Immobilization of septic arthritis is an ancient and always recommended notion. Before discovery of antibiotics, immobilization allowed an articular ankylosis in functional position. Since discovery of antibiotic chemotherapy, immobilization is justified for its antalgic and anti-inflammatory qualities. However, Salter demonstrated experimentally the interest of continuous passive mobilization during septic arthritis. The authors also demonstrated the deleterious effects of immobilization on articular cartilage during Staphylococcus aureus induced arthritis in a rabbit model. The authors compared two series of children treated for septic arthritis. All children were treated by articular lavage, and by intravenous antibiotic chemotherapy during 10 days, then by enteral antibiotic chemotherapy for 6 supplementary weeks. 14 children were immobilized during 1 month, while 14 others were mobilized from the first days. Consumption and class of antalgic chemotherapy, inflammatory balances (Blood Count, C Reactiv Protein), articular range motion during of the first and sixth month clinical review, were compared. Only articular range motion noted during the clinical review of the first month were significantly different in the two groups. Articular range motion of the not immobilized children were close of normal, while the other children suffered from articular stiffness. Immobilization had no beneficial effects either in pain or in correction of the inflam-matory process

Introduction. Traumatized musculoskeletal tissue often exhibits prolonged time to healing, mostly due to low blood flow and innervation. Intermittent Pneumatic Compression (IPC) increases blood flow and decreases thromboembolic event after orthopedic surgery,[1] however little is known about healing effects.[2] We hypothesized that IPC could stimulate tissue repair: 1.) blood flow 2.) nerve ingrowth 3.) tissue proliferation and during immobilisation enhance 4.) biomechanical tissue properties. Methods. Study 1: In 104 male Sprague Dawley (SD) rats the right Achilles tendon was ruptured and the animals freely mobilized. Half the group received daily IPC-treatment, using a pump and cuff over the hindpaw that inflates/deflates cyclicly, 0–55mmHg (Biopress SystemTM, Flexcell Int.), and the other half received sham-treatment. Healing was assessed at 1,3,6 weeks by perfusion-analysis with laser doppler scanner (Perimed, Sweden), histology and biomechanical testing. Study 2: 48 male SD-rats were ruptured as above. Three groups of each 16 rats were either mobilized, immobilized or immobilized with IPC treatment. Immobilization was performed by plaster cast. Healing was assessed at 2 weeks with histology and biomechanical testing. Results. Study 1: At 3 and 6 weeks reperfusion increased by 21% and 23% (p< 0.05) after IPC-treatment, strengthened by the observation of elevated numbers of blood vessels and nerves. Fibroblast density was at all time points significantly increased in the IPC group. At three and six weeks the IPC treated tendons displayed an increased tissue organization confirmed by higher collagen I/III ratio in the IPC group. No differences (p = 0.10) were found regarding biomechanical strength. Study 2: Compared to mobilization, immobilization caused a downregulation (p<0.05) of all biomechanical and histological parameters, eg. maximum force decreased 80% and collagen III occurrence by 83%. However when immobilization was combined with IPC biomechanical and histological healing increased significantly compared to pure immobilization, eg. maximum force increased 63% and collagen III occurrence by 150%. Conclusion. This study demonstrated that IPC treatment can counteract biomechanical and morphological deficits caused by immobilization by enhancing proliferative soft tissue repair. Thus, IPC promotes tissue repair by stimulating tissue perfusion and nerve ingrowth as well as accelerating both fibroblast proliferation and collagen organization

