Introduction: Limb reconstruction surgery (LRS) has a wide range of clinical applications within orthopaedic and trauma surgery. We sought a consensus view from limb reconstruction healthcare practitioners across the United Kingdom to help guide research priorities within LRS. Our aim is to guide future clinical research in LRS, and assist healthcare practitioners, clinical academics, and funding bodies in identifying key research priorities to improve patient care. Materials and methods: A modified Delphi approach was used; it involved an initial scoping survey and a 2-round Delphi process to identify the consensus research priorities in both adult and paediatric LRS. Participants were asked to rank approved submitted questions according to perceived importance on a 5-point Likert scale, where 1 represented lowest importance and 5 indicated highest importance. Mean scores were calculated to identify a consensus of the top ten research priorities for adult and paediatric LRS. Results: One hundred and fifteen participants primarily from across the United Kingdom working in LRS contributed to the modified Delphi process. Participants ranked and then re-ranked the presented research topics in terms of perceived importance. This led to the identification of a top ten research priorities in both adult and paediatric LRS, respectively, based on the collective responses of LRS practitioners. The highest-ranked questions in both adult and paediatric practice related to how to best assess and record patient-reported outcome measures (PROMs) in LRS patients. Other priorities included the effectiveness of specialist physiotherapy, the use of patient-focused psychological support, and the use of various operative management strategies for infection and limb length discrepancies. Conclusion: We present a consensus-driven research priority study that outlines the key research topics and themes determined by healthcare professionals within LRS in the United Kingdom. Clinical significance: These questions will assist funding bodies in prioritising where research funding may be best utilised and help drive future improvement in patient care.

Aims:The aim of this study was to determine the consensus best practice approach for the investigation and management of children (aged 0 to 15 years) in the UK with musculoskeletal infection (including septic arthritis, osteomyelitis, pyomyositis, tenosynovitis, fasciitis, and discitis). This consensus can then be used to ensure consistent, safe care for children in UK hospitals and those elsewhere with similar healthcare systems. Methods:A Delphi approach was used to determine consensus in three core aspects of care: 1) assessment, investigation, and diagnosis; 2) treatment; and 3) service, pathways, and networks. A steering group of paediatric orthopaedic surgeons created statements which were then evaluated through a two-round Delphi survey sent to all members of the British Society for Children's Orthopaedic Surgery (BSCOS). Statements were only included ('consensus in') in the final agreed consensus if at least 75% of respondents scored the statement as critical for inclusion. Statements were discarded ('consensus out') if at least 75% of respondents scored them as not important for inclusion. Reporting these results followed the Appraisal Guidelines for Research and Evaluation. Results:A total of 133 children's orthopaedic surgeons completed the first survey, and 109 the second. Out of 43 proposed statements included in the initial Delphi, 32 reached 'consensus in', 0 'consensus out', and 11 'no consensus'. These 11 statements were then reworded, amalgamated, or deleted before the second Delphi round of eight statements. All eight were accepted as 'consensus in', resulting in a total of 40 approved statements. Conclusion:In the many aspects of medicine where relevant evidence is not available for clinicians to base their practice, a Delphi consensus can provide a strong body of opinion that acts as a benchmark for good quality clinical care. We would recommend clinicians managing children with musculoskeletal infection follow the guidance in the consensus statements in this article, to ensure care in all medical settings is consistent and safe.

