Patients who have an injured limb treated in a cast may need to travel on an aircraft. The Civil Aviation Authority (CAA) have issued guidelines to help clinicians and airline companies decide if patients are safe to travel on an aircraft, or if they need to have the cast altered. Patients may seek advice from the airline companies without consulting their clinicians.

This study looked at the published advice on the websites of commercial airline companies, and requested written guidelines from those with whom no published advice was available. Out of the top 16 companies flying in and out of the UK, only six followed the CAA advice, seven did not have a clear policy, and some offered advice that could be worrying to some clinicians.

This study shows that there is little evidence available to help airline companies and clinicians decide if it is un-safe to allow people to fly with a cast. The advice from airlines is conflicting and confusing for patients, therefore a more consistent approach may be needed to allow safe air travel, to avoid inappropriate alterations of casts and to avoid unnecessary visits to the fracture clinic.

Supracondylar fractures of the humerus have historically been treated as an emergency case and operated on at the earliest opportunity. We undertook a study to examine whether surgical timing affects the need for open reduction or peri-operative complications in the type III injuries.

Between August 1995 and August 2004, 534 patients presented and were referred to our unit with these fractures. Those with closed, type III injuries without vascular compromise were selected (171 patients). These were divided into 2 groups: those undergoing surgery less than 8 hours from presentation (126 patients) and those undergoing surgery more than 8 hours from presentation (45 patients).

The two major differences between the two groups were: the delayed group were more likely to undergo open reduction (33.3% v 11.2%, p<0.05) and the mean length of the surgical procedure was increased (105.1 minutes v 69.2 minutes, p<0.05). Delay in treatment of the type III supracondylar fractures is associated with an increased need for open reduction and a longer procedure. We would recommend treating these injuries at the earliest opportunity.

Introduction

The gastrocnemius tendon extends from the musculotendinous junction proximally to the conjoint junction with soleus distally. The morphology of the junction has not, to our knowledge, been described previously. Lengthening of the gastrocnemius tendon is a standard surgical procedure in surgery for cerebral palsy. The aims of the study were to describe the morphology of the conjoint junction and to identify the location of the gastrocnemius tendon relative to palpable bony landmarks to assist with incision planning.