Introduction: Management of acute rupture of the Achilles tendon is controversial. Conservative treatment has a higher re-rupture rate while surgery has complications like infection and wound breakdown. We devised a protocol in our hospital to decide between the surgical or non-surgical options. At our institution, a well-documented and structured program of non-operative or opeartive management of Achilles tendon rupture with use of either casts or operation has been devised based on Ultrasound findings of the ‘Gap/distance between the two ends of the Tear’. PURPOSE: The purpose of this study was to compare the incidence of Re-rupture in those treated by cast immobilization where the ends were approximating at ultrasound examination at our institution. METHODS: This study Prospectively assessed the results in 50 consecutive patients with a complete rupture of the Achilles tendon who had been treated with our regimen depending on the findings of the ultrasound examination, between 2003 and 2006. All ruptured Tendoachilles had ultrasound done in Full Equinus position to assess whether the ends are approximating or not. If ends were approximating they were treated in an equinus cast. Patients were evaluated on the basis of the subjective results and functional outcome measure, along with validated visual analogue scores. Re-rupture rates were measured at 06 months after injury. There were 35 Male and 13 females. This was followed by a final questionnaire to assess their return to pre-injury activities. Two patients were lost to follow-up as they moved out of the area. RESULTS: All the 48 re-ruptures available for analysis had their ultrasound done on initial presentation. 25 were treated non-operatively and 23 underwent surgery. The overall complication rate for Non Operative was minimal, with NO re-rupture or documented deep vein thromboses. In operative group there were 2 re-ruptures, 5 postoperative infection and discharge. CONCLUSION: The results of our non-operative treatment were better overall than published results of non operative & operative repair of acute Achilles tendon rupture. In this study the ends are approximating, confirmed on ultrasound before being assigned to Cast Immobilization. SIGNIFICANCE: The previous studies have not assigned patients into operative or non-operative groups based on whether the ends are approximating in full equines position. By assigning only those in whom the ends are approximating, to cast immobilization, re-rupture rates are less, thus resulting in better and stronger healing of TAs’ and avoiding risks of surgery

Total shoulder arthroplasty (TSA) and Reverse Total shoulder arthroplasty (RSA) are two of the most performed shoulder operations today. Traditionally postoperative rehabilitation included a period of immobilisation, protecting the joint and allowing time for soft tissue healing. This immobilisation period may significantly impact a patient's quality of life (Qol)and ability to perform activities of daily living (ADL's). This period of immobilisation could be safely avoided, accelerating return to function and improving postoperative QoL.

This systematic review examines the safety of early mobilisation compared to immobilisation after shoulder arthroplasty focusing on outcomes at one year.

Introduction

A subset of patients in cast awaiting fixation of ankle fractures require conversion to delayed external fixation (dEF). We aimed to evaluate the effect of delayed versus planned external fixation (pEF), then identify objective characteristics contributing to need for conversion.

The detailed biomechanical mechanism of annulus fibrosus under abnormal loading is still ambiguous, especially at the micro and nano scales. This study aims to characterize the alterations of modulus at the nano scale of individual collagen fibrils in annulus fibrosus after in-situ immobilization, and the corresponding micro-biomechanics of annulus fibrosus.

An immobilization model was used on the rat tail with an external fixation device. Twenty one fully grown 12-week-old male Sprague-Dawley rats were used in this study. The rats were assigned to one of three groups randomly. One group was selected to be the baseline control group with intact intervertebral discs (n=7). In the other two groups, the vertebrae were immobilized with an external fixation device that fixed four caudal vertebrae (C7-C10) for 4 and 8 weeks, respectively. Four K-wires were fixed in parallel using two aluminum alloy cuboids which do not compress or stretch the target discs. The immobilized discs were harvested and then stained with hematoxylin/eosin, scanned using atomic force microscopy to obtain the modulus at both nano and micro scales, and analyzed the gene expression with real-time quantitative polymerase chain reaction. Significance of differences between the study groups was obtained using a two-way analysis of variance (ANOVA) with Fisher's Partial Least-Squares Difference (PLSD) to analyze the combined influence of immobilization time and scanning region. Statistical significance was set at P≤0.05.

Compared to the control group, the inner layer of annulus fibrosus presented significant disorder and hyperplasia after immobilization for 8 weeks, but not in the 4 week group. The fibrils in inner layer showed an alteration in elastic modulus from 91.38±20.19MPa in the intact annulus fibrosus to 110.64±15.58MPa (P<0.001) at the nano scale after immobilization for 8 weeks, while the corresponding modulus at the micro scale also underwent a change from 0.33±0.04MPa to 0.47±0.04MPa (P<0.001). The upregulation of collagen II from 1±0.03 in control to 1.22±0.03 in 8w group (P = 0.003) was induced after immobilization, while other genes expression showed no significant alteration after immobilization for both 4 and 8 weeks compared to the control group (P>0.05).

