Dislocation and fracture-dislocation of the knee are serious injuries, often related to high-energy trauma. Irreducibility with closed techniques is an extremely rare and challenging problem that has been described in posterolateral, posterior and lateral knee dislocations. Irreducibility in fracture-dislocations around the knee has only been described twice in the literature and never in association with a tibial plateau fracture. We report a unique case of an irreducible tibial plateau fracture-dislocation in which closed reduction was prevented by incarceration of the medial meniscus within the fracture site. The patient required transfer to our institution due to a concomitant traumatic brain injury. This contributed to a delay of 10 hours from injury to arrival in our resuscitation room. Progressive swelling and absent foot pulses resulted in immediate transfer to the operating theater where open reduction and internal fixation was performed with four-compartmental fasciotomies. The patient made a rapid and full recovery. Where closed techniques have failed, open reduction must then be undertaken in order to prevent the devastating complications of compartment syndrome and neurovascular compromise.

INTRODUCTION Controversy exists regarding the timing of surgery in children with displaced supracondylar fractures of the humerus. METHODS We reviewed retrospectively the postoperative outcomes and complications in these children managed in a district general hospital. RESULTS There were 81 children with displaced supracondylar fractures (64 Gartland type III and 17 type IIA). Of these, 46 children were treated within 6 hours of presentation and 35 were treated later. The rate of open reduction was higher in children treated early (23%) than in late cases (11%). There was no significant difference in the postoperative outcomes and complications between the groups. CONCLUSIONS In children with a supracondylar fracture, the timing of surgical treatment (before or after six hours from presentation to hospital) had no effect on postoperative complications and outcomes.

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INTRODUCTION Controversy exists regarding the timing of surgery in children with displaced supracondylar fractures of the humerus. METHODS We reviewed retrospectively the postoperative outcomes and complications in these children managed in a district general hospital. RESULTS There were 81 children with displaced supracondylar fractures (64 Gartland type III and 17 type IIA). Of these, 46 children were treated within 6 hours of presentation and 35 were treated later. The rate of open reduction was higher in children treated early (23%) than in late cases (11%). There was no significant difference in the postoperative outcomes and complications between the groups. CONCLUSIONS In children with a supracondylar fracture, the timing of surgical treatment (before or after six hours from presentation to hospital) had no effect on postoperative complications and outcomes.

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