A radiographic method is described for making the diagnosis of talo-navicular subluxation before ossification of the navicular bone occurs. Seven basic combinations of deformities are thought to occur in the club foot. Radiography before operation enables the surgeon to determine which of these combinations exists in a particular foot, and radiography during operation enables him to determine wheter or not all the existing deformities have been corrected, and therefore whether or not the operation must be extended

1. The cases of four children who presented with bowing or pseudarthrosis of the fibula only, are described. 2. There is a gradation in the severity and significance of this condition. There may be fibular bowing without fibular pseudarthrosis; fibular pseudarthrosis without ankle deformity; fibular pseudarthrosis with deformity but without the late development of tibial pseudarthrosis; or fibular pseudarthrosis with the late development of tibial pseudarthrosis. 3. Proper management is dependent on a knowledge of this range of conditions

Premature epiphysial fusion is a common complication of injury of the capitulum in childhood and sometimes results in valgus deformity. Premature fusion can either follow the normal pattern of fusion, perhaps being accelerated on the capitular side, or it can be confined to the capitulum and metaphysis. An optimistic prognosis with regard to valgus deformity and the possible onset of ulnar neuritis cannot be made in view of this complication, even in the undisplaced or perfectly reduced and immobilised cases

Eighteen patients (34 feet) with arthrogryposis multiplex congenita treated by talectomy for rigid equinovarus deformity were reviewed. The average follow-up was 11 years. Twenty-four feet (71%) were considered satisfactory; the remainder were improved. Seven feet required further operations to correct recurrence of the deformity, but finally all could be fitted with boots or shoes and all patients could walk. The history of talectomy is reviewed and the operative details described

Sixty-six deformities of the foot and ankle in forty-two patients with arthrogryposis multiplex congenita were reviewd. Pes equinovarus proved particularly difficult to treat as there was a tendency for the deformity to recur because of the thick and rigid capsule. Intracapsular procedures were more successful than those done adjacent to the joint. Wide capsulotomy or talectomy were the best procedures under the age of three years and triple arthordesis was most successful for the older child

A retrospective survey has been made of forty children with spinal tumours. Difficulties in establishing the correct diagnosis are mentioned and the value of radiological and cerebrospinal fluid investigations discussed. The major orthopaedic disabilities are spinal deformity or instability, and paraplegia. The main factor in the development of the former is the site of laminectomy: the higher the level the greater is the likelihood of deformity or instability developing. Measures to prevent this distressing complication are discussed. The role of the orthopaedic surgeon in the management of these children is emphasised

Eleven patients with arthrogryposis multiplex congenita neurologica have been reviewed. Distinct patterns of deformity and muscle activity were identified which have been correlated with specific levels of segmental neurological motor deficit without sensory loss. The clinical picture was consistent with localised lesions of the anterior horn cell cell columns. This finding agreed with the recorded pathological lesions. Orthopaedic treatment should take account of the paralytic nature of the deformities

Between 1990 and 1996 we performed 20 consecutive ulnohumeral arthroplasties for primary osteoarthritis of the elbow. The outcome was assessed using the Disabilities of Arm, Shoulder and Hand Score (DASH) and the Mayo Elbow Performance Score (MEPS) at a mean follow-up of 75 months (58 to 132). There were excellent or good results in 17 elbows (85%) using the DASH score and in 13 (65%) with the MEPS (correlation coefficient 0.79). The mean fixed flexion deformity had improved by 10° and the range of flexion by a mean of 20°. In 16 elbows (80%) the benefits of surgery had been maintained, and of 16 patients working at the time of operation, 12 (75%) had returned to the same job. There was no correlation between radiological recurrence of degenerative changes and the amount of fixed flexion deformity, the flexion arc, or the elbow scores

In two years we treated four women with ununited stress fractures of their proximal tibial diaphyses. They all had arthritis and valgus deformity. The stress fractures had been treated elsewhere by non-operative means in three patients and by open reduction and internal fixation in one, but had failed to unite. After treatment with a modular total knee prosthesis with a long tibial stem extension, all the fractures united. A modular total knee prosthesis is suitable for the rare and difficult problem of ununited tibial stress fractures in patients with deformed arthritic knees since it corrects the deformity and the adverse biomechanics at the fracture site, stabilises the fracture and treats the arthritis

The results of triple arthrodesis performed in 80 feet and followed for an average of 13 years are reviewed. Although the majority of patients were very pleased, the results of objective assessment were less favourable. There was a high incidence of degenerative joint changes in the ankle and midfoot and also of pseudarthrosis, avascular necrosis of the talus and residual deformity. Pre-operative rigid equinovarus deformity produced the majority of the poor results. It is suggested that bony resection alone might not be the best means of correcting severe equinus

