Abstracts 169

Table 2 Bone protection at discharge

Discharge onCa (%)

Discharge onvitamin D3 (%)

Discharge onbisphosphonates(%)

Discharge on calciumand vitamin D3 (%)

Discharge on calcium,vitamin D3 andbisphosphonates (%)

Geriatric ward 75 75 69 75 66

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days, n = 41). Seventy-two patients underwent surgical fixa-tion (Table 1).

Thirty-two patients were discharged from a geriatricward, 38 from an orthopaedic ward, 3 from private practiceand 1 from a respiratory ward. At the time of discharge twopatients had been referred to falls clinic and four patientshad DEXA scans. Fifty patients were discharged on at leastone form of bone protection (Table 2).

Conclusion: Adherence to BOA guidelines is sub-optimalwith inadequate identification and secondary preventionof fragility fractures. This is demonstrated by a failure torefer the majority of patients to falls clinics. BOA guide-lines recommend all patients above 60 years, presentingwith a fragility fracture, to be evaluated for osteoporo-sis by measurement of bone density (preferably by DEXA);at 1 year this applied to just four patients. Unless con-traindicated, all patients should be discharged on calciumand vitamin D; we achieved this in just two thirds ofpatients. A joint ortho-geriatric protocol may go someway toimproving this.

Keywords: Fragility; Fracture; Hip; BOA Guidelines

doi:10.1016/j.injury.2007.11.320

[O31]PDS sling fixation of Neer type 2 fractures of the distalclavicle—–A simple technique with excellent results

J. Robinson ∗, P. Kempshall, B. Sankar, M.G. Pritchard

Morriston Hospital, UK

Non-union rates following conservative management of lat-eral clavicular fractures can be as high as 30%. This studyreports the results of a simple technique using a PDS loopin the fixation of Neer type 2 fractures of the clavicle, per-formed in our institution.

Twelve patients with Neer type 2 fractures operated bya single surgeon over 3 years were included in the study.The mean age was 45, range 14—63. There were sevenmale and five female patients. Standard surgical and post-operative protocols were followed in all patients. A PDS cordlooped around the coracoid was used to hold the reducedmedial clavicular shaft fragment. Occasionally, this was sup-plemented with two ethibond sutures across the fracture.Patients were followed up postoperatively at 2, 6 and 12weeks. Final outcomes were assessed using radiographs andthe Oxford and DASH scoring systems at 12 months.

Ten fractures united within 12 weeks. All of thesepatients returned to their pre-injury activity level. Therewere two non-unions, both in non-compliant patients. Oneof these non-unions remained asymptomatic and one patient

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as lost to follow-up. The mean Oxford score at 12 monthsas 14.25 (range 12—16) and the mean DASH score was 5

range 3.75—7).We conclude that this technique is safe, simple and

ost effective. It achieves high rates of union without theeed for implant removal. As with other techniques, properatient selection is essential. We recommend this techniques an excellent treatment option when dealing with theseotoriously difficult fractures.

eywords: Clavicle; Fracture; Suture; Fixation

oi:10.1016/j.injury.2007.11.321

O32]ockwood pin fixation of clavicle fractures

. Ahmad, D. Sunderamoorthy ∗, H. Jahraja, A. Shah, M.aseem

Macclesfield District General Hospital, UK

im: To prospectively review the results of clavicle fracturesreated with Rockwood intramedullary pin fixation.

Patients and methods: Twenty-five patients with clavi-le fractures underwent fixation of clavicle fractures withntramedullary Rockwood pin. The indications were persis-ent wide separation of fracture with interposition of softissue in 12, symptomatic non-union in 3, associated multi-le injuries in 3, with 1 having a floating shoulder, impendingpen fracture with tented skin in 4 and associated acromio-lavicular joint injury in 3. All patients underwent openeduction through an incision centred over the fracture sitelong the Langer line. Intramedullary pin was inserted in ret-ograde manner. Autologous bone grafting from iliac crestas done in all patients with non-union. Radiographic and

unctional assessment conducted using DASH scores.Results: There were 21 male and 4 female patients

ith a mean age of 34 years (range 17—64 years). Meanollow-up was 12 months (range 5—30 months). Radiographicnion occurred in all patients within 4 months. The com-onest indication for Rockwood pin fixation was displacediddle third clavicle fracture followed by impending open

ractures. Commonest complication was skin irritation athe distal end of the pin with formation of tender bursaccurring in nine patients, three of whom had skin break-own. Fracture union occurred in all patients with nourther intervention and wounds healed completely afteremoval of the pin. One patient developed non-union and

as later treated with ORIF with DCP and bone-graft. Thereere no deep infections, pin breakage or migration or re-

ractures after pin removal. The average DASH score was 25range 18—52).

