Background
The incidence of paediatric traumatic elbow dislocation is about 6 per 100,000 children and is a serious injury with potential long term consequences.

Objectives
The aim of our study was to evaluate clinical and functional outcomes of these injuries.
Study Design & Methods
We performed a retrospective review of 20 children with an acute traumatic elbow dislocation who presented between February 2007 to February 2016. 10 children had associated fractures and were managed with open reduction and fixation, while the remaining managed with closed reduction and immobilization. Patient demographics, management, complications were recorded from the clinical notes. The functional outcome was assessed with KIM score at final follow up.

Results
The mean age was 12 years (7-15) and follow-up was 8 years (4 – 13 years). There was one (5%) redislocation case needing surgery and one (5%) with transient neuropraxia of ulnar nerve that resolved within one month. The average KIM’s score was 88.5 (65 – 100) versus 78.5 (60 – 100) in the closed reduction group and open reduction group respectively. 80% (16/20) reporting good or excellent results with KIM’s scores greater than 75 points and no poor functional outcome in our series.

Conclusions
Traumatic elbow dislocations in children with or without associated bony injury have a good functional result in long-term and minimal morbidity.

Background: Paediatric femoral fractures are not uncommon. We noted an anecdotal change in the age of patients treated over time. We reviewed all cases admitted since January 2011 to observe the change in the demographics of paediatric femoral fractures. Method: We utilised our online theatre system and reviewed operation lists from 2011 until 2019, noting all paediatric femoral fracture operations, age, co-morbidities, and surgery. Results: 108 cases were identified. All were unilateral. 75% were male. Ages ranged from 11 months to 16 years. Children under 5 years sustained injuries from trips, playing in nursery / play areas, and trampoline. There were 10 suspected non accidental injuries, including one confirmed. Contact sports, skateboarding and cycling dominated in those 6 years and older. There has been a gradual decline in the number of paediatric femoral fracture admissions from 2012. The average age of patients declined from 6.8yrs in 2011 to 3.8yrs in 2019. Prior to 2014, there were cases of high energy injury from road traffic collisions and motor-cross racing in children aged 12 years and over. After 2014, we did not have any admissions of children over the age of 13 years. Conclusion: The number of admissions and average age of patients has shown a gradual decrease over 9 years, with more cases being associated with falls. Major trauma femoral fractures were not seen after 2014. This is likely due to the regional trauma centre gaining its major trauma centre status that year and the increased sedentary lifestyle of modern children.

Restoration of the radial bow in the diaphyseal forearm fractures is crucial in the normal rotation of the forearm in adults, but the same could not be concluded in children. This study aims to determine if restoration of radial bow can be a predictor of functional outcome compared to post-reduction angulation among pediatric non-operatively treated diaphyseal forearm fractures. Patients 6-18 years old with diaphyseal forearm fractures and treated non-operatively with casting were ernrolled. The radioulnar anterolateral angulations, maximum radial bow and site of the maximal radial bow were measured on the post-reduction radiographs. The angulation, radial bow, forearm pronation-supination, DASH scores and the Grace and Eversmann rating scale were measured on the 6th, 10th and 12th week follow-up. 206 participants were included in this study. Mean radial bow was 11.1mm while site of maximal radial bow was 57.62%. Average radial anterolateral and ulnar anterolateral angulations were 9.7˚, 17.33˚, 8.39˚ and 10.47˚, respectively. Mean pronation-supination was 100˚. Median DASH scores at 6th, 10th and 12th weeks were 69, 43 and 22 points, respectively. Among the different parameters, maximal radial bow had a correlation with the functional outcome (r = 0.192, p = 0.006). Moreover, every millimeter increase in maximum radial bow led to a four-fold increase in the odds of having good functional outcome (aOR 3.86, 95% CI 1.52 to 9.80, p = 0.004). Measuring the maximal radial bow in non-operatively treated diaphyseal forearm fractures can be used as a parameter to predict the functional outcome in the pediatric population.

Introduction: The definitive treatment of pediatric diaphyseal fractures has always remained controversial. determined by surgical experience and local trends of practice. The aim of this study was to study the outcome of surgically managed diaphyseal fractures in pediatric age group. Methods: A prospective interventional study was done comprising of 42 fractures in 28 children having displaced diaphyseal fractures of major long bones. Flynn’s scoring criteria was used to study the outcome. Results: The observations are based on 42 surgically managed diaphyseal fractures in long bones in 28 children. 3 patients were lost to follow up. The mean age of patients in the study was 10.85 years. The commonest mode of injury was fall while playing (from level ground) (18 cases, 4.29%). The commonest bones to get fractured were both radius and ulna together (50%), followed by femur (25%), tibia (21.43%) and ulna alone (3.57%). The commonest location of fracture was middle third shaft (25 fractures, 59.52%). Transverse fractures accounted for major proportion of this series. Among the 42 fractures, 39 fractures were treated with Titanium elastic nailing. 2 compound fractures were treated with external fixator application. The mean period of union was 10.69 weeks. It was observed that the majority of the fractures had excellent outcome (30 fractures, 76.92%). Conclusion: Titanium elastic nailing is found to be an effective method of treating closed displaced diaphyseal fractures in children, due to shorter period required for union, better fracture reduction and stabilization besides prevention of stiffness of adjacent joints and fracture disease.

