Aims

No randomized comparative study has compared the extensile lateral approach (ELA) and sinus tarsi approach (STA) for Sanders type 2 calcaneal fractures. This randomized comparative study was conducted to confirm whether the STA was prone to fewer wound complications than the ELA.

Aims

To compare operative and nonoperative treatment for displaced distal radius fractures in patients aged over 65 years.

1. Out of 11,868 children born in one maternity department and examined neonatally three cases (possibly four) of typical dislocation were missed at the first examination but diagnosed and treated with good results within the following few months. 2. One single neonatal examination of the hip is not sufficient. Repeated examinations during the first weeks and months are essential. 3. Treatment with a Frejka pillow is unsatisfactory. The von Rosen splint is preferable. 4. Following the campaign for neonatal diagnosis and early treatment no case of established dislocation has been encountered after the age of six months. 5. Atypical cases present special problems

Aims

This study sought to estimate the clinical outcomes and describe the nationwide variation in practice, as part of the feasibility workup for a National Institute for Health and Care Excellence (NICE) recommended randomized clinical trial to determine the optimal treatment of torus fractures of the distal radius in children.

1. Six thousand consecutive newborn babies were personally examined by the author for congenital dislocation of the hip. Twenty-four cases were diagnosed and twenty-three treated. 2. Twenty-two of the twenty-three treated cases had excellent results after treatment in the von Rosen splint. 3. The baby should be five days old before a final decision is made as to whether treatment is necessary. 4. A further twenty-seven babies were found to have unstable hips. Eighteen of these were followed up and all were found to have developed normally without treatment. 5. The technique of examination is simple and quick but it is desirable that it should be carried out in each maternity unit by only one or two doctors

A prospective neonatal screening programme for congenital dislocation of the hip is reported. This covered over 20,000 live births including all the babies born in one area, with a virtually complete follow-up. All babies were examined within the first seven days of life and all hips which were dislocated or unstable after four days (1.6%) were splinted. Only two screened cases were "missed" and subsequently detected at 15 and 18 months. No later cases were discovered, and patients between 10 and 20 years of age had apparently remained asymptomatic. The detailed results show that neonatal screening is effective in detecting and preventing a crippling disorder in otherwise normal people. The examination, though brief, is difficult to perform well; it is considered that failure of the method lies with the examiner and not with the tests

Major ruptures of the rotator cuff were repaired in 89 patients over a six-year period, using an approach through the split deltoid muscle and the bed of the excised outer centimetre of the clavicle. Review of these patients showed that poor results were associated with larger cuff defects, with more pre-operative steroid injections and with pre-operative weakness of the deltoid muscle. A randomised prospective study showed that repair followed by splinting in abduction gave no better results than repair followed by resting the arm at the side. Excision of the coraco-acromial ligament was associated with worse results than leaving its divided halves in situ. Follow-up showed that the results continued to improve for two years after operation; their quality was maintained in patients less than 60 years old, but in those over 60 there was deterioration with time

Ninety-eight fractures of the shaft of the femur were seen in one unit over the two years 1974 and 1975, and the results have been assessed in sixty-nine. Of these, thirty-eight were treated by skeletal traction in a Thomas's splint followed by skin traction, and thirty-one by skeletal traction followed by a cast-brace. The technique of application is described in some detail. The average time for application of the cast-brace was six weeks after the injury, the time in hospital eight weeks and the time till removal fifteen weeks. The patients selected for a cast-brace were in hospital for just over half the time of the others and their fractures on average united more quickly, though with some trouble from angulation of fractures of the uppermost third of the shaft. It is concluded that when used with all the judgment and skill it demands, the cast-brace method is a great advance in conservative treatment

Subtrochanteric osteotomy has been reported to interrupt the destructive phase of coxa plana and speed up the rate of healing. The aim of this investigation was to test the validity of these statements. The material comprised twenty-five patients treated by osteotomy and thirty-three patients treated by support in a Thomas's splint. For every patient the extent of the radiological changes was estimated and plotted against time as a percentage of the normal epiphysial volume. The graph so obtained represents the rate of destruction and re-ossification, as well as the maximum involvement of the epiphysis. The curves for each group of patients were superimposed in a graph with all the minima coincident in time. The two patterns of curves are closely similar. It was confirmed statistically that the rates of destruction and re-ossification did not differ between the two groups. The results afford no evidence that osteotomy interrupts the disease or speeds up healing

