Aim. The current literature indicates that hip arthroscopy is safe in both adolescents and adults with good early outcomes but there are no available studies that directly compare the outcomes of this procedure for mixed indications between these two groups. Method. This was a prospective cohort study of 102 consecutive supine hip arthroscopies in 96 patients (48 adolescent (<18) hips, mean age 13.9 years and 54 adult (>18 hips), mean age 33.8 years) at a tertiary referral paediatric and adult university hospital followed-up for a minimum of two years. Patient demographics, indications for surgery, Modified Harris Hip (MHHS) and Non-Arthritic Hip (NAHS) scores, operative interventions and complications were recorded. Results. At two-year follow-up, the MHHS improved from a mean of 55.3 to 87.5 (p<0.05) in the adolescent group and from 58.7 to 86.9 (p<0.05) in the adult group while the NAHS improved from 57.1 to 86.7 (p<0.05) in the adolescent group and from 61.4 to 87.4 (p<0.05) in the adult group. There was no statistical significance difference in outcome between the two groups at 2 years. With respect to complications, there were 2 cases of transient lateral femoral cutaneous nerve palsy (1 adolescent and 1 adult) that resolved spontaneously. There were 3 transient pudendal nerve palsies that resolved spontaneously in the adolescent group by 4 weeks. There was no difference in mean operative traction time in both groups (47.6 minutes in adolescents versus 48.3 minutes in adults; p<0.05). No cases of proximal femoral physeal growth disturbance or osteonecrosis were seen at final follow-up. Conclusion. This study confirms that hip arthroscopy for mixed indications leads to good early outcomes with low complication rates in adolescent and adult patients. The incidence of pudendal nerve palsy in the adolescent group is however noted and is of concern

Purpose. To establish the early outcome, satisfaction and complications of sinus tarsi implants in the management of symptomatic flexible flatfeet for a paediatric population. Methods and results. We included all patients aged 18 years or less who were treated for flexible flatfeet with a sinus tarsi implant between January 2010 and June 2012. We excluded patients who had a history of clubfeet or tarsal coalition. 34 patients had 59 implants. The mean age at surgery was 13.7 yrs (9–17 yrs), with mean follow-up of 22 months (range 10–35). Mean AOFAS improved from 65.7 to 87.9 (p<0.001), with an improvement in AOFAS pain scores (p=0.0001). Radiographic correction occurred in all feet, with average improvement of the anteroposterior talar-second metatarsal angle of 16 degrees, and the lateral talar-first metatarsal angle of 9 degrees. Implant placement satisfaction rate was 86%, with 81% claiming that they would have the procedure again. Complications included peroneal spasm (8%), extrusion (7%), revision (5%), and removal (5%). Peroneal spasm was recalcitrant in 3 of the 5 cases, and those with spasm had a higher average forefoot abduction measurement (35 degrees) than the remaining treated cases (25 degrees). Conclusion. In paediatric patients with flexible flatfeet, utilisation of the sinus tarsi implant has good short-term outcome, with our failure and revision rates comparable to other published studies in the adult population. We introduce the concept of isolated subtalar hyperlaxity which appeared to be a distinct etiological factor. A learning curve in assessing implant size was noted. Overcorrection and implant migration were the indications for revision surgery. Severe forefoot abduction appears to have a poorer outcome, and may be associated with peroneal spasm. Level of evidence: IV

We evaluated results at one year after surgical correction of internal rotation deformities in the shoulders of 270 patients with obstetric brachial plexus palsy. The mean age at surgery was 6.2 years (0.6 to 35). Two techniques were used: open subscapularis elongation and latissimus dorsi to infraspinatus transfer. In addition, open relocation was performed or attempted in all patients with subluxed or dislocated joints. A mixed effects model approach was used to evaluate the effects of surgery on internal and external rotation, abduction, flexion and Mallet score. Independent factors included operative status (pre- or post-operative), gender, age, the condition of the joint, and whether or not transfer was performed. The overall mean improvement in external rotation following surgery was 84.6° (95% confidence interval (CI) 80.2 to 89.1) and the mean Mallet score improved by 4.0 (95% CI 3.7 to 4.2). There was a mean decrease in internal rotation of between 27.6° and 34.4° in the relocated joint groups and 8.6° (95% CI 5.2 to 12.0) in the normal joint group. Abduction and flexion were unchanged following surgery. Adding a latissimus dorsi transfer did not result in greater improvement in the mean external rotation compared with elongation of the subscapularis alone.

Cite this article: Bone Joint J 2013;95-B:1432–8.