Aims

The aim of this study was to describe, analyze, and compare the survival, functional outcome, and complications of minimally invasive (MI) and non-invasive (NI) lengthening total femoral prostheses.

We have treated seven children with relapsed infantile Blount’s disease by elevation of the hemiplateau using the Ilizarov frame. Three boys and four girls with a mean age of 10.5 years were reviewed at a mean of 29 months after surgery. All had improved considerably and were pleased with the results. The improvements in radiological measurements were statistically significant (p < 0.001). Three-dimensional CT reconstruction was useful for planning surgery. There were no major complications. The advantages of this technique are that in addition to elevation of the hemiplateau, rotational deformities and limb-length discrepancies may be addressed

Forty-four children, treated conservatively for fracture of the shaft of a femur, were studied radiographically to assess the consequent increase in longitudinal growth of the bone. Overgrowth averaged 8.1 mm and was shown to be significantly greater in boys than in girls. Overgrowth did not appear to be influenced by the age of the patient, the type of injury, the type or site of the fracture, the amount of overlap of the fragments or by the handedness of the patient

Thirty hips affected by congenital dislocation or subluxation underwent surgical treatment between the ages of five and fifteen years, and the results are presented. Reduction was aided by concurrent femoral shortening in seventeen. An aggressive approach in older children not only relieves the presenting symptoms in most, but also, by improving the anatomical relationships, increases the prospect of success should total replacement become indicated in the future

Eight children with missed Monteggia fracture-dislocations are described. Seven had reconstructive surgery which included resection of scar tissue from the radiohumeral joint, proximal ulnar osteotomy, reduction of the radial head and reconstruction of the annular ligament. One had excision of the radial head. Excellent results were obtained in patients under ten years of age, up to four years after the initial injury

In a population-based study we identified a cohort of 282 women, whose children had been treated for osteoarthritis of the hip. The incidence of hip fracture in these mothers was 0.54 (95% CI 0.35 to 0.83) of that in the whole population of their age and sex. This finding could be explained by a genetic factor for increased rigidity of subchondral bone, making osteoarthritis more likely and osteoporosis less likely

1. Methods of correcting flexion contractures of the knee following poliomyelitis fail if posterior subluxation of the tibia is allowed to occur. 2. Careful serial manipulations will give straight, congruous joints in younger patients. Posterior capsulotomy does not facilitate correction. 3. Supracondylar femoral osteotomy is indicated in children over fifteen and in adults, although sometimes arthrodesis of the knee is necessary

1. An operation suitable for the correction of hallux valgus in adolescents is described. 2. The results of thirty-three operations performed in children between the ages of nine and eighteen years are analysed. 3. Twenty-six operations are considered to have produced a good result, four a moderate result, and three a poor result. 4. It is suggested that the operation is best performed between the ages of eleven and fifteen years

Fresh-frozen allografts from the humerus were used to help to stabilise the spine after anterior decompression for tuberculosis in 47 children with a mean age of 4.2 years (2 to 9). The average angle of the gibbus, before operation, was 53°; at follow-up, two years later, it was 15°. Rejection of the graft or deep sepsis was not seen. Cross trabeculation between the allograft and the vertebral body was observed at six months, with remodelling occurring at approximately 30 months

We have reviewed 82 children with congenital dislocation of the hip, after treatment by anterior open reduction followed by derotation femoral osteotomy. The clinical and radiological results were significantly better in the group that had open reduction before the appearance of the capital femoral epiphysis; this group also had a lower incidence of avascular necrosis. We conclude that, when it is clearly indicated, the earlier an open reduction is carried out the better the results

In four children with primary subacute osteomyelitis of the talus seen one to five months from the onset of symptoms, the only constant complaints were of pain and a limp. All four were treated by curettage, immobilisation in plaster and appropriate antibiotics. All the bony cavities were healed within eight months of the operation and there were no growth disturbances nor any abnormalities of the adjacent joints

1. Nine cases of traumatic dislocation of the hip in children have been reviewed. 2. There was one instance of avascular necrosis of the femoral head, which became apparent six months after injury. 3. In one case fracture of the femur on the same side led to four days' delay in recognition and treatment of the dislocation. 4. At the time of review all patients were free from symptoms

1. The indications for ischio-femoral arthrodesis are considered. 2. The technique of operation through an open posterior approach is described. 3. Indications for the modified Trumble operation are given. 4. The results of ischio-femoral arthrodesis in a series of forty-seven patients (mostly suffering from tuberculous hip disease) are presented. 5. The writers consider that ischio-femoral arthrodesis is the operation of choice in tuberculous disease of the hip, especially in children

We report the arthroscopic drilling of classical lesions of osteochondritis dissecans in 11 knees in 10 children with at least six months history and no sign of clinical or radiological improvement. There were eight boys and two girls and the average age at operation was 12 years 11 months. Relief of pain was noticed within days of operation; radiological healing occurred within 12 months in nine of the 11 knees

Simultaneous dislocation of the elbow and the proximal radio-ulnar joint is rare. Two children with this uncommon injury are reported. One child had a transverse divergent dislocation that was treated successfully by closed reduction. The other had a convergent dislocation (or translocation of the radius and ulna) which needed open reduction. Convergent dislocation is even rarer than transverse divergent dislocation, and this is believed to be the first time it has been reported

We describe 11 children with fibular hypoplasia and three- or four-ray feet, two bilaterally. This deformity is a less severe form of the better known congenital short tibia with absent or dysplastic fibula. If the leg-length discrepancy is minor, no treatment or a simple orthosis are used. Epiphysiodesis or leg lengthening by callotasis is appropriate for mild to moderate discrepancy. If the foot is non-functional, or the projected leg-length discrepancy is too great, early amputation and a prosthesis are advised

Eight children with paralytic drop foot after intramuscular injections later developed gluteal fibrosis. Sciatic palsy, presenting as equinovarus or equinus deformity, was diagnosed on average 3.8 months after the intragluteal injections, but gluteal fibrosis was not diagnosed until 5.1 years after the injections. In three patients the equinovarus recurred after surgical correction due to persistent muscle imbalance and the effect of the external rotation contracture of the hip

Joint deformity secondary to extensive haemangiomatous involvement of the soft tissues has been well described and is easy to diagnose. If the haemangioma is small, localised and within the belly of a muscle the diagnosis is more difficult. In equinus deformity of obscure aetiology localised calf tenderness may be the only diagnostic sign. Three children with equinus deformity caused by a small haemangioma in the calf muscles were treated by simple excision with satisfactory results

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

1. A group of children with congenital malformations of the lower back involving the spinal cord or nerve roots is described. The malformations have little or no resemblance to spinal rachischisis, either embryologically or clinically. The lesions found are often complex. 2. It is considered from clinical and operative findings that the malformations are, in many patients, responsible for increasing neural damage in childhood and even in later life. 3. Early investigation and operative treatment are recommended