Introduction: Despite early screening, infants continue to present late ( > 4 months) with DDH. The impact of late diagnosis is significant. Established DDH causes significant morbidity and may have major medicolegal implications.

Aim: To review the incidence of late presenting DDH nationally for a single year and assess the patterns of referral. To identify the reasons for the late presentation of DDH in the presence of early clinical screening.

Methods: In a retrospective study all cases of late DDH presenting in 2004 were identified using inpatient database. Patient records were retrieved and data collected.

Results: Fifty nine cases of DDH were diagnosed at greater than 4 months. There was an additional 26 cases of isolated acetabular dysplasia treated at greater than four months.

The mean age of diagnosis was 14.6 months (range 4–72). Many of the late referrals had risk factors for DDH.

Conclusion: Despite routine clinical screening at birth and six weeks, children continue to present with late DDH. This represents a significant workload for our tertiary unit.

Introduction: Duchenne’s Muscular Dystrophy (DMD) is a progressive sex linked recessive disease, predominantly involving skeletal muscle. Scoliosis is almost universal in patients with DMD. Surgical stabilization carries a significant risks and complications with peroperative mortality of < 6%. Cardiopulmonary complications along with severe intraoperative blood loss requiring massive blood transfusion are the major cause of morbidity

Aim: To evaluate the efficacy of single rod fusion technique in reducing the peroperative and post operative complications especially blood loss, duration of surgery and progression of curve

Material & Methods: Retrospective review – 14 patients with scoliosis secondary to DMD with an average age of 14.5 years (range, 11–17) underwent single rod fusion technique using Isola rod system and pelvic was not included in fixation. Blood loss was measured directly from the peroperative suction and post operative drainage, indirectly by weighing the swabs. Vapour free hypotensive anesthesia was used in all case. Progression of curve was monitored over a period of five years.

Results: The mean operative time was 110 min (range, 80 – 180). The average blood loss was 1.6L (range, 0.7 – 5). The mean follow up was 32 months (range, 4 – 60). There was no progression noticed in the curve on follow up. Two patients develop complications, one had loosening & migration of the rod, required revision and superficial wound infection treated with intravenous antibiotics.

Conclusion: In our experience, single rod stabilization is a safe and quick method of stabilizing the spine in DMD with less blood loss and complications compared to traditional methods.

Introduction: A retrospective evaluation of early results of arthroereisis.

Material and Methods: Eight feet in five patients with pathological flexible planovalgus deformity that had failed non-operative management were treated with subtalar arthroereisis using the Kalix prosthesis. Diagnosis include oblique talus (2), vertical talus (1), diplegia secondary to head injury (1) and type I neurofibromatosis (1). The average age of patients was 6.4 years (range 4–12), and average follow-up was 9.9 months(range 4–20). Outcome was assessed using clinical assessment of the foot axis and functional improvement and radiographic measurements of change in the talocalcaneal angle and talonavicular sag.

Results: Arthroereisis was never performed in isolation, additional procedure included achilles tendon lengthening (2), gastrocnemius recession (6), talonavivular and spring ligament plication (5) and split tibialis anterior tendon transfer (1). All patients had improvement of foot function and restoration of foot axis to a position parallel to the axis of progression. Restoration and maintenance of the talocalcaneal angle was excellent in all cases with preoperative average of 42 degrees (range 20–70), improved to a postoperative average of 23 (range, 0 – 40). Talonavicular sag improved from preoperative average of 16.5 degrees (range 0–32), to post operative average of 26 degrees (range 18–35). Complications include persistent first ray extension which required a Lapidus procedure (1), Ongoing minor discomfort (1). No patients or parents were dissatisfied.

Discussion: The preliminary report supports the use of this technique in selected cases. Sizing of the implant and intraoperative assessment of correction of deformity and balanced surgery are critical to success. It is a simple and rapid procedure with advantages over alternatives such as Osteotomy and fusion. Long term results need further evaluation.