1. A simple test more sensitive than Ortolani's for the diagnosis of instability of the hip in the new-born is described. It takes only a few seconds to perform and can be quickly taught to doctors, nurses and midwives. 2. About one infant in sixty is born with instability of one or both hips. Over 60 per cent of these recover in the first week of life, and 88 per cent in the first two months. The remaining 12 per cent are true congenital dislocations and persist unless treated, giving an incidence of 1·55 per thousand. 3. Treatment with the type of splint described begun within the first week is simple and effective, and gives a hip clinically normal long before the child begins to walk. 4. The concept of a pre-dislocation phase should be abandoned

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 coronavirus 2019 (COVID-19) global pandemic has had a significant impact on trauma and orthopaedic (T&O) departments worldwide. To manage the peak of the epidemic, orthopaedic staff were redeployed to frontline medical care; these roles included managing minor injury units, forming a “proning” team, and assisting in the intensive care unit (ICU). In addition, outpatient clinics were restructured to facilitate virtual consultations, elective procedures were cancelled, and inpatient hospital admissions minimized to reduce nosocomial COVID-19 infections. Urgent operations for fractures, infection and tumours went ahead but required strict planning to ensure patient safety. Orthopaedic training has also been significantly impacted during this period. This article discusses the impact of COVID-19 on T&O in the UK and highlights key lessons learned that may help to proactively prepare for the next global pandemic.

Cite this article: Bone Joint Open 2020;1-7:420–423.

This is a retrospective study of primary repairs of flexor pollicis longus in 16 children under 15 years of age. Patients with injuries to the median or ulnar nerve at the wrist, crush injuries, skin loss or fracture were excluded. Repairs were carried out within 24 hours using a modified Kessler technique. The mean follow-up was for two years. The final results were evaluated using the criteria of Buck-Gramko and Tubiana. They were good or excellent in all except one patient who had a secondary tendon rupture. When compared with the non-injured thumb, however, there was a significant decrease in active interphalangeal flexion (> 30°) in one-third of cases. A new method of assessment is proposed for the recovery of function of the flexor pollicis tendon which is more suitable for children. Postoperative immobilisation using a short splint had a negative effect on outcome. The zone of injury, an early mobilisation programme or concurrent injury to the digital nerve had no significant effect on the final result

1. Some problems in the early diagnosis and management of congenital dislocation are discussed. 2. In a well-staffed maternity unit one dislocation completely escaped early detection in every 8,000 births over the period 1962 to 1968 inclusive. 3. The complications of early treatment on a Malmö splint are initial failure to obtain reduction, failure to maintain reduction, deformity of the upper femoral epiphysis or metaphysis, and persistent anteversion of the femoral neck. 4. Arthrography suggests that failure of early splintage and deformity of the upper femur are due to attempted reduction in the presence of an inverted limbus. 5. A trial method of treatment of frank displacement in the first year of life has been carried out by combining excision of the inverted limbus with a period in a frog position plaster to correct anteversion. This method avoided changes in the upper femur but failed to correct anteversion in four out of eighteen cases

1. We have reported our experience in fifty-two patients with arthrogryposis multiplex congenita. 2. The nature of the disorder, its possible cause, the clinical features and differential diagnosis are discussed. 3. Early management is described with special reference to the infant, his parents, and general principles of selection and timing. The treatment of the individual deformities which commonly occur is outlined. 4. We have emphasised that lower limb deformities should be treated vigorously in the first year, whereas in the upper limb treatment is better delayed until an accurate assessment can be made. 5. Correction in the young child should be by soft-tissue release rather than by osteotomy. 6. Prolonged splinting after operation is necessary. 7. Severe weakness may dominate the problem and make operation unrewarding. 8. The intelligence, determination and adaptability of these children flatters even modest surgical success

Aims

Fixation of scaphoid nonunion with a volar locking plate and cancellous bone grafting has been shown to be a successful technique in small series. Few mid- or long-term follow-up studies have been reported. The aim of this study was to report the mid-term radiological and functional outcome of plate fixation for scaphoid nonunion.

A review was conducted of the records of fifty-five children who were admitted to the Hospital for Sick Children in Toronto between 1955 and 1975 with a diagnosis of Volkmann's contracture in fifty-eight limbs. Ten patients had been transferred to this hospital with established ischaemia after Bryant's traction for a fractured femur; all had a very poor outcome. Thirteen other cases of Volkmann's contracture affecting the superficial posterior compartment had been treated with a fixed Thomas' splint and a Bradford frame after fractures of the femoral shaft. Supracondylar fractures of the elbow resulting in Volkmann's contracture frequently had both an arterial injury and a compartment syndrome. Most of the fifty-five children reviewed here had not had early appropriate treatment. For the past twenty-one years the frequency of Volkmann's contracture has not declined in spite of many published reports on the compartment syndrome, and the hazards of supracondylar fractures and of Bryant's traction