We used ultrasound to investigate the anatomy and stability of the hip during the phase of joint stabilisation after closed reduction of unilateral late CDH in 15 infants aged from two to 15 months. Conservative treatment by splintage in
We treated 12 shoulders in ten patients with irreparable rotator-cuff tears by transfer of the latissimus dorsi. There were nine men and one woman. Their average age was 64.0 years and the average follow-up was 35.6 months (26 to 42). The results were excellent in four shoulders, good in four, fair in one, and poor in three. Active forward flexion improved from a preoperative average of 99° to a postoperative average of 135°. Osteoarthritic changes appeared in five shoulders and proximal migration of the humeral head progressed in six. EMG revealed that nine of the 12 transferred muscles showed activity which was synergistic with the supraspinatus on external rotation with
1. Seventy-three congenital club feet in fifty-one children have been reviewed between the ages of four and fourteen years to determine the incidence of residual adduction ofthe forefoot. 2. A radiological method of measuring metatarsus varus, based on the naviculo-metatarsal angle, is described. 3. On clinical examination 52 per cent of the feet had residual adduction of the forefoot, and metatarsus varus was present in 74 per cent of these. 4. There was no residual adduction in 48 per cent but only 45 per cent of these showed normal radiographic features. In the remainder various forms of spurious correction were seen. 5. For early treatment, detachment of the origin of the
1. Pain at the front of the radial side of the wrist may be caused by various lesions of the tendon and sheath of the flexor carpi radialis tendon. 2. The diagnosis may be established by testing resisted movement at the wrist and by the effect of injecting local anaesthetic into the tendon sheath. 3. In women over the age of fifty the lesion is associated with osteoarthritis of the joint between the scaphoid and the trapezium. 4. Osteoarthritis of the joint between the scaphoid and the trapezium is found in about 25 per cent of women over the age of fifty. 5. If the pain is not relieved by simple conservative measures it can usually be cured by incision of the tendon sheath. 6. The histological changes in the tendon sheath are similar to those found in tenovaginitis of the
A method of treatment of Bennett's fracture is described. A Kirschner wire is drilled obliquely through the base of the first metacarpal bone and traction is applied in a distal, ulnar and palmar direction in order to counteract the dislocating action of
1. The problem of instability of reduction in congenital dislocation and congenital subluxation of the hip has been studied and it has been concluded that the basic cause of this instability is the abnormal direction in which the entire acetabulum faces. 2. An operation, innominate osteotomy, has been designed to correct the abnormal direction of the entire acetabulum in children over the age of eighteen months. The principle of innominate osteotomy is redirection of the acetabulum so that the reduced dislocation or subluxation, which previously was stable only in a position of
1. At an operation for recurrent posterior dislocation of the shoulder observations were made on the mechanism, head defect, method of reduction, and the position of greatest stability. 2. Experimentally, avulsion of the glenoid labrum in a monkey was shown to be capable of sound repair without operation. 3. In the treatment of primary posterior dislocation it is suggested that the position of
In order to investigate the functional anatomy of gluteus minimus we dissected 16 hips in fresh cadavers. The muscle originates from the external aspect of the ilium, between the anterior and inferior gluteal lines, and also at the sciatic notch from the inside of the pelvis where it protects the superior gluteal nerve and artery. It inserts anterosuperiorly into the capsule of the hip and continues to its main insertion on the greater trochanter. Based on these anatomical findings, a model was developed using plastic bones. A study of its mechanics showed that gluteus minimus acts as a flexor, an
The Ponseti method is the benchmark treatment for the correction of clubfoot. The primary rate of correction is very high, but outcome further down the treatment pathway is less predictable. Several methods of assessing severity at presentation have been reported. Classification later in the course of treatment is more challenging. This systematic review considers the outcome of the Ponseti method in terms of relapse and determines how clubfoot is assessed at presentation, correction, and relapse. A prospectively registered systematic review was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies that reported idiopathic clubfoot treated by the Ponseti method between 1 January 2012 and 31 May 2017 were included. The data extracted included demographics, Ponseti methodology, assessment methods, and rates of relapse and surgery.Aims
Patients and Methods
The aim of this study was to assess the functional gain achieved following hip resurfacing arthroplasty (HRA). A total of 28 patients (23 male, five female; mean age, 56 years (25 to 73)) awaiting Birmingham HRA volunteered for this prospective gait study, with an age-matched control group of 26 healthy adults (16 male, ten female; mean age, 56 years (33 to 84)). The Oxford Hip Score (OHS) and gait analysis using an instrumented treadmill were used preoperatively and more than two years postoperatively to measure the functional change attributable to the intervention.Aims
