Congenital spinal vertebral anomalies can present as scoliosis or kyphosis or both. The worldwide prevalence of the vertebral anomalies is 0.5-1 per 1000 live births. Vertebral anomalies can range from hemi vertebrae (HV) which may be single or multiple, vertebral bar with or without HV, block vertebrae, wedge shaped or butterfly vertebrae. Seventy per cent of congenital vertebral anomalies result in progressive deformities. The risk factors for progression include: type of defect, site of defect (junctional regions) and patient's age at the time of diagnosis. The key to success in managing these spinal deformities is early diagnosis and anticipation of progression. One must intervene surgically to halt the progression of deformity and prevent further complications associated with progressive deformity. Planning for surgery includes a preoperative MRI scan to rule out spinal anomalies such as diastematomyelia. The goals of surgical treatment for congenital spinal deformity are to achieve a straight growing spine, a normal standing sagittal profile, and a short fusion segment. The options of surgery include in situ fusion, convex hemi epiphysiodesis and hemi vertebra excision. These basic surgical procedures can be combined with curve correction, instrumentation and short segment fusion. Most surgeons prefer posterior (only) surgery for uncomplicated HV excision and short segment fusion. These surgical procedures can be performed through posterior, anterior or combined approaches. The advocates of combined approaches suggest greater deformity correction possibilities with reduced incidence of pseudoarthrosis and minimize crankshaft phenomenon. We recommend posterior surgery for curves involving only an element of kyphosis or modest deformity, whereas combined anterior and posterior approach is indicated for large or lordotic deformities. In the last decade, the use of growing rods and vertebral expandable prosthetic titanium rib has improved the armamentarium of the spinal surgeon in dealing with certain difficult congenital spinal deformities. The goal of growing rod treatment is to provide simultaneous deformity correction and allow for continued spinal growth. Once maximal spinal growth has been achieved, definitive fusion and instrumentation is performed.

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external fixator or plating anteriorly. 17 patients (group 2) exhibited minimal displacement less than 5 mm and were not stabilised. Rotational instability >2 cm was characterised by complete fracture of the sacrum posteriorly. Stabilisation of the pelvic ring in group I was associated with a significant reduction of the VAS within 72 h from surgery, early ambulation and discharge from the hospital. Conclusion: This study supports the view that not all LCI fracture patterns are mechanically stable. Examination under anaesthesia of the pelvic ring can assist the clinician in the decision-making progress.Background: Clinical coding has attracted significant interest recently as it has become synonymous with reimbursement. We hereby present the results of first and largest study in the UK involving 547 orthopaedic trauma cases wherein a meticulous in-depth analysis was performed. Study design: Completed audit cycle. Objectives: To review the existing coding for orthopaedic trauma, to ascertain accuracy of procedural codes and to identify limitations, implement changes, re-evaluate and close the audit loop. Methods: All orthopaedic trauma surgeries (244 cases) performed over 1 month (March 2006) were comprehensively analysed. The primary procedural accuracy of OPCS4.2, its limitations and loss of revenue due to missing codes (6 patients) were determined. Changes were implemented to streamline/optimise financial reimbursement and improve data quality/accuracy by education/training. Electronic discharge summaries were implemented to enhance efficiency. The audit loop was subsequently closed to evaluate implementation of these changes by re-auditing all trauma surgeries performed in the same month the following year, i.e. March 2007 (303 cases) against OPCS4.3 codes. Results: The primary procedural accuracy was 95.38% (11/238 coding errors) and omissions in 6 patients resulted in net loss of

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