Background: There are no clearly defined guidelines for the management of distal radial physeal injuries. We aimed to identify the risk factors for patients with distal radial physeal trauma for the risk of deformity, physeal closure, and revision procedure and develop a predictive model. Methods: The retrospective study included patients less than 16 years old with displaced distal radial physeal injuries treated between 2011 and 2018 across five centers in the United Kingdom. Deformity was defined as a volar angulation of >11°, dorsal angulation of >15°, a radial inclination of <15° or >23°, or positive ulnar variance. Presence of a bony bar spanning the physis was considered physeal closure. Results: This study comprised of 479 patients. In that, 32 (6.6%) patients had a second procedure. Also, 49 (10.2%) patients had closure of physis, and 28 (6%) patients had deformity at the end of follow-up. The occurrence of deformity had a strong correlation with age (p = 0.04) and immobilization duration (p = 0.003). Receiver operating characteristic analysis showed that age >12.5 years (p = 0.006) and sagittal angulation of >21.7° (p = 0.002) had a higher odd of deformity. Immobilization for <4.5 weeks (p = 0.01) had a higher revision rate. The nomograms showed good calibration, with a sensitivity of 70% and specificity of 75%. Interpretation: The nomograms provide accurate, pragmatic multivariate predictive models. Anatomical reduction is recommended in patients >12.5 years of age with >22° of dorsal angulation with cast immobilization for no less than 4.5 weeks. Any revision procedure should be performed within 11 days from the date of injury to reduce the risk of physeal damage.

Introduction:Tibial non-unions present with complex deformities, bone loss, infection, leg length discrepancy (LLD), and other features which influence function. Circular frame-based treatment is popular with the hexapod system used increasingly. This systematic review aims to determine the clinical and radiological outcomes of hexapod fixation when used for tibial non-unions. Materials and methods: The review was performed in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The search strategy was applied to MEDLINE and Embase databases on 15 December 2021. Studies reporting either clinical or radiological outcomes following hexapod fixation on tibial non-unions were included. Primary outcomes were radiological union and patient-reported outcome measures (PROMs). Secondary outcomes included LLD, tibial alignment deformity (TAD), return to pre-injury activity and post-operative complications. Results: After the abstract and full-text screening, 9 studies were included; there were 283 hexapod frame fixations for tibial non-unions. Infection (46.6%) and stiff hypertrophic non-union (39.2%) accounted for most non-unions treated. The average age and mean follow-up were 42.2 years and 33.1 months, respectively. The average time to union was 8.7 months with a union rate of 84.8%. A total of 90.3% of patients had TAD below 5 degrees in all planes, with an LLD <= 1.5 cm of the contralateral leg in 90.5%. Bony and functional results were at least good in over 90% of patients when using the Association for the Study of the Method of Ilizarov (ASAMI) criteria. A total of 84% of patients returned to pre-injury activities. There were complications as follows: a total of 34% developed pin-site infection, almost 9% experienced half-pin breakage and 14% developed an equinus ankle contracture. Conclusion: Hexapod frames for the treatment of tibial non-unions produce favourable functional outcomes. Complication rates are present and need to be discussed when this modality of treatment is proposed. Further comparative studies will allow for this option to be evaluated against that of the traditional Ilizarov frame and other methods of non-union surgery.

Displaced distal radius fractures involving the metaphysis are common childhood injuries requiring intervention. Patients frequently undergo operative treatment for these injuries. The aim of our study was to systematically review the literature comparing manipulation under anaesthesia (MUA) and Kirschner wire fixation(K wire). PRISMA guidelines were followed throughout. Medline and Cochrane databases were searched for comparative randomised controlled trials (RCTs) and cohort studies. Quality assessment was undertaken using the Jadad score, Cochrane assessment of bias tool and the Newcastle-Ottawa Scale. Data extraction was performed with customised forms. 2 RCTs and 4 cohort studies were included. There was significant variation in their methodologies, which included their inclusion criteria and threshold for remanipiulation. Re-operation rates for MUA varied from 14% to 91%. There were no recorded re-operations following K-wiring. There was a 2.2% infection rate and 4.5% rate of wire migration. There were no adverse long-term sequelae reported. All studies showed a higher re-operation rate with MUA alone. Further studies are required to identify which fracture subtypes are most susceptible to re-displacement. Current evidence suggests the use of a k-wire to stabIlise these fractures following manipulation.

