Aims

We studied the outcomes of hip and knee arthroplasties in a high-volume arthroplasty centre to determine if patients with morbid obesity (BMI ≥ 40 kg/m²) had unacceptably worse outcomes as compared to those with BMI < 40 kg/m².

In 15 consecutive patients with slipped capital femoral epiphysis we recorded height, weight and skeletal maturity. Sexual maturity was assessed clinically and biochemically, and Harris's hypothesis that there is an increased ratio of serum growth hormone to oestrogen was tested in comparison with 15 age and sex matched controls. We found no difference in skeletal or sexual maturity between the groups, or any overt endocrine abnormality in the patients. However almost half the patients with slipped epiphysis were over the 90th weight percentile, suggesting that mechanical factors such as obesity are more important aetiologically than endocrine abnormalities

Arthroscopy of the hip revealed a torn acetabular labrum in seven young patients. Three of them had had an acute onset of symptoms during sporting activities. On examination all seven patients had pain on passive flexion and medial rotation of the joint. All but one of the tears were located on the posterosuperior portion of the labrum, and, in the acute cases, vascular dilatation around the tear was observed. In these cases, repeated arthroscopy several months later showed that the vascular changes had disappeared, but the tear was still present. The aetiology, diagnosis and treatment of the torn acetabular labrum are discussed

The term "congenital scoliosis" contributes little to our understanding of aetiology, for "congenital" simply means "to be born with" and is applicable to deformities present at birth whether these are genetically determined or acquired in utero. The presentation of monozygotic twins, one of whom has congenital scoliosis (vertebral anomalies) while the other is normal, provides a rare opportunity to study the cause of this deformity. Three pairs of monozygotic twins, previously unreported, are presented with a review of the previous literature. These cases add weight to the argument that congenital scoliosis may be acquired in utero rather than being genetically determined

The Blackburne and Peel method of assessing the position of the patella was applied to 185 knees with Osgood--Schlatter disease in 125 patients. The normal index of 0.80 was confirmed in 73 control knees. The average index in the knees with Osgood--Schlatter disease measured 1.01 (patella alta) boys and 0.91 in girls. The value increased to 1.06 in boys with radiological evidence of loose ossicles in the tibial tuberosity or the patellar tendon. This finding indicates that the strong pull of the well-developed quadriceps muscle is probably the most important aetiological factor in patella alta associated with Osgood--Schlatter disease

Throughout 1976 orthopaedic surgeons in three regions of England forwarded details of all new patients with Perthes' disease attending outpatient clinics or admitted as inpatients. The incidence in the Mersey region (11.1 per 100 000 children under fifteen years) was twice that in Wessex (5.5) with Trent having an intermediate incidence (7.6). The ratio of male to female incidence varied between the regions as did the age distribution of male cases. These findings point to the importance of environmental factors in the aetiology of the disease, and suggest the need for further epidemiological studies

1. Congenital vertical talus is described and the criteria for diagnosis are emphasised. The need for its distinction from other forms of convex pes valgus is stressed. 2. The operative technique of Stone for Lloyd-Roberts (1963) is detailed and the results of seven such operations are examined. 3. Departure from the technique in any respect has resulted in an unsatisfactory outcome, whereas stringent observation of the operative details has resulted in uniformly good results in four patients. 4. Certain aspects of diagnosis, differential diagnosis, etiology, pathology and surgical management are discussed, together with a review of some of the relevant literature

1 . Twenty patients with fibrous dysplasia, confirmed histologically, are reported and discussed in regard to classification, etiology, pathogenesis and treatment. The various fibrous or fibrocystic lesions of bone are characterised briefly for purpose of contrast, and the position of fibrous dysplasia in this heterogeneous collection is suggested. 2. The classification of fibrous dysplasia based on the degree of skeletal involvement is used, and the diagnostic, therapeutic and prognostic implications of this classification emphasised. The authors endorse the opinion that fibrous dysplasia is a developmental defect. Clinical, histological and radiographic evidence is presented to point to the distinct evolution of the monostotic lesions, to which a positive and aggressive approach is recommended

1. A clinical study has been made of heterotopic ossification in 273 patients with paraplegia of traumatic and non-traumatic origin treated at the Liverpool Paraplegic Centre over a period of twelve and a half years. 2. The literature is reviewed and theories of etiology are discussed. 3. Etiological factors have been studied. Prominent among these is inadequacy of early treatment leading to urinary infection and to the formation of pressure sores. 4. It is concluded that there is no effective treatment for established heterotopic ossification. 5. The importance of prophylactic treatment is stressed. Special emphasis is placed on adequate primary treatment, correction of hypoproteinaemia and early mobilisation

It has recently been postulated that thrombophilia may have a role in the aetiology of Perthes’ disease. The published reports, however, remain conflicting. In this study a retrospective analysis of the coagulation parameters was made in 47 patients with Perthes’ disease and the results compared with the clinical data. Five patients with Factor V Leiden mutation were found (10.6%) and surprisingly four of them had a homozygous pattern. These four patients showed the most severe form of the disease, Catterall group IV, with flattening of the entire epiphysis, involvement of the metaphysis, shortening and broadening of the femoral neck, trochanteric overgrowth and developed mushroom-shaped aspherical laterally displaced femoral heads in dysplastic acetabula. We would like to suggest that the homozygous form of Factor V Leiden mutation has some role in the clinical course of Perthes’ disease and particularly its most severe form

