The incidence of DDH Varies depending on genetic and ethnic varieties but in Ireland on an average in 3 per 1,000 live births. Current treatment is focused on early diagnosis and congruent reduction of the hip joint. With conservative measures, principally skilful use of the Pavlik harness, the majority of (85%) of dislocated or subluxated hips will be successfully treated. Late diagnosis impacts on the mode of treatment and on the subsequent outcome.

An audit of annual incidence of DDH in North Eastern health board, in Ireland showed a dramatic increase in late diagnosis (> 4 month). There were 4668 live births in 2004 with 17 cases of DDH presenting between the ages of 4 – 36 months during this period. The mean age of presentation was 10 months. Two cases were bilateral. The male: female ratio was 4.6:1. Risk factor analysis showed, only 50% fell in to the high risk group, majority of them had positive family history. Three fourth of them were frank dislocations and all of them required operative intervention. As opposed to early presenters, only 10% needed operative intervention. 30% of the late presenters needed major osteotomies.

We examined the reasons for this extreme high rate of late presenters and argue for the introduction of routine ultrasound screening in this region based on historical high incidence of DDH and the dramatic incidence of delayed diagnosis.

Aim To document an outbreak of Vancomycin Resistant Enterococci in an elective Orthopaedic Unit. To describe the clinical course of the affected patients and treatment options. To describe methods employed in eradicating endemicity following the outbreak and to evaluate the lessons learnt.

Background VRE first appeared in the Microbiological literature in 1988. Very little is known about its effect in the Orthopaedic Realm. To our knowledge, this is the first report of a serious outbreak in such a unit and only the second reporting of peri-prosthetic VRE infection.

Material and methods All patients in the unit over a 1/12 unit formed the cohort for the study. Following identification of the index case, samples were taken form all in-patients. Immediately a nurse specialist in infection control oversaw sampling of all patients. Microbiological data, Clinical Data and antimicrobial therapy data was collected on all positive patients. Rapid laboratory procedure were instituted, environmental screening was preformed and a dedicated cleaning team was formed. The assistance of a Clinical Microbiologist and an Environmental Microbiologist was sought.

Results Following identification of the index case, 11 patietns had microbiological proven VRE. 1 patient had a VRE confirmed peri-prosthetic infection. This necessitated removal and appropriate anti-microbial therapy. However, this patient died. 2 pateints were found to have superficial wound infection, which resolved with oral Linezolid, while 8 patients showed colonization with the organism. No treatment was required other than clinical follow up and staged screening in these patients.

The unit was closed for 9 weeks following the outbreak and deep cleaning resulted in eradication of endemicity.

Conclusion Tracing of the index case and typing allowed us to confirm the source of the outbreak and to take steps to prevent a recurrence. Appropriate microbiological advice is essential in an outbreak situation, management of peri-prosthetic infection and follow up of affected cases. All protocols have been re-evaluated and retraining of all staff in good clinical hygiene has been undertaken. The speed of the outbreak and its devastating effect on a Joint Replacement Facility is alarming and should serve to aid other units in establishing preventative protocols and in preplanning their treatment options and an outbreak team.

Aim: The purpose of this study was to evaluate the long-term results of Cincinnati incision release in resistant clubfoot. Methods: 130 children with clubfoot deformity were treated at Our lady of Lourdes Hospital, Drogheda, during the four year period from January, 1994, toDecember, 1997. A Cincinnati release was performed on 41 feet in 32 patients with a resistant club-foot deformity. All the children had a previous hind foot release at the age of three months. At the time of surgery the children were aged between 9 months and 1.5 years with one exception. The average follow-up period was 60 months.

This approach enabled the surgeon to correct the deformity in all planes simultaneously, with a clearer visualization of the anatomical structures.

Emphasis was placed on correcting the foot position to neutral and in particular avoiding over-correction. The corrected foot position was maintained by inserting three pins at the time of surgery, which were removed 6 weeks later. Serial casts were used for a period of 16 weeks. Tarso-pronator boots were used to maintain correction in the ambulant child. Results: Parent satisfaction with the operation was very high and the children tolerated the procedure well with no significant post- operative complications. Using the Magone functional rating system 81% of the feet was good or excellent, with 19% fair results. There were no poor results in our series. All the children were pain free and no child suffered from limitation of daily activities. Conclusion: We conclude that the Cincinnati incision release technique is an effective method of correcting the deformity in resistant clubfeet. With meticulous attention to surgical technique complications can be minimized.