1. Two cases of fracture-dislocation of the trochlea are described. One case was complicated by complete ulnar nerve palsy. 2. The injury is caused by direct force applied to the point of the elbow, or it may be associated with posterior dislocation of the joint. 3. Open reduction is recommended, the fragment being held in position by soft-tissue sutures alone. 4. Four other cases mentioned in the literature are reviewed

We have reviewed 12 fractures of the coracoid process. In two of these patients the fracture extended into the body of the scapula and resulted in displacement of the glenoid. In some cases, there were associated acromioclavicular and glenohumeral dislocations or fractures of the clavicle and the acromion. Two patients required internal fixation to restore congruence of the glenoid; the others were treated conservatively with success. We present a new classification of coracoid fractures which helps in their management

From 1962 to 1986, 117,256 neonates were screened for congenital dislocation of the hip (CDH). When the primary physical examination was performed by the junior paediatric staff there was a persistent late diagnosis rate of 0.5 per 1000 live births. When the primary examination was undertaken by experienced orthopaedic personnel (1982 to 1984) the late diagnosis rate fell and fewer infants were splinted

Over a six-year period, 166 shoulder arthroscopies were performed in 153 patients with symptoms of subluxation, but no firm evidence of dislocation and no clear-cut clinical diagnosis. Arthroscopy confirmed the working diagnosis in 133 shoulders (80%), but changed it in 33 (20%). In 26 shoulders the presumed direction of instability was changed and in seven a different diagnosis was made. Arthroscopy was particularly helpful for patients with shoulder instability of uncertain type or direction

Ten patients were treated for anterior or posterior displacement of the hip after an innominate osteotomy for congenital dislocation of the hip. All required a repeated open reduction with an additional procedure, either at the same time as reduction or as a second stage. Stable reduction was achieved in eight cases, but in two the initial attempt failed and the operation had to be repeated. The clinical features of hips with this complication are described and the technique of the salvage operation is discussed

Three cases of the Nievergelt-Pearlman syndrome occurring in a family are presented. In addition to the major features of the syndrome (symphalangism, carpal fusion, atypical club foot with massive tarsal fusion, and congenital dislocation of the head of the radius), all three patients exhibited conductive deafness, which had not been recorded in previous reports. The clinical findings strongly suggested that the loss of hearing was due to fusion of the ossicles of the middle ear

1. The case is described of an eight-year-old girl with the Morquio syndrome (mucopolysaccharidosis type IV) who died from acute tetraplegia, due to atlanto-axial subluxation which occurred during general anaesthesia. 2. Hypoplasia of the dens of the axis vertebra entails a high risk of vertebral dislocation and spinal cord damage especially in circumstances such as general anaesthesia when excessive movements of the head may occur

I. Five cases of fracture and dislocation in the lower limb complicated by vascular injury are described and discussed. 2. Suspicion of arterial injury is an urgent indication for exploration. Conservative measures must not be undertaken without radiological evidence of an undamaged main limb artery. 3. The eventual outcome of arterial reconstruction cannot be forecast, but it is always worth while attempting unless the limb is obviously beyond hope of survival

The management of radial head fractures complicated by ligamentous disruption remains a matter of controversy. The use of a silicone radial head implant to provide temporary stability is thought to help to protect the ligaments during healing. The reported complications of long-term implantation of a silicone replacement include fracture, dislocation, synovitis, lymphadenitis and subchondral resorption. We now report one case in which an inflammatory process resulted in generalised cartilage degeneration. This has not previously been noted

Aims

The number of patients undergoing arthroscopic surgery of the hip has increased significantly during the past decade. It has now become an established technique for the treatment of many intra- and extra-articular conditions affecting the hip. However, it has a steep learning curve and is not without the risk of complications. The purpose of this systematic review was to determine the prevalence of complications during and following this procedure.

