The purpose was to compare the results of two different surgical techniques in the treatment of severe cerebral palsy scoliosis.

This is a retrospective review of 12 consecutive cerebral palsy patients with scoliosis greater than 90 degrees undergoing simultaneous anterior and posterior spinal fusion. The clinical notes were reviewed along with sequential radiographs. Twelve patients were operated on between March 1997 and October 2001. There were 6 patients who had anterior release and fusion followed by posterior fusion from T2 to the sacrum using the Luque-Galveston technique. (Group 1). The other 6 patients had identical surgery but with the addition of anterior instrumentation as well. (Group 2). There was no loss of fixation or metalware failure. There was no pseudarthrosis. One patient died at the time of rod removal for infection 2 years following their index operation.

These results show that a good outcome is achieved in this group of severely affected cerebral palsy patients using either of the techniques described. The addition of anterior instrumentation may make the surgery easier and was not associated with significant increase in complications.

This prospective study was designed to audit the introduction of this new technique for the treatment of club-feet in New Zealand. Although well proven in Iowa, USA the Ponseti Technique has rarely been practiced outside of this state.

Fifty feet in 32 consecutive patients have prospectively been followed since September 1999. All the patients have been treated by one surgeon in an identical fashion to that described by Dr Ponseti. The only difference was that the percutaneous tenotomies were preferentially performed under a general anaesthetic. Twenty four feet have had a detailed radiographic analysis as well. There have been 2 patients lost to follow-up. Twenty three patients were of Maori or Polynesian ethnicity. The pre treatment Pirani score averaged 5.0. The first cast was usually applied within 2 weeks of birth and the average number of casts was 6.0. The Achilles tendon tenotomy was not preformed in 4 feet. The mean follow-up Pirani score was 0.5. Four feet in 2 patients have required posteromedial release at 11 months of age. One patient has required a tibialis tendon transfer at 2 1/2 years of age. There have been minor skin complications from the boot wearing. The compliance with boot wearing is low with more than 50% of the patients wearing them less that 50% of the prescribed time.

The Ponseti Technique demands attention to detail if it is to be successful. These excellent early clinical and radiographic results support this method of treatment for idiopathic talipes equinovarus. Our concern is the long-term outcome in the patients with poor boot wearing compliance.

This is an outcome study of patients with spina bifida treated for scoliosis by anterior and posterior spinal surgery at the Starship Children’s Hospital.

The clinical notes and radiographs were reviewed of all spina bifida patients with scoliosis undergoing surgery between January 1991 and January 2001. In addition all patients were sent the Spina Bifida Health Related Quality of Life Questionnaire (HRQOL) and the Spina Bifida Spine Questionnaire (SBSQ). There were 19 consecutive patients with an average age at surgery of 13 years 5 months. Four patients had both anterior and posterior instrumentation. 14 patients had staged procedures.

There was an overall improvement in scoliosis of 61% and pelvic obliquity of 70% at latest follow-up that averaged 60 months. The major complications included 4 deep infections and 2 pseudarthroses. The patients scored an average of 68.8 on the SBSQ. The average score for 5–12 years old was178 and for 13–30 years old, 163, on the HRQOL questionnaire. There are good radiological results with combined anterior/posterior surgery in this group of spina bifida patients. Quality of Life does not seem to be greatly compromised in the operated spina bifida patient.

We recommend early single stage anterior and posterior fusion for these patients before the curve becomes too large and stiff.

We have prospectively followed 18 patients having an opening wedge high tibial osteotomy for medial compartment osteoarthritis of the knee using the Puddu plate and autologous bone graft. The purpose was to assess the learning curve involved in the introduction of a new procedure and to follow its long-term success. Ethics committee approval was obtained.

Eighteen consecutive patients (4 female, 13 male, 1 bilateral, average age 47), operated on by 5 different surgeons were assessed pre-operatively using the American Knee Society knee and function scores and SF-36 health questionnaires. Radiographs were assessed using the Ahl-bach grading system for severity of degenerative change and the long-leg mechanical axis was measured as a percentage of total joint surfaces from the medial side.

Pre-operatively patients had an average Ahlbach score of 1.8 (range 1–3, mode 2). The long-leg mechanical axis average was 14.7% (range 3.75–27.5%), American Knee Society knee score average was 49.2 (range 28–64) and function score average 58.4 (range 40–70). By six weeks post-operatively all patients had at least 90 degrees of flexion and pain of less than 2 out of 10. There have been five complications: 1 deep infection requiring admission for intravenous antibiotics, 2 superficial infections requiring oral antibiotics only, and 2 intra-operative fractures, both internally fixed at the time of surgery. At follow-up of minimum 12 months the average mechanical axis was 50.6% (range 32–64%), Knee Society score 79 and function score 82.

These early results suggest that despite some complications this procedure is weII tolerated and gives good functional results.

Aim: To determine the length of stay after adolescent idiopathic scoliosis (AIS) surgery in Starship and Mercy Hospitals to ascertain whether there is a difference in the length of stay of patients having AIS surgery in a private hospital compared with a public hospital. To determine the variables having significant influence on the length of stay.

Methods: Patients between the ages of 10 and 20 who had surgery for AIS during the period 1/1/96 to 31/12/2000 were identified from theatre logbooks. Patients who had anterior and posterior surgery were excluded. A retrospective analysis of case notes was carried out. Fisher’s Exact Test was used to analyse categorical data while Student T Test was used for continuous variables.

