The posterolateral approach to the distal humerus for open reduction and internal fixation of fractures of the lateral condyle in children.

Our study describes a posterolateral approach to the distal humerus for open reduction and internal fixation of displaced fractures of the lateral condyle. A total of 20 patients had open reduction and internal fixation over a four-year period using this approach, and at a mean follow-up of 12 months had full union, range of movement and no complications, either clinical or radiological. This approach is well suited to the exact visualisation and accurate reduction of this difficult fracture with minimal dissection of tissues.

Clavicular nonunion. 31/32 healed after plate fixation and bone grafting.

We report the long-term results in 32 patients with established nonunion of the clavicle; 15 treated with AO Dynamic Compression Plate and autologous cancellous bone graft and 17 treated with an AO reconstruction plate and autologous cancellous bone graft. The patients were followed up for a mean of 8 (4-21) years from injury and 7 (4-12) from non-union operation, both by clinical review and radiographs. 31/32 nonunions united successfully. One fracture which initially failed to unite was replated and subsequently united. 6 compression plates and 7 reconstruction plates were removed for discomfort or cosmesis. None broke. Both plates give equally good results, but we feel that the reconstruction plate is easier to contour to the complex form of the clavicle.

Posterior internal compression arthrodesis of the ankle.

We have reviewed the results of 19 ankle arthrodeses in 18 patients by a new technique of posterior internal compression. Sixteen of the ankles fused at a mean time of 14 weeks and the other three after reoperation. Complications included one case each of infection, Sudeck's atrophy and non-fatal pulmonary embolism. Clinical assessment using Mazur's ankle score showed excellent or good results in nine ankles and three painfree ankles in patients who were wheelchair-bound for other reasons. The mean position of fusion was in 1.7 degrees equinus and 0.8 degrees varus, and the mean range of midtarsal movements was 15.8 degrees. Twelve patients showed radiographic signs of talonavicular or subtalar osteoarthritis.

The use of injury scoring in the evaluation of the Kegworth M1 aircrash.

The Abbreviated Injury Scale (AIS) score and the Injury Severity Score (ISS) were calculated for all passengers and crew of the M1 Kegworth aircraft crash. Regional injury scores were significantly higher in nonsurvivors than survivors of the impact. Mortality and ISSs were found to correlate with the structural damage sustained by the aircraft. The use of injury scoring has highlighted variations in the severity of injuries sustained by occupants involved in an impact crash of an airliner. This information has demonstrated that other factors in addition to the force of the impact were involved in the causation of injury, such as structural integrity, attempts by occupants to protect adjoining passengers, and rear-facing seats.

External fixation of fractures in children.

We report a series of 20 children with 24 fractures that were treated using the AO tubular external fixator in a paediatric orthopaedic unit. There were no major complications related to fixator use. There were two cases of superficial pin track sepsis and one case of non-union. There were no cases of refracture after fixator removal or of leg length inequality.

'Buttonholed' femoral shaft fracture in adolescents: an indication for internal fixation?

Four patients aged 11 to 14 years sustained femoral shaft fractures. The fractures proved to be irreducible by conventional closed methods. At operation; either the proximal or distal end of the fracture was found to have 'buttonholed' through the lateral intermuscular septum, preventing reduction. The case histories and clinical results are presented. To our knowledge this complication has not been described previously, and we believe that it is an indication for open reduction and internal fixation, for reasons that will be discussed. In the patients described here there was no important leg length inequality as a result of the internal fixation.

Pediatric trauma. The last 30 years.

This Symposium is dedicated to the work of Sherman Coleman and reviews changes and events that have occurred during his last 30 years of pediatric orthopedic practice. This article is dedicated to Coleman and highlights the contributions to the management of trauma to the immature skeleton that have been made over these years.

Fractures of the tibial plateau in Nottingham.

A total of 45 patients, with fractures of the tibial plateau, were assessed. A method of joint evaluation is proposed that modifies the existing grading of these fractures to give a better assessment for treatment.

Open reduction or epiphysiodesis for slipped upper femoral epiphysis. A comparison of Dunn's operation and the Heyman-Herndon procedure.

Forty-eight consecutive patients (53 hips) were treated for moderate or severe slips of the upper femoral epiphysis between 1974 and 1984; 46 patients (96%) returned for clinical and radiological assessment at a mean of five years after operation. Twenty-three patients (23 hips) underwent a Dunn's open reduction and 25 patients (30 hips) were treated by epiphysiodesis and surgical osteoplasty as advocated by Heyman and Herndon. The results of the two methods of treatment are compared. Analysis revealed that 11 hips with moderate slip (30 degrees to 50 degrees) treated by the Heyman-Herndon procedure did significantly better than the 18 hips with severe slip (greater than 50 degrees) treated by the same method. Furthermore, when these hips with severe slip were compared to the hips treated by Dunn's open reduction, all of which were displaced greater than 50 degrees, the latter fared significantly better. The authors conclude that the Heyman-Herndon procedure gave consistently good results for moderate slips, but Dunn's open reduction gave better results for hips with severe slips.

Overgrowth of the femur after fracture in childhood. An increased effect in boys.

Forty-four children, treated conservatively for fracture of the shaft of a femur, were studied radiographically to assess the consequent increase in longitudinal growth of the bone. Overgrowth averaged 8.1 mm and was shown to be significantly greater in boys than in girls. Overgrowth did not appear to be influenced by the age of the patient, the type of injury, the type or site of the fracture, the amount of overlap of the fragments or by the handedness of the patient.

An improved technique of intra-operative bone scanning.

Radiopharmaceuticals have been successfully used to detect occult neoplasms and infective lesions. Bone scans using 99mTc-labelled methylene diphosphonate located osteoid osteomas accurately in a series of 30 symptomatic patients. A portable radiation detector system has been designed to help intra-operative localisation and facilitate complete excision of the lesions with minimal damage to normal tissue. A sodium iodide detector with a fibre-optic link was used at first, but a cadmium telluride system has provided a more durable, reliable and sensitive sterilisable probe.