Between 1994 and 2002, 42 patients aged over 65 years were admitted to the spinal injuries unit with odontoid fractures. Data was retrospectively collected by analysis of the national spinal unit database, hospital inpatient enquiry (HIPE) system, chart and x-ray review. Mean age of patients was 79 years (66–88). Mean following-up with 4.4 years (1–9 yrs). Male to female ratio was 1:1.2 (M=19, F=23). Among the mechanism of injury, simple fall (low-energy) was the commonest underlying cause in 76% of the odontoid fracture, whereas 23% fractures were sustained as a result of motor vehicle accident.

Fractures were classified according to Anderson and D’Alonzo method. There were 29 (69%) type 11 fractures, 13 (30%) were type 111 fractures and there was no type 1 fracture. Anterior and posterior displacements were recorded with almost equal frequency. Seven fractures displaced anteriorly and six fractures posteriorly. Primary union occurred in 59% of fractures. Forty (95.3%) fractures were treated non-operatively. Two fractures were stabilized primarily with C1/C2 posterior interspinous fusion. These fractures were odontoid type 11, anteriorly displaced. Three fractures (7.1%) failed to unite and another three fractures (7.1%) united with prolonged interval (9–11 months). Neurological compromise was mainly related to displacement of the fracture. The overall complication rate was significant (48%) with an associated in-hospital mortality of 11.1%. Loss of reduction, non-union after non operative treatment, pin site problems and complication due to associated injuries accounted primarily for this significant complication rate. Most fractures can be managed in orthosis but unstable fractures require rigid external immobilization or surgical fixation.

Outcome was assessed using a cervical spine outcome questionnaire from Johns Hopkins School of Medicine. Questionnaires were sent by post to all patients identified. Non responders were subsequently contacted by phone, if possible, to complete the questionnaire.

In the follow-up, additional 6(14.2%) patients were found deceased, 4 patients were unavailable for review and the remaining 69% had significant recovery. Functional outcome scores approached pre-morbid level in all patients. Outcome of these patients are related to increasing age, co-morbidity and the severity of neurological deficit.

Aims: Stribeck analyses were performed using both unimplanted and carbon (C) implanted heads of alumina, zirconia, zirconia-toughened-alumina and stainless steel so as to study the influence of C implantation on the frictional behaviour of these orthopaedic bearing materials. Methods: The selected biomaterials were implanted using an ion dose of 1 and 2.5 x 10¹⁷ C ions/cm² (75 keV). Friction testing was carried out on unimplanted and C implanted heads using a Hip Joint Friction Simulator with aqueous solutions of carboxy-methyl cellulose (CMC). Results: Both the unimplanted and C implanted bearing couples displayed a similar trend, i.e. by increasing the viscosity of the CMC fluid, the friction factor was found to decrease due to the formation of a fluid film between both bearing surfaces. However, the friction factor for the treated couples at low viscosities was lower than that of their unimplanted counterparts, with a drop of approximately 10% for the steel-on- UHMWPE and a drop of up to 85% being observed in the friction between the ceramic-on-ceramic bearing couples. This decrease can be explained by ion beam smoothening of the treated surface. Conclusions: The results from this study indicate a beneficial reduction in the friction factor of the C ion implanted surfaces. These results indicate that the use of C ion implantation to modify the bearing surfaces of present-day orthopaedic implants may be an effective means of reducing detrimental wear debris at the bearing interface.

Objective: Radicular symptoms of the cervical spine are usually effectively managed by cervical decompressive surgery when the symptomatic nerve root corresponds to the level of maximal radiological compression. The response is less predictable when the symptomatic level and the level of radiological compression are mismatched. The aim of this study was to retrospectively assess the efficacy of surgery in cases where symptom level and the level of radiological compression were mismatched.

Design: We conducted a casenote review of patients who underwent cervical decompressive surgery for radicular symptoms over a five year period with an average follow-up period of 3.5 years.

Subjects’ outcome: Three hundred and thirty-nine patients underwent cervical decompression during this period. Of these, 76 had surgery for isolated radicular symptoms. Nineteen of these patients had radiological and symptomatic mismatch.

Results: Seventy-five percent of those with mismatch initially had a good response to surgery, but 31% subsequently required a further operation. Comparable figures for those whose symptoms and radiology matched are 63% and 6%.

Conclusions: Patients who have radicular symptoms, which do not correspond to the level of radiological compression, do benefit from surgical decompression, but have an increased likelihood of requiring a second operation.