cards and admission records were reviewed.

The mechanism of injury was fall on or off the trampoline in 98.15%(53/54). All injuries occurred on back-garden or leisure-centre trampoline. 74% of injuries were sustained while unsupervised.

The incidence of soft tissue injuries were 59.25%(32/54) and fractures 40.75%(22/54). Soft tissue injuries commonly involved lower limb(16), upper limb(7) and head and neck(4). Fractures commonly involved upper limb(13), lower limb(8) and nasal bone(1). The fractures involved wrist and forearm in eight cases, ankle in five, elbow in four and one case each involving finger, hip, knee and toe. The treatment of trampoline-related injuries varied from reassurance, analgesia, tubigrip bandage to plaster cast. Fourteen(26%) patients were admitted into the wards and ten(18.5%) required surgical treatment.

The incidence of trampoline-related injuries in back-garden and leisure-centre when unsupervised was high. The supervision by an adult has not proved to be very effective in preventing the injuries as 26% of trampoline-related injuries occurred under supervision of an adult.

The morbidity related to leisure trampolining is high probably due to lack of training and non-compliance to the manufacturer instructions in the use of trampoline. We would recommend banning the routine use of back garden trampoline without proper training and supervision.