Transfer of flexor carpi ulnaris combined with selective release of the flexor pronator origin was undertaken in 35 patients with hemiplegic cerebral palsy for a pronation flexion deformity of the forearm, hand and wrist. The patients were divided into four groups depending on the severity of the deformity, the surgical procedure recommended, potential hand function and prognosis. The procedure reduces the power of wrist and finger flexion by release of the flexor pronator origin, and reinforces the strength of extension and supination of the wrist by transfer of flexor carpi ulnaris. After a mean follow-up of four years the appearance of the hand and forearm improved in all patients. None lost movement and all gained improved mobility of the forearm, wrist and hand. There was no overcorrection

1. Twenty-eight cases of the infantile and three cases of the adolescent type of tibia vara occurring in West Indian Negroes are reported. 2. The condition is characterised by failure of growth of the postero-medial part of the upper tibial epiphysis. 3. The deformity produced is acute varus at the upper tibia with medial torsion and eventually flexion of the diaphysis on the epiphysis. 4. These deformities are considered to be due to a vicious circle set up by considerable alteration of the lines of force on the medial portion of the upper tibial epiphysial line

1. The condition of persistent foetal alignment is discussed both as an entity and in its relationship to the development of a normal hip, and also to the varying degrees of congenital dislocation of the hip. A possible connection with osteoarthritis is also mentioned. 2. The secondary deformities to which it may give rise are discussed, and the way in which both primary and secondary deformities may be corrected is described. 3. The importance of estimating rotation with the hip in full extension is emphasised. 4. The results in eight patients so treated are mentioned

Although supracondylar fracture is a very common elbow injury in childhood, there is no consensus on the timing of surgery, approach for open reduction and positioning of fixation wires. We report our ten-year experience between 1993 and 2003 in 291 children. Most fractures (285; 98%) were extension injuries, mainly Gartland types II (73; 25%) and III (163; 56%). Six (2%) were open fractures and a neurovascular deficit was seen in 12 (4%) patients. Of the 236 children (81%) who required an operation, 181 (77%) were taken to theatre on the day of admission. Most (177; 75%) of the operations were performed by specialist registrars. Fixation was by crossed Kirschner wires in 158 of 186 (85%) patients and open reduction was necessary in 52 (22%). A post-operative neurological deficit was seen in nine patients (4%) and three (1%) required exploration of the ulnar nerve. Only 22 (4%) patients had a long-term deformity, nine (3%) from malreduction and three (1%) because of growth arrest, but corrective surgery for functional limitation was required in only three (1%) patients

We report the management of the acquired claw-toe deformity in ten adults. Each patient developed a varying number of claw toes at a mean interval of six months after the time of injury. There was clinical evidence of an acute compartment syndrome in one case. The clawing occurred at the start of heel-rise in the stance phase of gait. At this stage the patients complained of increasing pain and pressure on the tips of the toes. The deformities were corrected by lengthening flexor hallucis longus and flexor digitorum longus alone or in combination. The presence of variable intertendinous digitations between the tendons of flexor hallucis longus and flexor digitorum longus means that in some cases release of flexor hallucis longus alone may correct clawing of lesser toes

We reviewed 10 patients with symptomatic malunion of a carpal scaphoid fracture. All had displacement with dorsiflexed intercalated segment instability, and suffered from pain, restricted range of movement at the wrist and decreased grip strength. The restriction of flexion-extension and the decreased grip strength correlated with the severity of the DISI deformity. Seven patients had a corrective osteotomy, using an anterior wedge-shape bone graft with internal fixation by Herbert screw, and all had satisfactory results. We believe that symptoms associated with scaphoid malunion are related to consequent carpal deformity

It is difficult to determine the safe timing of weight-bearing or reconstructive surgery in patients with Charcot arthropathy of the foot and ankle. In this study the Doppler spectrum of the first dorsal metatarsal artery was used to monitor the activity of the disease activity and served as a guideline for management. A total of 15 patients (seven men and eight women) with acute diabetic Charcot arthropathy of the foot and ankle were immobilised in a non-weight-bearing cast. They were followed at two-week intervals and bilateral Doppler spectra of the first dorsal metatarsal arteries were obtained using a 10 MHz linear ultrasound probe. The patients were allowed to start weight-bearing or undergo surgery after the Doppler spectrum had returned to normal pattern. The Doppler spectra in the unaffected limbs were triphasic in pattern, whereas those in limbs with active Charcot arthropathy showed monophasic forward flow. They returned to normal after a mean of 13.6 weeks (6 to 20) of immobilisation. Three patients underwent pan-talar arthrodesis to correct gross instability and deformity. Doppler spectrum analysis of the foot may reflect the activity of the disease in patients with Charcot arthropathy, and may be used as a guide to begin weight-bearing or undergo reconstructive surgery

1. "Reed" osteotomy has proved a satisfactory method for the correction of torsional deformity of the tibia and of associated minor varus or valgus deformity. 2. It is an "osteotomy in continuity" and maintains stability of the bone. 3. The position of the limb may be adjusted at the first change of plaster. 4. Three cases of non-union occurred in thirty-eight operations. 5. The operation should not be done on adults. Perhaps it may be wise to reserve it for even younger patients because its success depends on the pliability of cortical bone, which rapidly diminishes with increasing age