Statement of Purpose To compare the functional outcome of Distal Tibial Metaphyseal fracture treated with Circular frame compared vs. Locking Plate Methods and Results Distal Tibial Metaphyseal fractures were retrospectively identified over an 18 month period. Each fracture was assessed individually using radiographs. All paediatric, compound, tibial plateau and intra-articular fractures were excluded from the study. Other methods of fixation including intramedullary nailing were also excluded. The remaining fractures were assigned to either the circular frame fixation or the locking plate intervention group. Outcomes were assessed using radiographs for union dates and microbiology results for evidence of infection. Patients were followed up by postal questionnaires, which included a modified American Orthopaedic Foot and Ankle Score (AOFAS), the Olerud and Molander Score (O&M) and a custom questionnaire. The custom questionnaire asked about co-morbidities, smoking status and work days lost following surgery. After exclusions, 30 patients (Frame=15, Plate=15), were sent out questionnaires via post. We received completed questionnaires from 21 patients (Frame=11, Plate=10) giving us a response rate of 70%. Results show no difference in infection rates, skin necrosis, non-union or re-operation rates. There was also no significant difference in patient AOFAS and O&M scores at follow up. Conclusion There is no significant difference in complications and functional Outcomes between locking plate fixation and circular frames in the treatment of distal Tibial Metaphyseal fractures.

AimIliopsoas tendinopathy occurs due to friction of the iliopsoas tendon on the iliopectineal bar or the hip capsule causing pain and snapping of the hip. In adolescent cases this condition is generally treated conservatively with physiotherapy, stretching and NSAIDs. Our aim was to study the outcome of non-operative management of iliopsoas tendinopathy.MethodA retrospective 4-year study identified adolescent patients with a clinical diagnosis of psoas tendinopathy managed non-operatively. These patients were followed up by postal questionnaire, which included functional assessment using the Non-Arthritic Hip Score (NAHS). A custom study questionnaire assessed current symptoms and the effects of physiotherapy. All patients not treated conservatively were removed from the study.Results36 patients were treated conservatively for psoas tendinopathy. 28 completed and returned the questionnaires to a satisfactory standard. Mean NAHS was 77.72 (CI: 69.91 to 85.54) at a mean follow up of 37 months (Range: 14 to ...

Slipped upper femoral epiphysis (SUFE) is a relatively common adolescent hip disorder that represents a biomechanical instability of the proximal femoral growth plate. A link between vitamin D deficiency and SUFE has emerged in recent years; however, we present a unique case of a 10-year-old girl who presented with a reslip of a previously fixed SUFE with an associated vitamin D deficiency.

