The Matrix seating system is an adaptable orthosis made of interlocking plastic components which can be shaped to fit the needs of the disabled. Twenty-five patients who had used this system for a minimum of 12 months have been assessed clinically. It was found to have several advantages over its rivals particularly in patient and guardian acceptance, versatility and on economic grounds. However, it was found not to prevent deterioration in spinal deformity nor to prevent hip dislocation

We report the results of transfer of the long toe flexors and lengthening of the calcaneal tendon in 33 patients with equinovarus deformity requiring orthoses after a stroke. Review of 29 patients more than two years after surgery showed that 21 were able to walk without an orthosis. Equinovarus deformity had recurred in six patients and hammer toe in 11, but walking ability without bracing was still better in seven of these. Results are improved by the release of the short toe flexors

Fractures of the atlas constitute 4% to 12% of all bony injuries of the cervical spine; most are treated successfully by a cervical orthosis. Nonunion may be associated with neck or scalp pain on movement and is treated conventionally by some form of craniocervical fusion, which restricts head movement. The authors describe a case in which direct repair of the bony ring with a titanium plate and screws allowed bone healing, relieved the symptoms and maintained a full range of neck movements. The titanium plate interfered little with postoperative MR and CT imaging

We report the results of 21 femoral osteotomies performed in 18 patients for genu recurvatum and flattening of the femoral condyles after poliomyelitis. Before operation the average angle of recurvatum was 31 degrees and all the limbs required bracing. After a mean follow-up of four years there has been partial recurrence in only one case. Nine patients (10 limbs) needed no orthosis and the others had less discomfort and an improved gait. Complete remodelling of the femoral and tibial epiphyses was noted in two of the younger patients

Background

Due to the overwhelming demand for trauma services, resulting from increasing emergency department attendances over the past decade, virtual fracture clinics (VFCs) have become the fashion to keep up with the demand and help comply with the BOA Standards for Trauma and Orthopaedics (BOAST) guidelines. In this article, we perform a systematic review asking, “How useful are VFCs?”, and what injuries and conditions can be treated safely and effectively, to help decrease patient face to face consultations. Our primary outcomes were patient satisfaction, clinical efficiency and cost analysis, and clinical outcomes.

Aims

The aim of this study was to assess the prognostic value of the modified three-group Stulberg classification, which is based on the sphericity of the femoral head, in patients with Perthes’ disease.

We performed distal chevron osteotomy of the second, third, or fourth metatarsal for painful plantar callosities in 19 non-rheumatoid patients (16 women, 3 men; 21 feet); their mean age was 59 years (32 to 85). The mean follow-up was four years (2 to 7). The overall results were good in 16 feet, fair in two, and poor in three, with four patients still having painful plantar callosities. There was union in all feet, but transfer metatarsalgia developed in three and three required an orthosis. Distal chevron osteotomy for intractable plantar callosities was successful both clinically and radiologically in most patients

Twelve adult patients with confirmed tuberculosis of the atlanto-axial spine are presented and a classification proposed. Stage I has minimal ligamentous or bone destruction and no displacement of C1 on C2; the suggested treatment is transoral biopsy and decompression followed by an orthosis. Stage II has ligamentous disruption and minimal bone destruction but anterior displacement of C1 on C2; treatment involves transoral biopsy and decompression, reduction by halo traction, then a posterior C1-2 fusion. Stage III has marked ligamentous and bone destruction with displacement of C1 forward on C2; the suggested treatment is transoral biopsy and decompression, reduction by halo traction, then fusion from the occiput to C2 or C3. One patient died before treatment started; all the others have gone on to solid union with resolution of any neurological deficit. There has been no evidence of reactivation of disease over an average follow-up of 36 months

