Difficulties posed in managing developmental dysplasia of the hip diagnosed late include a high-placed femoral head, contracted soft tissues and a dysplastic acetabulum. A combination of open reduction with femoral shortening of untreated congenital dislocations is a well-established practice. Femoral shortening prevents excessive pressure on the located femoral head which can cause avascular necrosis. Instability due to a coexisting dysplastic shallow acetabulum is common, and so a pelvic osteotomy is performed to achieve a stable and concentric hip reduction. We retrospectively reviewed 15 patients (18 hips) presenting with developmental dysplasia of the hip aged four years and above who were treated by a one-stage combined procedure performed by the senior author. The mean age at operation was five years and nine months (4 years to 11 years). The mean follow-up was six years ten months (2 years and 8 months to 8 years and 8 months). All patients were followed up clinically and radiologically in accordance with McKay’s criteria and the modified Severin classification. According to the McKay criteria, 12 hips were rated excellent and six were good. All but one had a full range of movement. Eight had a limb-length discrepancy of about 1 cm. All were Trendelenburg negative. The modified Severin classification demonstrated four hips of grade IA, six of grade IB, and eight of grade II. One patient had avascular necrosis and one an early subluxation requiring revision.

One-stage correction of congenital dislocation of the hip in an older child is a safe and effective treatment with good results in the short to medium term.

Aim: To propose new guidelines in the management of supracondylar fractures treated by percutaneous Kirschner wires.

Subjects and Method: We audited 62 children with displaced, unstable supracondylar fractures of the humerus, which were fixed with Kirschner wire over a period of 2 years. The fractures were classified according to the Wilkins modification of the Gartland system. 10% were type II and 90% type III. The protocol followed was that all unstable fractures that required closed or open reduction must be stabilised with Kirschner wires of adequate thickness used in a crossed configuration and supplemented with back slab. They were then followed up mostly weekly, often with multiple check X-rays until 3 weeks, and for wire removal at 3 weeks. The parameters studied are level of surgeon, adequacy of intra operative reduction, re operation rate, adequacy of intra operative X-rays, out of hour operations, number of post operative X-rays, number of follow ups and any complications.

Results:

Two patients had re operation because of poor intra operative reduction which were performed by junior grade surgeon without supervision during out of hours.

Conclusions: Unnecessary radiation can be avoided by obtaining adequate intra operative X-rays and avoiding check X-ray as no fracture had displaced at follow up. New guidelines proposed: 1. Patients with no N-V complications can wait till the morning trauma list. 2. All intraoperative X-rays to be reviewed by consultants before discharging home. 3. 3 weeks appointment for wire removal can be set at one week clinic follow up with out X-ray.

Flexible intramedullary nailing is gaining popularity as an effective method of treating long-bone fractures in children.

We retrospectively reviewed the records and radiographs of 56 unstable fractures of the tibia in 54 children treated between March 1997 and May 2005. All were followed up for at least two months after the removal of the nails.

Of the 56 tibial fractures, 13 were open. There were no nonunions. The mean time to clinical and radiological union was ten weeks. Complications included residual angulation of the tibia, leg-length discrepancy, deep infection and failures of fixation. All achieved an excellent functional outcome.

We conclude that flexible intramedullary fixation is an easy and effective method of management of both open and closed unstable fractures of the tibia in children.