The change in energy absorbed post removal of metalwork in a simulated paediatric long bone fracture.

Purpose: The surgical treatment of paediatric fractures is increasing. Open reduction and internal fixation (ORIF) with plates and screws is long established, whilst the use of elastic stable intramedullary nailing (ESIN) has become increasingly popular. This study quantifies, in terms of the energy required to produce a fracture, the biomechanical sequelae of both techniques post removal of metalwork, to provide clinicians with evidence to guide post-operative advice.

A retrospective review of the assessment of current perioperative management of diabetes in patients undergoing knee replacement surgery.

Objectives: The prevalence of diabetes mellitus is increasing. Previous work has shown that suboptimal glycaemic control is associated with poor perioperative outcomes with increased rates of postoperative morbidity and mortality in several surgical specialities. Recently published UK guidelines have laid out the standards of perioperative care for patients with diabetes.

Total knee arthroplasty in a patient with hemophilic arthropathy and high-titer inhibitors: a cost analysis.

A patient with hemophilia A, who developed factor VIII inhibitors and initially had funding for his total knee arthroplasty declined, is discussed. A total of £1 542 000 (US $2 474 603) was spent on medical treatment for recurrent hemarthroses over a 4-year period, while funding was sought. In comparison, the total cost for his knee arthroplasty was £542 858 (US $871 084) including perioperative recombinant clotting factors.

Laundry detergent and possible nonaccidental injury.

Nonaccidental injury is always a concern when children present with unusual injuries. The case of a child who presented with a partial thickness burn secondary to prolonged contact with a liquid biological laundry detergent is described. Initially there was some doubt as to whether the agent in question could cause this injury but a small experiment on a volunteer confirmed it was possible.

Giant anterior urethral diverticulum in a neonate.

Congenital anterior urethral diverticulum is an uncommon condition that tends to present in older children with signs of chronic urinary problems. A neonate presented following recurrent collapse, and cystography revealed a giant urethral diverticulum. The diverticulum was incised at cystoscopy, leading to a full recovery.

Elevated amylase in childhood.

A 3-year-old boy was referred to a regional centre with an acute abdomen. On admission, his abdomen was clinically benign but an extremely high serum amylase titre noted. The patient was treated with simple observation and over the following period he was found to have an inflamed parotid gland.