Background: Paediatric cervical spine injury (CSI) is rare compared to adult CSI. Very little has been published regarding the epidemiology and outcome of CSI in children in South Africa. The objective of this retrospective study is to characterise the epidemiology and report on the outcome of CSI in children <13 years at a tertiary referral centre for paediatric trauma. Methods: We performed a retrospective study of CSI at our hospital over a ten-year period. The Picture Archiving and Communication System (PACS) of our institution was searched for patients with CSIs. Search terms included: cervical spine fracture, subluxation, dislocation, contusion, SCIWORA (spinal cord injury without radiographic abnormality) and retroclival haematoma. Demographic and clinical data were obtained from hospital records. Injury-related variables were compared for children ≤8 and >8 years due to anatomical and biomechanical differences observed. Outcome was assessed using the Frankel grading. Results: Sixty-six children were identified with a cumulative incidence of 0.1%. The median age was 7 years (inter-quartile range 4-8.8) and 65% were male. All injuries were caused by blunt trauma. Passenger motor vehicle injury (MVA) accounted for 52% of injuries. Injuries due to physical abuse, and recreational and sporting activities did not occur. Children ≤8 years of age incurred more injuries than those >8 years (74.2% vs 25.8%). Ninety-eight per cent of injuries occurred in the upper cervical spine (C1-C4) of children ≤8 years. Of the 13 (19.6%) children with neurologic injury, five (7.5%) had complete spinal cord injury, four (6%) had incomplete neurology, and three (4.5%) died. SCIWORA occurred in six (9%) children with variable outcome. Seven patients (10.6%) were operated for instability. An injury severity score (ISS) of 25 (13-34) was associated with poor outcome. The mortality rate was 4.5% and all children who died were ≤8 years with upper CSIs and closed head injuries (CHIs) related to MVA. Conclusion: CSI occurred in 0.1% of patients evaluated following trauma. MVAs, either pedestrian or passenger, were responsible for the majority of these injuries. Children ≤8 years were more frequently injured and sustained injuries to the upper cervical spine. The majority of paediatric CSIs are stable injuries that can be managed conservatively; however, urgent surgical stabilisation is indicated for unstable injuries. CSI with associated CHI caused by MVAs in young children is associated with death. Even though our patients are referred from high violence communities, no CSIs were attributed to physical abuse or penetrating injury.

BACKGROUND: Highly porous Trabecular Metal™ acetabular components are increasingly being used in revision hip arthroplasty as they facilitate ingrowth, provide a useful mechanism to deal with bone loss and may decrease the risk of infection. The purpose of this audit was to describe: 1) the total number of hip arthroplasty surgeries over Ave years, the ratio of revision to primary hip arthroplasty and indications for revision; 2) the short-term outcomes of revision hip arthroplasty with Trabecular Metal™ components and augments METHODS: A retrospective folder and radiograph review of all patients who had revision total hip arthroplasty (THA) at a tertiary level hospital from February 2012 to February 2017 was done RESULTS: There were 979 THAs performed over the period - 863 (87%) primary THAs, and 116 (12%) hip revision cases performed in 107 patients. Of the 116 (107 patients) hip revisions, there were seven (6%) re-revisions in Ave patients. The indications for revision were aseptic loosening 67 (59%), septic loosening 11 (10%), liner wear 18 (16%), periprosthetic fracture Ave (4%), other 15 (13%). Trabecular Metal™ was used for revision in 16 hips (14 patients), which is 14% of the total 116 revisions. There were ten females and four males with an average age of 61 years. The average duration of follow-up in this group was 18.5 months (1.5-39.2). In these 16 Trabecular Metal™ hips, there were three (19%) early failures of fixation due to technical errors CONCLUSION: In our institution, 12% of the arthroplasty is revision surgery. The indications for revision are similar to published literature. Trabecular Metal™ revisions had a 19% early failure rate due to technical error Level of evidence: Level 4 Keywords: Trabecular Metal™, augments, total hip arthroplasty, revision hip arthroplasty