BackgroundApproximately a third of all fractures in children occur at the wrist, usually from falling onto an outstretched hand.ObjectivesWe aimed to evaluate removable splintage versus plaster casts (requiring removal by a specialist) for undisplaced compression (buckle) fractures; cast length and position; and the role of surgical fixation for displaced wrist fractures in children.Search strategyWe searched the Cochrane Bone, Joint andMuscle Trauma Group Specialised Register (October 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 4), MEDLINE (from 1966), EMBASE (from 1988), CINAHL (from 1982) and reference lists of articles. Date of last search October 2007.Selection criteriaAny randomised or quasi-randomised controlled trials comparing types and position of casts and the use of surgical fixation for distal radius fractures in children.Data collection and analysisTwo authors performed trial selection. All three authors independently assessed methodological quality and extracted data.Main resultsThe 10 included trials, involving 827 children, were of variable quality.Four trials compared removable splintage versus the traditional below-elbow cast in children with buckle fractures. There was no short-term deformity recorded in all four trials and, in one trial, no refracture at six months. The Futura splint was cheaper to use; a removable plaster splint was less restrictive to wear enabling more children to bathe and participate in other activities, and the option preferred by children and parents; the soft bandage was more comfortable, convenient and less painful to wear; home-removable plaster casts removed by parents did not result in significant differences in outcome but were strongly favoured by parents.Two trials found below-elbow versus above-elbow casts did not increase redisplacement of reduced fractures or cast-related complications, were less restrictive during use and avoided elbow stiffness.One trial evaluating the effect of arm position in above-elbow casts found no effect on deformity.Three trials found that percutaneous wiring significantly reduced redisplacement and remanipulation but one of these found no advantage in function at three months.Authors' conclusionsLimited evidence supports the use of removable splintage for buckle fractures and challenges the traditional use of above-elbow casts after reduction of displaced fractures. Although percutaneous wire fixation prevents redisplacement, the effects on longer term outcomes including function are not established.Further research is warranted on the optimum approach, including splintage, for buckle fractures; and on the use of below-elbow casts and indications for surgery for displaced wrist fractures in children.PLAIN LANGUAGE SUMMARYInterventions for treating wrist fractures in childrenApproximately a third of all fractures in children occur at the wrist as a result of falling onto an outstretched hand. Some fractures are relatively minor and involve a bulging of the bone surface. These are buckle fractures and they are traditionally treated with a below-elbow plaster cast. There are other more serious fractures where parts of the broken or fractured bone are displaced from each other. After reduction, where the bone is put back together again, two measures can be taken to keep the bone together. One option is cast immobilisation, where traditionally the cast is extended to include the elbow (fan above-elbow cast). Another option is surgical fixation. This generally involves placing wires through the skin and into the bone (percutaneous wire fixation).This review includes 10 randomised controlled trials, involving 827 children. Some of these trials used poor methods that meant their results were potentially unreliable.Four trials of children with buckle fractures compared devices such as removable splints with traditional plaster casts that need removal by a specialist. No trial found any participant with bone deformity at follow up and one trial found no refractures at six months follow up. Compared with traditional casts, the Futura splint was cheaper to use and a removable plaster splint was less restrictive to wear, enabling children to bathe and participate more in other activities, and preferred by both children and their parents. A soft bandage was found to be more comfortable and convenient and less painful. Plaster casts that could be removed at home by parents did not result in significant differences in outcome but were strongly preferred by parents.Two trials found below-elbow versus above-elbow casts did not increase redisplacement of reduced fractures or cast-related complications. Below-elbow casts were less restrictive during use and avoided elbow stiffness. One trial evaluating the effect of arm position in above-elbow casts found no effect on deformity.Three trials found that percutaneous wiring significantly reduced redisplacement and remanipulation. One trial found no advantage for function at three months.The review concluded that minor (buckle) fractures could be treated by a splint that is removable at home. Additionally, fractures which have the potential to redisplace could probably be treated safely with a below-elbow cast. Although surgery helped prevent redisplacement of some types of fractures, the long-term benefit was not confirmed. However, further trials on these three issues are needed to obtain more conclusive evidence.

BackgroundDiaphyseal forearm fractures in children are a common injury usually resulting from a fall. The treatment options include non-surgical intervention (manipulation and application of cast) and surgical options such as internal fixation with intramedullary nails or with plate and screws.ObjectivesTo assess the effects (benefits and harms) of a) surgical versus non-surgical interventions, and b) different surgical interventions for the fixation of diaphyseal fractures of the forearm bones in children.Search strategyWe searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (March 2011), the Cochrane Central Register of Controlled Trials (The Cochran Library, 2011 Issue 1), MEDLINE (1948 to February week 4 2011), EMBASE (1980 to 2011 week 09), trial registers and reference lists of articles.Selection criteriaRandomised or quasi-randomised controlled trials that compared surgical with non-surgical intervention, or different types of surgical intervention for the fixation of diaphyseal forearm fractures in children.Data collection and analysisAll review authors independently examined the search results to identify trials for inclusion.Main resultsAfter screening of 163 citations, we identified 15 potentially eligible studies of which 14 were excluded and one is an ongoing trial. There were thus no studies suitable for inclusion in this review.Authors' conclusionsThere is a lack of evidence from randomised controlled trials to inform on when surgery is required and what type of surgery is best for treating children with fractures of the shafts of the radius, ulna or both bones.

