Includes abstract. / Includes bibliographical references. / Distal femur locking plates have become a very popular means of internal fixation because of their ability to provide stable distal periarticular fixation. In spite of this enthusiasm however several studies have reported significant problems with healing. In the distal femur it is recognized that locking plate fixation may be too rigid if used in certain configurations that limit the essential micro movement required for biological healing. Implant failure may arise from rigid configurations that cause excessive hardware stress concentrations. In an attempt to address these problems longer plates and an increased working length have been proposed to reduce construct rigidity. The purpose of our study is to investigate whether an increased working length translates into improved healing.

Arthritis of the proximal interphalangeal joint of the hand can be debilitating disease resulting in pain and stiffness. Treatment is initially conservative but with diseasse progression surgical treatment often becomes necessary. Arthroplasty is one of the surgical options available.

Includes bibliographical references (leaf 60).

Includes summary. / Includes bibliographical references (leaves 47-50). / Rudimentary ulnar polydactyly is one of the most common congenital hand anomalies. These are conventionally treated by suture ligation in the neonatal period or by formal excision, when the child is one year of age. For the last three years, the Congenital Hand Unit at Red Cross Children’s Hospital has used vascular clip ligation as an alternative method of treatment for rudimentary ulnar polydactyly, based on the same principle as suture ligation, but with less associated complications. A study was performed at the unit, where two hundred and nineteen supernumerary digits were treated over a two-year period. The digits were ligated using a vascular clip, as an outpatient procedure.

Includes bibliographical references. / In 1937 WP Blount published a review of tibia vara or osteochondrosis deformans of the proximal tibia. Late-onset Blount's disease is varus deformity of the proximal tibia that occurs at or after 6 years old (excluding late presenting infantile Blount's) and has an associated femoral varus.

Introduction: Fragility fractures of the hip (FFH) constitute the most serious complication of osteoporosis carrying a mortality rate of up to 20 – 30% in the first year after injury and are associated with post injury decay in patient's level of activity in more than 50% of the cases. It is also a predictor of future osteoporosis related fractures. Surgical fixation of the hip fracture within 48 of admission, multimodal pain management, deep vein thrombo-prophylaxis, early physical therapy, appropriate assessment and management of osteoporosis and frailty in a multidisciplinary approach are the standard of care for FFH to keep the mortality and morbidity rate as low as possible and prevent future fragility fractures. Aim: To assess the standard of care of FFH at our institution and determine areas of care which need more attention and improvement. Methods: Retrospective review of clinical and radiographic records of all patients admitted at our level 1 trauma unit for fragility fracture of the hip from 1st January 2014 to 31st December 2014. The waiting time from admission to surgical fixation of the hip fracture, pain control and thrombo-prophylaxis strategies, the rate of geriatric referrals and the extent of osteoporosis management were assessed. Results: We admitted 113 fragility fractures of the hip from 1st January to 31st December 2014. Ninety- eight clinical records and 98 pelvis radiographs were included in the study. The other 15 clinical records were incomplete and were therefore excluded. The average waiting time from admission to surgery was 49 hours (range 9 -120). Low dose morphine, paracetamol and tramadol were the only perioperative pain control medication used for all patients. All patients had low molecular weight heparin and compression stockings prescribed for thrombo-prophylaxis. Only 2 (2, 04%) of patients had some osteoporosis investigations ordered. There were no geriatric referrals made and no formal osteoporosis management in all reviewed records. Conclusion: While the waiting time from admission to surgery was largely within the recommended time frame, there were no signs of a multidisciplinary approach to the management of fragility fractures of the hip at our institution leaving osteoporosis and frailty largely untreated.

Objectives: 1. Determine the amputation rate; and 2. identify risk factors in patients with tibia fractures and associated popliteal artery injuries. Intervention: Amputation or limb salvage. Design: Retrospective case-control study. Setting: Level 1 trauma center. Patients: Thirty popliteal artery injuries with ipsilateral tibial fractures. Outcome measures: Primary and delayed amputation rates were determined. Risk factors tested for significance (Fischer's Exact) included: mechanism of injury, signs of threatened viability, compartment syndrome, fracture pattern, surgical sequence, and time delay from injury or presentation to revascularization. Results: The study group consisted of 22 males and 8 females, with a mean age of 31 years. Motor vehicle accidents and gunshot wounds constituted the mechanism in 17 and 11 patients respectively. Twenty-one were polytrauma victims. Intra/extra16 articular metaphyseal fractures (OTA 41 A-C) were recorded in 19 and diaphyseal (OTA 42 A-C) in 7 patients. Primary amputation was performed in 7 and delayed in 10 patients (overall rate 57%). No individual risk factors were predictive of amputation; however, the "miserable triad" of a proximal tibia fracture (OTA 41) with signs of threatened viability, and delay to revascularization ≥ 6 hours from injury or ≥ 2 hours from presentation was predictive of amputation (p = 0,036 and p = 0,018 respectively). Conclusions: We should aim to intervene within 6 hours following injury or 2 hours following presentation to reduce the risk of amputation. This provides a target for trauma teams even with uncertain time of injury. Level of Evidence: III.

Includes bibliographical references. / Spinal deformity was recognised in the ancient works for philosophy, religion, myths, and fairy tales dating back as far as 3500BC[1,6]. Scoliosis was first described in the 5th century BC by Hippocrates. He recommended treatment with axial distraction on an extension apparatus (figure 1).

Study Rationale: Chronic exertional compartment syndrome often forces patients to change their sporting activities or reduce their level of participation. Many undergo surgery with the aim to return to their activities symptom free. The aim of the study was to determine if fasciotomies for chronic exertional compartment syndrome are a reliable treatment option with a predictable outcome to allow patients to return to the same level of activities. Objective: The evaluation of the functional outcomes and patient satisfaction in an active population who had surgery, namely fasciotomies, for chronic exertional compartment syndrome (CECS) of the lower leg. Design: A retrospective descriptive cohort study with a telephonic follow-up interview. Patients: A consecutive series of 41 patients that were surgically treated for CECS by a single orthopaedic surgeon from July 2005 to October 2013. Main Outcome Measures: Patient records were reviewed to determine their presenting symptoms, diagnostic investigations and surgical procedures performed. A questionnaire was completed by each participant to assess pain and level of activity before and after surgery, level of improvement after surgery and patient satisfaction with surgical outcomes. Results: Twenty-one of the 41 patients that were included in the study were categorized as active sportsmen, participating at a competitive or a non-competitive level. The remaining 20 were experiencing symptoms during leisure activities. The majority of all the patients (63%) had to stop their activity due to their symptoms. After surgery 95% were able to return to participate in the same level of activities as before surgery. Ninety percent of the active sportsmen were able to return to participation at a competitive or non-competitive level, with 45% reporting an increase in the level of intensity that they could maintain. Overall satisfaction was reported by 80% of participants although only 46% were completely pain free. Conclusions: Fasciotomies are a viable surgical treatment option for chronic exertional compartment syndrome in active patients, including athletes. There is an 87% return rate to previous activities within 6 months and an 80% satisfaction rate reported by patients post-surgery. We do acknowledge that some of the data collected regarding symptomology is subject to recall bias due to the interval between surgery and completion of the questionnaire.

Includes bibliographical references / Aim: To assess the MRI pathoanatomical changes 10 years after unrepaired full thickness supraspinatus tears in a population of patients that had acromioplasty done for symptomatic impingement with a rotator cuff tear.