The initial diagnosis of a sleeve fracture of the patella is key to a successful outcome with poor results well documented in the literature from delayed management. Diagnosis is difficult due to the rarity of this injury and thus the low likelihood the admitting junior doctor would think of this injury in their differential. They are very uncommon in incidence and have features on plain radiography that are difficult to interpret unless the surgeon is familiar with the anatomy of the immature patella. Missing the diagnosis can be disastrous for the patient. In this paper we describe the presentation of bilateral sleeve fractures in a healthy child, our initial investigations and subsequent management. We chose to repair with 5 Ethibond via 3 transosseous tunnels, initially reinforced with a circlage wire. On last review the boy maintains stable, pain-free knees with a full range of motion. The authors hope that this case and literature review will provide a valuable teaching aid and so assist in early, accurate diagnosis and cover the management options to achieve a positive outcome.

Although our VTE rate reduced by 0.4 % and our VTE-related mortality reduced by 0.04 % after introduction of chemical thromboprophylaxis, these differences were not statistically significant. Chemical thromboprophylaxis may not be required in all patients undergoing arthroplasty providing appropriate mechanical prophylaxis is used.

Results: 100% of patients recruited were high risk of malnutrition on admission. Overall average daily calorie intake over 3 days was 446.2 kCal average protein intake was 16.1 g. Intake for each group was well below recommended target intake of 1810 kCal and 46.5 g, p < 0.05. Discussion: Only 5% of 40 patients, all high risk for malnutrition, received dietician input and oral supplementation. Recorded nutritional intake was well below target nutrient intakes, this is likely to be detrimental to surgical outcome. Conclusion: Despite NICE nutrition guidance, acutely unwell, malnourished patients are not receiving their basic nutritional requirements.

No abstract