Tibial eminence fracture(TEF) represent an avulsion fracture at anterior cruciate ligamente (ACL) tibial insertion, they usually occur between 8-14 years during athletic activity. Depending on the degree of displacement, ir can be treated by conservative or surgical means. There is some consensus that for Meyers and Mckeever type II that do not reduce by closed means and type III fractures surgical treatment is associated with better outcomes. The objective was to review the outcome of arthroscopically treated TEF at our institution.
Observational retrospective study of all pacientes treated for TEF by arthroscopic fixation between 2010 and 2018. Demographic, clinical and imagiological review was done of all cases. Surgical technique and complications were also recorded. Functional outcome was assessed by IKDC and Lysholm scores.
14 patients, 12 males and 2 females, mean age of 14.2 years. Meyers and Mckeever classification: 6 had type II lesions, 6 type III and 2 type IV. 11 patients underwent fixation with high strength wire and 3 with cannulated screws. There was an associated meniscal injury in 7 cases. The mean follow-up was 32 months. In the last observation, all had complete knee extension, with an average flexion of 125 ° compared to 128 ° in the contralateral and did not present instability. The average of the IKDC and Lysholm scores was 93 and 96 respectively.
Arthroscopic fixation of TEF is a safe and reproducible treatment method with good functional outcome associated.

Osteogenesis imperfecta also named Brittle Bone Disease, is a genetically inherited disease characterized by mutations in collagen type 1, which leads to abnormal development of bone and connective tissues. It is common to present osteoporosis, resulting in higher risk for multiple fractures. Tendons can equally suffer ruptures, although not as frequently. Patellar tendon ruptures are common if fractures of the distal pole occur. The repair of tendon injuries is challenging because of the high mechanical loads. A 36-year-old woman fell getting out of her car, resulting in direct left knee trauma. She had been previously diagnosed with Osteogenesis Imperfecta. Tenderness at palpation and no active leg raise in full extension were present. A comminuted distal pole patellar fracture with associated proximal patellar tendon avulsion was diagnosed. Surgical repair was conducted with two suture anchors (two sutures each) inserted longitudinally towards the anterosuperior border of the patella. A Krackow interlocking transosseous suture technique was performed. Extension splint immobilization for 4 weeks necessary to heal the retinaculum. Full weight-bearing as tolerated. Active range of motion initiated afterward with the support of a hinged brace. It increased from 0º to 90º degrees of flexion. Quadriceps strengthening exercises. These are rare injuries and treatment is crucial for repair of the extensor apparatus, especially when Osteogenesis Imperfecta contributes to superior fragility. Resection of the distal pole has related to the shortening of lever arm of the extensor mechanism. A transosseous suture is indicated in comminuted lower pole patellar fractures with patellar tendon avulsion injuries.

Background: Supracondylar fractures of the humerus (SFH) are the most common paediatric elbow fractures, accounting for 3% of all children’s fractures. The British Orthopaedic Association’s Standards for Trauma for SFH in children specify that: ‘A documented assessment of the limb, performed on presentation, must include the status of radial pulse, digital capillary refill time and the individual function of the radial, median (including anterior interosseous) and ulnar nerves.’ As a department we should be achieving 100% in our adherence to this standard. Objectives: This audit process sought to analyse our adherence to national guidelines. Methods: Retrospective analysis of the documentation of cases of SFH fracture in a 1 year period. An electronic pro forma to be used when seeing patients with SFH was introduced, with prompts for the pieces of documentation required to meet national standards. After 6 months we re-audited. Results: Of the 35 cases analysed, there were 5 where no documentation could be located relating to their elbow injury. Documentation of each individual examination finding ranged from 10% for anterior interosseous nerve to 53% for radial pulse. In the re-audit, there were 16 cases. Documentation of each individual examination finding this time ranged from 50% for anterior interosseous nerve to 69% for median nerve function. There were 8 patients for whom all documentation was present, and for these patients the pro forma had been used. Conclusions: We have shown improvement in our documentation for these fractures. Use of an electronic clerking pro forma improves adherence.