Patients and Methods
We reviewed our experience with a modified triple innominate osteotomy for hip instability and limb shortening due to poliomyelitis in 62 adolescent and adult patients, treated from 1973 to 1990. Their ages at surgery ranged from 12 years to 35 years (average 22.3). At a mean follow-up of 4 years (2 to 18) 59 of the patients (95.2%) had substantial improvement in hip stability, and all but one had radiological improvement as determined by the acetabular angle, centre-edge angle and acetabulum-head quotient. In 59 cases in which transiliac limb lengthening was attempted, the mean gain was 1.7 cm (0.6 to 3.0). When the
We performed Kawamura's dome osteotomy of the pelvis, with simultaneous distal transfer of the greater trochanter on 101 hips in 91 patients with osteoarthritis secondary to hip dysplasia. The mean age at operation was 30 years (15 to 55), and follow-up was for a mean of 8.3 years (5 to 14). Clinical evaluation using the Merle d'Aubigne score showed 92% excellent or good results. Radiologically, 91 hips had good acetabular remodelling and showed no signs of progression of osteoarthritis. In ten hips the osteoarthritic process progressed despite the osteotomy and six of these eventually underwent total hip replacement. Factors which were significantly associated with a poor outcome included an advanced stage of osteoarthritis, valgus deformity of the proximal femur, old age at the time of operation and postoperative persistence of
Isolated dislocations of the navicular are rare injuries; we present our experience of six cases in which the navicular was dislocated without fracture. All patients had complex injuries, with considerable disruption of the midfoot. Five patients had open reduction and stabilisation with Kirschner wires. One developed subluxation and deformity of the midfoot because of inadequate stabilisation of the lateral column, and there was one patient with ischaemic necrosis. We believe that the navicular cannot dislocate in isolation because of the rigid bony supports around it; there has to be significant disruption of both longitudinal columns of the foot. Most commonly, an
Forty-four feet in 28 children previously treated by a one-stage posteromedial release operation (the Turco procedure) were reviewed clinically and radiologically to determine the cause of residual adduction of the forefoot. In 21 clinically adducted feet (48%) the main cause of residual deformity was metatarsus varus alone or metatarsus varus in spite of talonavicular overcorrection; in five feet the cause was talonavicular subluxation. There was no residual adduction in 23 feet (52%) but only 12 had normal radiographic measurements. In the remaining feet, various forms of spurious correction of metatarsus varus and talonavicular subluxation or both were seen, resulting in normal-looking feet. Recession of the origin of
Major ruptures of the rotator cuff were repaired in 89 patients over a six-year period, using an approach through the split deltoid muscle and the bed of the excised outer centimetre of the clavicle. Review of these patients showed that poor results were associated with larger cuff defects, with more pre-operative steroid injections and with pre-operative weakness of the deltoid muscle. A randomised prospective study showed that repair followed by splinting in
Disruption of the major ligaments of the knee was seen in six young men, five parachutists and a house painter, after what we have termed abduction-traction injury. This unusual complaint results from the application of a sudden block to the ankle while falling head first, leading to traction and
1. Six cases of posterior dislocation of the shoulder are described. 2. In four cases the diagnosis was made on clinical grounds. 3. The important clinical signs are the adducted and medially rotated position of the arm, a hard mass posteriorly below the acromion representing the displaced humeral head, and limitation of movement, especially
The primary objective of this study was to compare accuracy in restoring the native centre of hip rotation in patients undergoing conventional manual total hip arthroplasty (THA) This prospective cohort study included 50 patients undergoing conventional manual THA and 25 patients receiving robotic-arm assisted THA. Patients undergoing conventional manual THA and robotic-arm assisted THA were well matched for age (mean age, 69.4 years (Objectives
Materials and Methods
Short-stemmed femoral implants have been used for total hip arthroplasty (THA) in young and active patients to conserve bone, provide physiological loading, and reduce the incidence of thigh pain. Only short- to mid-term results have been presented and there have been concerns regarding component malalignment, incorrect sizing, and subsidence. This systematic review reports clinical and radiological outcomes, complications, revision rates, and implant survival in THA using short-stemmed femoral components. A literature review was performed using the EMBASE, Medline, and Cochrane databases. Strict inclusion and exclusion criteria were used to identify studies reporting clinical and radiological follow-up for short-stemmed hip arthroplasties.Aims
Materials and Methods
We report 22 patients (19 women and three men) of mean age 20.8 years who had painful snapping sensations in the groin. Most were able to reproduce the click by extending the affected hip from a flexed,