Circular frame treatment for limb reconstruction involves repeated follow-up visits, and a substantial number of these appointments are for pin site review only. We have encouraged our frame patients to take photographs of their pin sites when they carry out their weekly dressing changes. The photographs are taken with mobile phones or digital cameras by the patients themselves, and the images sent to us by email. We reply within 24 hours, with either reassurance or appropriate instructions as indicated. In the past 12 months, five patients have had their pin sites reviewed remotely using this method, and have expressed a high level of satisfaction. These early results are encouraging.

s / International Journal of Surgery 8 (2010) 501–578 556 an issue. There is limited evidence regarding the most appropriate treatment for subtrochanteric nonunions. It has been reported that subtrochanteric nonunions treated with the condylar blade plate are associated with good healing rates. Supportive methods in the treatment of nonunions include the use of the Reamer/Irrigator/Aspirator (RIA) system, human recombinant osteogenic protein-1 also known as rhBMP-7 and biocompatible materials such as hydroxyapatite (HA). Case Presentation: We report the case of a patient with a subtrochanteric fracture originally treated using a Trochanteric Gamma nail which failed to a nonunion and fracture of its proximal end. The nonunion was revised with removal of the broken trochanteric Gamma nail, application of a condylar blade plate, ipsilateral RIA autografting, rhBMP-7 and HA injectable cement, with success and healing. Conclusion: The essential requirements for success when revising a nonunited fracture is to provide anatomical reduction, mechanical stability, bone defect augmentation and biological stimulation to achieve healing. The combination of a condylar blade plate, the use of the RIA system, HA and rhBMP-7 provided the above requirements. POST-OPERATIVE DRESSING OF TOTAL HIP AND KNEE REPLACEMENTS: COMPARISON OF THE JUBILEE DRESSING METHOD TO A STANDARD ADHESIVE DRESSING N.G. Burke, J. Walsh, C. Kilcoyne, P. Kenny. Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin, Ireland Primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common orthopaedic operations. Frequently reported wound complications are infection, persistent leakage and blistering. This prospective, randomised study compared the Jubilee method (absorbent hydofiber inner layer and viscoelastic hydrocolloid outer layer) to a traditional adhesive dressing. Infected revision arthroplasty procedures were excluded. 124 patients over a 9 month period underwent total hip or knee arthroplasty by two consultants. 62 patients had the jubilee method wound dressing(35 THA, 27 TKA), and 62 patients received an adhesive dressing (35 THA, 27 TKA). The average length of hospital stay was 9 days for both groups. Wound blistering was reduced using the jubilee method (8%) compared to the standard adhesive dressing (15%). Leakage was decreased using the jubilee method at 5% compared to 15%. The number of dressing changes prior to discharge was significantly less, with 62% of patients using the jubilee method requiring only one dressing change. 87% of adhesive dressings requiring more than one change. Subjective assessment of wound inflammation showed no difference. No patient developed an infection. The hydrofiber/hydrocolloid dressing combination showed significant clinical improvement compared to the adhesive dressing. The authors advocate this wound dressing for primary hip and knee arthroplasty procedures. PAEDIATRIC DISTAL FOREARM FRACTURES: AN AUDIT OF LOCAL REDISPLACEMENT RATES Aziz Ul Haque , Sarim Mohammad , Alwyn Abraham. University of Leicester Medical School; 2 Paediatric Orthopaedics Leicester Royal Infirmary Fractures of the distal forearm account for a third of all fractures in children. The most commonly reported complication is residual deformity. This can lead to poorer functional outcomes. Deformities can remodel over years, but this capacity for remodelling is reduced with increasing age. Deformity at the time of presentation is minimised by manipulation. A redisplacement after the initial procedure may require a re-manipulation. Our aim was to find out re-manipulation rates here in Leicester and to compare them with national figures. The data would also be used to compare angular deformities between the different grades of surgeon and between different interventions (MUA and K-wire fixation). A retrospective log book review, over a 6 month period, identified 65 children matching our criteria. Radiographs were reviewed for evidence of remanipulations and the calculation of angular deformities. During this time, no child required a re-manipulation. Mean angular deformities were not affected by the grade of surgeon (Consultant1⁄4 4.7 1.92, Registrar1⁄4 4.0 0.88), but MUAs did lead to greater deformities when compared to K-wire fixation (MUA 1⁄4 42% of deformities >10 , K-wire 1⁄4 no deformity >10 ). Re-manipulation rates in Leicester were favourable when compared to national figures. The study also shows that an MUA with K-wire stabilisation results in less residual deformity. STANDARDS OF CARE FOR FRACTURED NECK OF FEMUR – ARE WE ON TARGET? E. Ieong, O. Jarral, P. Housden. William Harvey Hospital Introduction: Hip fracture is a common, serious and costly injury. Quality of care varies around the country and secondary prevention is often neglected. Two significant developments aiming to improve the management of hip fractures include the British Orthopaedic Association (BOA) Blue Book and the National Hip Fracture Database (NHFD). Methods: Six standards of care were identified from the BOA Blue Book. 131 hip fracture patients at the William Harvey Hospital (WHH) were identified between July 2009 and December 2009 and compared with national statistics from the NHFD. Results: 50% were transferred to an orthopaedic ward within 4 hours. Average time nationally was 7.8 hours. 66%were operatedwithin 48 hours, compared with 75% nationally. 95% had pressure ulcer risk assessment, compared with 96% nationally. 81% had antiresorptive therapy, compared with 62% nationally 89% had a falls risk assessment, compared to 46% nationally. 100% received orthogeriatric input at WHH. Discussion: Standard of care at the William Harvey hospital is variable. The NHFD is a powerful tool in monitoring performance and standardising care across the county. Trusts can easily compare their performance with national statistics. Improvements can be gained from education and multidisciplinary liaison and involvement JOINT LINE LEVELS IN TOTAL KNEE REPLACEMENT M. Binns, J. Marciniak, S. Bonczek, S. Jones. Mid Yorkshire Hospitals NHS Trust Introduction: Long term success of Total knee Replacement (TKR) depends on restoration of the normal alignment of the lower limb. Malalignment of the tibial tray is a fundamental cause of prosthesis failure, component loosening and leads gait abnormalities due the resultant shift in centre of gravity. Method: We looked into a novel way of measuring post op joint line levels accurately using the ‘Binns Barium Ball method’, in 45 consecutive cruciate retaining TKRs placed using a femoral mechanical axis of 4 degrees. A post operative weight bearing AP X-Ray of the knee was used along with an adjacent horizontal plane marker. The tibial component angle was measured using IMPAX computer based X-Ray viewer.

