Introduction and Aims: There is a variety of different procedures advocated to address the problems of cosmesis and limited abduction in Sprengel’s shoulders which are based on an understanding of the morphology of the deformity from two-dimensional images. We have reviewed the morphology of the scapulae using 3D CT to determine whether there are sub-groups in which different treatments would be more appropriate.

Method: We assessed 14 consecutive patients (age two to 21 years) between 1996–2002, using a spiral CT scanner with 1.5mm and 3mm slices. These were then reconstructed to give 3D images. These images were then rotated and measured to determine the dimensions, elevation, rotation and shape of the scapula, compared to the normal side. We also looked for the presence of an omovertebral connection and superior hook, and at the range of movement of the shoulder and incidence of associated anomalies.

Results: There was marked variation in the elevation of the scapulae. Three of the 14 had a very abnormal, small, high scapula with multiple associated anomalies. We called these dysplastic. The other 11 scapulae were longer (105%, range 64–132%) and narrower (85%, range 50–133%). They were rotated so the glenoid faced caudally. One out of 11 had a superior hook. The location of the tether could be determined by the shape of the medial border. There is a sub-group of Sprengel’s with a dysplastic scapula and multiple associated abnormalities. These may represent a difference in aetiology. Within the non-dysplastic group there was a wide variation in the size, elevation, orientation and length of the supra spinous portion of the scapulae.

Conclusion: We believe that there are different subgroups of Sprengel shoulder in whom different procedures are indicated and that CT scanning with 3D reconstruction is essential to adequately plan the procedure.

Introduction Localised Langerhans-cell histiocytosis of bone (eosinophilic granuloma) is a benign tumour-like condition with a variable clinical course. Different forms of treatment have been reported to give satisfactory results. However, previous series all contain patients with a wide age range. Our aim was to investigate the effect of skeletal maturity on the rate of recurrence of isolated eosinophilic granuloma of bone excluding those arising in the spine.

Methods We followed-up 32 patients with an isolated eosinophilic granuloma for a mean of five years; 17 were skeletally immature.

Results No recurrences were noted in the skeletally immature group even after biopsy alone. By contrast, four of 13 skeletally mature patients had a recurrence and required further surgery.

Conclusions This suggests that eosinophilic granuloma has a low rate of recurrence in skeletally immature patients.

A chance observation of asymmetrical bone ages in a child with spastic hemiplegia stimulated a prospective gathering of bilateral hand radiographs in 33 hemiplegic patients, and on a single occasion in a control group of 23 patients with leg length discrepancy in the absence of neurological disorder. The bone age assessments according to Greulich and Pyle, which by convention has used the left hand only, were done by a single expert observer blinded to the clinical details.

13 hemiplegic patients (39%) had delayed bone ages of 6 months or more. When present it was always delayed on the hemiplegic side. The mean delay for the whole group was 2.5 months, whereas there was no mean difference in the control group (p = 0.001). The oldest bone age with asymmetry was 14.5 years in males and 12 years in females, indicating that when present the delay “catches up” in the last 2-3 years of growth.

In hemiplegia the percentage leg length discrepancy also tends to decrease during later growth, and after 80% of growth the hemiplegic side outgrows the normal leg by a mean of 0.3cm/year. No correlation could be found between the delay of bone age and the severity of either the neurological abnormality or the actual discrepancy of length. The implications for clinical management will be discussed.