Background

Patterns of opioid overprescribing following arthroplasty likely developed given that poor pain control can diminish patient satisfaction, delay disposition, and lead to complications. Recently, interventions promoting responsible pain management have been described however most of the existing literature focuses on opioid naive patients. We sought to describe the effect of an educational intervention on prescribing for opioid tolerant patients.

Introduction

To investigate if the gap index measured in the follow-up X-rays predicts the reduction of swelling in the plaster cast thereby increasing the risk of re-displacement of fracture treated by manipulation alone.

Aim

To assess the results of Castles procedure performed at our hospital compared with those available in literature.

Purpose of the study

To report the difference in the rates of avascular necrosis (AVN) of the femoral head following change in the hip abduction angle in the hip spica.

Purpose of the study

We describe a new technique of talar dome osteotomy in the treatment of fixed equinovalgus deformity of the foot in patients with Fibular Hemimelia and successfully applied it in two patients.

Introduction: Following the work of Freeman et al. on the medial pivot and roll back in the normal knee and several other studies on tibial slope we got interested in the subject. In most studies tibial slope is always measured on standard radiographs (lateral view) and therefore the medial and lateral side are superimposed.

Materials & methods: We studied the lateral view of the medial and lateral tibial plateau on a magnetic resonance scan (subchondral line). The study group (N=80) consisted of young patients (18–40 y) all consulting for patellofemoral problems with a non arthritic and stable knee. A neutral tibial axis was determined on the lateral view. Perpendicular to this axis the posterior slope of the medial and lateral compartment was measured. Statistical analysis was done.

Results: This analysis showed a mean posterior slope of – 5 ° ( range 0 ° – 12 °) on the lateral side, but an upslope on the medial side of + 7 ° ( range 5 °– 10 °). A significant statistical difference was noted between both.

Discussion: These results suggest an upslope on the medial side of the knee which could be important for deep knee flexion since this increases the posterior condylar clearance. Roll back on the medial side after 120° of flexion could be roll up of the condyle (2 mm). This could also explain the femoral external rotation (or tibial internal rotation) in natural knee flexion since the medial condyle rides up the medial meniscus and plateau allowing the lateral femoral condyle to roll down the lateral plateau during internal rotation of the tibia around the medial pivot point. This observation could explain paradoxical motion in total knee arthroplasty, since until now we made an equally sloped cut in both compartments.

Aims: To determine the usefulness of isotope bone scintography in investigating skeletal pain in children. Methods: We reviewed bone scans, notes and radiographs requested for children under 16 years presenting to two teaching hospitals in the city. Results: There were 229 patients with and average age of 11 years.

139 were investigated for back pain and 90 for skeletal pain in the appendicular skeleton.

There were positive scans in 13 patients with back pain and 22 with pain elsewhere.

The management was altered in only 3 children with back pain and 6 with other skeletal pain. Conclusions: Isotope bone scintigraphy is a low yield, and non-speciþc investigation that imparts a signiþcant dose of radiation. Its role in the investigation of skeletal pain should be re-evaluated.

Aims: To evaluate whether in children with knee pathology there is any correlation between clinical diagnosis, magnetic resonance imaging and arthroscopy. Methods: Between 1993 and 2001 children age 3–16 years old, who presented in the orthopaedic clinics of our institution with knee pathology were included in this study. All of them underwent MRI investigation. Their history, physical examination and clinical diagnosis were ascertained from their case notes. Some of these children underwent arthroscopic surgery of the knee and þndings were also recorded. Clinical data, MRI þndings and arthroscopic þndings were computerised and analysed. Results were analysed and compared in the following 3 groups: a) clinical data versus MRI þndings, b) clinical data versus arthroscopic þndings and c) MRI report versus arthroscopic þndings. Comparisons were rated in one of three categories: total agreement, partial agreement or total disagreement. Partial agreement was deþned as the partial correlation of þndings. Results: 130 children (131 knees, one bilateral) were included in this study. The mean age was 8.5 years (range 3–16). Conclusion: In this study 1/3 of the knee MRI was normal and there was only 26% of total agreement between the clinical and MRI þndings. Further more in 50% of cases that underwent arthroscopy, there was no correlation of arthroscopic and MRI þndings.This study supports the view that knee MRI investigation in children may not provide a reliable diagnosis and guidance in children with knee pathology.

Aims: To evaluate whether in children with knee pathology there is any correlation between clinical diagnosis, magnetic resonance imaging and arthros-copy.

Methods: Between 1993 and 2001 children age 3-16 years old, who presented in the orthopaedic clinics of our institution with knee pathology were included in this study. All of them underwent MRI investigation. Their history, physical examination and clinical diagnosis were ascertained from their case notes. Some of these children underwent arthroscopic surgery of the knee and findings were also recorded. Clinical data, MRI find-ings and arthroscopic findings were computerised and analysed.

Results: were analysed and compared in the following 3 groups: a) clinical data versus MRI findings, b) clinical data versus arthroscopic findings and c) MRI report versus arthroscopic findings. Comparisons were rated in one of three categories: total agreement, partial agreement or total disagreement. Partial agreement was defined as the partial correlation of findings.

