We present our experience of the modified Dunn procedure in combination with a Ganz surgical dislocation of the hip to treat patients with severe slipped capital femoral epiphysis (SCFE). The aim was to prospectively investigate whether this technique is safe and reproducible. We assessed the degree of reduction, functional outcome, rate of complications, radiological changes and range of movement in the hip. There were 28 patients with a mean follow-up of 38.6 months (24 to 84). The lateral slip angle was corrected by a mean of 50.9° (95% confidence interval 44.3 to 57.5). The mean modified Harris hip score at the final follow-up was 89.1 (. sd. 9.0) and the mean Non-Arthritic Hip score was 91.3 (. sd. 9.0). Two patients had proven pre-existing avascular necrosis and two developed the condition post-operatively. There were no cases of nonunion, implant failure, infection, deep-vein thrombosis or heterotopic ossification. The range of movement at final follow-up was nearly normal. This study adds to the evidence that the technique of surgical dislocation and anatomical reduction is safe and reliable in patients with SCFE. Cite this article: Bone Joint J 2013;95-B:424–9

Two neonates, treated by the Pavlik harness for congenital dislocation of the hip, developed inferior dislocation due to excessive hip flexion. Early recognition of the complication and diminution of the angle of flexion gave a stable relocation of the hip in both patients

1. Six thousand consecutive newborn babies were personally examined by the author for congenital dislocation of the hip. Twenty-four cases were diagnosed and twenty-three treated. 2. Twenty-two of the twenty-three treated cases had excellent results after treatment in the von Rosen splint. 3. The baby should be five days old before a final decision is made as to whether treatment is necessary. 4. A further twenty-seven babies were found to have unstable hips. Eighteen of these were followed up and all were found to have developed normally without treatment. 5. The technique of examination is simple and quick but it is desirable that it should be carried out in each maternity unit by only one or two doctors

A patient with a fractured coracoid process in association with a dislocation of the shoulder is reported. The fracture was not recognised initially, and early mobilisation was encouraged; the widely separated fracture did not heal and a painful pseudarthrosis developed. We believe that this association may not be as rare as generally supposed, and emphasise the importance of careful clinical examination in patients with shoulder dislocation. If a coracoid fracture is suspected, lateral or oblique radiographs should be taken to confirm the diagnosis. A further radiograph after reduction is a useful precaution

Objectives. There are several reports clarifying successful results following open reduction using Ludloff’s medial approach for congenital (CDH) or developmental dislocation of the hip (DDH). This study aimed to reveal the long-term post-operative course until the period of hip-joint maturity after the conventional surgical treatments. Methods. A long-term follow-up beyond the age of hip-joint maturity was performed for 115 hips in 103 patients who underwent open reduction using Ludloff’s medial approach in our hospital. The mean age at surgery was 8.5 months (2 to 26) and the mean follow-up was 20.3 years (15 to 28). The radiological condition at full growth of the hip joint was evaluated by Severin’s classification. Results. All 115 hips successfully attained reduction after surgery; however, 74 hips (64.3%) required corrective surgery at a mean age of 2.6 years (one to six). According to Severin’s classification, 69 hips (60.0%) were classified as group I or II, which were considered to represent acceptable results. A total of 39 hips (33.9%) were group III and the remaining seven hips (6.1%) group IV. As to re-operation, 20 of 21 patients who underwent surgical reduction after 12 months of age required additional corrective surgeries during the growth period as the hip joint tended to subluxate gradually. Conclusion. Open reduction using Ludloff’s medial approach accomplished successful joint reduction for persistent CDH or DDH, but this surgical treatment was only appropriate before the ambulating stage. Cite this article: Bone Joint Res 2014;3:1–6

We reviewed 15 patients, nine girls and six boys, with chronic anterior dislocation of the radial head which was treated by ulnar osteotomy, external fixation and open reconstruction of the elbow joint but without repair of the annular ligament. Their mean age was 9.5 years (5 to 15) and the mean interval between the injury and reconstruction was 22 months (2 months to 7 years). All radial heads remained reduced at a mean follow-up of 20 months (6 months to 5 years). Normal ranges of movement for flexion, extension, pronation and supination were unchanged in 96.1% (49/51) and worse in 3.9% (2/51). Limited ranges of movement were improved in 77.8% (7/9), unchanged in 11% (1/9) and further decreased in 11% (1/9).There were two superficial pin-track infections and two cases of delayed union but with no serious complications. Reconstruction of the radiocapitellar joint is easier using external fixation since accurate correction of the ulna can be determined empirically and active functional exercises started immediately. Only patients with a radial head of normal shape were selected for treatment by this method

