The aim of this pilot study was to evaluate the accuracy of two different methods of navigated retrograde drilling of talar lesions. Artificial osteochondral talar lesions were created in 14 cadaver lower limbs. Two methods of navigated drilling were evaluated by one examiner. Navigated Iso-C. 3D. was used in seven cadavers and 2D fluoroscopy-based navigation in the remaining seven. Of 14 talar lesions, 12 were successfully targeted by navigated drilling. In both cases of inaccurate targeting the 2D fluoroscopy-based navigation was used, missing lesions by 3 mm and 5 mm, respectively. The mean radiation time was increased using Iso-C. 3D. navigation (23 s; 22 to 24) compared with 2D fluoroscopy-based navigation (14 s, 11 to 17)

1. A case is described of bilateral congenital contracture of the ilio-tibial bands in a healthy girl of ten months. 2. With the hips extended each lower limb was held in about 25 degrees of fixed abduction. 3. Division of the ilio-tibial bands abolished the abduction contractures

1. The case is reported of a girl born by normal delivery whose right lower limb showed reduplication of the femur below the single femoral head. 2. The tibia was absent but the ossific centres in the foot appeared to be normal. We are grateful to Processor Robert Roeaf for permission to publish details of this patient

Objectives

X-linked hypophosphataemic rickets (XLHR) is a disease of impaired bone mineralization characterized by hypophosphataemia caused by renal phosphate wasting. The main clinical manifestations of the disorder are O-shaped legs, X-shaped legs, delayed growth, and bone pain. XLHR is the most common inheritable form of rickets, with an incidence of 1/20 000 in humans. It accounts for approximately 80% of familial cases of hypophosphataemia and serves as the prototype of defective tubular phosphate (PO4³⁺) transport, due to extra renal defects resulting in unregulated FGF23 activity. XLHR is caused by loss-of-function mutations in the PHEX gene. The aim of this research was to identify the genetic defect responsible for familial hypophosphataemic rickets in a four-generation Chinese Han pedigree and to analyze the function of this mutation.

We studied 16 hips (eight cadaver specimens) using arthrography, arthroscopy and anatomical dissection, under incremental traction of up to a maximum of 64 kg, to determine the relationship of the portals to nearby neurovascular structures. The distance of each arthroscopic portal (anterior, anterolateral, and posterolateral) to the associated neurovascular structures was measured after the application of 23 kg of traction. Traction of up to 64 kg on the lower limb failed to produce evidence of labral or capsular injury. Furthermore, traction of 23 kg resulted in little change in the position of adjacent neurovascular structures relative to the standard arthroscopic portals

1. Five cases of fibrosarcoma arising after radiotherapy in cases of ankylosing spondylitis are reported. 2. The relationship of the tumours to irradiation is discussed. 3. Objective neurological signs arising in the lower limbs of patients with ankylosing spondylitis after a latent period following radiotherapy may indicate an underlying sarcoma

Aims

The aim of this study was to report our experience at 3.5 years with outpatient total hip arthroplasty (THA).

1. The results are reported of a series of operations designed to stimulate growth of the bones of the lower limb by the insertion of pegs of bone or ivory close to the epiphysial cartilage. 2. The evidence is that growth was stimulated in twelve of twenty-eight patients. 3. Growth is more likely to be stimulated if the operation is done on children between the chronological ages of six and twelve

1 . The extraordinary background and circumstances of discovery of a man, aged fifty, the subject of the rare congenital anomaly of posterior dichotomy, taking the form of a hemipelvis and complete lower limb is reported. 2. The appendage is described and illustrated. 3. Investigations and treatment are described and the result illustrated. 4. Reference is made to previous recorded cases in the literature

A patient with polyostotic fibrous dysplasia had several fractures of the right lower limb. An above-knee amputation was eventually performed, followed by arthrodesis of the hip. Five years later the stump became painful and swelled with dramatic rapidity. Biopsy showed that this was not due to malignant change, but that an aneurysmal bone cyst had developed in association with the fibrous dysplasia