The biomechanical properties at both nano and micro scales altered in different degrees between inner and outer layers in annulus fibrosus after immobilization for different times. Meanwhile, the fibril arrangement disorder and the upregulation of collagen II in annulus fibrosus were observed using hematoxylin/eosin staining and real-time RT-PCR, respectively. These results indicate that immobilization not only influenced the individual collagen fibril at the nano scale, but also suggested alterations of micro-biomechanics and cell response. This work provides a better understanding of IVD degeneration after immobilization and benefits to the clinical treatment related to disc immobilization.

Lower limb fractures are commonly treated with cast immobilization, and as a main consequence of strict immobilization this typically leads to loss in muscle mass, decrease of bone density and decline in functional abilities. Body-worn sensors are increasingly used to assess outcome in clinical trials by providing objective mobility parameters in a real-world environment. The aim of this study is to investigate the usability aspects and potential changes in mobility parameters in partial-immobilization patients in real-world conditions. Six healthy young males (age 22.2 ± 1.2 years; weight 76.5 ± 6.7 kg, height 185.8 ± 6.1 cm. Mean ± standard deviation) wore a leg cylinder cast with walker boot to immobilize their dominant leg for two consecutive weeks. Subjects were asked to continuously wear a tri-axial accelerometer on the waist (actibelt) during waking hours for 6 weeks including 2 weeks before, during and after cast immobilisation. The total amount of days of continuous recording was 339 days with a total wearing time of 120 days. Software packages which allow to detect steps and to estimate real-world walking speed were used to analyse the accelerometry data. It was suspected that knee immobilization would affect strongly the wave form of the signal with an impact on the accuracy of the speed algorithm, whereas the step detection should be more robust. This effect was confirmed in a preliminary study performed to quantify the accuracy under immobilization conditions. On the other hand, step numbers are known to be sensitive to fluctuations in wearing time which was not uniform throughout the entire study. We concluded that in this setting step frequency is the most reliable parameter. Step frequency showed a systematic decrease in the values during the immobilization period which recovered to pre-immobilisation values after cast removal. This confirms the usability of accelerometry and sensitivity of its mobility parameters for clinical outcome assessment.

In a prospective randomized trial, we divided a group of patients with a clinically suspicious, although radiographically normal, acute fracture of the scaphoid into 2 groups, 1 treated with a cast (group I), the other with a splint (group II). There were 14 patients in group I, and 18 in group II. Patients were reviewed at 2,6, and 12 weeks for range of movement, grip strength, pain and satisfaction rating. Work disability costs were also calculated for both groups. Patients in group II had better range of movement and grip strength at 2 weeks, although complained of more pain. There was no difference in range of movement, grip strength, or pain at 6 or 12 weeks. Group II was more satisfied at 2 weeks, although not at 6 or 12 weeks. Group I required more time off work, and disability costs were significantly higher [€15,209 per person compared to €3,317 per person]. We recommend that all patients, with only a clinical suspicion of a fractured scaphoid, should have a short period of splint immobilization until symptoms resolve, or until further investigations reveal a fracture which can be appropriately treated. This policy is cost efficient and improves the short term outcome.

Cervical extrication collars are frequently used in pre hospital stabilization and in the definitive treatment for lesions of the cervical spine. The control of extensionflexion, lateral bending, and rotation given to individual segments is variable with different designs.

Objective: To highlight the patient satisfaction and reported pain perception with immobilization of cervical injury with the extrication collar.

Method: We present prospective cohort of fourteen patients with median age of 28 years with suspected C-spine injury waiting for CT scan. Unreliable patients were defined as those with admission Glasgow Coma Scale score < 15. They were treated with extrication collar immobilization. The initial diagnosis was made by supine cross-table lateral radiograph and then by computed tomographic scan as early as possible. All had no apparent neurologic deficit attributed to the C-spine at admission.

Results: All reported increased level of pain despite administering adequate analgesia. Most patients reported increased pain at the pressure point of the collar.

Conclusion: These cases demonstrate the limitations of current management techniques of suspected cervical fractures in unreliable trauma patients and highlight the lack of appropriate orthosis for cervical immobilization in our institution.