Forty patients with acute complete rupture of the calcaneal tendon were managed conservatively and randomly allocated to treatment groups using either cast immobilisation for eight weeks, or cast immobilisation for three weeks, followed by controlled early mobilisation in a Sheffield splint. The splint is an ankle-foot orthosis which holds the ankle in 15 degrees of plantar flexion, but allows some movement at the metatarsophalangeal joints. It is removed to allow controlled movement during physiotherapy. Patients treated with the splint regained mobility significantly more quickly (p less than 0.001) and preferred the splint to the plaster cast. The range of dorsiflexion at the ankle improved more rapidly after treatment in the splint (p less than 0.001), and patients were able to return to normal activities sooner. Recovery of the power of plantar flexion was similar in the two treatment groups, and no patient had excessive lengthening of the tendon. One re-rupture occurred in each group

We treated 36 patients with unilateral facet dislocations or fracture-dislocations of the cervical spine at the Mayo Clinic between 1975 and 1986. Adequate records were available for 34: ten patients were treated by open reduction and posterior fusion, and 24 by nonoperative management. Of these, 19 had halo traction followed by halo-thoracic immobilisation, four had a simple cervicothoracic orthosis, and one received no active treatment. Anatomical reduction was achieved more frequently in the operative group (60% compared with 25%). Nonoperative treatment was more likely to result in cervical translation on flexion/extension lateral radiographs, and in significant symptoms. Only 36% of the patients treated by halo traction achieved anatomical alignment; in 25% halo traction failed to achieve or maintain any degree of reduction. During halo-thoracic immobilisation, half of the patients lost some degree of reduction and patient satisfaction with the appliance was low. Open reduction and internal fixation of unilateral facet injuries gave better results. 6

Aims

The treatment of tibial aplasia is controversial. Amputation represents the gold standard with good functional results, but is frequently refused by the families. In these patients, treatment with reconstructive limb salvage can be considered. Due to the complexity of the deformity, this remains challenging and should be staged. The present study evaluated the role of femoro-pedal distraction using a circular external fixator in reconstructive treatment of tibial aplasia. The purpose of femoro-pedal distraction is to realign the limb and achieve soft tissue lengthening to allow subsequent reconstructive surgery.

Since 1987, 22 children with myelomeningocele have been fitted with reciprocating orthoses. The level of the spinal lesions ranged from T10 to L4 and 13 had associated spinal deformities. Twelve of the patients currently use a Reciprocating Gait Orthosis, seven use a Hip Guidance Orthosis or Parawalker, one has progressed to a Knee Ankle Foot Orthosis, one has died and one has been lost to follow-up. The reciprocating orthoses are worn for a mean of 3.5 hours per day (1 to 6.5); daily usage by girls is almost twice that by boys. The mean daily usage by community walkers is 4.2 hours (13 children) as against 2.8 hours by household ambulators (8 children). Active hip flexion is not essential and fixed-flexion contractures up to 35 degrees can be accommodated. The average breakdown rate is 0.45 per year with an average of 1.5 adjustments each year. The average annual cost of a reciprocating orthosis is Aus$750 (375 pounds, US$570); this includes fabrication, adjustments and repairs

Aims

To describe the clinical, radiological, and functional outcomes in patients with isolated congenital thoracolumbar kyphosis who were treated with three-column osteotomy by posterior-only approach.

Aims

The objective of this study was to evaluate the clinical and radiological outcomes of patients younger than six months of age with developmental dysplasia of the hip (DDH) managed by either a Pavlik harness or Tübingen hip flexion splint.

Aims

Complex joint fractures of the lower extremity are often accompanied by soft-tissue swelling and are associated with prolonged hospitalization and soft-tissue complications. The aim of the study was to evaluate the effect of vascular impulse technology (VIT) on soft-tissue conditioning in comparison with conventional elevation.

Aims

The aim of the present study was to answer the question whether curve morphology and location have an influence on rigid conservative treatment in patients with adolescent idiopathic scoliosis (AIS).

Aims

To compare changes in gait kinematics and walking speed 24 months after conventional (C-MLS) and minimally invasive (MI-MLS) multilevel surgery for children with diplegic cerebral palsy (CP).