1. Seven cases of sacral extradural cyst are reported. 2. The etiology and clinical features are discussed and the literature reviewed. 3. The differential diagnosis is discussed; certain features, useful in making the diagnosis of sacral extradural cysts, are recorded. 4. When a cyst causes symptoms excision brings relief. Because some cysts are symptomless, it is important to exclude an accompanying prolapsed intervertebral disc

1. It is suggested that abruptness of the condylar ridges on the femur plays a major role in the etiology of chondromalacia patellae. The medial condylar ridge is always abrupt in these cases, and indeed in many knees with no evidence of chondromalacia patellae. The lateral condylar ridge is rarely abrupt. 2. The short-term results of forty operations for reduction of femoral ridges in thirty-eight patients, with preservation of the patella in thirty-two cases, are satisfactory

1. Thirty-two infants with genu recurvatum congenitum are reported. 2. Fifteen infants responded completely within eight weeks with conservative treatment; the remaining cases were recalcitrant. 3. The etiology, pathology and treatment of the two groups are discussed. 4. The prognosis is adversely affected by delay in treatment by the presence of certain associated deformities and by generalised joint laxity. 5. Indications for operative treatment are suggested

1. An account of fifty-four patients suffering from ainhum is presented, and the clinical and pathological findings are discussed. 2. Etiology is considered, and a plan of treatment proposed. 3. Ainhum in Ibadan is a disease of all ages and both sexes. 4. Most patients have considerable pain. 5. It is due to a non-inflammatory change in the basal layer of the epidermis. 6. Surgical treatment has gratifying results

Recent work has suggested that thrombophilia may be an aetiological factor in up to 50% of children with Perthes’ disease, and that up to 75% may have a coagulopathy. Our aim was to test these findings in the local population of children with Perthes’ disease and attempt to correlate them with the severity of the condition. In 64 children there were only eight (12%) with low levels of clotting proteins, as defined by normal paediatric ranges. Of these eight, only five could be said to show any thrombophilic tendency

Seven cases of massive osteolysis are presented. The aetiology of this disease is as yet unknown; neither age nor sex seems to be a factor in its incidence, nor are standard bone grafts or radiotherapy successful methods of treatment. However, in this series, operation produced a satisfactory outcome for five patients at a mean follow-up of 17 years; in three of these patients a custom-built prosthesis was inserted, and in one a conventional bone graft was combined with intramedullary nailing

Aims

This study aimed to determine the minimal detectable change (MDC), minimal clinically important difference (MCID), and substantial clinical benefit (SCB) under distribution- and anchor-based methods for the Mayo Elbow Performance Index (MEPI) and range of movement (ROM) after open elbow arthrolysis (OEA). We also assessed the proportion of patients who achieved MCID and SCB; and identified the factors associated with achieving MCID.

Spinal osteochondrosis, previously known as Scheuermann's disease and spinal osteochondritis, is common and is probably becoming increasingly prevalent. Its incidence in patients whose primary complaint was of backache was shown to be twice as great as that in the general population. There was also a significantly higher incidence of lower lumbar spondylosis in patients with previous osteochondrosis compared with those without. Osteochondrosis is thereby shown to be an important aetiological factor in spondylosis

1. The pathogenesis of recurrent anterior dislocation of the shoulder has been studied at operation and by experiments on cadavers. 2. Lesions of the subscapularis muscle leading to lengthening and laxity have been demonstrated. 3. This lengthening is the prime factor in producing instability of the shoulder; capsular and bony defects are no more than subsidiary causes. 4. Good results have been obtained by a procedure based on this theory of etiology

Benign paroxysmal torticollis is a self-limiting condition occurring during infancy. It resolves by the age of two to three years. Periodic episodes of torticollis may randomly alternate from side to side and be associated with other symptoms. The aetiology is unknown and no treatment is effective. It is relatively uncommon, and has not been previously reported in the orthopaedic literature, although initial referral may well be to an orthopaedic surgeon. We report four cases, and review the literature

