A method of triple arthrodesis is described which involves inlay of the subtalar and midtarsal joints. It is applicable to the undeformed and valgus foot as is encountered in poliomyelitis, spasmodic flat foot, cerebral palsy and spina bifida. The operation was successful in controlling deformity and pain. The only significant complication was failure of fusion of the midtarsal joint which occurred in three of eighty-five feet (3-5%)

We describe a technique of femoral derotation osteotomy performed according to the Ilizarov principles of percutaneous corticotomy and fixation with a frame. We performed 24 femoral osteotomies in 16 patients, four with cerebral palsy and 12 with idiopathic femoral anteversion. All had rapid union and there were few complications. The advantages of the method include early ambulation, good control of rotation and axial alignment, and minimal scarring

Seven children with a post-traumatic cubitus varus deformity were treated using the Ilizarov technique of distraction osteogenesis. The outcome was rated as excellent in each case and all were satisfied with the cosmetic appearance. No complications had been encountered by the latest follow-up at a mean of 66.7 months. This technique seems reliable for the treatment of such deformities, provided that it achieves full correction by gradual distraction. Nerve palsy and unsightly scars are avoided, and the range of movement of adjacent joints is preserved

1. Two cases of fracture-dislocation of the trochlea are described. One case was complicated by complete ulnar nerve palsy. 2. The injury is caused by direct force applied to the point of the elbow, or it may be associated with posterior dislocation of the joint. 3. Open reduction is recommended, the fragment being held in position by soft-tissue sutures alone. 4. Four other cases mentioned in the literature are reviewed

Craniodiaphyseal dysplasia (CDD) is a rare sclerosing bone disorder, the severity of which depends on its phenotypic expression. Hyperostosis can cause progressive foraminal stenosis leading to palsy of cranial nerves, epilepsy and mental retardation. We report the only case of CDD in an adult, with stenosis of the cervical canal leading to quadriparesis as a late complication of hyperostosis, and describe the problems associated with its treatment. Although the syndrome is rare, its pathophysiological and therapeutic considerations may be applicable to the management of stenosis of the spinal canal in other hyperostotic bone disorders

Pelvic discontinuity with associated bone loss is a complex challenge in acetabular revision surgery. Reconstruction using ilio-ischial cages combined with trabecular metal acetabular components and morsellised bone (the component-cage technique) is a relatively new method of treatment. We reviewed a consecutive series of 26 cases of acetabular revision reconstructions in 24 patients with pelvic discontinuity who had been treated by the component-cage technique. The mean follow-up was 44.6 months (24 to 68). Failure was defined as migration of a component of > 5 mm. In 23 hips (88.5%) there was no clinical or radiological evidence of loosening at the last follow-up. The mean Harris hip score improved significantly from 46.6 points (29.5 to 68.5) to 76.6 points (55.5 to 92.0) at two years (p < 0.001). In three hips (11.5%) the construct had migrated at one year after operation. The complications included two dislocations, one infection and one partial palsy of the peroneal nerve. Our findings indicate that treatment of pelvic discontinuity using the component-cage construct is a reliable option

1. Maffucci's syndrome consists of dyschondroplasia (Ollier's disease) in association with cavernous haemangiomata and phlebectasia. Twenty-two cases have hitherto been described. 2. A further case is recorded with autopsy findings showing the characteristic features of the syndrome. Death was caused by a chondrosarcoma of the sphenoid, which led to subarachnoid haemorrhage, cranial nerve palsies, crossed hemiplegia and cavernous sinus thrombosis with almost total pituitary necrosis

Aims

As the peak of the COVID-19 pandemic passes, the challenge shifts to safe resumption of routine medical services, including elective orthopaedic surgery. Protocols including pre-operative self-isolation, COVID-19 testing, and surgery at a non-COVID-19 site have been developed to minimize risk of transmission. Despite this, it is likely that many patients will want to delay surgery for fear of contracting COVID-19. The aim of this study is to identify the number of patients who still want to proceed with planned elective orthopaedic surgery in this current environment.

Although arthroscopy of the hip is being carried out increasingly, little is known about the rate of associated complications. We describe a prospective study of 640 consecutive procedures in which a consistent technique was used. The overall complication rate was 1.6%. Complications, none of which was major or long-term, included transient palsy of the sciatic and femoral nerves, perineal injury, bleeding from the portal wounds, trochanteric bursitis and intra-articular breakage of the instrument. We believe that it is possible to undertake this operation safely using the technique described

The transiliac method of leg lengthening uses a modification of Salter's innominate osteotomy. The bone graft increases the length of the hemipelvis distal to the sacro-iliac joint. Leg-length inequality in 23 patients was treated by this method with an average gain in length of 2.8 cm (2.0 to 3.5). Apart from one residual femoral nerve palsy there were no notable complications. The facility to redirect the acetabulum allowed by the technique, may be useful in cases of potential hip instability or acetabular dysplasia