Results: 130 children (131 knees, one bilateral) were included in this study. The mean age was 8.5 years (range 3-16). 81 were male and 49 were female, ratio 1.7:1. 38 (30%) patients underwent arthroscopy. 43 (33%) of the MRI scans were reported as normal. Lesions reported on MRI included meniscal and ACL tears, osteochondritis dessicans, osteochondral fractures and discoid lateral meniscus. Overall, the results between the comparison of the 3 groups are summarised as follows:

Conclusion: In this study 1/3 of the knee MRI were normal and there was only 26% of total agreement between the clinical and MRI findings. Further more in 50% of cases that underwent arthroscopy, there was no correlation of arthroscopic and MRI findings.This study supports the view that knee MRI investigation in children may not provide a reliable diagnosis and guidance in children with knee pathology.

To evaluate whether in children with knee pathology there is any correlation between clinical diagnosis, magnetic resonance imaging and arthroscopy.

Between 1993 and 2001 children age 3–16 years old, who presented in the orthopaedic clinics of our institution with knee pathology were included in this study. All of them underwent MRI investigation. Their history, physical examination and clinical diagnosis were ascertained from their case notes. Some of these children underwent arthroscopic surgery of the knee and findings were also recorded. Clinical data, MRI findings and arthroscopic findings were computerised and analysed. Results were analysed and compared in the following 3 groups: a) clinical data versus MRI findings, b) clinical data versus arthroscopic findings and c) MRI report versus arthroscopic findings. Comparisons were rated in one of three categories: total agreement, partial agreement or total disagreement. Partial agreement was defined as the partial correlation of findings.

130 children (131 knees, one bilateral) were included in this study. The mean age was 8.5 years (range 3–16). 81 were male and 49 were female, ratio 1.7:1. 38 (30%) patients underwent arthroscopy. 43 (33%) of the MRI scans were reported as normal. Lesions reported on MRI included meniscal and ACL tears, osteochondritis dessicans, osteochondral fractures and discoid lateral meniscus. Overall, the results between the comparison of the 3 groups are summarised as follows:

In this study 1/3 of the knee MRI was normal and there was only 26% of total agreement between the clinical and MRI findings. Further more in 50% of cases that underwent arthroscopy, there was no correlation of arthroscopic and MRI findings. This study supports the view that knee MRI investigation in children may not provide a reliable diagnosis and guidance in children with knee pathology.

To determine the usefulness of isotope bone scintigraphy in investigating skeletal pain in children, we reviewed the bone scans, plain radiographs and clinical notes of consecutive children under 16 years of age presenting to children’s orthopaedic surgeons at two teaching hospitals in one city.

There were 229 patients, of which 87 were boys and 142 girls. They had an average age of 11 years. 139 were investigated for back pain and 90 for skeletal pain in the appendicular skeleton. They were investigated for a variety of conditions including idiopathic back and skeletal pain, scoliosis, Scheuermann’s disease, spondylolysis, osteomyelitis and postoperative pain.

There were positive scans in 4 out of 78 patients with idiopathic back pain, and 13 out of 64 with idiopathic skeletal pain.

Overall the positive scan rate for all conditions was 10% for back conditions and 22% for pain in the appendicular skeleton.

Of all patients with back pain the management was altered in only 3 children. Of all those investigated for appendicular skeletal pain, the management was altered in 6 children. Isotope bone scanning is a low yield and non-specific investigation that imparts a significant dose of radiation to the patient.

It should not be used as a first line investigation for idiopathic back or skeletal pain in children. Other tools such as MRI should be considered initially.

It still has a role in the investigation of children with obvious abnormality on radiographs, with spondylolysis and probably where there are worrying clinical features to the pain such as night pain and recent onset.

The role of bone scanning in the investigation of skeletal pain should be re-evaluated in the investigation of skeletal pain.

We undertook a review of bone scans requested for children to determine the usefulness of isotope bone scintigraphy in investigating skeletal pain in this population.

We reviewed the bone scans, plain radiographs and clinical notes of consecutive children under 16 years of age presenting to children’s orthopaedic surgeons at two teaching hospitals in one city.

There were 229 patients, of which 40% were boys and 60% girls. They had and average age of 11 years. 139 were investigated for back pain and 90 for skeletal pain in the appendicular skeleton. They were investigated for a variety of conditions including idiopathic back and skeletal pain, scoliosis, Scheuermann’s disease, spondylolysis and stress fractures, osteomyelitis and post-operative pain.

There were positive scans in 4 out of 78 patients with idiopathic back pain, 1 of 25 patients with scoliosis and 1 out of 5 with spondylolysis and 11 out of 70 with idiopathic skeletal pain.

Of all patients with back pain the management was altered in only 3 children. Of all those investigated for appendicular skeletal pain the management was altered in 6 children.

Conclusion: Isotope bone scanning is a low yield, and non-specific investigation that imparts a significant dose of radiation to the patient. It should not be used as a first line investigation for idiopathic back or skeletal pain in children. Other tools such as MRI should be considered initially.

The role of isotope bone scanning in the investigation of skeletal and joint pain in children should be reevaluated.

Four patients with pectoralis major ruptures underwent clinical and dynamometric assessment and one patient underwent late surgical repair. The operation is described. Dynamometry proved a useful and objective method of estimating the loss of strength and indicating patients who might benefit from surgical repair.