The role of muscle function in the aetiology of recurrent dislocation of the patella has been examined. Eleven of the 12 patients we studied had joint hypermobility. Muscle biopsies from eight of nine patients treated by surgery had a predominance of abnormal Type 2C fibres, and three of six patients whose quadriceps muscles were studied by electromyography also had abnormal results. Our preliminary findings suggest that there may be a primary muscular defect in many cases of recurrent dislocation of the patella

1. Two patients with recurrent dislocation of the head of the fibula are described. 2. The difficulties in diagnosis are discussed

A case of simultaneous posterior dislocation of both shoulders, occurring in an epileptiform fit, is described. Manipulative reduction succeeded after five days, and full function was gained

A case of rotatory dislocation of both atlanto-axial joints is presented. A review of the literature reveals two other cases, both in children. This would appear to be the first report in an adult, who survived and made a full recovery

The anatomy of the first metatarso-phalangealjoint and of dorsal dislocation of the phalanx are described. As with similar lesions in the hand, closed reduction is impossible because of interposition of the volar plate. Open reduction is essential and should be performed as soon as possible after the injury

I. Five cases of dislocation of the head of the radius associated with fracture of the upper end of the ulna in children are reported. It is important that fractures of the upper end of the ulna, especially those with some varus deformity in children, should arouse suspicion of the possible co-existence of a dislocation of the head of the radius. 2. The association of the injury to the elbow with a fracture of the lower end of the radius and ulna in three of our cases indicates the necessity for keeping in mind the possibility of this combination. 3. Closed reduction seems to be the best method of treatment. 4. Our five cases were seen during a period ofonly three years. We therefore believe that this injury is not as unusual as appears from the literature

1 . Two cases of chronic progressive dislocation of the talo-navicular joints are discussed. 2. Radiographs are presented showing the development of the lesions over a period of eighteen years. 3. It is thought that the lesion is caused by laxity of ligaments and subsequent osteoarthritic changes

The frame described has a place in the treatment of congenital dislocation of the hip especially if the diagnosis is not made until after the age of one year. Analysis of comparable series of hips reduced on the frame and by manipulation shows that dysplasia of the femoral head is decidedly commoner after the manipulative method

1. Rupture of the brachial artery or of one of its divisions in association with elbow injuries is probably more common than a survey of the literature would imply. Three cases of rupture of the brachial artery complicating compound dislocation of the elbow are reported. 2. These cases appear to have a consistent pattern of soft-tissue damage, with avulsion of the common flexor origin, and a varying degree of damage to the biceps and brachialis. The median nerve escaped injury. 3. The method of dealing with the divided vessels does not appear to be of importance in determining the outcome, simple ligation being as satisfactory as attempts at grafting or suture. 4. In no case was there any evidence of Volkmann's contracture. Provided rapid reduction of the dislocation is effected, together with ligation of the vessels, a satisfactory return of the circulation may be expected

1. Five cases of postero-lateral dislocation of the knee with capsular interposition are described. 2. The mechanism of the injury is considered in the light of the case histories and the findings at operation. 3. The constant clinical findings associated with this injury are described. 4. Open reduction is recommended: with early operation the prognosis for function and stability is good

1. Semitendinosus tenodesis with adequate lateral release for recurrent dislocation of the patella has a high success rate and a low complication rate. 2. The technique of operation is simple. 3. Its particular application is in the young patient before epiphysial closure, although it can give good results in the older patient

1. Two cases are reported of the uncommon condition of simple anterior dislocation of the head of the ulna at the inferior radio-ulnar joint. 2. The literature concerning the condition and its treatment is reviewed. 3. The mechanism of the inferior radio-ulnar joint is discussed with particular reference to the function of the triangular fibrocartilage. 4. The mechanism of injury is discussed and a new idea of this mechanism is put forward

Persistent dislocation of the elbow after a fracture of the coronoid process is a difficult problem. We have performed an open reduction with reconstruction of the coronoid by an osteocartilaginous graft from the ipsilateral olecranon for two patients. Both achieved a painless, stable joint with a functional range of movement. The joint surface of the graft has a similar curve to that of the coronoid giving good congruency and stability. The technique is simple and the graft is obtained through the same incision

We have reviewed 21 cases of dorsal dislocation of carpometacarpal joints. In 15 of them the diagnosis was missed when they were first seen in an accident and emergency department. General swelling may obscure the characteristic clinical deformity and routine radiographs may not show the displacement clearly. It is recommended that a true lateral radiograph of the hand be requested when this injury is suspected