Hallux valgus (HV) deformities have been well defined in the adult population. HV appears to be more prevalent in elderly and female populations and it is postulated that women's shoe wear contributes to its progression.

This study was a pilot to quantify the prevalence of foot deformities and foot pain in an adolescent population.

Our cohort consisted of 202 school children aged 11–17 recruited from two schools in Edinburgh. Foot health data was recorded via the Manchester Scale (MHVS) and the Oxford Ankle and Foot Questionnaire (OAFQ). Photographic assessment of all participants allowed MHVS to be calculated by two orthopaedic surgeons. The photographic assessment was then repeated by the same surgeon 12 months later to allow inter and intra observer reliability to be calculated.

Results showed that the prevalence of HV in our cohort was 32.7% and there was a female preponderance 56% to 44%. Other foot measurements revealed 48.5% had HV-interphalangeus, 25.7% had a low medial longitudinal arch and 22.3% had a valgus hindfoot angle. Significantly more females (18%) than males (5%) wore shoes narrower than their feet (p=0.003). OAFQ scores revealed that foot pain was more common in those with HV deformities although not statistically significant (75% to 68%, p=0.243). The prevalence of foot pain was negatively correlated with age (r=−0.175, p=0.14).

This study suggests that there is a significant prevalence of HV and foot pain amongst female adolescents. This will need to be confirmed by a population study based on power calculation informed by this pilot.

Between 1944 to 2003, eighty nine cases were registered with a diagnosis of Paget’s sarcoma in the Scottish Bone and Soft Tissue Tumour Registry. We found thirteen cases of sarcomatous degeneration of the spine (0.26% of the total bone tumour registry case) which were analysed in this study elaborating clinical, radiological and histopathological features. The mean age was 66.9 years (range 56 to 79 years). There were ten males and three females. There were seven cases involving sacral spine (63.6%), three cases involving lumbar vertebrae and two affecting dorsal spine. One case had diffuse dorso-lumbar involvement from D11 to L3 vertebrae. The mode of presentation was increasing low back pain (in all 13), unilateral sciatica (6, left sided-5, right sided-1), bilateral sciatica (2), lower limb weakness (8) and autonomic dysfunction (4, presented as chronic cauda equina syndrome). The majority of the cases (69.23%) were osteosarcomas. Out of these osteosarcomas, two showed giant cell rich matrix and one revealed predominant telengiectatic areas. Rest of the histological types was shared by chondrosarcoma, fibrosarcoma and malignant fibrous histiocytoma. Decompression laminectomy was performed in three cases. Eight patients had received radiotherapy. The mean survival was 3.93 months (range, 1 week to 7 months), nearly half to the whole Scottish Paget’s sarcoma series with a mean survival of 7.5 months. We found a constellation of symptomatology due to radiculo-medullary compression with a fatal evolution, predominantly lumbosacral involvement, predominantly osteosarcomatous histopathology with a poorest prognosis of all Paget’s sarcoma. Although, decompression laminectomy and adjuvant radiotherapy provided reasonable pain relief and palliation; however, there was no significant influence on the overall prognosis of the patients with Paget’s sarcoma of spine in the last six decades.

Introduction: To measure the incidence of late presenting DDH following the introduction of selective ultrasound screening of neonatal hips with associated risk factors.

Method: Retrospective cohort study of children with late diagnosed DDH in a defined population of Greater Glasgow Region. A hip ultrasound program was introduced in the year 1997 for secondary screening of children with risk factors for DDH. The departmental and theatre database was used to identify children with late diagnosed DDH. (Defined as diagnosed 3 months after birth) Demographic details, age at presentation, presence of risk factors (Breech presentation, family history, clicks, caesarian section) and details of treatment were recorded. The number of live births for each year was obtained from the General Registrar Office for Scotland. The incidence of late presenting DDH was calculated taking in to account the year of child’s birth. The incidence of late DDH was then compared between the period 1992 –1996 and 1997– 2001.