1. The knee-chest position offers the surgeon excellent conditions for operations on lumbar intervertebral discs. 2. Hypotension on resumption of the prone or supine position is common: it is influenced by the anaesthetic technique, the physical state of the patient, the operation time and the extent of surgical bleeding. 3. The hypotension is thought to be due to poor perfusion of the lower limbs while the patient is in the knee-chest position

Five children with chronic renal failure and severe rachitic deformities of the lower limbs were treated with 1 alpha-hydroxyvitamin D (1 alpha-OHD3) for 16 to 53 months. There was symptomatic, biochemical and radiological improvement in all five children and operative correction of their deformities was not needed. We recommend a trial of treatment with 1 alpha-OHD3 for this condition before surgical procedures

Radiography and CT and MRI scans of the lumbar spine were performed in young patients complaining of pain during extension of the lumbar spine but without neurological signs in the lower limbs. T1-weighted MR images in the coronal plane showed a hypo-intense area in the pars interarticularis before the detection of spondylolysis at that site by plain radiography or CT. We suggest that this may be useful in the early diagnosis of spondylolysis

Adults with deformities of the lower limb due to spasticity may be considerably improved by operation, but thorough pre-operative assessment as an inpatient is essential in order to pinpoint the disability. The commonest deformity is equinovarus which often responds to simple operative procedures. The results of seventy-seven operative procedures in fifty patients are recorded. Correction once achieved is stable and the deformity does not recur

Aims

Commonly performed unicompartmental knee arthroplasty (UKA) is not designed for the lateral compartment. Additionally, the anatomical medial and lateral tibial plateaus have asymmetrical geometries, with a slightly dished medial plateau and a convex lateral plateau. Therefore, this study aims to investigate the native knee kinematics with respect to the tibial insert design corresponding to the lateral femoral component.

The clinical and radiological features of 12 knees (10 patients) with congenital absence of the anterior cruciate ligament are presented. The high frequency of this condition in association with other more easily recognised congenital abnormalities of the knee is discussed. It is concluded that congenital absence of the anterior cruciate ligament is more common than generally suspected and is associated with other developmental abnormalities of both bone and soft tissue in the lower limb, particularly around the knee joint

In this retrospective study, we analysed the clinical features of neurilemoma when it is located in muscle. Twelve patients had an intramuscular neurilemoma as shown on magnetic resonance (MR) scans and confirmed at operation. In six it was located in the upper limb, in five in the lower limb, and in one in the back. The mean age of the patients was 41 years (12 to 58). Nine complained only of a palpable mass and the other three of a mass with slight tenderness. None had neurological symptoms or signs, such as radicular pain, a positive Tinel sign, or motor weakness. There were no postoperative complications or recurrence of the tumour after a mean follow-up of two years (1 to 10)

Aims

This study of patients with osteoarthritis (OA) of the hip aimed to: 1) characterize the contribution of the hip, spinopelvic complex, and lumbar spine when moving from the standing to the sitting position; 2) assess whether abnormal spinopelvic mobility is associated with worse symptoms; and 3) identify whether spinopelvic mobility can be predicted from static anatomical radiological parameters.

A diastasis between the femoral head and the acetabulum can be achieved for a short while by the application of manual traction on the lower extremity. The intra-articular low-pressure area can be visualised radiographically and is known as a "vacuum phenomenon". The resulting arthrogram clearly outlines the shape, thickness and extent of the cartilage. In the presence of an effusion the diastasis occurs without a vacuum phenomenon. This simple, non-invasive and inoffensive method of traction radiography will not only show abnormalities of the cartilage but also demonstrate the presence or absence of an effusion of the hip

Experiments have been carried out on rhesus monkeys to determine the effect of the application of a pneumatic tourniquet on the ultrastructure of the muscles of the lower limb. Tourniquets were applied for periods lasting between one and five hours. The changes in the muscle lying immediately under the cuff of the tourniquet were more marked than those observed in muscle distal to the cuff. Three hours appears to be close to the limit of the time that a muscle can resist the sustained compression of a tourniquet