The frame described has a place in the treatment of congenital dislocation of the hip especially if the diagnosis is not made until after the age of one year. Analysis of comparable series of hips reduced on the frame and by manipulation shows that dysplasia of the femoral head is decidedly commoner after the manipulative method

Congenital convex pes valgus (congenital vertical talus) is a rare condition. We reviewed ten feet in seven patients who had had surgical correction. All had been operated on by the senior author (JF) and the same surgical technique was used throughout, incorporating transfer of the tibialis anterior to the neck of the talus. The mean age at surgery was 31 months and the mean follow-up was nine years (6 to 14). All patients completed a questionnaire and had clinical, radiological and photographic evaluation performed by an independent examiner. None had required further surgery. All but one were satisfied with the result, and had no functional limitations. They all wore normal shoes. The mean ankle dorsiflexion was 17° and plantar flexion 21°. The mean arc of subtalar motion was 27°. All radiological parameters measured were within the normal range, although irregularity of the talonavicular joint was common. No avascular necrosis of the body of the talus was seen. We conclude that the medium-term results of this procedure are very satisfactory

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

The incidence of congenital dislocation of the hip in 156 children with infantile idiopathic scoliosis was 6.4 per cent, approximately 10 times its frequency in the general population. In both of these deformities there was a predominance of girls (eight girls: two boys). In unilateral dislocation of the hip the convexity of the thoracic scoliosis was on the same side as the dislocation. Eight out of the 10 children with both deformities also had plagiocephaly

1. The indications for open reduction in congenital dislocation of the hip are discussed. 2. The technique of the operation and the post-operative treatment are briefly described. 3. The results of the operation in fifty hips are presented. 4. The function and the radiographic appearances of the hip were usually good in the early years after open reduction, but there was a marked tendency to deterioration ten to thirteen years afterwards. 5. The indications for the shelf operation and for rotation osteotomy after open reduction are discussed

The operative technique for combined fusion of the knee and rotationplasty of the limb in the management of congenital deficiency of the femur is presented. The technique described allows earlier definitive prosthetic fitting of a child with proximal femoral deficiency; it has reduced the number of operative procedures needed to obtain the optimal function from that deficient limb; and it has enabled these procedures to be performed at an earlier age. The technique differs from those previously described and represents a significant improvement in management of the patient with femoral deficiency

A retrospective study of the development of the hip opposite a congenitally dislocated hip was carried out to identify at an early age those hips which would develop abnormally. Recognised radiological measurements were used showing the development of the joints with age. The development was compared with that of a control group of normal hips. Single measurements were shown to be unreliable in predicting the development of the hip. A simple hip ratio is proposed which predicts, at an early age and with a high degree of accuracy, the developmental outcome

1. A method of treatment of the congenitally dislocated hip is described. 2. The rationale of the treatment is considered. 3. The subsequent development of the hip generally, and of its individual components, is described. 4. Comparison between the results of other methods of treatment and of this method is not attempted for reasons stated. 5. The advantages of a shortened period of splintage are discussed. 6. The state of fifty completely dislocated hips treated consecutively is described at the end of a follow-up period of from three to seven and a half years

1. The cases of six Chinese children affected by so-called congenital fibrosis of the vastus intermedius muscle are described. The reasons for the choice of name are discussed. 2. Reasons for early operation are put forward: in young children simple division of the tendon of the vastus intermedius is adequate. 3. With increasing age severe changes in all the joint tissues occur, notably in the articular cartilage of the patella. These changes are likely to vitiate the result after operation. 4. The importance of getting as much flexion as possible in children of Asiatic race is stressed

We describe 95 patients with previously treated congenital dislocation of the hip who underwent femoral osteotomy after the age of five years. The commonest indication for surgery was progressive uncovering and subluxation of the femoral head; other reasons were coxa vara, long leg dysplasia and persistent anteversion. Femoral osteotomy for uncovering of the femoral head (Severin Grade III) in this age group gave good results at maturity only when the acetabular angle was less than 25 degrees before operation. Femoral osteotomy alone was inadequate for true subluxation of the hip (Severin Grade IV)

1. Congenital vertical talus is described and the criteria for diagnosis are emphasised. The need for its distinction from other forms of convex pes valgus is stressed. 2. The operative technique of Stone for Lloyd-Roberts (1963) is detailed and the results of seven such operations are examined. 3. Departure from the technique in any respect has resulted in an unsatisfactory outcome, whereas stringent observation of the operative details has resulted in uniformly good results in four patients. 4. Certain aspects of diagnosis, differential diagnosis, etiology, pathology and surgical management are discussed, together with a review of some of the relevant literature

The exact measurement of femoral head cover is essential for an assessment of reduction of congenital dislocation of the hip. We have compared standard anteroposterior radiographs with computerised tomograms and thereby classified the shape of the acetabular roof into four types. We found that the CE angle of Wiberg is a more reliable measure of head cover when the lateral point of bony condensation of the roof is chosen as the reference point rather than the edge of the bone, where these two points do not overlap. We conclude that head cover can be more accurately determined in younger children with dysplastic hips by our 'refined' CE angle, than by the original method of Wiberg

