Three hundred and ten patients having elective cholecystectomy were randomized to either laparoscopic cholecystectomy or mini-cholecystectomy. There were 155 patients in each group. Conversion to open cholecystectomy was significantly more common with laparoscopic cholecystectomy (13 versus 4 per cent) and complications were significantly more frequent with laparoscopic cholecystectomy (9 versus 3 per cent). If laparoscopic cholecystectomy was successful, hospital stay was significantly shorter than for mini-cholecystectomy (2 versus 3 days respectively), but overall the hospital stay was not significantly different. Postoperative analgesia requirements were reduced and return to normal activities and to work were faster after laparoscopic cholecystectomy. There was no significant cost difference between the two procedures.

In a retrospective review of 725 children's tibial fractures between 1990 and 2004, we found paediatric tibial fractures to have a bimodal distribution according to age, peaking at the age 14 years with incidence of 17.1 in 1000 in boys and 5.1 in 1000 in girls. Two hundred and twenty-five (31.0%) cases involved the distal tibial physis, associated with Salter-Harris (SH) I (0.4%), SH II (56.9%), SH III (21.7%) and SH IV (20%) injury patterns. Of these fractures, 77% had initial displacement of more than 2 mm and independent of treatment modality, 20% of cases still had residual displacement of more than 2 mm after reduction. There was significantly less residual displacement in patients who had a computed tomography scan before the intervention versus those who did not (0.3 vs. 1.4 mm, P=0.003). Twelve cases (11.2%) of premature physeal closure were identified after SH II (67%), SH III (17%) and SH IV (17%) fractures. No significant link was found between premature physeal closure and displacement (either initial or residual), mechanism of injury, or treatment modality. In those fractures with an intact fibula, we found significantly less initial displacement (4.7 vs. 7.4 mm, P<0.05) and significantly shorter time to union (6.27 vs. 7.55 weeks, P=0.001). Good anatomical reduction with or without open reduction and internal fixation is one of the important factors in reducing complication rates, and we suggest but cannot statistically prove that open reduction and internal fixation is indicated in fractures with a residual displacement of 2 mm or more. The presence of an intact fibula at the time of tibial fracture has a significant positive influence on fracture outcome. Level III: Retrospective Review.

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Higher Pirani scores were associated with the late relapse group. The TPS and HFCS were shown to be statistically significant predictors of potential relapse. Closer follow-up is advised for patients at risk of relapse.