Results: 78 children were identified, of which 49 babies were between 1992 – 96 and 29 between 1997 –01. The average age at diagnosis was 17 months (Median 15 months, range 5 –84 months). The average annual incidence from 1992 –6 was 0.84 per 1000 live births and from 1997 – 2001 was 0.57 per 1000 live births. This decrease in incidence of late DDH was not significant at 5% level (chi squared p = 0.088). 64 children (82%) with late diagnosed DDH had no factors that could be perceived as risk factors for the condition.

Discussion: Targeted ultrasound screening of babies with risk factors appears to have reduced the average incidence of late DDH from 0.84 to 0.57 per 1000 live births. However this reduction in incidence is not statistically significant. The vast majority of late presenters (82%) do not have risk factors. It remains unclear whether universal ultrasound screening program, practiced in some parts of United Kingdom is a cost effective alternative to eliminate the incidence of late presenting DDH.

Aims: We undertook an analysis to determine the prognostic indicators of successful outcome following decompression for radiculopathy from lumbar spinal stenosis. Methods: 203 patients underwent spinal decompression in a þve year period till June 2001 and were subsequently followed up. Age, sex, number of levels, the speciþc levels involved, type of stenosis, symptoms, duration, bilaterality were preoperative factors looked at. The type of decompression, number of levels decompressed, the speciþc levels and intra-operative complications were noted. Postoperative resolution of pain, duration to alleviation of pain were assessed. Patient satisfaction and discharge from clinic indicated successful outcome. Referral to the pain clinic reßected a failure of treatment. Results: 65% of patients who had primary decompression experienced satisfactory improvement in symptoms. Logistic Regression analysis showed that the presence of radicular pain at þrst review signiþcantly increased the likelihood of failure of surgery and referral to the pain clinic for (p=0.02) for leg symptoms. 57% of patients who had decompression following previous surgery at the same level were relieved of leg pain. The duration of leg pain alone adversely affected þnal outcome (p=0.01) amongst all the factors assessed including complications from surgery. The complication rate from revision surgery (7/30) was signiþcantly greater (p=0.01) than primary decompression (16/173). Conclusions: Persistance of radicular pain early after decompression increases the likelihood of eventual failure to improve symptoms Patients with long periods of pain prior to decompression following previous back surgery should be cautioned about the decreased likelihood of success and an increased risk of complications.

A prospective randomised study was carried out to compare two methods of pain control following arthroscopically assisted ACL reconstruction.

Twenty patients each were randomly recruited to receive either femoral nerve block with 0.5% Bupivicaine or an intra-articular injection with the same. Both groups were prescribed Diclofenac regularly and Coproxamol as required. Visual analogue scores (VAS) were used to assess pain levels preoperatively, four hours postoperatively and on the morning after. The duration between surgery and the first dose of PRN analgesia was recorded, along with the total quantity of analgesia required before discharge. Patients with associated PCL or collateral ligament injuries were excluded beforehand.

Both groups were evenly matched for age (t-test p< 0.05). Tourniquet time did not differ significantly between the groups (t-test p:0.24). The VAS pain levels were not significantly different at four hours and the first morning postoperatively in both groups. Femoral block (Ave VAS: 21 & 25) did not confer a significant advantage (t-test p: 0.69, 0.7) over intra-articular injections of Bupivicaine (Ave VAS: 25 & 22). The total quantity of Coproxamol consumed did not vary significantly (p=0.99). There was no correlation between tourniquet time and postoperative pain (r=0.19, 0.08). All but one patient was discharged home on the first postoperative morning.

Our study demonstrates that pain levels can be sufficiently controlled by intra-articular infiltration of Bupivicaine coupled with oral analgesia. The level of pain relief achieved could allow this procedure to be increasingly performed in a day surgery setting without the need for femoral block thereby allowing for quicker mobilisation.