The Salter osteotomy was first described in 1961 for treatment of acetabular dysplasia associated with congenital dislocation of the hip. The use of an innovative Korean modification, first reported by T Yoon in 2003, is outlined in this study. This modification has real advantages for both patient and surgeon.

A review of patients undergoing this surgery at the Starship Hospital between July 2003 and July 2006 by a single surgeon was carried out. All patients were independently assessed from the point of view of any complication of the procedure. All x-rays were reviewed independently of the operating surgeon, with the parameters being measured, including centre edge angle, acetabular index and percentage uncovering (migration index).

All ten osteotomies united with wires being removed at an average of four weeks post-osteotomy. All patients were asymptomatic at follow-up, the only complication recorded being a transient lateral cutaneous nerve palsy. Preoperatively, the centre edge angle was < 20 degrees in seven out of nine patients, indicating poor femoral head coverage. The mean centre edge angle was 11.8 degrees (range of 0.1– 21.1). Post operatively, the centre edge angle ranged from 14 to 38.9 degrees, with an average value of 25.6 degrees. The average improvement was 14.2 degrees. The acetabular index pre-operatively measured an average of 20.8 degrees (11.3–28.3 degrees) and improved an average of 8.3 degrees to a mean value post operatively of 12.5 degrees. The percentage uncovering also revealed improvement- the average uncovering was 34.9% pre-operatively (0–52%) and decreased to a mean of 18% (0–30%) post operatively.

This modification of the Salter osteotomy makes it easier to perform and provides better stability to the graft in the osteotomy site. It prevents the posterior and medial displacement of the distal innominate bone that has been observed in the standard Salter osteotomy. Image intensification is not required. A stable construct is created that can allow the patient to be free of a hip spica. The early results are excellent.

We studied the results of multi-level surgical intervention for children with cerebral palsy.

Thirty patients, aged 7–16 years, with spastic diplegia (n=20), or spastic hemiplegia (n=10) were studied prospectively by gait analysis. Multilevel surgery included a combination of psoas lengthening, medial hamstring lengthening, rectus femoris transfer and gastrocnemius lengthening +/− foot surgery or femoral derotation osteotomies. Gait analyses were carried out pre-op and at 6 and 24 months post-op.

Children with spastic diplegia increased their walking velocity by an average of 20% at two years (p< 0.05). Mean stride length increased from 89cm pre-op to 102cm at two years (p< 0.05) with similar improvements in both groups of children. Maximum knee extension in stance improved from an average 17.5 degrees flexion pre-operatively to an average 5 degrees flexion postoperatively (p< 0.05). Peak knee flexion in swing was maintained and the timing improved. Peak ankle dorsiflexion in stance was unchanged following surgery but the timing of peak ankle dorsiflexion was normalised to late stance (from 24% of cycle pre-operatively to 48% of cycle post-operatively (norm = 48%). Average maximum hip extension in stance did not change. The mean anterior pelvic tilt did not change post-operatively. However, a number of children with spastic diplegia had increased anterior pelvic tilt post-operatively.

These results are similar to those reported internationally, with most improvement seen distally at the knee and ankle and less improvement at the hip. Increased anterior pelvic tilt was seen as a consequence of hamstring lengthening in some more involved patients.

Hallux rigidus was first described by Davies-Colley and Cotterill in 1887 and varied management techniques have been described by authors since. This paper carries out an audit looking at the management of hallux rigidus in 108 patients.

A retrospective study was carried out on 108 patients coded as hallux rigidus/hallux valgus over a ten year period from 1992 to 2002 (33 male and 75 female) with a follow-up range from 3 to 144 months. Thirty three toes (27 patients) were fused, 20 toes had Tel Aviv procedures (17 patients) and 61 patients were managed conservatively.

Of the 33 toes fused, 18 required a second procedure in the form of wire removal, two developed transient transfer metatarsalgia, one developed IP joint pain and one had asymptomatic fibrous non-union. Of the 20 Tel Aviv procedures, one toe developed hallux valgus requiring re-operation and two toes had unrelated complications, one requiring re-operation.

A single method of MTP fusion when the audit was performed revealed an interesting outcome. Hallux rigidus must be managed as an ongoing continuum, not a static state.

The purpose of the study was to document the outcome in adulthood of treatment for idiopathic toe walking.

Twenty of 23 adults who had been previously treated for idiopathic toe walking from 1984 to 1990 were contacted. Three of the 20 subjects lived outside Auckland and four subjects declined to participate, giving a total of 13 subjects suitable for study. All but one of the subjects had had serial casts between the ages of 3.7 to 9.5 years. Six subjects had no further treatment while the other seven subjects went on to surgical lengthening of either TA or calf (average age 10.7 years). All participants underwent 3-D gait analysis and heel-rise test. Average follow-up was 10.8 years (range 5.4–15.6 years). Three patients still had signs of toe walking on visual observation of their gait. The maximum ankle dorsiflexion in stance averaged 90 on 3-D gait analysis (range 20 to 140). Eleven subjects showed maximum ankle dorsiflexion in stance greater than 2 standard deviations below normative values. Nine subjects had abnormal timing of maximal ankle dorsiflexion in stance with maximum ankle dorsiflexion prior to 50 percent of the gait cycle. Only two patients had ankle push off powers below normative values of 2 watts/kg.

This is the first study to report on adults treated for idiopathic toe- walking as children. Most subjects showed restricted range and altered timing of ankle dor-siflexion in gait, however this was detectable visually in only three subjects.

The purpose was to review the results of latissimus dorsi and teres major transfer in a group of children with shoulder disability due to brachiaI plexus palsy. Whilst their incidence has steadily declined, obstetric brachial plexus palsies are a continuing problem in paediatric orthopaedic practice. Lesions of the upper plexus (C4, C5, C6) are characterised by a loss of abduction and external rotation at the shoulder. The L’Episcopo procedure and its variants aim to address this by transfer of the latissimus dorsi and teres major. There have been conflicting reports in the literature as to the functional benefit of such procedures.

A retrospective review of such procedures performed by one surgeon at a paediatric orthopaedic tertiary referral centre in New Zealand. Patients were assessed pre- and post-operatively in terms of range of movement and function. The Mallet scoring system was also used. Eight patients were examined by an independent observer up to 120 months following surgery (average 52 months). In most cases significant increases in range of movement, function and Mallet scores were noted. With regard to complications, where the paresis is severe to the extent that it is causing shoulder subluxation, tendon transfer surgery is contra-indicated.

The L’Episcopo procedure was largely successful in restoring improved function to the shoulder girdle in this group of patients.

Twelve patients ranging in age from 10 to 35 years have undergone 14 Ganz Osteotomies. The surgical approach used to define the anatomy is described and questions asked as to its safety with regard to the vascularity of the acetabular segment.

The complications encountered in the learning curve of this operation are described together with the early outcomes.