A prospective study was carried out over a period of 4 years. 31 patients with a mean age of 49 years were treated using the clavicular hook plate. The mean follow up was 28.34 months. 23 patients were operated primarily and 8 patients were operated for symptomatic non-union.

All the patients achieved clinical and radiological union in a mean 12.71 weeks. According to Constant scoring the mean was 94. According to HSS (Hospital for Special Surgery) scoring 9 patients had excellent, 21 had good.

The clinical results of the clavicular hook plate were good leading to good shoulder girdle function.

Aim: To evaluate the clinical outcome of Titaneum hemi-arthroplasty in the management of hallux metatarsopha-langeal joint arthritis. Methods: 55 joints in 46 patients were treated surgically with Titaneum implant for arthritic hallux metatarsophaelangeal joints. There were 35 women and 11 men. The pathological indications were hallux rigidus (74%), rheumatoid arthritis (10%) and degenerative changes associated with hallux valgus (16%). 6 cases were done as a revision of sialastic to titanium prosthesis due to severe silicone synovitis. Results: The mean age was 60 (range 43–76) years, and the mean follow up was 56 (range 28–86) months. The mean time taken to get back to normal activities is 36.6 (range 21–90) days. The mean range of motion achieved was 32 (range 20–64) degrees and the relief of pain was excellent or good in 86% of the patients. There were no surgical complications in the form of infection, osteolysis or instability. The synovitis in the revision group has subsided. Conclusions: The clinical results of Titaneum hemiarthroplasty were good. The advantages of this procedure were preservation of joint movement and good pain relief.

Aim: To investigate the versatility of ßexible intramedullary nails (FIN) in the surgical treatment of forearm fractures in children. Methods: 28 children were treated using FIN for displaced forearm fractures over a period of 5 years. There were 18 boys and 10 girls. The mean age was 11.5 years and the mean follow up were 7.9 months. Two nails were used one each for radius and ulna. 12 children were operated for unstable displaced fractures, 14 were operated after failed initial reduction and 2 were operated for open fractures. 16 were nailed by closed method, 12 had mini open technique in cases of failed initial closed reduction. The nails were removed on an average of 6–8 months. Results: All the children achieved bony union in excellent position. The average time for union was 5.6 weeks. All but 2 patients had full range of movements and none had any functional difþculty. 3 children had transient hypo aesthesia in the area of superþcial radial nerve distribution and one child developed compartment syndrome which needed fasciotomy. There were no long term sequel. Conclusions: Use of FINs in paediatric forearm fractures should be encouraged when surgical intervention is needed. They are axially and rotationally stable. They are safe to introduce and remove at a later date. Their ßexibility allows remodelling of the fracture and growth of the long bones.

Aims: This study shows the efþcacy of The Pavlik harness for the treatment of Development Dysplasia of hip (DDH) using ultrasonographic monitoring. Methods: Between 1995–2000 we treated 149 dysplastic hips in 117 babies. According to the Grafñs classiþcation 90 were dysplastic type IIB, IIC, IID hips; 59 were dislocated Type IIIA, IIIB and IV hips. Babies were regularly monitored using ultrasound unto 26 weeks and radiographs up to 5 years in dislocated hips for bony roof angle. Results: The average full time harness treatment was 12.2 (range 6–20) weeks, average follow up was 55 (range 30–90) months. The harness failed to reduce 14 hips (9.5% of total hips). Two cases continue to show a small femoral ossiþc nuclei at 30 months follow up. The hips showed no signiþcant difference in acetabular index from the normal values at follow up radiographs. Conclusions: We conclude that using this protocol, successful initial treatment of DDH with the Pavlik harness appears to restore normal development of the hip.

In five years 55 joints in 46 patients were treated surgically with a titanium implant for arthritic hallux meta-tarsophalangeal joints. There were 35 women and 11 men. The pathological indications were hallux rigidus (74%), rheumatoid arthritis (10%) and degenerative changes associated with hallux valgus (16%). Six cases were done as a revision of silastic to titanium prosthesis due to severe silicone synovitis.

The mean age was 60 (range 43–76) years, and the mean follow up was 56 (range 28–86) months. The mean time taken to get back to normal activities is 36 (range 21–90) days. The mean range of motion achieved was 32 degrees (range 20–64) and the relief of pain was excellent or good in 86% of the patients. There were no surgical complications in the form of infection, osteolysis or instability. The synovitis in the revision group has subsided.

The clinical results of titanium hemiarthroplasty were good. The advantages of this procedure were preservation of joint movement and good pain relief.

This study shows the efficacy of The Pavlik harness for the treatment of Development Dysplasia of Hip using ultrasonographic monitoring. Between March 1995 and February 2000 we treated 149 dysplastic hips in 117 babies. According to the Graf’s classification 90 were dysplastic type IIB, IIC,IID hips; 59 were dislocated Type IIIA, IIIB and IV hips.

Babies were regularly monitored using ultrasound until the age of 26 weeks and radiographs there after for bony roof angle. The Pavlik harness was abandoned if there was persistent dislocation of hip at the end of 3 weeks of treatment. The average full time harness treatment was 12.2 ( range 6–20 ) weeks. The average follow up was 55 ( range 30–90 ) months.

The harness failed to reduce 14 hips ( 9.5 % of total hips). These required arthrogram and closed or open reductions. Late presentation beyond 12 weeks and a higher grade on the Graf’s classification reduces the success rate of the pavlik harness treatment. Two cases continue to show a small femoral ossific nuclei at 30 months follow up. The hips treated successfully showed no significant difference in acetabular index from the normal values at follow up radiographs.

We conclude that using our protocol, successful initial treatment of Developmental Dysplasia of Hip with the Pavlik harness appears to restore normal development of the hip. We continue to monitor patients by regular radiological surveillance up to 3 years in dysplastic hips and 5 years in unstable and dislocated hips.