Background: Since high incidences of serious complications like death and pneumonia during halo vest immobilization (HVI) have been reported in recent literature, a tendency of restraint in using the halo vest is rising. Nevertheless, most of these studies were small-scale retrospective reports. The real incidence of complications in a highvolume center with sufficient experience is unknown. It was our objective to determine incidence and risk factors associated with complications during HVI prospectively.

Methods: During a 5-year period a prospective cohort study was performed in a single level-I trauma and spinal disorders center. Data of all traumatic and non-traumatic patients who underwent HVI were prospectively collected. Every complication during follow-up, i.e. the period of HVI, was recorded. Primary outcome was presence or absence of complications. Statistical significance of relations between 30 covariates and primary outcome was determined with Chi-square analysis.

Results: In 239 patients treated with HVI 26 major, 59 intermediate and 132 minor complications were observed. Fourteen patients (6%) died during the treatment, although only three were possibly related directly to the immobilization. Increasing age (p=0.005) was the only risk factor significantly related to mortality during HVI. Patients over the age of 70 were especially at risk (p=0.002). Twelve patients (5%) acquired pneumonia during HVI. Halo related complications ranged from 3 patients (1%) with incorrect initial assembly of the halo vest to 29 patients (12%) with pin site infections. Both pin site infection (p=0.003) and pin loosening (p=0.021) have been identified as significant risk factors in development of pin site penetration.

Conclusions: Compared to previous retrospective reports, we found a lower percentage of mortality and pneumonia during HVI. Nevertheless, the numbers of minor complications remain substantial. This study confirms that awareness and responsiveness to minor complications can prevent subsequent development of serious morbidities and reduce mortality, while it is the first prospective report to identify risk factors for the development of complications during HVI.

Purpose: To determine if patients randomized to a knee immobilizer following a primary hamstring tendon anterior cruciate ligament (ACL) reconstruction have lower visual analog scale (VAS) pain scores at day two postoperative than patients who do not wear a knee immobilizer.

Method: Patients aged 18–40 with symptomatic ACL deficiency as determined by MRI or physical exam who met the study inclusion criteria were eligible. Patients meeting intra-operative inclusion critiera were randomized (immobilizer or no immobilizer) during wound closure. The immobilizer used was a soft unhinged brace with velcro straps and three metal bars (Breg). Pre, intra and post operative protocols were standardized. Analgesic use and VAS scores were recorded at: one hour after surgery, 8am and 8pm for the first two days postoperative, and 5pm for days 3–14 postoperative. Patients were examined by the surgeon within 14–28 days postoperative. Based on a published survey and the literature, the primary outcome was patient self-assessed pain using a 0–100mm VAS (no pain-worst pain) at day 2 postoperative. Secondary outcomes included: analgesic use, complications, and range of motion. A sample size estimate was calculated resulting in 44 patients per group. A total of 102 patients were enrolled; 88 randomized and 14 excluded intra-operatively. Recruitment was achieved within 11 months.

Results: There was no difference in mean VAS pain scores at 2 days post-operative between immobilized and non-immobilized patients (32.6 and 35.2, respectively; p=0.59, 95% CI −6.99, 12.3). Regardless of group allocation, the greatest pain reported was on the evening of day 1 post-operative. Throughout the first week, patients medicated to a pain level of approximately 30/100. There were no differences between groups in medication consumed, range of motion or complications. At 2 days post-operative all patients randomized to the immobilizer group reported that they worn their brace 76–100% of the time.

Conclusion: No differences in pain were detected between immobilized and non-immobilized patients at any point during 14 days post ACL reconstruction. Based on these findings, a knee immobilizer is not recommended post-operatively for pain control. This study does not address other reasons for immobilizer use such as graft protection or range of motion.

