Dynamic hip screw fixation is a common orthopaedic procedure and to date, still can cause difficulties to the senior trauma surgeon. We present a case where an extra-capsular fracture of the proximal femur was managed with a dynamic hip screw (DHS) fixation. She proceeded to the operating theatre, where the fracture was stabilized with a 75-mm DHS and short-barrelled plate. The implant position was checked with intraoperative screening and the position accepted. Following attempted mobilization at 11 days post-operatively, the patient developed a recurrence of her preoperative pain. X-ray showed that the implant screw had separated from the barrel. Later scrutiny of the intraoperative screening films revealed that the barrel and screw were not engaged at the time of surgery. Intraoperative screening films should be carefully checked to ensure congruity of implant components.

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Abstracts / Injury Extra 42 (2011) 95-169 127 Purpose of the study: To evaluate the mobility, discharge destination, presence of back pain and length of stay of patients who sustained combined pubic rami and SOFs and to identify the significance of this association.Methods: We prospectively studied 67 patients with low-impact pubic rami and/or SOFs over 12 months. The patients were over 60 years of age and were assessed by the fracture liaison service. MR imaging or bone scan were done when there was back pain or lumbo-sacral tenderness.Results: There were 54 (80.4%) female and 13 (19.6%) male patients and the average age was 87.5 years (range 65-96). The mean length of stay was 45 (±35) days. Mortality rate was 10.4%. There was a significant relationship between low back pain and the presence of sacral fracture. Patients with combined pubic rami and SOFs showed significantly longer length of stay than those with isolated pubic rami fractures.Conclusion: We recommend considering the high association between SOFs and pubic rami fractures and the presence of back pain in planning the management of patients with POFs and their rehabilitation, which would potentially exhaust resources, due to their significantly increased length of stay and reduced mobility.Introduction: Pelvi-acetabular injuries are associated with significant blood loss. This is further compounded by multiple surgical interventions undertaken including definitive fracture fixation which put patients at further risk of post-operative transfusion. We routinely use intra-operative cell salvage as a blood conservation strategy to address this issue. This is a prospective evaluation of clinical efficacy and cost-effectiveness of using intra-operative cell-salvage in patients with pelvi-acetabular injuries.Materials and methods: Data was collected prospectively in all the patients who underwent pelvi-acetabular fracture fixation at our institution. A total of 30 patients (25 males, 5 females) with a mean age of 41 years (range 31-79 years) were assessed over a period of 10 months.Results: Mean pre-operative and post-operative haemoglobin was 11.8 and 9.9 respectively. Mean intraoperative blood loss was 1232.5 ml (range 150-2693 ml). Mean amount of blood salvaged and re-transfused through cell-saver was 388 ml. 14 patients (47%) required transfusion after surgery and a total of 26 units of blood