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22 Abstracts / Injury

B.24

eurological status documentation in upper limb fractureatients

.S. Uppin, A. Khurana, U.K. Choudhuri, R. Trickett ∗

Morriston Hospital, Swansea, South Wales, United Kingdom

Background: Documentation of the neurological status is vitaln the clinical management of fracture patients. It is also impor-ant for medico legal reasons. Inadequate pre-operative evaluationnd documentation can lead to dilemma in the post-operativeanagement if a patient is then found to have a neurological

eficit.Aims: To identify the current standard of documentation of pre-

perative and post-operative neurological status in upper limbracture patients in this tertiary trauma centre and compare it withhe accepted guidelines/practice.

Methods: A retrospective audit was performed in this unitetween September 2009 and April 2010 to evaluate the documen-ation in the notes of all patients admitted with upper limb fracturesecessitating a surgical intervention. The A&E, pre-operative andost-operative Orthopaedic documentation was reviewed.

Results: 100 case notes of patients admitted with an upper limbracture were reviewed. 15% patients had no documentation of theeurological status in the pre-operative notes and 16% patientsad no documentation in the post-operative notes. Neither pre-perative nor post-operative documentation of neurological statusas present in 3 notes. 3 patients were found to have a neurologicaleficit post-operatively but had no clear pre-operative documen-ation.

Conclusion: It is considered unacceptable to have no docu-entation of neurological status of a limb following trauma. It is

urprising that there was a failure of documentation in our studyn spite of three separate occasions when a doctor would havessessed these patients. This raises questions about the empha-is on clinical method teaching in the undergraduate curriculum asell as decreasing attachments in many trauma and orthopaedic

ttachments.Given the shorter attachments in the trauma unit for the junior

rainees, neurological assessment of injured limb should form a partf the induction/teaching program. Our unit now uses a definedroforma in the clerking sheet for all limb injury patients to enable

mproved outcomes.

oi:10.1016/j.injury.2011.06.276

B.25

late fixation of acute midshaft clavicle fractures—Results of 172ases

. Modi, T. Marjoram, A.D. Patel, P. Hallam

Norfolk and Norwich University Hospital NHS Foundation Trust, Nor-ich, UK

Aim: To determine the union rate of displaced, mid-shaft clavicleractures fixed through an infraclavicular approach using a varietyf plating systems.

Introduction: Fractures of the clavicle are common with annnual incidence of 29.3 per 100,000 adult populations of which9% are mid-shaft.

The rationale for fixing displaced mid-shaft fractures is to

ecrease non-unions and reduce symptomatic mal-unions. A vari-ty of plating systems are available but there is little evidence touggest which gives the best result.

2 (2011) 95–169

Patients and methods: Between May 1999 and November 2010,450 clavicular fractures were treated operatively of which 192 wereacute mid-shaft fractures. All patients were followed up until clin-ical and radiological union was achieved.

Results: At the final follow-up 172 patients (173 fractures) wereavailable for review. There were 133 male and 39 female patientswith an average age of 55 years. The fractures were classified usingthe system described by CM Robinson (91 type B1 fractures, 76type B2 fractures, 4 type A2 fractures and 2 Type A1 fracture). Theaverage union time was 4 months.

44 fractures were treated with a Dynamic Compression Plate(DCP), 45 with a Reconstruction Plate, and 84 with a Locking Com-pression Plate (LCP).

In the DCP group, 1 plate failed due to inadequate fixation at 4weeks post op.

In the Reconstruction Plate group, 6 plates bent but the frac-tures united, 3 plates failed due to inadequate fixation and requiredrefixation.

I n the LCP group there were 2 plate failures, which requiredrefixation and 1 stress fracture medial to the plate which wastreated non-operatively.

In our series there was 1 superficial infection treated with oralantibiotics.

Conclusion: We believe that plating of displaced midshaft clavi-cle fractures through an Infraclavicular approach is safe so long asthe construct biomechanically sound. We would caution the use ofreconstruction plate as they seem to bend. Our current practice isto favour an LCP plate.

doi:10.1016/j.injury.2011.06.277

1B.26

Olecranon fractures in the elderly. Is tension band wiring theright treatment?

S. Umer, M. Vioreanu, J. Baker, P. Fleming

Cork University Hospital, Cork, Ireland

Purpose of study: The purpose of this study was to assess theoutcome and complications of operative treatment of olecranonfractures in the elderly.

Material and methods: We retrospectively reviewed the outcomeand complications of olecranon fractures in the elderly (>70 yearsold) treated during 2004–2010. From 79 patients the majority (69patients) were treated with TBW and 10 patients were treated withother form of internal fixation: 8 patients treated with plate fixationand 2 with Ticron sutures. Fracture type, complications, range ofmovements (ROM) was analysed.

Results: Mean age of the TBW group was 80.1 years (range70–99). They were predominantly males (57 men). Non dominantelbow was predominantly involved. Three patients sustained anopen olecranon fracture. The majority of fractures (63%) were com-minuted and 27 patients had simple fractures (19 oblique and 8transverse fractures). We report a high complication rate (30%)consisting of wound problems (14%) and persistent pain (16%). 44patients had metal problems (19% required metal removal). Lossof ROM (average of loss of extension of 320) was present in 75%patients. The group of 10 patients treated with plate fixation orTicron suture fixation had a very low complication rate (one patienthad a superficial wound infection) and a smaller reduction in ROM(average loss of extension of 200).

Conclusion: In elderly population, general and local factorsinfluence on decision making and on fixation methods used totreat olecranon fractures. Most of fractures in the elderly arecomminuted or oblique and tension band wiring alone may not