Four cases of slipped upper femoral epiphyses in patients with intracranial tumours causing hypopituitarism and chiasmal compression are presented. Detailed endocrine studies in three cases showed severe deficiencies of growth hormone as well as of gonadotrophin and sex hormones. The literature is reviewed and the aetiology is discussed with special reference to Harris's hypothesis that an increase in growth hormone relative to oestrogen predisposes to slipping of the upper femoral epiphysis in humans, which these cases do not seem to support. In all cases the slip was bilateral, and it is emphasised that surgical treatment can provide only temporary fixation because fusion is dependent on correct hormonal therapy

1. A case is described of severe birth injury to the sternomastoid muscle in a breech-delivered two-day-old infant. The affected muscle showed widespread haemorrhage, fragmentation and necrosis of its fibres, and disruption and disorganisation of the endomysial sheaths. 2. Disruptive muscular trauma of this type is known to lead to florid fibroblastic proliferation with formation of a large mass of scar tissue. It is suggested that the "sternomastoid tumour" of infancy develops as a sequel to such trauma occurring during birth. 3. The theories of birth trauma and of ischaemia, in the etiology of the "sternomastoid tumour" of infancy and of congenital muscular torticollis, are not mutually exclusive but may be complementary, the circumstances causing the trauma also leading to ischaemic damage

Six children who complained of pain and stiffness in the back had been treated with lumbar punctures between six and ten years before they came under observation. They were found to have intrathecal epidermoid tumours in the lumbar region which are presumed to have arisen from implanted skin fragments. The main evidence for this assumption is that since 1956 sixteen patients with lumbar epidermoid tumours in patients who had had previous lumbar punctures have been reported, in contrast to the five patients with lumbar epidermoid tumours recorded before that date. This suggests that there is an additional etiological factor

We studied the aetiology of vertebral slip in a long-term follow-up of 22 adult patients with isthmic spondylolysis or spondylolisthesis of L5. Of the 18 with spondylolysis without slip, 13 showed no slip after ten years, but five developed displacement of over 5%. All four patients with spondylolisthesis showed progression of the slip. We found that the vertical thickness of the transverse process of L5 was significantly greater (p < 0.01) in the 13 patients with no slip than in the other two groups. The relationship of vertebral slip to the shape of the transverse processes of L5 may be explained by differences in the bulk or physiological strength of the posterior bands of the iliolumbar ligament

Aims

This study aims to enhance understanding of clinical and radiological consequences and involved mechanisms that led to corrosion of the Precice Stryde (Stryde) intramedullary lengthening nail in the post market surveillance era of the device. Between 2018 and 2021 more than 2,000 Stryde nails have been implanted worldwide. However, the outcome of treatment with the Stryde system is insufficiently reported.

Reports of spondylolysis in vertebrae other than those of the lower lumbar spine are rare. We report 32 patients with upper lumbar spondylolysis who have been studied clinically, radiologically and scintigraphically. Twenty patients had bilateral lesions, and seven of those with unilateral lesions had structural changes or anomalies in the opposite posterior arch. Positive scans were found to be associated with a short clinical history, and indicated stress-related lesions. Our findings suggest that mechanical factors may play a role in the aetiology of spondylolysis in the upper lumbar spine similar to that which they play in the lower lumbar spine, and that local structural anomalies may contribute to abnormal loading of these vertebrae

Ten children who had clinically stable hips at birth were radiographed at one month because they had factors predisposing to hip dislocation. In all cases one or both hips gave rise to a suspicion of dysplasia, though clinical abnormalities were slow to appear. Four of these hips subsequently dislocated. We believe that infants with late presentation of acetabular dysplasia and clinical abnormality belong to a different aetiological group from those with neonatal instability due to ligamentous laxity. The significance of this differentiation is that some infants presenting late have only recently dislocated, and the diagnosis has not necessarily been "missed" at neonatal examination

Widespread periarticular new-bone formation (myositis ossificans) was studied in 45 patients with brain damage who were in long-term coma. Thirty-six of these patients displayed myositis ossificans around at least one major joint. The development of myositis ossificans was shown to be independent of the sex and age of the patient and also of the aetiology, duration and outcome of the coma. Radiographic evidence first appeared between one and two months after the onset of coma. The maximal spread of myositis ossificans was reached in the first five months after the onset of coma. Progression of the disease was not observed after 14 months. Myositis ossificans was defined as a progressive self-limiting disease found in comatose patients

Skeletal age was estimated by examination of radiographs of the carpus in 182 children suffering from Perthes' disease after the reliability of the Greulich and Pyle Atlas had been checked for a control group of British children. A striking tendency to delayed skeletal maturation was shown in the children with Perthes' disease. This trait was also found in ninety-three unaffected siblings of the patients. The velocity of skeletal ageing as the disease progressed was estimated. In some patients the carpal skeleton failed to mature at all for periods of up to three years and the term "skeletal standstill" is applied to this phenomenon. The significance of these findings is discussed and it is suggested that the maturation defect may have aetiological significance

1. The etiology and natural progress of lumbar kyphosis in children from three to twelve years of age with myelomeningocele are reviewed. 2. The indications for operation have included intractable or recurrent skin ulceration, inability to wear calipers for walking, inability to sit in a wheel-chair and inability to perform ileal conduit operations. 3. The technique of osteotomy-excision of lumbar vertebrae used in eighteen cases is described. 4. The results in fourteen children are described. The primary aims of operation have been achieved in all patients. 5. A comparison is made with the results of neonatal osteotomy-excision of the spine in the newborn. Recurrence of deformity, but at a much reduced rate, must be anticipated after either operation