1. Four cases of congenital lateral dislocation of the patella are described. 2. The significance of the associated flexion contracture is emphasised. 3. Early diagnosis and operative realignment of the extensor mechanism is considered to be important because it should avoid the secondary growth changes which can produce serious disability

Instability may present at a different level after successful stabilisation of an unstable segment in apparently isolated injuries of the cervical spine. It can give rise to progressive deformity or symptoms which require further treatment. We performed one or more operations for unstable cervical spinal injuries on 121 patients over a period of 90 months. Of these, five were identified as having instability due to an initially unrecognised fracture-subluxation at a different level. We present the details of these five patients and discuss the problems associated with their diagnosis and treatment

1. Polymyalgia rheumatica is a disease of unknown cause, manifested by severe pain and stiffness of the muscles of the shoulder and pelvic girdles, which may be accompanied by a variety of other systemic symptoms. 2. Twenty-three patients with this condition are reviewed. 3. The difficulties of diagnosis, especially when presenting as an orthopaedic problem, are discussed

1. The previous literature in English on tuberculosis of the subdeltoid bursa is reviewed. 2. Two further cases are reported. 3. Emphasis is placed on the neglect of the condition in standard text-books and the need for bearing the diagnosis in mind. 4. Treatment by radical excision, a period of immobilisation and full supportive antibiotic therapy are recommended

Aims

Controversy about the use of an anatomical total shoulder arthroplasty (aTSA) in young arthritic patients relates to which is the ideal form of fixation for the glenoid component: cemented or cementless. This study aimed to evaluate implant survival of aTSA when used in patients aged < 60 years with primary glenohumeral osteoarthritis (OA), and to compare the survival of cemented all-polyethylene and cementless metal-backed glenoid components.

Objectives

The Precice nail is the latest intramedullary lengthening nail with excellent early outcomes. Implant complications have led to modification of the nail design. The aim of this study was to perform a retrieval study of Precice nails following lower-limb lengthening and to assess macroscopical and microscopical changes to the implants and evaluate differences following design modification, with the aim of identifying potential surgical, implant, and patient risk factors.

A case of paraplegia presumed on clinical grounds to be due to bilharziasis is reported. The patient was treated with antibilharzial drugs and steroids. She has been followed up for eight years and has recovered almost completely. The literature is reviewed, and the incidence and types of spinal lesion, the possible routes of infection and the diagnosis and treatment are discussed

1. Eight cases of congenital vertical talus in infancy are reported. The principal differential diagnosis at this age is from talipes calcaneo-valgus. 2. The deformity is primarily a dorsal dislocation of the talo-navicular joint. 3. Closed reduction can be achieved if treatment begins at birth. Open reduction is indicated for the deformity uncorrected by the age of three months

1. The clinical features in twenty cases of osteoid osteoma have been analysed and compared with other cases reported in the literature. 2. The lesion is regarded as a benign neoplasm and its unusual clinical behaviour is attributed to its vascular nature. 3. The frequency with which an erroneous diagnosis of "neurosis" is made is stressed

We report a case of systemic Penicillium marneffei infection in a Chinese woman who presented with multiple osteolytic lesions and radiographic changes similar to those seen in other fungal osteomyelitides. This infection is often misdiagnosed as tuberculosis and has a high mortality rate. The correct diagnosis is important since early antifungal therapy is life-saving

We prospectively studied 50 patients with the diagnosis of primary frozen shoulder. The serum lipid levels were measured in 43 of these patients and compared with those in 43 age-matched and sex-matched control subjects. The fasting serum triglyceride and cholesterol levels were significantly elevated in the frozen-shoulder group (cholesterol p < 0.01; triglyceride p < 0.02)

Osteomyelitis is a rare manifestation of cat-scratch disease in patients who do not have AIDS. The clinical presentation and non-specific subacute course of the disease make diagnosis difficult. We present a child with osteomyelitis of a metacarpal following a dog scratch. Bartonella henselae was found to be the aetiological agent. The bone healed after treatment with antibiotics. Increased awareness and a comprehensive medical history are needed to identify patients with suspected Bartonella henselae osteomyelitis

Thirty patients with non-tuberculous pyogenic osteomyelitis of the spine are reported in all of whom the diagnosis was confirmed bacteriologically, histologically or serologically. The clinical and radiological features and investigations are analysed. Back pain, localised to the level involved, was the predominant symptom. The erythrocyte sedimentation rate was raised in all cases, and a characteristic sequence of radiological features is described

We report two cases of bilateral chronic exertional compartment syndrome (CCS) in the forearmand hand. Measurement of the intramuscular pressure was useful for diagnosis. These two cases illustrate that bilateral CCS should be suspected in patients complaining of bilateral exercise-induced pain in the anconeus muscle, the forearms, the thenar and hypothenar regions and in the first dorsal interosseous muscle. Fasciotomy relieved the pain in both cases

1. A case is reported which shows the typical features of osteopathia striata in all the long bones and probably in the pelvis, with the features of osteopetrosis in the skull and ribs. 2. The occurrence of longitudinal striation in osteopoikilosis and osteopetrosis is described, and the possible relationship between these two diseases and osteopathia striata is discussed. 3. The differential diagnosis is indicated

The management of carpal dislocation after a late diagnosis is difficult. Open reduction is the usual treatment but collapse of the carpus may be hard to overcome without extensive dissection and consequent damage to the blood supply, ligaments and articular cartilage. A technique of distraction by an external fixator followed by semi-closed reduction is described and its successful use is reported in two cases

We report four patients with unilateral postpartum sacroiliitis presenting with agonising unilateral pain, an elevated ESR, elevated alkaline phosphatase levels, leucocytosis and positive bone scans. The diagnosis of a non-infectious inflammatory cause was supported by the postpartum onset, the response to non-steroidal anti-inflammatory drugs, negative aspiration cultures in two cases and the lack of changes in the sacroiliac joints on long-term follow-up radiographs

Three patients referred for rehabilitation of brachial plexus lesions and two referred with leg weakness associated with sciatica were found to have conversion paralysis. The diagnosis was made by demonstrating normal motor nerve conduction to the clinically weak muscles. The weakness was treated by intensive physical rehabilitation with complete and sustained recovery in all cases

We report 11 patients who, over a five-year period, were treated for pyogenic infection of the sacro-iliac joint. This condition is uncommon and difficult to assess, so that diagnosis is liable to be delayed and morbidity increased. Skeletal scintigraphy, with perfusion phase imaging, is usually positive in early lesions and prompt antibiotic treatment reduces complications