Objective: To establish a relationship between the scoliotic curve and the centre of gravity during level walking in patients diagnosed with adolescent idiopathic scoliosis.

Background data: There is no established aetiology for adolescent idiopathic scoliosis and the reasons for the progression of the curve are still unknown. But there is an agreement regarding multifactorial nature of the aetiology among many authors. One of the interesting factors suggested is asymmetry in the ground reaction forces during walking and their relation to the deformity, indicated by gait analysis studies. Studies have also indicated that the cause and progression of the deformity in idiopathic scoliosis may be due to kinematic differences in the spine, pelvis and lower limb. If a relation could be established between the scoliotic curve and the centre of gravity, it is possible to draw some conclusions regarding the aetiology. There is no method or study till date which looked at the relation of scoliotic curve with the centre of gravity.

Materials and Methods: Patients who were diagnosed with adolescent idiopathic scoliosis were selected. Informed consent was taken for gait analysis. 16 Markers were placed over the lower limb and force plate, using modified Helen Hays set. 5 markers were placed over the surface landmarks of selected spinous processes (C7, T6, T12, L3 and S2). Ground reaction forces and motion data were analysed, using APAS gait system and the lines of vectors were developed and correlated with the marker over the second sacral spinous process.

Results: With the help of this method we were able to establish a relationship between the scoliotic curve and centre of gravity line. These in turn were expressed in terms of changes in the moment in relation to the midline of the coronal plane. The results indicated that the changes were proportional to the severity of the scoliotic curve.

Conclusion: We present a new method of establishing the relation of scoliotic curve with the ground reaction force and the centre of gravity. Initial results obtained from this method indicate the asymmetries in the deviation of the centre of gravity line in relation to the curve, during walking. Ongoing studies based on this method, will help to understand the pathogenesis and aetiology of scoliosis on a biomechanical basis which can help in developing new treatment modalities and efficient management of these patients.

Objective: To report the use of a pedicled patellar transplant (d’ Aubigne procedure) in the reconstruction of femoral condyle for unicondylar giant cell tumours, in developing countries where facilities for custom made prostheses are not widely available.

Case Report: A 28 year old male presented with 5 month history of left knee joint swelling and pain and 1 month history of inability to walk. X-ray showed eccentric, expansile lytic lesion of the lateral femoral condyle associated with a pathological fracture of the subchondral bone. A diagnosis of Enniking’s stage-III Giant cell tumour was made based on the x-ray and histopathology findings. Due to the associated subchondral fracture, joint reconstruction using custom made prosthesis was considered as an ideal option. But, as this prosthesis was not available, d’ Aubigne procedure was considered as an alternative, in order to preserve the joint. Femoral condyle was removed “en bloc” with the tumour. Patella was prepared with intact vastus lateralis and fixed in continuity and in level with the medial condyle. Gap between the patella and femoral shaft was filled by combined cancellous and cortical grafts from iliac crest and tibia. Post operative course was uneventful. After a follow up of 2 years there was no recurrence and the range of flexion was 90° without any instability and pain.

Conclusion: In patients with unicondylar giant cell tumours with subchondral fractures, arthrodesis can be avoided and the joint can be preserved using pedicled patellar transfer, when arthroplasty can not be carried out.

Objective: To report a case of non-obstructive urinary retention secondary to cord compression due to metastases from undiagnosed carcinoma of prostate in a middle aged patient. This is the first case to be reported of its kind.

Case Report: A 58-year old brick layer, presented with urinary retention with overflow incontinence was referred by GP to A& E. No obstruction was felt during catheterisation and residual urine of 1.2 litres was drained. He also had dull low back pain since 5–6 weeks that was relieved by simple analgesia and he was able to work normally. He had no other symptoms or significant past medical history. Clinical examination including digital rectal examination (DRE) was normal. Laboratory investigations were normal except a rise in Alkaline phosphatase(194U/L) and ESR (43 mm/hr). X-rays of his spine were normal. MRI scan of the spine showed multiple metastatic lesions, bilateral end plate fractures and loss of vertebral body height of D12 with bulging of posterior vertebral body wall causing extradural compression of the conus.

An urgent D12 decompression and biopsy of D12 was done with D10-L2 instrumentation. PSA levels were > 500ng/ml.Histopathology showed moderately to poorly differentiated adenocarcinoma with a cribriform pattern. Immunohistochemistry showed a strong staining for PSA consistent with metastatic adenocarcinoma of the prostate. Post-operatively, he regained bladder control and was referred to oncologists for further management.

Conclusion: Urinary retention may be the only presenting symptom of spinal cord compression due to metastasis from prostate cancer. High index of suspicion of prostate cancer in middle-aged and elderly male patients with urinary retention, especially when associated with back pain of any severity, even though prostate is normal on DRE is needed. PSA in patients complaining of low back pain who are at high risk for prostate cancer is recommended, even though DRE is normal.