Congenital vertical talus was diagnosed in 15 feet of 10 children, and was treated by operative reduction. Forefoot deformity was corrected first, using anterolateral soft-tissue release on 11 feet, and manipulation alone in four feet. After prolonged immobilisation in plaster the affected feet had posterior release at the ankle and elongation of the calcaneal tendon. Clinical and radiographic examination at follow-up 15 months to 21 years later showed that a satisfactory outcome had been achieved in 12 of the 15 feet

1. A review of intra-articular and peri-articular fractures of the phalanges has been carried out, and the late results of such injuries have been examined. 2. These fractures usually unite by bone. 3. The results of conservative treatment by immobilisation are satisfactory in the case of mallet fractures, hyperextension sprain fractures and collateral avulsion fractures of the proximal phalanges. 4. The less satisfactory results after collateral avulsion fractures of the interphalangeal joints and avulsion fractures complicating dislocations are discussed

We performed 45 wrist arthrodeses in 43 patients by a modification of the AO technique using the dynamic compression plate. Radiological follow-up was obtained in 41 wrists; all had united at a mean of ten weeks. Clinical follow-up was obtained in 32 wrists. Subjectively, the surgical outcome was satisfactory in 26, marginally satisfactory in two and unsatisfactory in four. This method is safe and reliable. The plate can be contoured to allow a variety of positions of fusion, and gives rigid immobilisation. The rate of union is higher than that for other techniques

Between March 1987 and March 1997, we performed a modified Thompson quadricepsplasty on 20 stiff knees and followed the patients for a mean of 35 months (24 to 52). After the operation, the knee was immobilised in flexion and periodically extended. At the final follow-up, the mean active flexion was 113.5° (75 to 150). The final mean gain in movement was 67.6° (5 to 105). One patient had a deep infection which resolved after wound care and intravenous antibiotics. The modified Thompson quadricepsplasty with appropriate postoperative care can give good results

1. The results of compression arthrodesis of the ankle performed on fifty-five patients (four bilateral) are presented. 2. Fifty per cent of these ankles were immobilised for a total period of no more than eight weeks. 3. Bony fusion occurred in 91 per cent. 4. The subjective result was good or excellent in 88 per cent. 5. The theoretical disadvantages of the transverse incision are not serious in practice. 6. The best position for arthrodesis of the ankle is at, or close to, the right angle

Fractures of the proximal forearm in young children may be unstable with the elbow flexed but stable with it in extension. Fifteen such fractures were managed by immobilisation in long-arm casts with the elbow extended. Only one patient had more than 15 degrees angulation at the time of bony union. All obtained normal elbow movement at two weeks and full forearm rotation at follow-up. No casts fell off. The extended elbow cast is awkward but it provides an alternative to internal fixation for some unstable fractures

We have reviewed 22 patients with scaphoid fractures treated by internal fixation with the Herbert screw. Three patients had trans-scaphoid perilunar dislocations, one had an oblique displaced fracture of the waist of the scaphoid and 18 had fractures with delayed or non-union. Corticocancellous bone grafts were added in nine of the cases of non-union. Results were excellent or good in 80% of cases after a mean duration of postoperative immobilisation of four weeks. The technical difficulties are analysed and the problems of applying the jig and of operative exposure are discussed

The results of vascularised rib graft transfers are analysed in 25 patients followed up for more than two years (average 34 months). Radiographs showed early and rapid incorporation of the grafts in 4 to 16 weeks (average 8.5 weeks); external immobilisation averaged 11 weeks (range 5 to 24 weeks). The technique seems a useful alternative to allografts or homografts employing an avascular rib or fibula since it promotes rapid healing without needing microsurgical techniques

A patient with recurrent dislocation of the hip is described. The initial injury had been a posterior dislocation without associated fracture of the acetabular wall, and the hip had not been immobilised or protected from weight-bearing during treatment. Exploration of the hip for recurrence revealed disruption of the posterosuperior acetabular labrum with formation of a pouch between the posterior acetabular wall and the short rotator muscles. We have found no previous report of this lesion, which resembles a Bankart lesion of the shoulder. Repair using a bone block is described

1. Haemophilic cysts are a rare but serious complication of bleeding ilito the musculo-skeletal system. Five cases are reported. 2. The cysts may arise from bleeding into muscle, under periosteum, or into bone. 3. In early cases conservative treatment by immobilisation and replacement therapy should produce resolution. 4. When alarming increase in size or progressive neurovascular compression occurs, excision of the cyst or amputation should be carried out to prevent the dangerous consequences of rupture, sinus formation or chronic infection

