During the cold snap in the West of Scotland 20 December 2009 to 10 January 2010 there was a cluster of uncommon lower limb injuries in children from sledging accidents. These cases are presented as a series.

This retrospective descriptive study details acute orthopaedic admissions for the period of the cold snap. The case-notes for all admissions were reviewed for diagnosis, mechanism of injury.

Five (ex 20 ie 1/4) trauma admissions involved sledging: (1) combined avulsion of anterior and posterior cruciate ligaments left knee (2) Lisfranc injury, (3) distal femoral fracture, (4) distal tibial plafond fracture, (5) pelvis, patella also forearm and facial fractures. These cases are analysed in more detail

Sledging injuries comprise a substantial portion of workload and morbidity. In children, there is a propensity for lower limb and higher energy trauma. Tertiary referrals and non-standard trauma equipment may be required.

AIM: The purpose of this prospective study was to asses the outcome of antegrade intramedullary wiring of displaced distal end of fifth metacarpal fracture in skeletally immature. Intramedullary wiring for fracture metacarpals have been well described in the literature. Retrograde wiring for neck of metacarpal fractures have been associated with limitation of extension at metacarpo-phalangeal joint due to involvement of gliding extensor mechanism. Foucher described ‘Bouguet’ osteosynthesis with multiple wires for metacarpal neck fracture which can be technically demanding in small bones of children. We describe an antegrade wiring using a single bent K-wire at the tip for reducing and stabilising displaced metacarpal neck fracture by rotating 180 degree after crossing fracture site, a method similar to Methaizeau technique for stabilisation of displaced radial neck fractures using nancy nail.

METHOD: Between 2000 to 2006 we treated 9 boys with displaced distal end of fifth metacarpal fracture +/− rotational deformity of little finger using above technique. All of them had closed injuries and the indication for surgery was rotatory mal-alignment or fracture angulation more than 40 degrees. The assessment involved a clinical and radiological examination. The mean age was 13 years. The mean follow-up was 15 months.

RESULTS: All fractures healed in anatomical alignment. There was no loss of active or passive movement of the little finger metacarpo-phalangeal joint or weakness of grip strength in any children. All children returned to pre-injury activity level within 4–6 weeks. There were no complications.

CONCLUSION: Early results of treating displaced little finger metacarpal neck fracture in children using antegrade intramedullary wire are encouraging.