The outcomes of this technique are satisfactory in adulthood; reoperation rates are high but are most commonly related to the patient outgrowing the rods. Concerns regarding insertion of this fixed device at the knee and ankle were unfounded, although proximal femoral fixation remains a problem.

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Purpose Osteogenesis imperfecta (OI) has been treated with bisphosphonates for many years, with some clear clinical benefits. In adults, there are reports of a new pattern of atraumatic subtrochanteric fractures with bisphosphonate treatment. This study assesses if bisphosphonate treatment leads to an altered pattern of femoral fractures. Methods Retrospective review of imaging for a cohort of 176 bisphosphonate-treated OI patients to identify the locations of femoral fractures over a two-year period, as compared to a historical control group managed prebisphosphonates. Results Sixteen femoral fractures were identified in this time period in the bisphosphonate-treated group. All but two were within the subtrochanteric region. In comparison, the historical group-composed of 26 femoral fractureshad a more widespread fracture pattern, with the most frequent location being the mid-diaphysis. Many of the subtrochanteric fractures in the treatment group occurred with minimal trauma. Conclusions It appears that concerns over the treatment of the adult osteoporotic population with bisphosphonates are amplified and mirrored in OI. It is possible that the high bending moments in the proximal femur together with altered mechanical properties of cortical bone secondary to the use of this group of drugs increase the risk of this type of injury, which warrants further modification of surgical management of the femur.

Purpose Large scale databases that offer a reflection of clinical negligence are rare. By assessing commonly occuring cases of negligence, we hope to highlight areas where pediatric orthopedic care might be improved. One such database is the National Health Service Litigation Authority, which deals with claims brought against all health trusts in England. By collating their data we aimed to highlight areas of commonly occurring clinical negligence and then suggest ways to avoid similar happening again. Method We reviewed all cases pertaining to pediatric orthopedic claims between 1995 to 2006 as provided by the NHSLA. Results Of those considered in our study (341), by far the most common cause of litigation is missed or incorrectly diagnosed injuries/ conditions-accounting for 57% of all cases. 44% of those are upper limb injuries, mainly fractures around the elbow. Misdiagnosed disorders of the hip such as hip dysplasia and SCFE also represent a frequent reason for litigation (11%). Other common causes are poor plaster application and removal (7.3%) and non-surgical site specific errors such as chemical burns from skin prep. Conclusion Although specific to the English system, these findings are likely to mirror that found in other countries. Highlighting these commonly occurring errors, better education of doctors in targeted areas and due care in simple procedures may have significant improvement of child orthopedic care.

INTRODUCTION Concern exists regarding potential damage to the rotator cuff from repeated corticosteroid injections into the subacromial space. PATIENTS AND METHODS In this retrospective, case-controlled study, 230 consecutive patients presenting to three orthopaedic units with subacromial impingement and investigated as an end-point with magnetic resonance imaging (MRI) of the shoulder were divided into groups having received less than three or three or more subacromial injections of corticosteroids. RESULTS With no significant difference in age and sex distribution, analysis by MRI showed no significant difference between the two groups in the incidence of rotator cuff tear (P < 1.0). CONCLUSIONS This suggests that corticosteroid use in patients with subacromial impingement should not be considered a causative factor in rotator cuff tears.