We performed one-stage lengthening using intercalary autogenous bone graft in 34 metatarsals and seven proximal phalanges in 21 patients with congenitally short metatarsals. At operation, in order to decrease the tension in the surrounding soft tissues, we gradually distracted the osteotomies of the affected bones for 20 to 30 minutes. The patients, all women, were followed up for a mean period of 2.1 years (1 to 6.5). The average gain in length for the 34 metatarsal procedures was 14 mm (6 to 21), equivalent to an increase of 32% (11 to 51), and for the seven proximal phalangeal lengthenings 8 mm (5 to 11), an increase of 54% (47 to 65). There was no evidence of neurovascular impairment. The technique of gradual distraction during operation is simple and effective. It overcomes the disadvantages of one-stage lengthening such as a small gain in length and neurovascular damage

In 1957 Somerville and Scott described their "direct approach" to the management of established congenital dislocation of the hip; arthrography after a period of traction served to distinguish the dislocated from the subluxated hip. We review the long-term outcome of hips which, using their criteria, were subluxated; 72 hips have been reviewed at periods ranging from 15 to 37 years after treatment by traction, closed reduction and femoral osteotomy. The results have been classified clinically and radiologically according to Severin's criteria. There was progressive deterioration with age in both clinical function and radiographic appearance: 48.5% of hips showed evidence of dysplasia or subluxation at review. The results are similar to those found in a series treated by open reduction and limbectomy, differing only in the much lower incidence of degenerative changes after closed reduction

1. Congenital defects of the extremities are described. Although the detailed anatomy is infinitely variable, a broad classification in relation to prosthetic management has been suggested. 2. Most patients with these deformities can be fitted with a prosthesis without major surgical intervention. With this they will have at least as good function as they would have after amputation. A plea is made for a conservative attitude in this respect. It is suggested that recourse to amputation should be confined to cases in which prosthetic equipment falls short of functional and cosmetic requirements, and that, when possible, it should be deferred until the child is old enough to share in the decision. 3. The prostheses applicable to the various types of deformity are briefly described. 4. The application of similar techniques to cases of acquired shortening is mentioned. 5. The incorporation of certain features of artificial arms in flail arm splints is discussed

The term developmental dysplasia of the hip (DDH) describes a spectrum of disorders that results in abnormal development of the hip joint. If not treated successfully in childhood, these patients may go on to develop hip symptoms and/or secondary osteoarthritis in adulthood. In this review we describe the altered anatomy encountered in adults with DDH along with the management options, and the challenges associated with hip arthroscopy, osteotomies and arthroplasty for the treatment of DDH in young adults.

Cite this article: Bone Joint J 2013;95-B:732–7.

1. The results of treatment of 134 patients with congenital dislocation of 167 hips are reviewed. 2. Late diagnosis is still a major problem. 3. Subluxations rarely give rise to poor results, but in dislocations first treated over the age of five years there is a one-in-three risk of failure. 4. Manipulative reduction is successful less often than reduction on a frame and carries a higher risk of avascular necrosis. 5. Closed reduction on a frame was satisfactory in 58 per cent of patients under the age of three years, and can succeed up to the age of five. 6. Open reduction was required in 20 per cent of cases under the age of three, and can be used successfully up to the age of six. 7. Seven anatomical barriers to closed reduction have been recognised and two or more are commonly found in one hip when open reduction is performed. 8. The acetabular roof may fail to develop after reduction, especially if this is delayed. A C.E. angle of under 20 degrees does not necessarily forebode this, unless measured on an arthrograph. Sclerosis of a sloping acetabular roof is an indication for operation. Acetabuloplasty is the proper operation for a sloping acetabulum and can be done successfully up to the age of twelve. Over this age, a shelf operation should be performed; this is appropriate also in younger patients in whom the curvature of the acetabulum is normal but does not extend far enough laterally. These operations were required in 38 per cent of hips treated in patients under the age of three, and in 64 per cent over this age. There is a one-in-three risk of avascular necrosis when acetabular reconstruction is done in patients under three. 9. Anteversion, if excessive, should be corrected by subtrochanteric osteotomy, and any valgus of the femoral neck should be corrected simultaneously. 10. Unilateral dislocations in patients over the age of six are best treated by Colonna's operation. In our few bilateral cases over this age our results have been disappointing. 11. Avascular necrosis is less common but more serious when it occurs over the age of three. Manipulative reduction and the use of frog-leg plasters are two avoidable factors which appear to increase its incidence. The more serious degrees are accompanied by stiffness of the hip, and when this sign is present weight bearing should be avoided. 12. Prolonged, though rarely permanent, limitation of movement occurs in some 10 per cent of cases. In a few, operative correction was required

A bilateral congenital abnormality of the trapezium and first metacarpal is described. The condition may be related to abnormal ossification of the trapezium in accordance with Pfitzner's plan. It is quite distinct from osteoarthritis of the trapezio-metacarpal joints

1. A case of congenital arteriovenous aneurysm involving the left femur, with dangerous cystic changes in the shaft of the bone, is described. 2. After ligation of the anastomosing fistulae the radiological appearance of the femur became normal

Congenital anomalous bands of the extremities are variable in position, depth, and in the completeness of their encirclement. They represent one of a group of abnormalities which are often present in the same individual. Cases associated with gross lymphoedema are rare. The treatment of such a case is presented