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Tci2srtpaiConstant scores (anterior = 89, superior = 86), patient satis-faction with operation, return to activity and occupation ineither groups. In our study, the incidence of hardware failureand hardware removal was higher in the superior compared

Table 1

Demographic data Anterior group(N = 22)

Superior group(N = 27)

Male 16 20Female 6 7Mean age (year) 36.3 37.6Dominance 17/22 (77.3%) 21/27 (77.7%)

Mech of injuryRTA 14 (63.6%) 21 (77.7%)Fall 4 (18.2%) 2 (7.1%)Assault 3 (13.6%) 2 (9.1%)Sports 1 (4.5%) 2 (7.4%)

EmploymentLight 12 (54.5%) 15 (55.5%)Heavy manual 9 (40.9%) 11 (40.7%)Unemployed 1 (4.5%) 1 (3.7%)

Table 2

Complications Anteriorgroup(N = 22)

Superiorgroup(N = 27)

Hardware removal 5 1Hardware failure 0 2Superficial infection 1 1Deep infection 0 1

70

Conclusion: Open reduction and intramedullary fixationf clavicle fractures with Rockwood pin is an effectiveethod of treatment when surgical fixation of displaced or

on-union of middle third clavicle fracture is indicated.

eywords: Rockwood pin; Clavicle; Fracture;ntramedullary

oi:10.1016/j.injury.2007.11.322

O33]ension band wiring in the treatment of acromioclavicularoint injurieso broken threaded K-wires migrate?

.S. Bhachu ∗, R. Middleton, R. Chidambaram, D. Mok

Epsom General Hospital, UK

ntroduction: Threaded has now replaced the use of smoothransacromial K-wires in tension band wiring (TBW) due tohe high incidence of migration of the latter. However, theeak point between the smooth and threaded interface of

hreaded K-wires may be prone to breakage.This study aims to assess the functional and radiological

utcome of TBW fixation of ACJ injuries and see whetherhreaded K-wires migrate.

Methods: A retrospective review of a consecutive seriesf 37 patients undergoing TBW with threaded K-wires forCJ injuries between 2000 and 2005 was undertaken. Thirtyne patients were available for follow-up. Nine patients hadeer type II distal clavicle fractures and 22 had Rockwoodype III ACJ dislocations. Twenty-six males and 5 femalesith an average age of 40 years (10—61) were indepen-ently reviewed at a mean follow up of 40 months (18—62onths). Patients were objectively assessed by Constant and

ubjectively by Oxford scores. Radiographs were taken tovaluated fracture healing, alignment of the ACJ and brokenin tip migration.

Results: Of 31 patients reviewed the mean constant scoreas 93.7/100 and the mean Oxford shoulder score was 12.9.

wo patients developed keloid scaring and night pain. Allatients regained full pre-operative range of movement.n radiological examination all distal clavicle fractures hadnion. Ten patients had 0—25% ACJ subluxation, only 2 had aalpable clinical deformity on examination. Six patients hadocumented K-wire tip breakage; none showed migrationadiologically.

The results demonstrate good functional outcome ofBW in the fixation of ACJ injuries. ACJ dislocations wereeduced post-operatively but many retained residual sub-uxation. Broken threaded K-wire tips did not migrate, aell-documented complication.

Discussion: TBW fixation using threaded K-wires is a reli-ble technique of treating ACJ injuries and distal clavicleractures. Using threaded K-wires prevents broken pin tip

igration.

eywords: Clavicle; ACJ; Tension; Band

oi:10.1016/j.injury.2007.11.323

Abstract

O34]nterior versus superior plating of fresh mid-shaft clavic-lar fractures

. Venkatachalam, G.J. Packer, C.K. Sivaji ∗, A. Shipton

Southend Hospital, UK

he aim of this nonrandomised retrospective study was toompare the results of anterior plating with superior plat-ng on acute mid-shaft clavicular fractures. From 2000 to004, 49 fresh mid-shaft clavicular fractures in adults withhortening of >20 mm on the radiographs were treated witheconstruction plates (Table 1). Follow-up varied from 6o 24 months. Functional outcome was analysed by thehysiotherapist with Biodex machine using Constant scorend patient satisfaction questionnaire. They are tabulatedn Tables 2 and 3. There was no significant difference in