The aim of this study was to assess the usefulness of the cast index and an indigenously developed gap index as measures of poor moulding of plaster. Twenty cases of re-manipulation of distal third radius fractures in children excluding growth plate injuries were compared with a control of 80 patients. A significant difference (<0.001) was observed in the cast index and the gap index of both the groups. The gap index was more sensitive than the cast index in predicting failure. At a level of cast index of more than 0.8 the relative risk of failure is 6.8 as compared with 35 when the sum of the gap index is more than 0.15. The gap index is a better predictor of failure than the cast index. A quick assessment of these indices is a good practice before accepting any plaster following a manipulation of distal radial fractures.
We identified 25 children (10 girls and 15 boys) who had been treated with single bone intramedullary fixation for diaphyseal fractures of both forearm bones. Their mean age was 10.75 years (4.6 to 15.9). All had a good functional outcome. We conclude that in selected children, single bone intramedullary nailing is a suitable method of treatment for diaphyseal fractures of both bones of the forearm.The most common fractures in children seen in the Accident and Emergency department involve the arm. Distal (epiphyseal and metaphyseal) radial fractures are the most common followed by supracondylar humeral fractures. Diaphyseal fractures of the forearm account for approximately 13% of all paediatric fractures.
The efficacy of cryoanalgesia for the control of trigger-point back pain is assessed in this study. Fifty-one consecutive patients who underwent cryolesioning with a cryoprobe in the in the spinal surgery professorial unit of a teaching hospital in the UK in the last 2 years were sent a questionnaire to identify the type and severity of pain they suffered, the underlying diagnosis and the treatments received before the cryoprobe were noted and eventually the results of the latter. Twenty-three out of the 51 patients were found to be suffering from trigger point backpain exclusively.Croprobe analgesia using the age old method of freezing the trigger point resulting in long term neuropraxia was offered to the patients who were suffering unremitting backpain despite several previous attempts to control pain. Results showed that 83% of them benefited from the procedure.An easily reproducible method of locating the trigger points and the results are presented.
The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) recognised that children have specific anaesthetic and surgical needs. Out of hour surgery should be confined to life or limb threatening conditions.With the care of the child paramount it would be useful to establish the practice of British orthopaedic surgeons regarding timing of surgery in this difficult fracture. Other factors of interest are associated injuries with particular reference to head injury, which is poorly documented in the literature.We utilised the data available on the Trauma Audit and Research Network (TARN) database of children's fractures to establish the epidemiological trends in fractures of the humerus that were admitted to hospitals in the UK from 2000 to 2006. Using AIS codes for humeral fracture we looked at absolute numbers, mechanism of injury, time to theatre and time of surgery. We were also able to look at numbers of associated injuries including head injuries. AIS code 752604.3--open/comminuted/displaced humeral fractures (<16 years) recorded 708 entries. Statistics show in this group a median age 9.6 years, 63% male, in 41.4% the mechanism of injury was fall <2 m, 7.2% had an associated head injury, 28.4% had associated limb injuries, median time to theatre in this group was 11.80 h and the % operated on >5 pm was 35.9%. Interestingly AIS codes for associated brachial artery injury recorded 20 entries, median time to theatre 2.24 h and % operated on >5 pm was 55%. As a separate cohort, head injury associated with humeral fracture numbering 51 (7.2%) differed with median age 12.4 years, % involved in RTA 90.2% (26% in no head injury group) and median time to theatre 9.42 h. It can be seen that these fractures are being operated on out of hours and trends occur within the range of severity of the associated injuries. These large cohorts of children from a multicentre database may give a clue to surgical prioritisation in the UK.Paediatric fractured neck of femur injuries are rare and historically have high complication rates post-operatively. We present 10-year results from Diana Princess of Wales Children's Hospital, Birmingham.We retrospectively identified all patients who had fixation for neck of femur fractures. Cases were identified from theatre records, clinic appointments and data held on computer. Data was reviewed over a 10-year period (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006). In the follow-up, the range of movement and leg length discrepancy were measured clinically and an antero-posterior pelvic radiograph was taken. Function was assessed using Ratcliff's criteria, incorporating clinical examination and radiographic findings.Fifteen displaced femoral neck fractures were identified in 14 children over a 10-year period (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006). Mean age at the time of injury was 10 years (range 6-14 years). Mean follow-up was 31 months (range 6-110 months). Anatomical reduction and internal fixation was performed in all cases.Two fractures wer...
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