Approximately a third of all fractures in children occur at the wrist, usually from falling onto an outstretched hand. We aimed to evaluate removable splintage versus plaster casts (requiring removal by a specialist) for undisplaced compression (buckle) fractures; cast length and position; and the role of surgical fixation for displaced wrist fractures in children. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (October 2007), the Cochrane Central Register of Controlled Trials ( The Cochrane Library 2007, Issue 4), MEDLINE (from 1966), EMBASE (from 1988), CINAHL (from 1982) and reference lists of articles. Date of last search October 2007. Any randomised or quasi-randomised controlled trials comparing types and position of casts and the use of surgical fixation for distal radius fractures in children. Two authors performed trial selection. All three authors independently assessed methodological quality and extracted data. The 10 included trials, involving 827 children, were of variable quality. Four trials compared removable splintage versus the traditional below-elbow cast in children with buckle fractures. There was no short-term deformity recorded in all four trials and, in one trial, no refracture at six months. The Futura splint was cheaper to use; a removable plaster splint was less restrictive to wear enabling more children to bathe and participate in other activities, and the option preferred by children and parents; the soft bandage was more comfortable, convenient and less painful to wear; home-removable plaster casts removed by parents did not result in significant differences in outcome but were strongly favoured by parents. Two trials found below-elbow versus above-elbow casts did not increase redisplacement of reduced fractures or cast-related complications, were less restrictive during use and avoided elbow stiffness. One trial evaluating the effect of arm position in above-elbow casts found no effect on deformity. Three trials found that percutaneous wiring significantly reduced redisplacement and remanipulation but one of these found no advantage in function at three months. Limited evidence supports the use of removable splintage for buckle fractures and challenges the traditional use of above-elbow casts after reduction of displaced fractures. Although percutaneous wire fixation prevents redisplacement, the effects on longer term outcomes including function are not established. Further research is warranted on the optimum approach, including splintage, for buckle fractures; and on the use of below-elbow casts and indications for surgery for displaced wrist fractures in children. Interventions for treating wrist fractures in children Approximately a third of all fractures in children occur at the wrist as a result of falling onto an outstretched hand. Some fractures are relatively minor and involve a bulging of the bone surface. These are buckle fractures and they are traditionally treated with a below-elbow plaster cast. There are other more serious fractures where parts of the broken or fractured bone are displaced from each other. After reduction, where the bone is put back together again, two measures can be taken to keep the bone together. One option is cast immobilisation, where traditionally the cast is extended to include the elbow (an above-elbow cast). Another option is surgical fixation. This generally involves placing wires through the skin and into the bone (percutaneous wire fixation). This review includes 10 randomised controlled trials, involving 827 children. Some of these trials used poor methods that meant their results were potentially unreliable. Four trials of children with buckle fractures compared devices such as removable splints with traditional plaster casts that need removal by a specialist. No trial found any participant with bone deformity at follow up and one trial found no refractures at six months follow up. Compared with traditional casts, the Futura splint was cheaper to use and a removable plaster splint was less restrictive to wear, enabling children to bathe and participate more in other activities, and preferred by both children and their parents. A soft bandage was found to be more comfortable and convenient and less painful. Plaster casts that could be removed at home by parents did not result in significant differences in outcome but were strongly preferred by parents. Two trials found below-elbow versus above-elbow casts did not increase redisplacement of reduced fractures or cast-related complications. Below-elbow casts were less restrictive during use and avoided elbow stiffness. One trial evaluating the effect of arm position in above-elbow casts found no effect on deformity. Three trials found that percutaneous wiring significantly reduced redisplacement and remanipulation. One trial found no advantage for function at three months. The review concluded that minor (buckle) fractures could be treated by a splint that is removable at home. Additionally, fractures which have the potential to redisplace could probably be treated safely with a below-elbow cast. Although surgery helped prevent redisplacement of some types of fractures, the long-term benefit was not confirmed. However, further trials on these three issues are needed to obtain more conclusive evidence.

