Twenty-one patients with leg-length inequality underwent femoral lengthening using the Wagner technique. When reviewed, seven were found to have varying degrees of posterior subluxation of the knee. Critical assessment demonstrated that each of these was associated with a hypoplastic femur. It is postulated that posterior displacement of the tibia on the femur occurred as a result of the distal femoral and intraarticular bony deficiencies.

The diagnosis of acute osteomyelitis is often very difficult during the first 24 to 48 hours. Bone scanning has been a useful adjunct in this diagnosis by demonstrating increased uptake in the area or areas of involvement. Occasionally the pathological area is "cold" on scanning, which may lead to a misdiagnosis. This paper presents three cases demonstrating this unusual finding.

The results obtained in a consecutive series of thirty-seven Pemberton operations for congenital dislocation or subluxation of the hip are reported. Over the period under review, 1967 to 1973, it was the only type of acetabuloplasty employed at Winford. Unless the mandatory concentric reduction could be obtained with ease, preliminary open reduction was favoured, especially in cases of primary care. Femoral rotation osteotomy was added for marked anteversion. The programme was designed to be complete inside fourteen weeks, and was so for eighteen hips. Secondary acetabuloplasty was performed on hips with instability or dislocation persisting despite previous treatment. The operations were performed from eighteen months to thirteen years of age. One initial failure required a repeat operation which was successful, but one severely dysplastic hip remained so. The average follow-up was six years.

The Norwich Health District (population 400,000) has been studied during a five-year period in an attempt to assess the value of examination of the hip in the newborn. It is confirmed that complicated deliveries produce higher rates of neonatal instability. But, in sixteen out of the seventeen cases with hip dislocations diagnosed late, delivery had been normal. It is estimated that after normal deliveries, hospital doctors detect only 50%, and family doctors only 28%, of cases of instability of the hip. It is concluded: 1) that the problem of congenital dislocation of the hip will not be eliminated by neonatal examination alone, even if skill in clinical examination could be improved and maintained; 2) that repeated examinations should be considered mandatory until the child is walking. In this regard, the value of the sign of limitation of abduction requires study; 3) that the public should be made aware by an appropriate health education programme that the problem of congenital dislocation of the hip has not yet been solved.

Coxa valga may sometimes occur as a complication of varus osteotomy for congenital dislocation of the hip. Six such cases are described with a minimum follow-up of nine years. In three cases the varus osteotomy had been performed on only one side; in one case it was done on both sides and coxa valga developed bilaterally; and in two further bilateral cases coxa valga developed on one side only. In each case the coxa valga was sub-capital. Detailed radiographic analysis included measurements of neck-shaft angle, acetabular angle and C.E. angle. The epiphysis-shaft angle is described; it is an index of the constant tendency of the capital epiphysis to assume a horizontal position. The cause remains unknown, but damage to the trochanteric growth plate or to the lateral part of the capital growth plate could not be identified as aetiological factors. Poor acetabular cover was considered a possible factor. All the patients in this series had functionally excellent hips, but the long-term prognosis of the hips with partly uncovered femoral heads is doubtful.