Neglected traumatic dislocation of hip in children is very rare and most of the studies are too small to draw a conclusion. There is no consensus on timing for closed VS open reductions and post reduction care. The aim of our prospective study was to analyse and characterise the short term treatment outcome of treating 20 such cases in children (<12 years). All had posterior dislocation without any associated fractures (Thompson & Epstein type 1) sustained during typical childhood play activities and/or a fall from a height less than 10 feet. All attended the hospital between 1-52 weeks of injury. Closed reductions under GA were performed in 12 cases which were less than 3 weeks old, followed by hip immobilisation for 3 weeks and PWB mobilisation for 3 weeks. 8 hips (> 3 weeks old) had open reductions as none of them could be reduced by skeletal tractions and were allowed for FWB mobilisation after 9 weeks. Functional result (Garrett et al) at 2 years follow-up showed a complete range of motion in 18 children while the remaining two had 80% of normal hip movements with no deformity. All the hips showed varying degrees of avascular necrosis, with preservation of joint space on radiographs (Ficat & Arlet stage 1-3). There were no redislocations.

We suggest that closed (for <3 weeks old dislocation) and open (for >3 weeks old dislocations) reductions are satisfactory treatment for traumatic neglected hip dislocations in children

Decompression of the lumber spine for spinal stenosis is the most commonly performed spinal surgical procedure in patients over 60 years old. The aims of surgery are to relieve compression of the spinal nerves and retain integrity of the structural elements of the spinal column and its function as a supportive structure. In trying to avoid excessive removal of the posterior supportive structures of the spinal column without compromising full and safe decompression of the spinal nerves, techniques are being developed to reduce bone removal but also allow access to the spinal canal.

One such micro-decompression involves a hemi-laminectomy and lateral recess decompression on the more symptomatic side followed by undercutting the spinous processes and decompressing the opposite side from within the canal aided by the use the operating microscope, a high speed burr and a copper moldable retractor to protect the dura and nerves.

We have reviewed our first 100 consecutive patients who have had a spinal micro-decompression over a period of 5 years. 58 Female and 42 male patients are included in this series. Mean age was 65 years. Patients were assessed by a combination of clinical review and self-assessment questionnaires. After a follow-up period of up to five years (mean 3.5 years) we have seen symptomatic late instability develop in four patients requiring a further surgical procedure in two of these. Symptoms typically developed two years after the original operation following an initial improvement in radicular symptoms and back pain.

This compares favourably with published results for wide decompression where re-operation rates of 18% are reported. We have analysed the cases of delayed instability in more detail to evaluate whether the late deterioration could have been predicted.

Micro-decompression is shown to be safe with few complications and has advantages over wide decompression without compromising safety.

Purpose: To determine the incidence and outcome of late costoplasty in surgical management of IdS.

Methods and results: A retrospective review of prospectively collected data on patients with IdS who underwent costoplasty after definitive fusion during a 10 year period (1994–2004).

We reviewed surgical records of 318 patients who underwent instrumented spinal fusion for IdS at our centre. Amongst these, 15 patients had undergone late costoplasty. Pre-operative assessment included rib hump measurement, photographs and plain radiographs. 4 patients had computerised tomography to evaluate deformity. Outcome measures included patient satisfaction and clinical evaluation.

Results [Mean (SD)]: Age at primary operation was 12.3(3.3) years; age at costoplasty 17.1(2.7) years. Pre-operative Cobb angle was 64.1 (19.5) and postoperative Cobb 36.9 (15.7) degrees. Median time between primary operation and costoplasty was 4 years. Median follow up was 7 years. Indication for costoplasty was cosmetic deformity with prominent rib hump (n=9) and curve progression (n=6). Approach at primary operation was anterior 1 case, posterior 3 and combined 9 cases. Median length of stay was 5 days.

All patients except 1 had significant reduction in rib hump deformity. Complications included 1 case of surgical scar tenderness, 1 transient neuralgia and 1 patient required a chest drain due to haemothorax.

Discussion: Costoplasty is a cosmetic procedure for the correction of rib prominence in scoliosis. There is low incidence of late costoplasty (i.e. after definitive spinal fusion) in IdS. Following costoplasty, patients were satisfied with their cosmetic appearance; no major complications occurred and no further reoperation was needed.

Ethics approval: Audit/service standard in trust number: 1236

Interest Statement: None

Necrotising fasciitis is a rare but severe infection of soft-tissue associated with rapid progression, systemic toxicity and high mortality. Monomicrobial necrotising fasciitis caused by Pseudomonas aeruginosa is exceptionally uncommon with only 12 cases reported in the literature. We describe a fatal case with an atypical presentation in a patient following spinal decompression for a metastasis from prostate cancer.