Aims

Our aim was to evaluate the radiographic characteristics of patients undergoing total hip arthroplasty (THA) for the potential of posterior bony impingement using CT simulations.

Aims

The aim of this retrospective multicentre study was to evaluate mid-term results of the operative treatment of Monteggia-like lesions and to determine the prognostic factors that influence the clinical and radiological outcome.

We treated 35 patients with primary malignant tumours of the periacetabular area by resection and prosthetic reconstruction of the defect. At a mean follow-up of 84 months, 15 patients (43%) were free from disease. The most common complications were deep infection (26%), local recurrence (24%) and recurrent dislocation of the hip (17%). The surviving patients achieved an average of 70% of their premorbid function. This method of reconstruction has a high morbidity and should be performed only at specialist centres, but the functional and oncological outcomes are satisfactory

The results of the Ferguson medial approach for open reduction of developmental dysplasia of the hip (DDH) were reviewed for 49 hips with a follow-up of more than 48 months. The mean age at operation was 12.3 months (6 to 23). The mean length of clinical and radiological follow-up was 82 months (48 to 148). Three redislocations occurred. Group I avascular necrosis according to the classification of Kalamchi and MacEwen was seen in four hips, group II in two hips and group III in one hip; 92% of the hips were classified as Severin class I and II. The acetabular index and centre edge (CE) angles were within normal limits at final follow-up, but were still significantly different from the unaffected side. We conclude that the Ferguson procedure is safe and reliable for low dislocations in children aged six to 18 months

1. Twenty-two feet injured at the tarso-metatarsal level are reviewed. 2. Experiments with eleven cadaveric feet are reported. 3. The injuries are caused by forced plantar-flexion combined with rotation in most cases. Crushing of the foot alone often does not produce dislocation. 4. A classification is suggested. 5. The results of various treatments in this small series are presented. It is concluded that anatomical reduction is important, achieved if necessary by operation and internal fixation

1. Six cases of malunited anterior Monteggia fracture have been treated, five of them successfully, by open reduction and reconstruction of the orbicular ligament by turning down a slip from the triceps tendon. 2. One relapse occurred after a slight injury; this was because of an unsuitable triceps tendon. 3. A slip from the triceps tendon has retained reduction of the head of the radius in a patient with congenital dislocation of the radial head

1. Injuries of the sternum from flexion-compression violence are described and contrasted with injuries from direct violence. The characteristic feature of flexion-compression injuries is a dislocation or fracture at or near the manubrio-sternal joint with backward displacement of the manubrium. 2. Treatment is outlined, with special reference to the indications for open reduction and wire fixation. 3. The mechanism of flexion-compression injuries of the sternum is discussed. The opinion is expressed that most of the force is transmitted to the sternum by the ribs—especially the upper ribs

1 . Complications of the Judet arthroplasty are few. 2. The antero-lateral approach provides good access to the joint for insertion of the prosthesis. 3. Details of treatment before and after operation are described and their importance in limiting complications is emphasised. 4. The complications that have been encountered—including dislocation and fracture of the stem—are described and factors in their causation are discussed. 5. Study of the mechanical state of the new joint and the diagnosis of complications are aided by radio-opaque markers in the prosthesis

Our aim in this paper was to investigate the guidelines and laws governing informed consent in the English-speaking world. We noted a recent divergence from medical paternalism within the United Kingdom, highlighted by the Montgomery v Lanarkshire Health Board ruling of 2015. We investigated the situation in the United Kingdom, Australia, New Zealand, Canada, and the United States of America. We read the national guidance regarding obtaining consent for surgical intervention for each country. We used the references from this guidance to identify the laws that helped inform the guidance, and reviewed the court documents for each case.

There has been a trend towards a more patient-focused approach in consent in each country. Surgeons should be aware of the guidance and legal cases so that they can inform patients fully, and prevent legal problems if outdated practices are followed.

Cite this article: Bone Joint J 2018;100-B:687–92.