Children's forearm fractures treated in plaster after closed reduction can redisplace and require remanipulation. A retrospective review of 164 consecutive manipulations of fractures of radius and ulna in theatre over a 3-year period was carried out. After various exclusions, 114 patients entered the study. The overall rate of remanipulation was 14.04% (16 children). Presence of preoperative translation deformity predisposed to loss of position in plaster (P<0.0001). Residual deformity on intraoperative films also had a strong adverse influence on the outcome (P = 0.001). Usage of below-the-elbow plaster in distal fractures (P = 0.840), having a low cast index (P = 0.538), fracture of both radius and ulna (P = 0.248), site of the fracture (P = 0.048, not significant on logistic regression) or surgeon grade (P = 0.744) did not have any significant bearing on the rate of manipulation. We propose that fractures with preoperative translation where anatomical reduction is not achieved should be fixed internally.

Abstracts 191 demands on hospitals' radiology departments, especially out of hours. We have shown that the guidelines are not followed.Aim: The aim of the study is to assess whether ED physicians can interpret and act on CT head data following trauma and whether, by doing so, adherence with the guidelines can be improved.Method: ED Specialist Registrars received instruction on the reading of CT heads. A prospective study of patients presenting to the ED with a head injury is underway. The ED physicians document their interpretation of the scans in real time and prior to the scans being reported on by a neuroradiologist. These initial interpretations are then compared with the official CT report.Results: Thirty-eight patients have been recruited for the study so far. Twenty-four (63.2%) were male (mean age 43.7 years). Thirty (79%) scans were reported as having no clinically significant abnormality by the ED physician. Of these 26 were ultimately reported as normal and 4 were reported as having facial/orbital fractures (but no intracranial abnormality) by the neuroradiologist. The ED physicians reported eight scans as having clinically significant abnormalities. Of these seven were reported as abnormal by the neuroradiologists (two subdurals, five skull fractures with intracranial bleeds). The average time from scan to interpretation was 27.9 min.Conclusion: Whilst this study is ongoing, it shows that Emergency Department physicians, with a focussed period of training, are prepared to act on their interpretations of CT heads in trauma patients, and appear safe in doing so. This could have important resource implications towards fully implementing the NICE head injury guidelines.