Introduction: Percutaneous epiphysiodesis is a well established procedure in the treatment of leg length discrepancy. Many techniques have been described ranging from an open technique to the more recently described percutaneous technique. This study assesses the percutaneous single portal technique, in combined distal femoral and proximal tibial lower limb epiphysiodesis, performed by a single surgeon.

Methods: We performed a retrospective review of cases performed in a single institution by a single surgeon from 1994 to present. A total of 45 combined epiphysiodesis were performed. 40 patients qualified for the study group with at least 2 years follow up. There were 19 female and 21 male patients, with the operative side equally shared between left and right.

Results: The mean predicted leg length discrepancy using the Mosley Straight Line Graph was 2.43 cm. The mean final leg length discrepancy, at an average follow up of 31 months, was 1.5 cm with a range of 0 to 2.81 cm. There were no angular deformities at follow up. One female patient had a knee effusion which resolved spontaneously. One male patient complained of anterior knee pain initially post surgery however this resolved at final follow up without treatment. The majority of patients (n=34) were inpatients, however more recently this procedure has been successfully carried out as a day case (n=6).

Discussion: Percutaneous epiphysiodesis has been accepted as a standard technique to treat leg length discrepancy of 2 cm to 5 cm. Several techniques have been described in the literature with varying complication rates. This study shows that single portal combined epiphysiodesis is successful and has a relatively low complication rate.

The Extensor Digitorum Brevis is an easily visualised superficial muscle present on the dorsolateral aspect of the foot. It is innervated by the terminal branches of L5. Wasting of this muscle has been described as a sign of L5 radiculopathy, however its specificity and sensitivity as a clinical sign in patients with disc disease has never been assessed to the best of our knowledge.

The purpose of our study was to determine the effectiveness of this sign in patients with a know L5 radiculopathy. We included three groups of patients, which were prospectively assessed by a blinded single examiner. Group A were patients with a clinical L5 radiculopathy confirmed on MRI, Group B were patients with a clinical a S1 radiculopathy confirmed on MRI and Group C were a control group. There were 20 patients in each group, 10 male and 10 female, mean age 38 years (range 19 – 57 years). Our inclusion criteria were leg pain greater than 6 weeks, we excluded and patient with a history of previous disc disease or foot surgery. A positive sign was defined as a gross clinical wasting of the extensor digitorum brevis compared to the opposite foot.

The sign was negative in all 20 patients in the control group. The sign was positive in 12 patients (60%) with L5 radiculopathy and only one patient (5%) with S1 radiculopathy. Fishers exact test confirmed statistical significance between the two groups with a p value of < 0.05.

We conclude that this easily performed objective clinical sign, when used inpatients with leg pain, is highly specific in determining the pressure of an L5 root involvement.

The pathogenesis of frozen shoulder remains unclear. Fibroblast proliferation has been implicated in the pathogenesis with subsequent fibrosis of the capsule. We studied patients undergoing manipulation under anaesthesia for frozen shoulder. All fitted Codman’s criteria for the diagnosis. Normal saline was injected and then aspirated from 14 patients undergoing manipulation under anaesthesia for treatment of frozen shoulder and from 15 patients undergoing shoulder arthroscopy for other pathology. Human fibroblasts were cultured from sections of human anterior abdominal wall obtained from patients undergoing elective surgery. The effect of frozen shoulder aspirate versus normal control on human fibroblast proliferation and apoptosis was measured. Cellular proliferation was determined using the Promega celltitre 96TM non-radioactive cell proliferation assay.

Results: Proliferation of human fibroblasts was significantly increased in the cells treated with aspirate obtained from frozen shoulder patients versus both negative control (growth medium only) and control (normal shoulder aspirate) at concentrations of 105, 25% and 50%. This increase in proliferation was in a dose dependent manner, with the most significant increase seen in cells treated with a 505 concentration of frozen shoulder aspirate. Apoptosis was unregulated at all concentrations of shoulder aspirate, but only achieves statistical significance at 255 and 505 concentrations.

Conclusion: This study supports the hypothesis that frozen shoulder results from alteration in fibroblast regulation. Pharmacological modulation of fibroblast proliferation may be a potential therapeutic option.

The pathogenesis of frozen shoulder remains unclear. Fibroblast proliferation has been implicated in the pathogenesis with subsequent fibrosis of the capsule. We studied patients undergoing manipulation under anaesthesia for frozen shoulder. All fitted Codman’s criteria for the diagnosis. Normal saline was injected and then aspirated from 15 patients undergoing manipulation under anaesthesia for treatment of frozen shoulder and from 15 patients undergoing shoulder arthroscopy for other pathology. Human fibroblasts were cultured from sections of human anterior abdominal wall obtained from patients undergoing elective surgery. The effect of frozen shoulder aspirate versus normal control on human fibroblast proliferation and apoptosis was measured. Cellular proliferation was determined using the Promega celltitre 96TM non-radioactive cell proliferation assay.

Proliferation of human fibroblasts was significantly increased in the cells treated with aspirate obtained from frozen shoulder patients versus both negative control (growth medium only) and control (normal shoulder aspirate) at concentrations of 105, 25% and 50%. This increase in proliferation was in a dose dependent manner, with the most significant increase seen in cells treated with a 505 concentration of frozen shoulder aspirate. Apoptosis was upregulated at all concentrations of shoulder aspirate, but only achieves statistical significance at 255 and 505 concentrations.

This study supports the hypothesis that frozen shoulder results from alteration in fibroblast regulation.

Acute haematogenous osteomyelitis remains a significant cause of morbidity in the paediatric population. The clinical presentation has changed, however, over the last number of decades. The typical picture of established osteomyelitis is less commonly seen. Children more often present with a less fulminant picture.

The treatment of acute haematogenous osteomyelitis remains controversial. Antibiotic therapy, initially intravenous, then orally, is the gold standard. Hover, the role of surgery is unclear. Some centres, particularly in North America treat 25–40% of patients surgically.

We present our experience with acute haematogenous osteomyelitis in children over a three year period. The total number of patients was forty-five. The mean age was 6.1 (range 6 months to thirteen years). The most common isolated organism was Staphylococcus Aureus. The mode of treatment was intravenous antibiotics for two weeks, or until clinical, and laboratory evidence of improvement, and the oral antibiotics for six weeks. No patients required surgical interventioin. All patients made a satisfactory recovery.

We conclude that the treatment of acute haematogenous osteomyelitis in the paediatric population should consist of antibiotic therapy only, and that there is no place for surgery.