Between 1980 and 2003, 600 patients with idiopathic clubfoot attended our clinic.

Until 1989, we manipulated the feet according to the Robert Jones method. After that we changed to the Ponseti method. Depending on the residual deformity at age 3 months, patients underwent either percutaneous Achilles tenotomy or full posteromedial release, as described by McKay, and were supplied with a thermoplastic splint until walking age. Minor changes to the surgical technique were made over the years. At follow-up, a minimum of 2 years postoperatively, the feet were evaluated both according to the McKay scoring method and by a simpler method that correlated well with it.

Although our results compare unfavourably with those of Ponseti (80% non-surgical correction), we had excellent overall outcomes, with low revision and complication rates.

Purpose: A modification of the arthrodesis as described by F R Thompson is reviewed in ten children.

Method: Between September 1997 and July 2001, six patients ranging from 6 to 13 years underwent hip arthrodesis. Indications included trauma (one), idiopathic chondrolysis (one) post-septic arthritis (four) and tuberculosis of the hip joint (four). The subtrochanteric osteotomy was performed as a coronal chevron, differing from the previously described techniques. Patients were immobilized in a spica (six) and external fixation (four) in a functional position of 20 degrees flexion and neutral position (1degree abduction per year of growth left) for six weeks postoperatively.

Conclusion: This review re-establishes hip arthrodesis as an acceptable treatment for children with destroyed joints and intractable pain. The modification used provides an attractable alternative in preventing the displacement of the subtrochanteric osteotomy, but allows correct positioning of the limb. The use of the external fixation allows lengthening if needed.

Between September 1997 and April 2000 hip arthrodesis was performed on six patients, using a modification of the techniques described by F.R. Thompson. The ages of patients ranged from 11 to 13 years, and indications included trauma (one patient) post-septic arthritis (two patients) and tuberculosis of the hip joint (three patients).

The subtrochanteric osteotomy was performed as a coronal chevron, differing from previously described techniques. Patients were immobilised in a spica in a functional position of 20° flexion and the zero position (1° abduction per year of growth left) for six weeks postoperatively. The follow-up period ranged from 16 to 40 months.

Union was achieved within six weeks. All patients achieved a pain-free gait, with minimal signs of disability.

We believe that hip arthrodesis is an acceptable way of treating children with destroyed joints and intractable pain. The modification we used prevents displacement of the sub-trochanteric osteotomy but allows correct positioning of the limb.

We studied the outcome of displaced supracondylar fractures in 98 children treated over three years to December 2000. In 74 patients fractures were treated by closed reduction and percutaneous K-wire fixation. Through a direct posterior approach, open reduction was obtained in the other 24. Postoperatively the elbow was immobilised in a posterior cast in 30° flexion for three to four weeks. The cast and K-wires were removed in the clinic and the elbow mobilised.

In patients treated by closed reduction, the mean range of movement (ROM) was 10° to 120° at the one-month follow-up. There was a cubitus varus deformity in four patients. One patient developed pintract infection. There were five neurological complications, of which only one (ulnar nerve) was surgical. The mean ROM of patients treated by open reduction was 15° to 110° at the one-month follow-up. Pre-operatively two patients in this group had a neurological deficit (one median and one radial nerve), which had improved at follow-up.

Treatment of supracondylar humeral fractures in children by closed reduction and percutaneous K-wires is safe and reliable. Where open reduction is necessary, a posterior approach is more acceptable cosmetically and does not lead to functional loss.