In an attempt to improve the accuracy of diagnosis, 16 patients suffering from Morton's metatarsalgia were investigated clinically and electrophysiologically. The histological findings were related to these observations. The precise aetiology of Morton's metatarsalgia remains obscure, but the findings are compatible with an entrapment syndrome. Nerve conduction studies have a place in the investigation of patients with atypical presentation of pain in the foot. Further refinement of the electrophysiological technique should be possible

Joint deformity secondary to extensive haemangiomatous involvement of the soft tissues has been well described and is easy to diagnose. If the haemangioma is small, localised and within the belly of a muscle the diagnosis is more difficult. In equinus deformity of obscure aetiology localised calf tenderness may be the only diagnostic sign. Three children with equinus deformity caused by a small haemangioma in the calf muscles were treated by simple excision with satisfactory results

A 69-year-old man presented with a 20-year history of a slowly enlarging mass of the left index finger dating from a hammer injury. The mass was excised, and seen to have the characteristic histological appearance of an elastofibroma, a benign tumour-like growth usually found in the soft tissue of the back. Such a lesion has not previously been documented in the hand, which we consider surprising in view of the generally accepted traumatic aetiology of this entity and the susceptibility of the hand to injury

The clinical, radiological and pathological features of hallux rigidus affecting nine toes (in seven patients) are described. Characteristic chondral and osteochondral lesions are seen to occur at a specific site on the metatarsal head, and account for the limitation of dorsiflexion but relatively unrestricted plantarflexion typical of hallux rigidus. Radiologically these lesions are often missed because they are mainly cartilaginous and are later obscured by secondary degenerative changes. Histological evidence indicates a traumatic aetiology and a mechanism of injury is suggested

Fracture of the carpal scaphoid is uncommon in children, but does occur and may fail to unite. Eight patients with established non-union have been reiewed, with an average follow-up of almost four years. All non-unions were grafted with autogenous bone. Excellent clinical and radiological results have been obtained. It is concluded that non-union in children is best managed by bone grafting through the anterior approach. Possible aetiological factors concerned in non-union of scaphoid fractures in this age group are discussed

1. A case of local gigantism is described, with enlargement of the left thumb, the left ring finger, the right little finger, and the right second and third toes. 2. No other record can be found in the literature of an association of local gigantism of fingers of both hands with a similar condition of the toes of one foot, though there is no theoretical reason why macrodactyly should not affect the digits in any combination. 3. Theories regarding the etiology are discussed

Condensing osteitis of the clavicle was first described as a disease entity in 1974. There is painful localised swelling of the clavicle of undetermined origin, with increased radio-density, but an infective aetiology has not been excluded by previous authors. We report three children with the clinical and radiological findings of 'condensing osteitis'. Two of them had raised levels of antistaphylolysin titres and all responded to antibiotic therapy. We conclude that condensing osteitis is due to low-grade staphylococcal osteomyelitis; biopsy and treatment by antibiotics is recommended

1. The aetiology of a destructive lesion through a former interspace in a spine fused by ankylosing spondylitis is reviewed. 2. From the findings in three patients treated by anterior spinal fusion, evidence was obtained to show that a stress fracture, originating posteriorly between two fused spinous processes, leads to a pseudarthrosis between two vertebral bodies that may simulate a tuberculous lesion. 3. If spinal fusion is indicated, the anterior approach is recommended, both for direct observation of the lesion and to achieve sound union

Scoliosis seen in the chicken after pinealectomy resembles adolescent idiopathic scoliosis in man. It has been suggested that in both species, deficiency of the pineal hormone, melatonin, is responsible for this phenomenon. In nine patients with adolescent idiopathic scoliosis and in ten age- and gender-matched controls, the circadian levels of serum melatonin and the excretion of urinary 6-hydroxy-melatonin-sulphate, the principal metabolite of melatonin, were determined. There were no statistically significant differences in the secretion of serum melatonin or the excretion of urinary 6-hydroxy-melatonin-sulphate between the patients and the control group. The hypothesis of melatonin deficiency as a causative factor in the aetiology of adolescent idiopathic scoliosis cannot be supported by our data