Aims: To determine the effect of fracture and immobilization on bone mineral density and mechanical parameters in postemenopausal women with a distal radius fracture. Methods: Seventeen postmenopausal women with a distal radius fracture with an indication for conservative treatment were included in the study. pQCT measurements of the fractured forearm were performed 2–3 days after the fracture, at 10 days after the fracture and at cast removal (35–45 days). All measurements were performed at a 10mm, 20mm and 40mm distance from a reference line set at the most proximal part of the distal radioulnar joint. Cortical, trabecular and total density and SSIx, SSIy and SSIpolar parameters were assessed. Results: At the fractured forearm, a high statistically signiþcant decrease of cortical density was observed only between second measurement and cast removal at 10 and 20mm (p< 0.01) Total density was not signiþcantly altered and trabecular density at 10mm was signiþcantly increased at cast removal compared to values at the time of the fracture (p< 0.01). Subcortical bone density at 10mm was also signiþcantly decreased at cast removal (p< 0.01). At cast removal, SSIx and SSI-polar parameters of the fractured forearm were also statistically signiþcantly decreased at distances of 10 and 20mm (p< 0.05). Conclusions: Distal radius fractures in postmenopausal women treated conservatively lead to a decrease of cortical density and an increase of trabecular density near the fracture site. They also aggravate bending and torsional mechanical properties. The shift from cortical bone to trabecular bone seems to be time-dependent and is signiþcant at cast removal.

Introduction: The management atlanto-axial fractures, particularly those of the odontoid peg, remains controversial. We managed patients with C1/C2 fractures non-operatively in rigid immobilization until CT-scanning confirmed bony union, rather than for the standard 3-month period. We examined whether this improved outcomes and reduced the need for surgery.

Method: All patients admitted to our unit with atlanto-axial fractures between 2001–2007 were retrospectively analyzed. All fractures had the ‘intention-to-treat’ conservatively in either halothoracic vest (85%) or Aspen collar (15%). Rigid immobilization was maintained until CT-scanning demonstrated bony fusion. Functional stability was subsequently assessed with flexion-extension radiographs after removal of rigid immobilization.

Results: Twenty-seven patients were studied. Nineteen had odontoid peg fractures (10 type II; 9 type III). The remainder consisted of 3 Hangman’s, 3 lateral mass and 2 atlas ring fractures. 83% of patients progressed to union at an average of 13.2 weeks (range 5–22). Six complications related to halo immobilization were observed (three skull perforations/pin-site infections). All of these patients progressed to union non-operatively.

Failure of non-operative management was deemed as non-union or poor patient tolerance of halo, and occurred in 4 patients (17%). All four had type II odontoid peg fractures, and had transarticular screw fixation. One postoperative complication of screw fracture was recorded.

Conclusion: Non-union rates of conservatively managed atlanto-axial fractures with standard 3-month rigid immobilization have been reported as high as 35%. In our series, CT-imaging to confirm bony union prior to removal of the rigid immobilization (prolonging immobilization where necessary) significantly lowered the rate of non-union and therefore the need for subsequent surgery.

Ethics approval: None Audit

Interest Statement: None

Introduction Musculoskeletal injuries, especially fractures, cause reduced limb mobilization. The diminished limb activity promotes muscular atrophy, leading to a slower return to function. Attempts to prevent this atrophy using electrical stimulation have been described after knee reconstruction.

The Myospare percutaneous electrical stimulator has been developed to prevent immobilization related atrophy. We undertook this pilot study to assess feasibility, safety, and efficacy of applying electrical stimulation under a cast after ankle fractures.

Patients and Methods Between May and December 2004, patients who sustained closed ankle fractures requiring surgery, were recruited to participate in this study. 24 patients took part in the study, sixteen male and eight female. Age range was 18 to 62 years (average 40). All patients underwent open reduction and internal fixation using standard AO technique. A short walking cast was applied after surgery. Patients were randomized into a treatment and a control group. The experimental device was applied in the treatment group for 6 weeks. Patients were examined at 2, 6 and 12 weeks.

Evaluation included measurement of calf and ankle circumference, dorsiflexion and plantiflexion, and calculation of the ratio between the injured and uninjured side. At each visit pain intensity was assessed using a visual analog score, and patients filled out a function assessment questionnaire. Analysis was performed using chi square, t-test and repeated measures analysis.

Results All patients tolerated the stimulator well. No adverse effects were encountered. There is a trend toward improvement in calf diameter, dorsiflexion and plantarflexion. However, with the small number of patients in this study, no significant difference was apparent. Functional recovery and VAS scores were borderline higher in the treatment group at 12 weeks (p=0.043 and p=.049) when compared to baseline.

