We used ultrasonography in ten children with pulled elbow to compare measurements of the radiocapitellar distance (RCD) on the affected and the unaffected sides. Similar measurements were made in a group of ten age-matched normal children. The mean RCD in pronation of the affected and normal sides in the patients with pulled elbows was 7.2 mm +/- 0.7 and 3.8 mm +/- 0.5, respectively (p < 0.0001). In the normal children the mean RCD in pronation was 4.5 mm +/- 0.5. We conclude that ultrasonography is of value for documenting pulled elbow in children.

We compared the results in two groups of patients with late reduction of posterior elbow dislocations, one of which had lengthening of the triceps (group A, n = 36) and the other did not (group B, n = 34). The elbows had all been dislocated for more than one month and less than three months. The patients in group B had better clinical results and significantly less postoperative flexion contracture (p < 0.05).

We describe a method of closed, unlocked nailing for femoral fractures using ultrasound instead of an image intensifier. Radiography was used only to confirm that the guide wire had been passed into the intramedullary canal of both fragments. The method succeeded in 26 of 30 cases. The failures all occurred in fractures which could not be reduced within 20 minutes. The operating time in those nailed successfully with ultrasound control was not different from the time for 30 control cases using conventional methods with an image intensifier.

Several methods for the correction of cubitus varus have been described, but most reported series are small and show a high rate of complications. We report a six-year personal experience of 77 osteotomies by a new technique which provides rigid fixation and allows correction of both varus and rotation deformities. It also prevents lateral bulging at the level of the osteotomy. In 58 cases followed up for an average of 16 months, there were no serious complications, a satisfactory carrying angle and no significant loss of movement, giving 88% excellent or good results.

Continuous passive motion (CPM) is an established method of preventing joint stiffness and of overcoming it. The optimum duration of treatment, however, is not known, though a period of one to three weeks is usual. This may be unnecessarily long and a programme lasting only three days has been tried in 34 patients: in 22 (Group A) treatment was designed to increase movement in stiff joints which had been operated on or manipulated, and in 12 (Group B) it was to prevent stiffness after an injury. A specially designed CPM device was used. In Group A, the range by the third day of treatment was significantly greater than before manipulation or operation and this increase was maintained until the latest follow-up at an average of 24 weeks. In Group B, the pre-injury range was almost retained and thereafter there was a gradual increase. Patient compliance in the first 12 hours of CPM was relatively poorer than that described in previous reports, and in five patients treatment had to be discontinued.