Conventional fixed-bearing (FB) knee prostheses have been proved clinically successful. Rotating platform, mobile-bearing (MB) total knee replacements (TKR) have been developed to improve knee kinematics, lower contact stresses on the polyethylene tibial component, minimize constraint, and allow implant self-alignment. The purpose of this study was to characterize and compare the functional outcome of FB- and MB- TKR during gait and deep knee bends, using a motion analysis system. Two groups of five patients with a unilateral FB TKR (PFC) or MB TKR (LCS) underwent a gait analysis study. The normal contralateral limb was used as a control to compare data in the stance phase of gait. Demographic, clinical, and radiographic data were equivalent in the 2 groups. Both MB and FB TKRs gave good functional results in spite of different design rationales. No statistically significant difference was demonstrated between the two groups. However, gait and knee function after TKR was abnormal even though the patients were asymptomatic. A flexional pattern for flex-ion-extension moments at the knee during level walking was present in both types of TKR. Differences in rotational moments between the two groups were observed, with a higher internal rotational moment in the PFC group (PFC, 0.14 Nm/kg; LCS, 0.09 Nm/kg; p=0.094). A stressful weightbearing activity, such as deep knee bends, amplified the functional differences between the different prosthetic designs, indicating that knee kinematics are activity-dependent. Kinetic and kinematic differences noted between the 2 groups reflect different patterns of joint surface motion and loading, with postulated effects on long term failure of the implants through wear, mechanical failure, and loosening. Gait analysis using external skin markers has a limited role in the characterization of the joint surface motion of the prosthetic knee during ambulatory activities because of errors and assumptions inherent in the technique. However, it provides scope for the study of kinetic parameters acting on different knee prostheses during gait.

Introduction: Slipped Upper Femoral Epiphysis (SUFE) is very rare in children less than 10 years of age but may be more common with increasing obesity in children. There are concerns with the presentation of SUFE in this age group regarding bilateral slips and prophylactic pinning, fixation with multiple pins to preserve growth, and complications.

Methods: We identified 12 cases of SUFE in 8 patients who presented aged less than 10 years to our institution between 1997 and 2004. Case note and radiographic review were carried out.

Results: There were 5 boys and 3 girls in this group, with an average follow-up of 48 months (6 – 90 months). Bilateral SUFE was present in 4 patients (50%). Only 3 slips were unstable. One child was found to be hypothyroid and another had oculocutaneous albinism. The remaining children had normal genetic and endocrine profiles. Six children were above the 90th centile for weight. The severity of slip was mild in 9 hips and moderate in 3 hips.

Multiple threaded pins were used in 10 hips and a cannulated screw in 2 hips.

Complications include revision surgery due to loss of fixation in 3 hips and a superficial wound infection. There were no cases of avascular necrosis and chondrolysis.

Discussion: Gross obesity is the commonest predisposing factor. The high incidence of bilateral involvement is an indication for prophylactic pinning. Multiple threaded pins may need to be revised if the fixation is lost as the child grows. These should be left proud of the lateral femoral cortex to facilitate removal, although at the risk of producing a windscreen wiper effect.

Stickler’s syndrome, also called Hereditary Progressive Arthro-Ophthalmopathy, is an autosomal dominant connective tissue disorder with strong expressivity, characterised by ocular, orofacial, skeletal, cardiac, and auditory features.

We describe a case of valgus slipped capital femoral epiphysis in a 13 year-old boy with Stickler’s syndrome. He presented at routine rheumatology clinic follow-up with a 1-month history of progressively worsening right hip pain, which radiated to the knee. He underwent insitu cannulated screw fixation of the right slipped capital femoral epiphysis.

Joint pains are a common manifestation in Stickler’s syndrome and this might delay the diagnosis of slipped capital femoral epiphysis. Valgus slipped capital femoral epiphysis is a rare entity. Obesity and the increased femoral anteversion are predisposing factors. Insitu fixation with a single cannulated screw is the treatment of choice.

Introduction: Forearm shaft fractures are common injuries in children (3.4% of the total of children’s fractures. The majority are treated with closed reduction (CR) and plaster cast application. Percutaneous Intramedullary (IM) wires are indicated in compound, and grossly unstable fractures, or following failed CR.

Method: In this study, we examined the complication rate associated with IM wiring of these fractures in 92 children treated in our institution over a 7-year period. K wires were usually used.

Results: Six percent of 3,446 forearm shaft fractures were treated with internal fixation. Ninety-two fractures had IM wires, 15 (16%) of which were compound. Nerve injuries were present in 3 cases. Following treatment, there were 33 complications (36%), with 9 cases of delayed union, and 5 cases of malunion. Infection occurred in 10 cases, refracture in 6, and failure to pass wires in 2. Growth arrest occurred in 1 patient.

Discussion: IM wiring is a very useful and usually straightforward technique. However it is not risk-free and therefore should only be done on selected cases. Meticulous wound and pin site care is necessary to avoid infection, and fracture healing should be carefully assessed prior to and following wire removal. Careful cast technique after wire removal, or burying and retaining wires for longer, should be carried out to prevent malunion.

We performed a prospective, randomised study on 57 patients older than 60 years of age with unstable, extra-articular fractures of the distal radius to compare the outcome of immobilisation in a cast alone with that using supplementary, percutaneous pinning.

Patients treated by percutaneous wires had a statistically significant improvement in dorsal angulation (mean 7°), radial length (mean 3 mm) and radial inclination (mean 3 mm) at one year. However, there was no significant difference in functional outcome in terms of pain, range of movement, grip strength, activities of daily living and the SF-36 score except for an improved range of movement in ulnar deviation in the percutaneous wire group. One patient developed a pin-track infection which required removal of the wires at two weeks.

We conclude that percutaneous pinning of unstable, extra-articular fractures of the distal radius provides only a marginal improvement in the radiological parameters compared with immobilisation in a cast alone. This does not correlate with an improved functional outcome in a low-demand, elderly population.

We assessed hyperextension of the knee and joint laxity in 169 consecutive patients who underwent an anterior cruciate ligament reconstruction between 2000 and 2002 and correlated this with a selected number of age- and gender-matched controls. In addition, the mechanism of injury in the majority of patients was documented. Joint laxity was present in 42.6% (72 of 169) of the patients and hyperextension of the knee in 78.7% (133 of 169). All patients with joint laxity had hyperextension of their knee. In the control group only 21.5% (14 of 65) had joint laxity and 37% (24 of 65) had hyperextension of the knee. Statistical analysis showed a significant correlation for these associations. We conclude that anterior cruciate ligament injury is more common in those with joint laxity and particularly so for those with hyperextension of the knee.

Purpose of the study A prospective observational study to ascertain any correlation between joint laxity and knee hyperextension to anterior cruciate ligament rupture.

Methods used Joint laxity as defined by Beighton’s method and hyperextension of uninjured knee in 169 patients with symptomatic isolated anterior cruciate ligament rupture was recorded in a prospective fashion. This was correlated to the scores obtained in a selected group of age and sex matched controls

Results 72 out of 169 of the patients had hyperlaxity in their joints and 133 out of 169 had knee hyperextension. In the control group 14 out of 65 had hyperlaxity in their joints and 24 out of 65 had knee hyperextension.

Statistical analysis showed that ACL injury was common in those with lax joints and with knee hyperextension with a p < 0.001

Conclusion ACL injury is common in patients with joint laxity especially in those with knee hyperextension.