Between June 2001 and November 2008 a modified Dunn osteotomy with a surgical hip dislocation was performed in 30 hips in 28 patients with slipped capital femoral epiphysis. Complications and clinical and radiological outcomes after a mean follow-up of 3.8 years (1.0 to 8.5) were documented. Subjective outcome was assessed using the Harris hip score and the Western Ontario and McMaster Universities osteoarthritis index questionnaire.

Anatomical or near-anatomical reduction was achieved in all cases. The epiphysis in one hip showed no perfusion intra-operatively and developed avascular necrosis. There was an excellent outcome in 28 hips. Failure of the implants with a need for revision surgery occurred in four hips.

Anatomical reduction can be achieved by this technique, with a low risk of avascular necrosis. Cautious follow-up is necessary in order to avoid implant failure.

Little is known about the risk of later development of osteoarthritis after operative clubfoot correction. There are only a few long-term reports of 30 years and more after operative correction with a standard technique.

Slight deformity after correction of an idiopathic clubfoot may be well tolerated by children and young adults. However, if these slight deformities become symptomatic with advancing age remains unsettled. To answer this question, a long-term follow-up of more than 30 years is needed. Functional and radiological correlation is poor in the adult foot with a slight under-corrected clubfoot deformity. A computer-assisted foot scan will provide the exact static and dynamic measurement of the pressure under each part of the foot at every moment of gait. This instrument allows better analysis of residual clubfoot.

Between 1962 and 1966 we operated 15 children with the standard operative technique of Phelps-Codivilla. In all cases there was a persistent deformity after continuous casting since birth. In two cases a heal cord lengthening procedure had been previously performed. Mean age at operation of the four girls and 11 boys was four (1 to 8) years. Six had unilateral involvement, whereas the remaining nine patients required bilateral surgery. In four cases there was a second medial release for relapse. A Steindler procedure was used in two cases and in two cases correction of clawtoes was necessary. Operative technique: Two separate incisions were made. One was longitudinal posterior that enabled lengthening of the heel cord, the tendon of the tibialis posterior and long flexors, as well as release of the posterior capsule. A second incision was made on the medial aspect of the foot in order to release the talonavicular and navicularcuneiform joints. The reduced navicular was fixed with a K-wire.

Twelve patients were examined clinically, radiologically and by functional testing after a mean follow-up of 33.5 (34 to 38) years. Eight patients had no pain and were not disturbed. There was a slight malreduction of the subtalar joint, but without any signs of joint degeneration. The foot pressure showed overpressure of the lateral forefoot. Four patients had pain and functional limitation. Their complaints had begun only two to four years earlier, and had been asymptomatic until then. All patients developed osteoarthritis of the subtalar joint, and their foot scans were abnormal.

Definitive assessment of the successful treatment of idiopathic clubfoot deformity is only possible with a long-term follow-up study. A slight undercorrection can be functionally well tolerated for a long period of time. The first occurrence of pain is still possible at the age of 35 years and older. A computer-assisted assessment of foot pressure by using a foot scan is a sensitive diagnostic tool.

In order to determine the incidence of avascular necrosis after osteotomy of the talar neck, we re-evaluated 11 patients (16 feet) with idiopathic club foot who had undergone this procedure at a mean age of eight years (5 to 13) to correct a residual adduction deformity. All had been initially treated conservatively and operatively. The mean follow-up was 39 years (36 to 41). Surgery consisted of a closing-wedge osteotomy of the talar neck combined, in 14 feet, with lengthening of the first cuneiform and a Steindler procedure.

At follow-up eight feet were free from pain, three had occasional mild pain and five were regularly painful after routine activities. Two patients were unlimited in their activity, six occasionally limited after strenuous and three regularly limited after strenuous activity. Using the Ponseti score, the feet were rated as good in four, fair in three and poor in nine. In seven feet avascular necrosis with collapse and flattening of the talar dome had occurred. In all of these feet the children were younger than ten years of age at the time of surgery. In three feet, avascular necrosis of the talar head was also observed.

We conclude that osteotomy of the talar neck in children under the age of ten years can cause avascular necrosis and should be abandoned.

We reviewed 25 children who presented consecutively with voluntary (habitual) subluxation of the shoulder. Thirty-six shoulders were involved and symptoms had been present for an average period of 12 years. Eighteen children were managed by 'skillful neglect': all these had become fully active in the profession of their choice and were satisfied with the outcome. Two of them had required shoulder surgery in adult life but only after trauma. Seven children (ten shoulders) had undergone stabilising operations during childhood with the aim of preventing later degenerative arthritis. These patients were also active in their selected professions, but only three (five of the ten shoulders) had good results: two shoulders had recurrent instability, two were painful and one was stiff. None of the shoulders in either group had developed osteoarthritic changes. There was no association with emotional or psychiatric problems. We conclude that voluntary subluxation of the shoulder in children has a favourable prognosis and that there is no indication for surgical intervention during childhood.