Background: Osteogenesis Imperfecta (OI) is characterized by increased bone fragility and susceptibility for fractures. A few studies described treatment modalities for diaphyseal leg fractures in patients with OI, most of them with small number of subjects and in non-adult patients making difficult to define consensus on the optimum surgical treatment for these fractures.
Case Presentation: The authors report a case of a 39-years-old women with type III OI. The patient reported more than eight fractures in eight years, most of them treated nonoperatively. A proximal right bone leg fracture (OTA 42A1) was resulted after a stumble fall on her right side. An open reduction and internal fixation with a proximal locking compression plate was performed.
Clinical Outcomes: Clinical and radiographic follow-up showed no displacement with consolidation of the fracture after 8 weeks. The patient was followed up for 12 months and presented already after 5 months with a physical status comparable to the pre-operative level without any limitation.
Discussion: In general, intramedullary fixation is recommended for the treatment of long bone fractures in OI. However, concers with the narrow tibial canal, the tibial bowing and the impaired bone quality comparable to osteoporotic bone lead the authors to choose a locking compression plate. Due to the lack of information, and the small cohort studies in the literature, this case report, add one additional case of a successful treatment of a leg bone fracture in an adult patient with OI with a locking compression plate.

Introduction: Although intra-medullary nailing of displaced diaphyseal tibia fractures is considered the gold standard treatment, its use in open fractures is often debated. Deep infection rates in these cases is reported between 4-13%. To reduce this risk, our unit has switched to using a gentamicin coated antibiotic nail. We present our experience of using this intra-medullary nailing device in the treatment of open fractures of the tibia. Methods: All open tibia fractures treated with intra-medullary nail were identified via our daily trauma lists. Operation notes, radiographs and outpatient clinic letters were reviewed and data collected on patient demographics, Gustilo-Anderson classification, surgical treatment, complications and time to union. Patients were excluded if they had less than 12 months follow up. Results: 25 patients have undergone nailing of their open tibia fractures with this antibiotic coated nail since it’s introduction in 2018. Age range 19-84 (mean 38.9 years). Gustilo-Anderson classifications were 2 grade I, 8 grade II, 8 IIIA and 7 IIIB. 21 patients achieved bony union within their 12 month follow up period. 1 patient with a non-union developed deformity and was later treated with a circular frame. Deep infection occurred in 1 patient (4%) with a IIIB open fracture, and was treated with exchange nailing. Conclusion: So far the use of this antibiotic coated nail has resulted in a low deep infection rate when compared to other published data on internal fixation of open tibia fractures. Further work is required as case numbers continue to increase within our unit.

Ttibial tuberosity fractures are uncommon with an incidence of 0.4-2.7%, however they must be identified and properly addressed as early as possible.
This study intends to evaluate the short-term results of the fixation methods applied in the
fractures of the anterior tibial tuberosity in adolescents.
Retrospective study in patients with fractures of the tibial tuberosity surgically treated between January 2007 and December 2017. The parameters included were: age and gender, laterality, co-morbidities, imaging classification, treatment, return to activity and complications.
Six male patients were identified, with an average age of 13.3 years old. 5 fractures on the left knee and one in the right. One of the patients had previous Osgood Schlatter's disease.
According to the Ogden classification, 3 cases were classified as type IIB, 1 type IIIA and 2 type IIIB. All cases were treated with open reduction and internal fixation with screws. One patient had concomitant distal rupture of the patellar tendo, which was reinserted with an anchor. Imaging control was performed at 2, 6 and 12 weeks and 6 months. One case of neuropraxia of the common peroneal nerve was identified, with full recovery.
On average, patients removed the immobilization at 4 weeks, resuming their sport activity after 4 months. The follow-up was an average of 21.8 months, and at the
last observation, all patients had complete range of motion and none presented recurvatum.
The majority of anterior tibial tuberosity fractures (Ogden >grade 2) when properly addressed with internal fixation can achieve excellent functional outcomes.

We present the case of a 70-year-old female who attended the Emergency Department of
Cork University Hospital, a level 1 trauma centre serving the southwest of Ireland. She
sustained a Gustillo and Anderson grade IIIC open fracture with 8 cm cortical bone loss of
the distal tibia and comminuted distal fibula fracture. Her case was complicated by multiple
co-morbidities including hypertension, diabetes mellitus, pancreatic failure, peptic ulcer
disease and liver cirrhosis. Her Non-Union Risk Determinator (NURD) score was 14, and the
score of Non-Union Percentage was 65%. We fixed this patient with a unique micromotion
enabled tibial nail supplemented with a fibular allograft. The fracture healed over a fourmonth period and the patient is currently mobilising pain free. This case exemplifies the need
for novel techniques and implants in our armamentarium to deal with such complex fractures
in the elderly population