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Results: It was noted that there was a delay of more than three days in taking the patients to theatre if wait and watch policy was adopted and the INR fell to levels below 2.0 in patients who were given vitamin K on admission within 12-24 h hence expediting their operation.Discussion: We propose that in discussion with local haematologists, every trust should have a policy for reversing warfarisation in semi emergencies like fracture neck of femur and that vitamin K should be considered in patients with atrial fibrillation without other risk factors on admission.Introduction: Fracture classification systems help in communication, treatment planning, assessing prognosis and form standards to report treatment results. The ideal classification system should be reliable, reproducible, all-inclusive, mutually exclusive, logical and clinically useful. The aim of our study was to assess the inter-observer reliability and intra-observer variability for the AO, Schatzker and Hohl and Moore classification systems.Materials and methods: We randomly selected fifty sets of radiographs of tibial plateau fractures occurred between 2000 and 2005.Exclusion criteria: Only one available view, inadequate films. Four orthopaedic surgeons at various level of experience, i.e. one senior house officer, two registrars and a trauma consultant classified the fractures. Radiographs were blinded and each time the radiographs were presented to the observers in a different order. Radiographs were viewed at two separate sittings 8 weeks apart. The data was analysed using kappa statistics through SPSS version 14. The kappa coefficients were interpreted according to Landis and Koch grading. (<0.00 = poor; 0.0-0.2 = slight; 0.21-0.4 = fair; 0.41-0.60 = moderate; 0.61-0.8 = substantial; >0.8 = excellent).Results: For the AO classification the mean kappa coefficients for inter-observer and intra-observer reliability were 0.36 (0.33-0.39) and 0.83(0.61-1.00), respectively. For the Schatzker classification the mean kappa coefficients for inter-observer and intra-observer reliability were 0.47(0.45-0.49) and 0.90 (0.75-1.00), respectively. For the Hohl and Moore classification mean kappa values for interobserver and intra-observer variability were 0.14 and 0.81 (0.59-1.00), respectively. According to Landis and Koch grading, AO classification is fair in terms of inter-observer reliability, the Schatzker classification is moderate and the Hohl and Moore is slight.Conclusions: None of the three systems fulfils the criteria for an ideal classification system. However, the Schatzker classification system was found to be superior. The Hohl and Moore system was least reliable of all. Hence, we rec-

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✓ The authors report a rare case of rotational dislocation of the thoracolumbar spine in a 12-year-old girl with neurofibromatosis Type 1. The patient had progressive spinal kyphoscoliosis with acute-onset paraplegia. She was treated with corrective traction preoperatively, followed by spinal decompression and circumferential spinal fusion without instrumentation. She had complete neurological recovery after a solid fusion of her spine.

We are presenting an unusual intra-operative complication of penetration of sliding hip screw (SHS) into the pelvis during fixation of an intertrochanteric fracture neck of femur in a 78-year-old man along with the technique of retrieving it.

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