Introduction: Growing pains are a common complaint in school age children, but no definite organic causes have been identified. An association between musculoskeletal pain and joint laxity has been proposed. This study therefore investigates the relationship between growing pains and joint hypermobility in children.

Materials and Methods: Thirty three children with growing pains and thirty one controls of similar age and sex were recruited from outpatient clinics of a specialist paediatric hospital. Joint hypermobility was assessed in each group using the Beighton score. A Beighton score of greater than or equal to 4 out of 9 was considered hypermobile.

Results: The median Beighton scores were 6 for the study group and 0 for the control group. 93.3% of the study group had a Beighton score of equal to or greater than 4, compared to 22.6% of the control group. There was a highly significant difference in Beighton score between the two groups (P< 0.0001), with an estimated difference of 4 points 95% CI 4–6.

Discussion and Conclusion: A link between joint hyper-mobility and musculoskeletal symptoms has been demonstrated in adults. There is also some evidence that hypermobile children are more likely to experience musculoskeletal pain, particularly articular, but the extent to which joint hypermobility is related to growing pains specifically has been poorly defined. We have investigated a selective population of children with growing pains and have shown them to be significantly more hypermobile than the control children. The aetiology of growing pains remains unclear. While the growing pains will get better, in view of the possible association of joint hypermobility and other musculoskeletal complains, these children should be carefully assessed for joint laxity.

We examined differences in the rate of open reduction, operating time, length of hospital stay and outcome between two groups of children with displaced supracondylar fractures of the humerus who underwent surgery either within 12 hours of the injury or later.

There were 77 children with type-3 supracondylar fractures. Of these, in 43 the fracture was reduced and pinned within 12 hours and in 34 more than 12 hours after injury. Both groups were similar in regard to gender, age and length of follow-up. Bivariate and logistical regression analysis showed no statistical difference between the groups. The number of peri-operative complications was low and did not affect the outcome regardless of the timing of treatment.

Our study confirmed that the treatment of uncomplicated displaced supracondylar fractures of the humerus can be early or delayed. In these circumstances operations at night can be avoided.

We report 12 consecutive cases of vertical scapular osteotomy to correct Sprengel’s deformity, performed during a 16-year period, with a mean follow-up of 10.4 years. The mean increase in abduction of the shoulder was 53°. The cosmetic appearance improved by a mean of 1.5 levels on the Cavendish scale. Neither function nor cosmesis deteriorated with time. We recommend the procedure for correction of moderate deformities with a functional deficit.

Introduction: To determine whether there is a correlation between severity of the slip and duration of symptoms in patients presenting with slipped capital femoral epiphysis.

Methods: 50 patients with slipped capital femoral epiphysis were identified from the Royal Hospital for Sick Children database from 1998 to 2003. Of these, 47 patients had casenotes and radiographs available. 12 patients had bilateral slips resulting in a total of 59 slipped capital femoral epiphyses studied. On the basis of their history, 16 of these hips were unstable and were excluded leaving 43 stable slips in 35 patients. Case-notes were reviewed and the exact age, weight, symptom duration and treatment were recorded. X-rays were assessed and the slip angle was measured by the technique described by Southwick.

Results: The mean age of the patients was 11years 9months (7yrs 5 mths – 16 yrs 5mths). There were 19 males and 16 females. Weights were plotted against age on a centile chart with 85% of patients weighing > 75th centile for age.The mean duration of symptoms was 12.1weeks (2days – 52weeks)The mean slip angle was 22° (5° – 65°)There were 34 mild slips (< 30°), 8 moderate slips (30° – 60°) and 1 severe slip (> 65°). There was no statistical difference in duration of symptoms between these groups.

Statistical analysis by ordinal regression analysis showed there was no correlation between slip severity and duration of symptoms. In addition, there was no correlation between slip severity and age or weight.

Conclusion: There appears to be no relationship between slip severity and duration of symptoms in patients presenting with stable slipped capital femoral epiphysis.

We have reviewed the incidence of bacteriologically or radiologically confirmed acute haematogenous osteomyelitis in children under 13 years of age resident in the area of the Greater Glasgow Health Board between 1990 and 1997. In this period there was a fall of 44% in the incidence of both acute and subacute osteomyelitis, mainly involving the acute form (p = 0.005). This mirrors the decline of just over 50% previously reported in the same population between 1970 and 1990. Using multiple regression analysis a decline in incidence of 0.185 cases per 100 000 population per year was calculated for the 28-year period (p > 0.001).

Staphylococcus was the most commonly isolated pathogen (70%). Only 20% of patients required surgery and there was a low rate of complications (10%). In general, patients with a subacute presentation followed a benign course and there were no complications or long-term sequelae in this group.

Haematogenous osteomyelitis in children in this area is becoming a rare disease with an annual incidence of 2.9 new cases per 100 000 population per year.

We describe ten patients with Turner’s syndrome (karyotype 45, XO) who had leg lengthening for short stature. A high incidence of postoperative complications was encountered and many patients required intramedullary fixation as a salvage procedure. We discuss the reasons for this and highlight the differences between our findings and those of a similar series recently reported. In view of the considerable difficulties encountered, we do not recommend leg lengthening in Turner’s syndrome.

Peripheral limb ischaemia is rare in children. We have treated only 12 infants and children with this condition in the past 15 years at the Royal Hospital for Sick Children in Glasgow.

There were nine neonates and three older children. Most were suffering from life-threatening illnesses or severe infection. Two were born with ischaemic arms with no apparent cause. We have analysed the factors leading to ischaemia, the outcome of the initial treatment and the later orthopaedic problems.

Two required amputation of both legs, one of an arm, two of feet and one of toes. Two had skin grafts. All surgery was performed after demarcation was well established and delayed closure was used after amputation.

Five children developed limb-length discrepancy or an angular deformity. To date two have required additional corrective surgery.