Spasm or contracture of gastrocnemius causes an equinus deformity of the ankle in both cerebral palsy and hemiplegia. Its release is therefore required in the treatment of those patients who do not respond to conservative measures. The Vulpius procedure is a simple and effective method for the release of gastrocnemius and is particularly indicated when long periods of immobilisation of the foot and ankle are not desirable. We have used this procedure with good results to correct an equinus deformity in 230 adults with a cerebrovascular accident and various associated medical conditions. It is not only effective in cerebral palsy, but should be considered at an early stage in all adult patients with deformity of the ankle and foot in whom spasm of gastrocnemius is the major cause

1 . This case of post-traumatic osteochondritis of the lower tibial epiphysis is important because the condition is rare. 2. The similarity to osteochondritis in other sites dating from a single injury is noted. 3. The ankle joint bears more body weight per surface area of articular cartilage than other weight-bearing joint surfaces. It is of interest that regeneration took place in spite of the fact that the child continued to bear weight and that the joint was immobilised for only two months, beginning four months after the original injury

One of the most important factors in the rehabilitation of the amputee is the preparation of the patient and stump for limb fitting and training. The different procedures for the upper and lower extremities are described. Emphasis is laid on the importance of early reassurance and rehabilitation whenever possible. Patients unavoidably immobilised for long periods require general physical reconditioning before limb fitting and training can be undertaken. Special care is needed to avoid the upper limb amputee's becoming dependent on the surviving hand and using the artificial limb only for its cosmetic effect

The late results of tarsometatarsal injuries in 33 patients have been reviewed. The average follow-up period was 15 years (range 11 to 20 years). Methods of treatment included cast immobilisation, and closed or open reduction with or without internal fixation. All patients noted diminishing symptoms after injury and all but six returned to their former occupation. Neither the initial fracture type nor the treatment had any apparent bearing on subsequent function; nor was there any correlation between radiographic assessment of the injury and the patient's symptoms

The calcaneal tendons of rabbits were excised and either replaced with a carbon or polyester fibre implant, or left as controls. The strength of the neotendons and their mode of failure under tension were examined at intervals up to six months after operation. Return to near normal strength took six months to develop, suggesting that patients having ligament or tendon reconstructions should not resume normal activity for several months. Carbon fibre-based neotendons showed progressive elongation which, unless avoided by a sufficient period of immobilisation, would affect the functional result

1. One hundred and eighty-one fractures of the tibial shaft were treated by rigid fixation using conventional plates. 2. Comparison is made with series of fractures treated by the closed method. 3. The incidence of non-union, or delayed union requiring a long period of plaster immobilisation, was found to be less with the open method of treatment. 4. Plating was also found to give better functional results with a shorter period of disability except in severe open fractures. 5. Plating is a valuable method of treatment for tibial fractures in the elderly

1. Seventy-five injuries of the cervical spine are reported. Fifty-three were dislocations and fracture-dislocations involving the third to the seventh segments. 2. The importance of careful examination in all neck injuries is stressed. 3. The injuries are divided into stable and unstable types and the causation of the instability is discussed. 4. Plaster immobilisation for more than six months failed in some patients to prevent recurrence of dislocation. 5. Operative treatment was advised in all cases of dislocation, the spine being wired and grafted with iliac bone. This prevents recurrence and shortens the period of convalescence

In a group of 25 patients with traumatic dislocation of the knee, four, all of whom had similar ligament and medial soft-tissue injuries, also had associated lateral patellar dislocation. In all four reconstruction was delayed because of their other serious injuries. Having encountered the combination of knee dislocation and lateral patellar dislocation in 16% of our patients, we believe that it may be less rare than is commonly believed. We think that it is important to maintain a high index of suspicion of possible patellar dislocation when medial structures have been severely damaged. Early recognition and immobilisation in extension can prevent fixed lateral dislocation of the patella

We describe 74 patients with disabling instability of the knee due to isolated anterior cruciate deficiency. None responded to conservative measures or correction of internal derangements. All patients were treated by replacement of the anterior cruciate ligament with the medial third of the patellar tendon as a free graft, supplemented by an extra-articular MacIntosh lateral reconstruction. A satisfactory outcome was found in 93% of knees after an average of 70 months follow-up. Cast immobilisation after operation, the interval between injury and reconstruction, the age of the patient and the severity of symptoms before reconstruction had no significant effect on the final outcome

The incidence of deep vein thrombosis in 244 patients who had total knee replacement has been studied. In 120 the prosthesis was cemented and in 124 it was cementless. In all cases the replacement was primary and a porous-coated prosthesis with a porous-coated central tibial stem was used. Deep vein thrombosis was diagnosed by venography, and pulmonary embolism by perfusion scanning. The incidence of deep vein thrombosis in the cementless knees (23.8%) and in the cemented (25%) was approximately the same. The only significant predisposing factors for deep vein thrombosis in both groups were obesity, prolonged postoperative immobilisation, previous venous disease and hyperlipidaemia