Purpose: To determine if oral midazolam reduces the anxiety of children undergoing removal of percutaneous Kirschner wires (K-wires) from the distal humerus in the Orthopaedic Outpatient Department.

Methods: This was a prospective double blind, randomised controlled trial. 46 children aged between 3 and 12 years who had supracondylar fractures of the distal humerus internally fixed with K-wires were randomised into 2 groups. 0.2mg/kg oral midazolam (active group) or the same volume of an oral placebo (control group) was administered 30 minutes prior to removal of K-wires.

Venham Situational Anxiety Score was performed before and immediately after removal of K-wires. University College London Hospital sedation score was recorded every 20 minutes.

Results: 42 children with an average age of 7.1 years (range 3.6–12.3 years) had complete documentation for analysis. The two groups had similar demographics. All wires were removed in the clinic with or without midazolam.

There was no significant difference in anxiety scores between the groups either before or after wire removal. The change in scores was not significantly different between the 2 groups. However, 45% of children in the active group had reduced anxiety levels in the active group compared to 18% of children given placebo but this difference was not significant (p=0.102). No child was excessively sedated but one in the active group became agitated and restless.

Conclusions: The anxiety scores before and after wire removal in the active group were not significantly different from the placebo group scores. We do not recommend the routine administration of midazolam (0.2 mg/kg) to all children requiring k-wire removal in the outpatient department.

The aim of the study was to compared the various treatments of femoral diaphyseal fractures in children. The endpoints being length of hospital stay, clinical and functional outcome. The prospective part of the study started with the appointment of a dedicated children’s orthopaedic surgeon in 1999. Prior to this in patient traction was the main treatment. Now early hip spicas for the under 5 year old, Nancy nails for the over fives and external fixation for polytrauma are the treatments of choice.

Anyone under the age of fifteen sustaining a traumatic femoral diaphyseal fracture was included in the study. In both groups’ details of the injury, demographic details, other injuries sustained, treatment performed and length of hospital stay were recorded. In the prospective group clinical and radiographic assessments were made at three months and one year. The range of movement of the affected limb was measured and compared to the unaffected side.

There were 47 fractures in the retrospective group and 16 fractures in the prospective. In the retrospective group 94% were treated with traction, and in the prospective group the treatments were, early hip spicas 44%, external fixator 31% and flexible nails 19%. The mean hospital stay was 31 nights in the retrospective group and 16 in the prospective group. In the retrospective group 17% had a mal-union greater than ten degrees, and at three months in the prospective group this was 46%. Clinical follow up at three months in the prospective groups, they all had a full range of movement, and only two had any pain.

The use of varied treatments result in shorter hospital stay which allows children home earlier and reduces the demand on hospital beds. The children returned to normal function with a good range of movement using these modern treatments.