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O58]losed tibial fractures in footballers treated with mono-

ateral external fixation: A prospective study of 92 cases

. Mahmood ∗, O. Ennis, N. Hussein, I. Moorcroft, P.B.M.homas, P. Ogrodnik

University Hospital of North Staffordshire NHS Trust andtaffordshire University, UK

e looked at our management of closed tibial diaphy-eal fractures sustained during football. Data was collectedrospectively in a dedicated tibial fracture research clinic,ollowing the protocol of the senior author. This method ofreatment is considered unusual now due to many centressing intramedullary nailing as the first line treatment oflosed fractures. We present our results using our particularechnique of reduction using a locally developed reductionevice and a solid and repeatable end point to define frac-ure healing.

We followed-up 92 patients until 1 year post-fractureealing. All fractures were reduced using the Staffordshirerthopaedic reduction machine (S.T.O.R.M).

Fracture healing was determined by fracture stiffnesseasurements (15 N m/◦).Average age 24 (range 9—42).Two patients complicated with compartment syndrome,

ut no other significant concurrent injuries.Time to fracture healing was 17.4 weeks on average

range 8—52).One non-union (hypertrophic) and also a single mal-union

asymptomatic).One patient underwent fibula osteotomy for the non-

nion.About 7.6% of patients required antibiotics for pin site

nfections and only one pin was removed for persistent infec-ion. No fixators had to be removed in this group.

There was one case of established osteomyelitis, whichas successfully treated with Lautenbach irrigation follow-

ng debridement.One re-fracture at 52 weeks successfully managed in plas-

er.There was a re-operation rate of 5%, which compares

avourably with IM nailing.Our results show that external fixation of closed tib-

al fractures in footballers is a viable alternative to otherreatment methods, with regard to healing time and com-lications, if basic principles are adhered to. This is the firsttudy to use a well-validated end-point to define fractureealing and not rely on the difficulty of defining healing on

linical or radiological grounds. We also suggest a methodf defining pin-site infection to rationalise the use of antibi-tics.

oi:10.1016/j.injury.2007.11.348

tcatcbdiay

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Abstract

O59]he floating knee—–Outcome following surgical manage-ent

. Rethnam1,∗, R.S. Yesupalan1, R. Nair2

Glan Clwyd Hospital, UKSt. John’s Medical College, India

ntroduction: Floating knee injuries are complex injuries.he type of fractures, soft tissue and associated injuriesake this a challenging problem to manage. We present the

utcome of these injuries after surgical management.Materials and methods: Twenty-nine patients with float-

ng knee injuries were managed over a 3-year period. Thisas a prospective study were both fractures were surgi-ally fixed using different modalities. The associated injuriesere managed appropriately. Assessment of the end resultas done by the Karlstrom criteria after bony union.

Results: The mechanism of injury was road traffic acci-ent in 27/29 patients. There were 34 associated injuries.0/29 patients had intramedullary nailing for both fractures.he complications were knee stiffness, foot drop, delayednion of tibia and superficial infection. The mean bony unionime ranged from 15 to 22.5 weeks for femur fracturesnd 17—28 weeks for the tibia. According to the Karlstromriteria the end results were excellent — 15, good — 11,cceptable — 1, and poor — 3.

Conclusion: The associated injuries and the type of frac-ure (open, intra-articular, comminution) are prognosticndicators in the Floating knee. Appropriate managementf the associated injuries and intramedullary nailing of bothhe fractures and post-operative rehabilitation are neces-ary for good final outcome.

eywords: Floating knee; Surgical management; Outcome

oi:10.1016/j.injury.2007.11.349

O60]cost analysis of treatment of tibial fracture non-unions:comparative study between autologous iliac crest bone

rafting and bone morphogenetic protein-7

. Dahabreh ∗, N.K. Kanakaris, P.V. Giannoudis

Leeds Teaching Hospitals, UK

urpose: To estimate and compare the direct medical costsf treatment of tibial fracture non-unions (TFNUs) withither autologous bone graft or BMP-7.

Methods: Patients who were successfully treated forFNUs between 2001 and 2005 were enrolled. Exclusion cri-eria included infected non-unions, children, malignancy, orhronic debilitating diseases. The decision to use BMP-7 orutogenous bone graft was guided by the defect size andhe treating surgeon’s preferences. Group 1 received iliacrest bone grafting (ICBG) and Group 2 received recom-inant human Bone Morphogenetic Protein-7 (BMP-7). Theirect medical costs of treatment — including hospital stay,mplants, theatre costs, drains, antibiotics, investigations

nd outpatient appointments — were documented and anal-sed.

Results: The study sample consisted of 27 patients (14emales). Group 1 and Group 2 included 12 patients (4