This is a summary, including tables of key findings and quality of included trials of a Cochrane review, published in this issue of EBCH, first published as: Abraham A, Handoll HHG, Khan T. Interventions for treating wrist fractures in children. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD004576. DOI: 10.1002/14651858.CD004576.pub2. Further information for this Cochrane review is available in this issue of EBCH in the accompanying Commentary . Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration

INTRODUCTION:A cross-sectional study was performed to compare the practice of total hip replacement (THR) in the UK against national guidelines.MATERIALS AND METHODS:A postal questionnaire was sent to all fellows of the British Orthopaedic Association.RESULTS:Of the 1587 questionnaires sent out, 966 (60.9%) were returned. Of these, 706 (73.1%) were available for data collection and analysis.CONCLUSIONS:Consensus was observed in several areas including the use of pre-admission clinics and modern cementing techniques. Facilities deemed necessary for THR surgery such as HDU/ITU back-up, ultra-clean air and dedicated orthopaedic wards are almost universally available. However, a lack of consensus is evident in many areas including the process of obtaining written consent, thrombo-embolic prophylaxis, duration of antibiotic prophylaxis, supervision of trainee surgeons and follow-up arrangements. The proliferation in the range of implants, particularly aimed at 'younger' patients, available to surgeons has once again been highlighted.