Discussion The use of the Myospare device under a cast in patients after surgical fixation of ankle fractures has been demonstrated as feasible and safe. In this pilot study a trend toward enhanced recovery was apparent in the treatment group.

Introduction: In April 2007, NICE published guidance on reducing the risk of venous thromboembolism. Immobilization of a limb in plaster was identified as a risk factor for thromboembolism. NICE recommend that all orthopaedic patients with risk factors are offered low molecular weight heparin (LMWH) whilst an inpatient. There was no cost effective evidence to continue treatment as an outpatient in foot and ankle patients. Foot and ankle surgery often requires prolonged periods of immobilization postoperatively. This study aims to provide a snapshot of current practice amongst foot and ankle surgeons in the UK, highlighting any differences between current practice and NICE guidelines. Materials and Methods: A random sample of the 267 members of the British Foot and Ankle Surgery Society listed in the 2007 BOA Handbook was obtained. In order to have a 90% confidence level, the sample size was calculated to be 71. The specialist teams identified were contacted by telephone and questioned on their use of thromboprophylaxis for elective patients in plaster. The results were collated and compared to NICE guidelines. Results: 94% of foot and ankle surgeons prescribe LMWH to post operative elective inpatients in plaster. 65% of specialists continue thromboprophylaxis for out-patients. The duration and agent of thromboprophylaxis varied markedly. The commonest agents were LMWH and aspirin. The length of treatment ranged from ten days to the duration of plaster immobilization. Discussion: The results highlight a trend amongst foot and ankle surgeons to exceed current NICE guidelines for thromboprophylaxis, continuing treatment for an extended outpatient period. Although there was shown to be no cost effective evidence to continue treatment, the practice continues. Conclusion: The vast majority of UK foot and ankle surgeons fulfill the NICE recommendations on thromboprophylaxis. There is a clear need for a policy statement from BOFAS on the extended use of thromboprophylaxis for outpatients immobilized in plaster

Aims: Foot deformities following diabetic-neuropathic osteoarthropathy are often responsible for major amputations at the lower limbs. To preserve foot and lower limb length salvage procedures have to be introduced. Methods: In 59 patients with severe deformities of the foot (Sanders II-IV) surgical reposition and resection of necrotic bony substance has resulted in an axial correction of foot-malposition. Stabilization was effected using a fixateur externe device (Hoffmann II) over a period of 6 weeks. After removal of the fixateur externe stabilization of the lower leg was performed for another 6 weeks by means of orthotic devices. Results: Surgical reposition and stabilization in a total of 59 feet has resulted in 57 cases to conservation of the foot, in 2 cases later amputation was necessary. Immobilization in the fixateur externe resulted in a fast detumenescence of accompanying oedemas and in wound healing without special problems. Post-treatment examination after two years on the average revealed in all patients a stable pseudarthrosis without bony connection. 43 from 57 patients after about 6 months were provided with orthopaedic footwear. Conclusions: Surgical procedures which refrain from the use of implants and which do not increase arthropathic activities are capable to correct severe malpositioning of the foot without increasing the activity of arthropathy and result in superior long-term results in diabetic patients. They should therefore be applied with preference

Introduction: Avulsion fractures of the anterior tibial spine are not so common. The best form of treatment for displaced fractures is still debatable. Aims: We aimed to analyze the results of different forms of internal fixation for avulsion fractures of the anterior tibial spine. Material and Methods: Twenty-five patients with avulsion fractures of the anterior tibial spine had open reduction and internal fixation with different implants (AO screw, Herbert screw, stainless steel wire loop and absorbable stitch) and techniques. The mean follow up period was 3.66 years. They were evaluated clinically and radiologically, using KT 1000 arthrometer for ACL laxity and goniometer for range of movements. The outcome was measured using Lysholm Knee Score. Results: Significant residual anterior laxity despite adequate fracture union was a common finding. Maximum ACL laxity was seen in adults in whom absorbable stitches had been used and they had a corresponding lower Lysholm score. Significant migration of the Herbert screws was noted in two of five patients in which it was used. Five of the eight patients with higher Lysholm score had AO screw fixation. Three patients with steel wire loop for stabilization of the fracture also had better results comparatively. Three individuals who had their knee immobilised in 25°–50° of flexion developed fixed flexion deformities, which took 12–18 months to recover. Conclusions: The use of absorbable stitches as the primary method of fixation for avulsion fractures of the tibial spine should be avoided in adults. Herbert screw in this situation has a tendency to migrate. AO screws and non-absorbable loop yields better functional outcome. Immobilization of the knee in excessive flexion leads to prolonged fixed flexion deformity. Early range of movements can be achieved by replacing cast with a brace allowing flexion up to 90 degrees