We report the case of a child with cerebral palsy and spastic diplegia treated for bilateral fixed flexion of the knee by bilateral hamstring lengthening. An attempt to straighten the legs from 90 degrees to 20 degrees flexion damaged the sciatic nerve. There are no objective means of estimating how much deformity can be reduced safely. We present a method of calculating the extra strain in the sciatic nerve produced by reducing a flexion deformity. The result, combined with clinical judgement, provides guidelines for safe corrective surgery

Aims

Rheumatoid arthritis (RA) is a systematic autoimmune disorder, characterized by synovial inflammation, bone and cartilage destruction, and disease involvement in multiple organs. Although numerous drugs are employed in RA treatment, some respond little and suffer from severe side effects. This study aimed to screen the candidate therapeutic targets and promising drugs in a novel method.

Aims

It is uncertain whether instrumented spinal fixation in nonambulatory children with neuromuscular scoliosis should finish at L5 or be extended to the pelvis. Pelvic fixation has been shown to be associated with up to 30% complication rates, but is regarded by some as the standard for correction of deformity in these conditions. The incidence of failure when comparing the most caudal level of instrumentation, either L5 or the pelvis, using all-pedicle screw instrumentation has not previously been reported. In this retrospective study, we compared nonambulatory patients undergoing surgery at two centres: one that routinely instrumented to L5 and the other to the pelvis.

1. Talipes equinovarus is a specific type of club foot which has a genetic basis. Its occurrence along with certain neurological disorders has been noted. 2. An investigation of its incidence in 1,447 mental defectives, excluding those with cerebral palsy, revealed an incidence of 228 per 1,000, which is about ten times that for the general population. 3. There may be an upset early in embryonic development to account for the co-existence of both mental deficiency and talipes equinovarus

We describe the results after open reduction and internal fixation of 22 consecutive displaced fractures of the glenoid with a mean follow-up of ten years. A posterior approach was used in 16 patients and an anterior in six, the approach being chosen according to the Ideberg classification of the fractures. The fixation failed in two patients, one of whom required a further operation. There were two cases of deep infection. At follow-up the median Constant score was 94% (mean 79%, range 17 to 100). The score was less than 50% in four patients, including the two who became infected. A further two had an associated complete palsy of the brachial plexus

Controversy surrounds the aetiology of obstetric brachial plexus lesions. Most authors consider that it is caused by traction or compression of the brachial plexus during delivery. Some patients, however, present without a history of major traction during delivery, and some delivered by Caesarean section also suffer the injury. In our series of 42 infants, 28 had an Erb’s palsy, and the remaining 14 presented with a more extensive lesion, involving the lower roots. In five of these, a complete ossified cervical rib was found. We believe that anatomical variations, such as cervical ribs or fibrous bands, can cause narrowing of the supracostoclavicular space, and render the adjacent nerves more susceptible to external trauma

1. A case is reported of traumatic dislocation of the shoulder joint complicated by rupture of the axillary artery and vein and complete brachial plexus palsy. Whether the rupture occurred at the time of injury or during reduction is not known. 2. Despite a delay of five weeks before operative treatment was undertaken the usefulness of the arm was preserved. 3. After rupture of the axillary artery at this level an adequate collateral circulation is rapidly established in a healthy young adult. 4. The case illustrates the importance of careful examination of the peripheral nervous and vascular systems before and after reduction of a dislocated shoulder

Aims

We hypothesized that the wide-awake local anaesthesia with no tourniquet (WALANT) technique is cost-effective, easy to use, safe, and reproducible, with a low learning curve towards mastery, having a high patient satisfaction rate. Furthermore, WALANT would be a suitable alternative for the austere and developing nation environments where lack of funds and resources are a common issue.

Traction injury to the sciatic nerve can occur during hamstring lengthening. The aim of this study was to monitor the influence of hamstring lengthening on conduction in the sciatic nerve using evoked electromyography (EMG). Ten children with spastic cerebral palsy underwent bilateral distal hamstring lengthening. Before lengthening, the evoked potential was recorded with the patient prone. During lengthening, it was recorded with the knee flexed to 90°, 60° and 30°, and at the end of lengthening with the hip and knee extended. In all patients, the amplitude of the evoked EMG gradually decreased with increasing lengthening. The mean decrease with the knee flexed to 60° was 34% (10 to 77), and to 30°, 86% (52 to 98) compared with the pre-lengthening amplitude. On hip extension at the end of the lengthening procedure, the EMG returned to the pre-lengthening level. Monitoring of the evoked EMG potential of the sciatic nerve during and after hamstring lengthening, may be helpful in preventing traction injury