Results: Thirty-three patients fulfilled the entry criteria. Sixteen male patients were operated on in Starship Hospital. Seventeen patients had operations at Mercy Hospital but only one of these was male. The groups were not significantly different in terms of age, sex, weight, ASA, number of levels, or curve pattern. The Mercy Hospital patients had a significantly lower Cobb angle (by 12 degrees). The Starship Hospital patients tended to retain their PCA pumps longer and tended to use more PCA morphine, however, this result was not significant. The Mercy Hospital patients had their intravenous access removed and were mobilised significantly earlier (1.7 and 1.9 days earlier respectively). The Mercy Hospital patients had a significantly shorter length of stay (6.4 and 8.4 days respectively, p= 0.0002).

Conclusions: Patients at the Mercy Hospital had a significantly shorter post-operative length of stay after AIS surgery. This was not completely explained by the lower Cobb angle seen in the Mercy Hospital patients. The Mercy Hospital patients had their drips removed and were mobilised significantly earlier. This may be the key to early discharge.

Introduction: The management of idiopathic talipes equino varus remains controversial. Excellent long term results have been reported with non operative management using the Ponseti technique.

Aim: To assess prospectively the early radiologic and clinical results in idiopathic club feet treated in New Zealand by the Ponseti technique.

Method: We have reviewed prospectively 29 feet in 19 consecutive patients presenting with idiopathic club feet. The initial assessment consisted of a clinical examination, assessment of the Pirani score and clinical photographs. At follow-up the Pirani score, ankle range of motion, foot length and calf circumference were measured and radiographs were taken. Follow-up was at an average age of 7.3 months.

Results: The Pirani score improved from an average of 4.9 to 0.5. The range of motion averaged 32 degrees dorsiflexion and 42 degrees plantar flexion. Radiographs showed good correction of the hindfoot with a mean talocalcaneal index of 55 degrees, and a dorsiflexion tibiocalcaneal angle of 62 degrees. A normal mean AP talo-first metatarsal, AP calcaneo-fifth metatarsal angle, and lateral talo-first metatarsal angle showed good correction of midfoot adductus and cavus. Forced dorsiflexion radiographs showed that ⅗ ths of dorsiflexion motion occurred in the hindfoot and ⅖ ths in the midfoot. Complications were all minor. One non-compliant patient required bilateral posteromedial releases.

Conclusions: This is the largest reported series outside of Iowa City using this technique and the first to show the early radiographic findings. Excellent early clinical and radiographic results have been shown.

Introduction: There is a paucity of published data concerning major thoracolumbar spine trauma in the paediatric population, reflecting the rarity of these injuries.

Aim: To review retrospectively 11 cases of thoracolumbar paediatric spinal fractures and dislocations requiring operative management by one surgeon from 1991 to 2001 at Starship Children’s Hospital.

Methods and results: The mean age was 10 years (range: four to 15). Four patients had a neurological deficit (three were incomplete, one was complete). All patients underwent surgery with internal fixation. Canal decompression was achieved by operative realignment in most patients although two patients underwent additional decompression by corpectomy. Seven patients had flexion-distraction injuries with facet joint dislocations. These patients were treated with posterior instrumentations in compression. A further two patients with fracture-dislocations were also treated by posterior instrumentation and the remaining two patients (one burst fracture and one fracture-dislocation) by anterior instrumentation. The general principles for surgical management of thoracolumbar spine trauma in adults were found to be applicable to the children in this series. Suitably sized internal fixation devices were available to allow stabilisation in all cases. The preponderance of dislocations presumably reflects differing biomechanics in the immature versus the adult spine and necessitated a posterior operative approach in most cases.

The limping or non-weight bearing child can present a difficult diagnostic dilemma. It may be possible to avoid admission of a large proportion of these patients if septic arthritis or other serious pathology can be exclude d.

We have established a continuing, prospective study of all patients admitted for hip pain (with normal radiographs) to Starship Children’s’ Hospital between two and 13 years of age. Forty-two patients had a final diagnosis of transient synovitis. Only two patients during an eight month period had septic arthritis. Due to small numbers of patients with serious pathology we compared the transient synovitis group with a retrospective review of those with septic arthritis treated at Starship Hospital in the previous four years.

Following comparisons of these two groups, we found that there was a greater incidence of septic arthritis in Maori and Pacific Islanders and septic arthritis tended to occur in younger children. The patients’ initial history, temperature, white cell count and ESR were sensitive in discriminating between septic arthritis and irritable hip.

Once the diagnosis of “irritable hip” was made it was unlikely to be altered. We therefore would recommend that it is possible to avoid admission in a large number of these patients. We would however continue to recommend admission for those with a clear history of current illness, Maori or Pacific Islanders, children under the age of four, those with an elevated temperature, and any patient with an elevated white cell count especially neutrophil count or ESR.

Previous studies have documented a variation in the occurrence of musculo-skeletal conditions affecting the hip and foot in the New Zealand Maori and Pacific Island races compared with the European race in New Zealand. Similar data regarding scoliosis are lacking. A manual and computerised review of outpatient records of Starship Hospital (1989–2000) and Middlemore Hospital (1997–2000) revealed 363 patients less than 20 years of age with a diagnosis of scoliosis. Major aetiological diagnoses included adolescent idiopathic (63), syringomyelia (12), myelomeningocele (16), cerebral palsy (55) and congenital (55). Significant racial variations were noted in the idiopathic, syringomyelia and neuro-muscular groups compared with New Zealand census predictions. Idiopathic scoliosis was uncommon in Maori (9%) and rare in Pacific Islanders (1%). Conversely, these groups accounted for 66% of all scolioses and over 50% of Maori and Pacific Islanders were found to have a syrinx. MRI is indicated in Maori and Pacific Islanders with apparent adolescent idiopathic scoliosis. Maori accounted for 31% of patients with myelomeningocele and scoliosis. 40% of patients with cerebral palsy and scoliosis were Maori, reflecting the known inferior status of perinatal and other health parameters in this group of people.