The Ponseti and French taping methods have reduced the incidence of major surgery in congenital idiopathic clubfoot but incur a significant burden of care, including heel-cord tenotomy. We developed a non-operative regime to reduce treatment intensity without affecting outcome. We treated 402 primary idiopathic clubfeet in patients aged < three months who presented between September 1991 and August 2008. Their Harrold and Walker grades were 6.0% mild, 25.6% moderate and 68.4% severe. All underwent a dynamic outpatient taping regime over five weeks based on Ponseti manipulation, modified Jones strapping and home exercises. Feet with residual equinus (six feet, 1.5%) or relapse within six months (83 feet, 20.9%) underwent one to three additional tapings. Correction was maintained with below-knee splints, exercises and shoes. The clinical outcome at three years of age (385 feet, 95.8% follow-up) showed that taping alone corrected 357 feet (92.7%, ‘good’). Late relapses or failure of taping required limited posterior release in 20 feet (5.2%, ‘fair’) or posteromedial release in eight feet (2.1%, ‘poor’). The long-term (> 10 years) outcomes in 44 feet (23.8% follow-up) were assessed by the Laaveg–Ponseti method as excellent (23 feet, 52.3%), good (17 feet, 38.6%), fair (three feet, 6.8%) or poor (one foot, 2.3%). These compare favourably with published long-term results of the Ponseti or French methods. This dynamic taping regime is a simple non-operative method that delivers improved medium-term and promising long-term results.

Cite this article: Bone Joint J 2013;95-B:271–8.

Congenital talipes equinovarus occurs in 1.2 per 1000 live births in Europe and is twice as common in boys. Over the last decade, non-surgical management has re-established itself as the first line treatment; after long-term follow-up of surgically treated patients, revealed high rates of over correction, stiffness and pain. The commonly practiced non-surgical approaches are the Ponseti technique of serial manipulation and casting, and French taping. Ram's technique of taping is a truly conservative approach with a higher success rate to address this problem. Unlike French taping, it involves taping alternate days during the first week followed by twice in the second week, then once the following week, which is left in situ for a further two weeks. After the initial five weeks of taping, patients are provided with talipes splint for all time use, up till a year. This is followed by talipes shoes for walking and splint for nighttime use for another year. At the end of two years patients can wear normal shoes.

The study includes 225 patients with 385 clubfeet, who were treated with Ram's taping technique from September 1991 to August 2008. Inclusion criteria were age up to three months and previously untreated clubfeet. Average follow up was of 5.6 years. Outcome ratings at a minimum of two years were performed. Initial correction rate at the end of five weeks was 99%. A relapse of 21% was noted, two-third of which was salvaged via further taping and exercise, while remaining one third needed some form of surgical intervention. The comparative outcome for Ram's taping is better to Ponseti or French taping with good outcome in 93%, in comparison to 72% and 67% respectively.

To conclude Ram's taping is a fast, more effective, less cumbersome and fully conservative approach of correcting the clubfoot deformity.

Proximal femoral fractures, whether it is due to meta-static destruction or periprosthetic fractures with loose femoral component with secondary osteolysis of the proximal femur in the elderly patient is a major task. We find the Cannulock hip system quite useful in tackling this issue. It offers various options for the management of this complex pathology.

We present the results of 11 Cannulock Hip Arthroplasty performed in 10 patients (Age Range 55–92). 6 out of 11 patients was noted to have metastatic destruction of proximal femur including the head and neck down to lesser trochanter. Ca of Bronchus and Breast with multiple bony metastsis were responsible for these cases. 4/11 had loose femoral component with type 2 periprosthetic fractures. 1 out of 11 had failed DCS fixation for Reverse oblique fracture. The procedures were done in a district general Hospital in the UK between August 2001–Jan 2006. The patients were mostly ASA 4.

The Cannulock Hip system offered the simplicity of a Hemiarthroplasty with an advantage of Intramedullary nailing option. This has the option of fitting standard Bipolar Head or 22 mm metallic head in case of Peri Prosthetic fracture where the acetabular component is intact. Long stem with HA coating and standard options for cemented stem insertion. The long stem with a bow enables easy insertion with distal locking facility.

In our study all the patients were excellent with both clinical and readilogical out come, however sadly 1 patient died with in 3 months of surgery. 5/6 patients with metastatic bone tumour were discharged at the mean of 8 weeks with no clinical concerns. 4 patients with femoral stem revisions and 1 patient with failed DCS were discharged at a mean of 4 months. We find the Cannulock hip arthroplasty system quite versatile in the management of these complex injuries.