With the protection of crocodile species in Far North Queensland it was proposed that an increase in crocodile related injuries could be expected. The aim of this paper was to prospectively follow any crocodile injuries admitted for treatment at the Cairns Base Hospital and to establish a treatment regime for these injuries.

A database was created in 2000 and patients admitted for treatment at the Cairns Base Hospital were followed prospectively. Prior to 2000 chart reviews were undertaken back to 1993. The injuries sustained, place of attack, wound infections and treatments were reviewed. Approval for this study was obtained from the ethics committee.

The majority of patients treated over that period of time were attacked in the wet season and occurred in the water or at the waters edge. All of the injuries were related to the extremities, except for a single case of multiple abdominal lacerations. All wounds were contaminated with positive swab cultures at the time of their initial debridement. Four of these wounds developed a deep infection. In the majority of wounds adequate debridement, temporary stabilisation, and subsequent definitive surgery and skin coverage (coupled with appropriate antibiotic coverage) related in fracture healing.

Avoidance of attack is the best form of defence. If exposed to crocodile wounds then surgical debridement, antibiotic coverage with keflin, gentamicin and metronidazole and delayed stabilsation will result in successful fracture and soft tissue healing.

Introduction We present prospective and retrospective reviews of sacral nonunions treated with posterior tension band plate and iliosacral screws at Frenchay Hospital from 1994.

Methods Using the pelvis data base at Frenchay (Bristol, UK) Hospital six patients were identified. A further two patients were followed prospectively. Clinical outcome was measured using a visual analogue score ( VAS ) for pain. Radiological analysis was done using pre-injury x-ray and CT when available, pre-revision and post-operative CT. Eight patients were reviewed. Average follow-up was two years (range 6 months to 5.5 years). The average time from initial injury and surgery to diagnosis of sacral nonunion was 7.5 months (range 3 to 18). Six patients had been treated previously with sacro-iliac screws and an anterior external fixator.

Results Pre-operative VAS scores averaged 9.2, postoperatively they averaged 3.4. All nonunions fused radiologically post-operatively. Anterior posterior displacement was able to be corrected by an average of five millimetres. The three fractures that were vertically displaced were not corrected because of coexisting neurological injury.

Conclusions Posterior tension band plating and iliosacral screw fixation reliably allows union to be obtained in sacral nonunions.

Introduction We report on the clinical and radiological outcomes and complications associated with percutaneous ilio-sacral screw fixation of the pelvis.

Methods Patients were located on the plevic data base held at Frenchay Hospital, Bristol, UK. Patient charts were reviewed and their clinical outcomes had been determined using a visual analogue (VAS) pain score. All patients had pre and post-operative x-rays and CT scans. These were used to determine fracture type and subsequent post-operative reduction. All complications and subsequent surgery required was noted.

Results One hundred and seven patients with 76 disruptions of the sacro-iliac joint and 62 sacral fractures treated with percutaneous ilio-sacral screws were reviewed. Average follow-up was 2.5 years (range 6 months to 8 years). Half of the patients had a VAS score of zero post-operatively, 30% had scores of one to five and 20% had scores of greater than five. The majority of these patients had a coexisting neurological lesion. Seventy-one percent had an anatomical reduction (within 5 mm), 18% had displacements of between five and 10 mm and 11% had displacements of greater than 10 mm. There were five infections, four sacral nonunions, four failures of fixation and one case of a transient L5 nerve plasy following inadvertent screw positioning.

Conclusions Percutaneous ilio-sacral screw fixation of the pelvis allows safe, reliable and accurate reduction. Poor clinical results are often attributable to coexisting neurological lesions.