SummaryAcute pancreatitis has a mortality of about 10%: this figure has not changed over the last 20 years. A retrospective audit of fatal acute pancreatitis was performed in a teaching hospital with a catchment population of about 750 000 patients to examine patient charactistics. Using Hospital Activity Analysis code 577.0, all fatal cases of acute pancreatitis were studied in a six-year period 1987-93. Additionally, all post mortem diagnoses of acute pancreatitis were traced. The overall post mortem rate in Nottingham at the time ofthe study was about 35 %. All available records, X-ray and biochemical data were studied and appropriate information recorded and analysed for 65 fatal cases. Only 15% were post mortem diagnoses, lower than in previous series; 72% had respiratory and 67% had renal complications. Only 34% had been admitted to the intensive care unit. A third of patients had had surgery; 67% of these was some form of external drainage. England' and in Finland9: we therefore wished to examine whether recent advances in treatment had altered the outcome of severe acute pancreatitis. We were also able to compare our

Paediatric fractured neck of femur injuries is rare and historically has high complication rates postoperatively. We present results from the Birmingham Children's Hospital. Fifteen displaced femoral neck fractures were identified in 14 children over a 10-year period (1997-2006). Mean age at the time of injury was 10 years (range 6-14 years). Mean follow-up was 31 months (range 6-110 months). Anatomical reduction and internal fixation was performed in all cases. Two fractures were classified as Delbet's type-I (13.3%), four type-II (26.7%), six type-III (40%) and three type-IV fractures (20%). Eleven patients were operated on within 24 h (range 4-19 h) and four after 24 h (range 2-11 days). The rate of avascular necrosis was 6.7% overall and 10% excluding pathological fractures. The rate of premature physeal closure was 33.3% overall and 40% excluding pathological fractures. Ninety-three percent of the total study population had a good result according to the Ratliff scoring system. There were no nonunions. One patient had a poor result with avascular necrosis and collapse.

Preoperative antibiotics should be avoided in the management of septic arthritis in children. Their prescription delays diagnosis and definitive surgery, and leads to additional washouts and complications. A high index of suspicion and expedite referral to a specialist paediatric orthopaedic unit is needed if septic arthritis is suspected.

CorrespondenceMulticentre audit of death from acute pancreatitis Sir The interesting audit of fatal acute pancreatitis by Mr Mann and colleagues (Br J Szug 1994; 81: 890-3) prompts us to write. We have recently completed a similar audit in Nottin am based on two lar e patients. Using Hospital Activity Analysis code 577.0, all fatal cases of acute pancreatitis were studied in a 6-year period between 1987 and 1993. Additionall , all post-mortem diagnoses of acute

IodineAir arthrogram a b s t r a c t Aim: Hip arthrography usually requires the injection of iodine based dyes which can cause complications. We wanted to determine the accuracy of using air for hip arthrography. Method: A prospective study was undertaken including all adults who had a hip arthrogram. We initially did an air arthrogram and subsequently injected iohexol to see if we were still in the joint. Results: Forty injections were done. Mean age 32 years. There was a 100% success rate with obtaining a positive air arthrogram. Conclusion: Air arthrogram of the hip offers a safe, cost free and accurate alternative to iodine based arthrograms.