Triplane fractures of the distal tibia in children.

PURPOSE: To review 28 cases of paediatric triplane fractures of the distal tibia over a 7-year period in a tertiary paediatric hospital. METHODS: Records of 21 boys and 7 girls aged 11 to 15 (mean, 13) years presented with triplane fractures of the left (n=14) and right (n=14) ankles were retrospectively reviewed. RESULTS: Injury mechanism included low-energy trauma (n=10) and moderate-energy trauma (n=18). Fractures were 2-part in 20 patients, 3-part in 6, and 4-part in 2. 11 patients had concomitant fibular fractures. Articular displacement was <2 mm in 17 patients and ≥2 mm in 11 patients. 17 patients were treated conservatively (cast immobilisation); 11 were treated surgically by closed reduction and percutaneous pinning (n=1), open reduction and percutaneous pinning (n=5), closed reduction and internal fixation (n=3), or open reduction and internal fixation (n=2). Transepiphyseal partially threaded cannulated screws were used for fixation. The mean period of casting was 5.8 weeks, and the mean non- weight bearing period was 6.1 weeks. The mean follow-up period was 14.2 (range, 9-20) weeks. All patients had excellent outcome. No patient had any infections, delayed or non-union. Six patients had decreased range of motion and 4 had pain 4 weeks after cast removal. CONCLUSION: Treatment outcome of triplane fractures of the distal tibia in children is good when guidelines are closely adhered to.

Total hip arthroplasty in patients with chronic autoimmune inflammatory arthroplasties.

OBJECTIVE: Patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and ankylosing spondylitis (AS) often require total hip arthroplasties. We present a retrospective review of 32 total hip arthroplasties (THA) performed for patients with SLE, RA or AS from 2003 to 2008 in a tertiary hospital in Singapore. MATERIALS AND METHODS: A total of 323 THAs performed between January 2003 to December 2008 were traced and cases of arthroplasties performed for such patients were isolated. Pre- and post-operative range of motion, Harris hip score, limb length discrepancies and complications were studied. RESULTS: Twenty-six patients aged 24-66 years (mean 47 years) were reviewed, with two AS patients (7.7%), 16 RA patients (61.5%), seven SLE patients (26.9%) and one patient (3.8%) with both RA and SLE. Thirty-two THA operations were conducted with six patients requiring bilateral THAs. The average follow-up was 3.3 years. Mean Harris hip score for 25 patients (one excluded due to patient expiry 2 month post-surgery) improved from 41.3 to 86.53 (P < 0.05). Mean pre-operative hip flexion improved from 61.3 degrees (0-120) to 89.7 degrees (30-120) (P < 0.05). Seventeen cases had preoperative limb length discrepancies (median 1 cm) which were all corrected. There were no implants loosening, infective arthritis, dislocations or neurovascular injuries documented. CONCLUSION: Our series demonstrated the excellent outcome of THA for patients with chronic autoimmune arthropathies at the time of follow-up. Careful patient selection remains a priority as long-term outcomes for such patients of a significantly younger population is yet to be determined.