On the first to second day after birth, equinus, varus, forefoot adduction, calcaneopedal block derotation degree, reducibility characteristics, creases, cavus and muscle condition are evaluated using the clubfoot severity scale, and a long-leg cast is applied. Casting is preceded by the Ponseti treatment: the first ray is dorsiflexed while maintaining finger pressure on the talar neck just in front of the lateral maleolus in the external rotation and abductus. Immobilization is interrupted by redressive manipulation therapy depending on the clubfoot appearance and parents’ participation. Redressive manual and casting therapies typically provide good correction of the foot; yet the equinus persists in the majority of cases. The undercorrected equinus is the major reason for one-stage surgery, consisting of postero-medial-lateral release, capsulotomies and à-la-carte tendon elongation through the modified Cincinnati incision, done at the age of 7 to 9 months. As a rule forefoot derotation and heel fixation are not necessary. There are no skin problems or oedema, and the child usually stays in hospital only for one day after surgery. The outcome, however, is unpredictable even in a fully corrected foot. After surgery, the foot is regularly checked for a potential adductus, lack of dorsiflexion and cavus, and redressive therapy is promptly instituted. Any residual deformation resistant to conservative measures is treated surgically. In the long term, children should as a rule wear ordinary shoes. A typical reoperation – medial release with sectioning of the plantar fascia – is required in approx.10% of cases. Derotation below the knee and transposition of the tibialis anterior tendon are less frequent. At this Department, complete re-correction is required in less than 1% of cases

Aims

Complete ruptures of the ulnar collateral ligament (UCL) of the thumb are a common injury, yet little is known about their current management in the UK. The objective of this study was to assess the way complete UCL ruptures are managed in the UK.

Restoration of the bone defects on the background of the purulent osteomyelitis process is one of most pressing problems in orthopedics. In the last few years the medical procedure was improved thanks to use of semi-synthetic or syntetic implantation biodegradable composite materials. The object of the investigation is to study possibilities of use of fast-biodegradable implant LitAr (Russia) for filling infected bone defects in course of complex treating various osteomyelites forms. The composite material LitAr (in plates) is a mixture of components: xenocollagen and hydroxoapatite. Material is intended for stimulating osteogenesis. In event of infection materials LitAr in 7-10 days is lysed by the wound and microbe ferments and cannot support purulent process. Composite material was introduced into osteomyelitis defect intraoperative through an open wound by introducing a dry substance through fistu-las as well as in form of a suspension in 0.9%-sodium chloride solution. For 13.6% of patients postoperative time period was complicated by suppuration of operative wound. It was stated in course of use of material LitAr that in spite of secondary wound suppuration active osteogenesis rate was little different from similar process for patients with wound healing by first intention. It made it possible to use material more active for patients of advanced years because it was impossible to use a radical sanitation of purulent bone cavity for these patients. Material LitAr was used for 13 patients with osteomyelitis cavities. In form of a suspension (injection-ally or through a fistular duct) in 0.9% NaCl solution material was introduced through fistulas for 8 patients with an affected shin bone. Roentgenological signs of consolidation emerged by 35-40 days. A complete ossi-fication set in by 95-120 days. Immobilization was performed by use of plaster. In far-off time periods (about 2 years) no pathologic fractures were noted. 2 patients had a relapse of fistulas formation (15.4%). The use of implant LitAr for filling infected bone defects for stimulating osteogenesis and for restoring bone continuity in a complex treatment of various forms of osteomyelitis can be considered as an effective one including for patients because it was impossible to perform a radical sequestrectomy for these patients