The mean length of hospital stay was 32 nights in the traditional group and 19 nights in the early active group ( p < 0.001). Excluding severely injured patients the mean stay was 29 nights and 10 nights ( p < 0.001), respectively. There was no significant difference in the mal-union rate between the two groups. Ten patients were short at 3 months (0.5—3 cm) and eight of these had been treated by EHS. None were short at 2 years. Eight children were long at 2 years. Seven of these were treated with anatomical reduction. At 2 years they all had good clinical and functional results. Four cases (which were treated with an ExFix) had complications. In our population, a 40% reduction in the incidence of femoral fractures over the 6-year period was noted. The reduction has been in falls and sports injuries. These modern treatments have resulted in a shorter hospital stay that has many advantages for the child and family as well as financial savings. doi: 10.1016/j.injury.2006.06.092 Ottawa knee rules in management of acute injuries to the knee in accident and emergency A. Lakdawala, K. Akhtar, M. El-Zebdeh, J. Ireland Department of Trauma & Orthopaedics, Woodford Green Essex, UK Introduction: Judicious use of radiographs is impor- tant to avoid unnecessary radiation and waste of resources. Aim: The purpose of this study was to audit our practice against the Ottawa knee rules. Materials and methods: A retrospective review of A&E notes with documented acute knee injuries was carried out over a period of three months. A total of 172 patients with acute knee injuries (injury-con- sultation <72 h) were identified. Patients <16 years and >55 years were excluded. The notes of 138 patients were reviewed for adequacy of clinical examination and indications for knee radiographs. These were compared against Ottawa knee rules. Results: There were 109 males and 29 females. The mean age was 33.1 years. Seventy three percent of the patients presented to A&E within 8 h of injury. Majority (89%) were seen by SHOs and ENPs. The most consistent clinical finding documented was site of tenderness (90%) followed by range of movement (67%). Ability to extend the knee (18%), ability to weight bear (11%) and walk four steps (7%) were poorly documented. The plain radiographs without adequate clinical examination were performed in 93% of patients. The radiographic findings were documented in only 24%. Only 8% of the patients required hospital admission. Conclusions: Our audit showed that majority of knee radiographs were being carried out without adequate clinical examination. Unnecessary use of radiographs can be avoided by implementing clinical decision making rules such as Ottawa knee rules. doi: 10.1016/j.injury.2006.06.093 Posterolateral corner reconstruction of the knee–—A prospective study of clinical outcome J.V. Banks, I. Pengas, M.J. McNicholas Department of Trauma & Orthopaedics, Warring- ton, Cheshire, UK The purpose of this study was to evaluate the out- come of posterolateral corner reconstruction of the knee, using prospective pre- and post-operative scoring and clinical evaluation. We reviewed those patients who underwent pos- terolateral corner (PLC) reconstruction in our unit between October 2001 and October 2004. Seven- teen patients were identified, all male. Mean age 35 years (range 22—46). Mean follow-up 21 months. The commonest mode of injury was football. All patients had damaged other structures in the knee. Fifteen patients also underwent ACL reconstruction, five PCL reconstruction, six LCL reconstruction, six meniscal repair, eight meniscal debridement and two patients had microfracture, all performed at the same operation. Patients were prospectively scored pre-operatively and at 3, 6, 12 and 24 months post-op (depending on length of follow-up), using Lysholm, IKDC 2000 and KOOS scoring systems. The knee scores showed a significant improvement in all patients post-op. Post-operatively one patient developed a chronic pain syndrome, one patient developed osteopenia and is under investigation for RSD. Two patients subsequently requested removal of the screw used for PLC reconstruction. Conclusions: Injury to the posterolateral stabiliz- ing structures of the knee usually occurs in associa- tion with other ligamentous injuries, in particular either or both of the cruciate ligaments. The recog- nition and adequate management of this injury is crucial, particularly in order not to compromise any associated ligament reconstructions. doi: 10.1016/j.injury.2006.06.094 Altered signal intensity in the posterior horn of the medial meniscus: An MR finding of questionable significance N.T. O’Malley, J.A. Sproule, F. Khan, J.J. Rice, P. Nicholson, J.P. McElwain 30 Abstracts