Decompression of the lumbar spine for spinal stenosis is the most commonly performed spinal surgical procedure in patients over 60 years old. The aims of surgery are to relieve compression of the spinal nerves and retain integrity of the structural elements of the spinal column and its function as a supportive structure.

In trying to avoid excessive removal of the posterior supportive structures of the spinal column without compromising full and safe decompression of the spinal nerves, techniques are being developed to reduce bone removal but also allow access to the spinal canal. One such micro-decompression involves a hemi-lami-nectomy and lateral recess decompression on the more symptomatic side followed by undercutting the spinous process and facet joints and decompressing the opposite side from within the canal aided by the use the operating microscope, a high speed burr and a metal guard to protect the dura and nerves.

Although previous reports exist, as yet, there is no long-term evidence that the theoretical benefits of this “micro-decompression” translate into real clinical improvement in outcome with a reduction in the incidence of post-operative instability in comparison with the bilateral “fir-tree” type of decompression.

We have reviewed our first 100 consecutive patients who have had a spinal micro-decompression carried out by a single spinal surgeon over a period of 5 years. Patients with central or lateral recess stenosis with unilateral or bilateral symptoms were considered for this procedure with 58 female and 42 male patients included in the follow-up series. Mean age was 65 years. Patients were assessed by a combination of clinical review and self-assessment questionnaires. After a follow-up period of up to 5 years (mean 3 years) we have seen symptomatic late instability develop in 4 patients requiring a further surgical procedure in 2 of these. Symptoms typically developed 2 years after the original operation following an initial improvement in radicular symptoms and back pain. This compares favourably with published results for wide decompression where re-operation rates of 18% are reported. We have analysed the cases of delayed instability in more detail to evaluate whether the late deterioration could have been predicted. This has allowed us to clarify the specific indications and contra-indications to the micro-decompression procedure.

Lumbar micro-decompression has proved to be safe with few complications. It would appear that this technique has advantages over wide decompression without compromising safety but it will be important to continue with longer term follow-up of these cases.

Traumatic dislocation of the hip in children is rare. Large series have shown this injury to be 25 times less common in children than in adults. Only 70 cases of Neglected traumatic dislocation of hip in children has been reported in the English literatures and most of those studies are too small to draw a significant conclusions. We report our experience of treating 20 such cases of neglected traumatic dislocation of hip in children (< 12 years). All had posterior dislocations without any associated fracture. They attended the hospital between 1–52 weeks after injury.Closed reduction under G.A was performed in 12 cases which were less than 3 weeks old while 8 hips(> 3 weeks old) had open reductions following failed reductions with skeletal traction. At 2 years follow-up, a complete range of motion was found in 18 children while the remaining two had 80% of normal hip movement with no significant deformity. All the hips showed varying degree of avascular necrosis, with preservation of joint space on radiographs.

We suggest that attempted closed reduction of under 3 weeks old and open reductions for older dislocations gives satisfactory results. Also an anatomically placed femoral head maintains the stimulus for growth of pelvis and the femur.

Dislocation of the distal radioulnar joint (DRUJ) in association with fractures of both bones of the forearm has received relatively little attention in the literature. The purpose of this study was to evaluate the integrity of DRUJ and evaluate the association between the level of fracture and instability of DRUJ following fracture both bones of forearm.

This was a prospective study of 65 patients, over 3 years followed up for 12 months. All patients were treated with open reduction and internal fixation of radius and ulna. The mean age of the patients was 34.8 years (15–68 yrs). There were 51 males and 14 females. There were 18 fractures involving distal third of forearm, 42 fractures in the middle third and 5 fractures of the proximal third. 38 fractures (58.4%) had subluxation of the DRUJ and 27 had no DRUJ subluxation. All subluxations were dorsal. Post-operatively, 30 of the 38 fractures (78.9%) had persistent DRUJ subluxation. Of the 27 fractures, which had no pre-operative DRUJ subluxation, 10 fractures (37%) revealed dorsal subluxation in the post-operative radiographs. All fractures were immobilised in above elbow plaster casts for 6 weeks. All patients were followed up at 3, 6 and 12 months. Patients were assessed clinically, radiologically with standardised radiographs and functional assessment of grip and pinch strength using Jamar dynamometer. At 12 months, 12 patients had significant symptoms associated with DRUJ. Of these, 4 had functional restriction, which were related to complex DRUJ dislocations.

DRUJ dislocations are more common in fractures, which are in the direction of the interosseous membrane (p< 0.002). They are commonly associated in fractures involving the middle and distal third of the forearm. There is a tendency for under-reporting of DRUJ dislocations in fractures of both bones of forearm and hence, more attention should be paid to this entity.