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Maybe I am being pedantic (gasps of shock - quite out of character!), but this study would not answer the question. This is research not audit. The question appears to be "Is it better to fix fractures early?". A data collection exercise and multivariate analysis would involve a huge amount of effort, but not answer this question. If the results were positive (more FES the longer fixation was delayed) what would the conclusion be? Maybe late fixation causes FES. BUT, maybe another factor (such as multiple injury) causes both late fixation and FES. A large data collection exercise would entail a huge amount of work, and would not add to the sum of knowledge about this area. If this is really a crucial gap in the knowledge of emergency medicine we should push it as a topic to be included in the Faculty's suggestion to the Health Technology Assessment Program for NHS R&D Commissioning. (Or submit it ourselves to their website). This way the appropriate method (a randomised trial) might be funded. Tim. > It would appear from the papers quoted that there is a better outcome > from early repair. So one could set a relative standard of repair > using a multivariate analysis to see if there is a cut off point (12 > hours, 24 hours, 36 hours, whatever) beyond which the risk of > symptomatic FSE becomes too great to be acceptable. > Timothy J Coats MD FRCS FFAEM Senior Lecturer in Accident and Emergency / Pre-Hospital Care Royal London Hospital, UK. %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%