Innominate Osteotomy first described by Salter is one of the commonest procedures performed for treatment of Developmental Dysplasia of the Hip (DDH) in children. We recently described a less invasive technique for Innominate Osteotomy, which significantly reduces the operation time without compromising outcome (J Pediatr Orthop B. 2010 Jul;19(4):318–22). As part of the evolution of this procedure we now routinely use bioabsorbable pins (INION OTPS PIN, made from co-polymers of L-lactic acid, D-lactic acid and trimethylene carbonate) instead of K-wires to secure the graft.

We prospectively followed-up 120 consecutive cases done using bioabsorbale pins over a 2 year period. The surgical technique was as described in our less invasive innominate osteotomy paper. Average age at surgery was 24 months (18–52) with mean follow-up period of 15 months (6–24 months). The mean preoperative acetabular index was 36.2^o. Our results show a mean acetabular index of 18.7^o (P< 0.0001) at latest follow-up with no loss of correction. We recorded three superficial wound infections (one MRSA), all resolved uneventfully. There was no foreign body reaction.

The use of bioabsorbable pins eliminates the need for a second anaesthetic to remove the pins with significant cost benefit without compromising outcome.

Radiographic follow-up of traumatic spondylolisthesis of the axis is well documented in the literature. However, there is a paucity of studies regarding the long-term functional outcome of this type of injury.

To study the population, treatment and outcome following traumatic spondylolisthesis of the axis, we reviewed 36 consecutive patients presenting to our institution, a tertiary referral spinal trauma centre, over a 6-year period. We assessed: (a) the mechanism of injury, (b) the mode of treatment, (c) the radiographic classification using the Levine and Edwards system and (d) functional outcome using the Cervical Spine Outcomes Questionnaire (CSOQ) by BenDebba.

Of the 36 patients presenting there were 24 males and 12 females with a mean age of 46 (range18-82) years. The commonest mechanism of injury was road traffic accidents. There were 14 Type-I, 11 Type-II and 1 Type-IIA fractures. Twenty-seven patients were treated with halo vest immobilisation and nine were immobilised in a Minerva jacket. Four patients were converted from halo to Minerva because of pin failure. The mean duration of hospital stay was 10 (range 3-30) days. All fractures demonstrated radiographic union at a mean of 12 (range 10-16) weeks. There were no neurological complications. Upon review, all patients, whether Type-I or Type-II demonstrated low CSOQ scores approaching their pre-morbid status. However, Type-II fractures scored higher in 3 functional outcome categories when compared to Type-I fractures.

This unique study of an uncommon fracture shows for the first time a difference in the functional outcome scores of Type-II fractures of the axis when compared to Type-I fractures at a mean follow-up of 3 years and 10 months.

We analysed the morbidity, mortality and outcome of cervical spine injuries in patients over the age of 65 years in a retrospective review of 107 elderly patients admitted to our tertiary referral spinal injuries unit with cervical spine injuries between 1994 and 2002. The data were acquired by analysis of the national spinal unit database, hospital inpatient enquiry (HIPE) system, chart and radiographic review. Mean age was 74 years (range 66-93yrs). The male to female ratio was 2.1: 1(M=72, F=35). The mean follow-up was 4.4 years (1-9 years) and mean in-hospital stay was 10 days. The mechanism of injury was a fall in 75 and a road traffic accident (RTA) in the remaining 32 patients. The overall complication rate was 18.6% with an associated in-hospital mortality of 11.2%. Outcome was assessed using the Cervical Spine Outcomes Questionnaire (CSOQ) from Johns Hopkins School of Medicine.

Functional outcome scores approached pre-morbid level in almost all patients. Functional disability was more marked in the patients with neurological deficit at the time of injury. Outcome of the injury is related to the increasing age, co-morbidity and the severity of the neurological deficit. Injuries of the cervical spine are a not infrequent occurrence in the elderly and occur with relatively minor trauma.

Neck pain in the elderly patient should be thoroughly evaluated to exclude C2 injuries. Most patients can be managed in an orthosis but unstable injuries require rigid external immobilisation.

Introduction: Total hip arthroplasty for osteoarthritis secondary to developmental dysplasia of the hip (DDH) is technically difficult due to the abnormal anatomy involved. The use of a modular hip replacement system is advantageous in that its versatility allows for intra-operative adjustment to accommodate for final acetabular position and version.

Aim: The aim of this study was to assess our early results with the S-ROM hip (DePuy), a cementless modular femoral implant.

Methods and materials: We performed 22 total hip replacements on 20 patients with DDH over a three and a half year period. Nineteen patients were female and one was male. Ages ranged from 30 to 59 years (average 38.3 years). Ten patients had had previous osteotomies performed, including two of whom had Ganz periace-tabular osteotomies performed in our centre.

Nine patients had additional acetabular bone grafting with autologous femoral head, two patients had subtrochanteric osteotomy, and another patient had an adductor tenotomy performed at the time of their surgery. Follow-up ranged from 6 to 44 (mean 19.6) months.

Results: Harris hip scores improved from an average of 42 points pre-operatively to 90 points post-operatively. No radiographic evidence of osteolysis was seen around the femoral implant. Two patients required revision of their acetabular components. Both had satisfactory outcomes.

Conclusion: Our early results with the S-ROM femoral prosthesis correlate well with those from other studies involving arthroplasty for DDH. There were no complications related to the use of uncemented prostheses. Modularity makes this implant extremely versatile and easy to use in this complex patient population.

First described in 1910, Legg Calve Perthes disease is considered to be a complication of osteonecrosis of the femoral head-affecting children between the ages of 2 and 12. Treatment has centred on containment, surgical and non-surgical in the hope that keeping the femoral head covered by acetabulum that it will remodel and maintain congruency with the acetabulum. We know from previous studies that deformities of the femoral head increase the risk of development of arthritis in later life and that the shape of the femoral head is the only alterable parameter in the development of this early onset arthritis.

During the natural history of the disease, once the central part of the femoral head collapses the integrity of the femoral head is reliant on the support of the lateral and medial columns. These columns then collapse altering the shape of the femoral head. We induced LCPD in the femoral heads of twenty skeletally immature rabbits and buttressed the central column of the femoral head in twelve. These treated rabbits had cement, bone graft or bone paste inserted through a drill hole that extended into the centre of the femoral head. The rabbits were then recovered and x-rayed at six weeks. All the rabbits had evidence of varying degrees of head collapse radiologically. Once the rabbits reach skeletal maturity in March, they will be euthanised and their femoral heads examined histologically and radiologically to determine the effects of central column enhancement by each of the three substances.

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.