Two cases are reported of the late diagnosis of compartment syndrome secondary to alcohol and drug overdose. Surgical decompression at two and a half days and at six days, respectively, produced worthwhile recovery. Other reports are reviewed and a case is made for the value of decompression even when performed late, and for delayed and minimal excision of apparently necrotic muscle

We report a patient with a subperiosteal ganglion cyst of the tibia which was imaged by radiography, arthrography, CT and MRI. The images were correlated with the arthroscopic surgical and histological findings. Spiculated formation of periosteal new bone on plain radiographs led to the initial suspicion of a malignant tumour. Demonstration of the cystic nature of the tumour using cross-sectional imaging was important for the precise diagnosis. Communication between the ganglion cyst and the knee was shown by a delayed arthrographic technique, and the presence of this communication was confirmed at arthroscopy and surgically

We report eight patients with prominent cystic changes in the head of the fibula. Seven of these had osteoarthritis of the adjacent knee, and five had evidence of local deposition of calcium pyrophosphate dihydrate crystals. A radiographic survey of 470 knees in 254 patients with osteoarthritis suggested that such cysts are rare, but should be considered in the differential diagnosis of such changes before expensive or invasive investigations are performed

The case histories and investigations for five adolescent girls with a presumed diagnosis of either primary acetabular protrusio or acute idiopathic chondrolysis are presented. The follow-up ranged from three to nine years. All were treated by extensive soft-tissue release but in no case did this improve movement of the affected hip and permanent stiffness was the inevitable result. The literature is reviewed and methods of treatment are discussed in the light of the CT findings

A chart is presented to assist with the assessment and treatment of patients with growth-related deformities. It is based on anthropometric values from five published sources and relates sitting height to stature, limb length, the radiographic lengths of the leg bones and the lengths of the feet and hands. It has proved useful in the prediction of leg-length discrepancies, in the diagnosis of cases of short stature, and in the assessment of spinal shortening from scoliosis

Four military recruits with complete distraction-type stress fractures of the femoral neck were treated conservatively. The radiographic diagnosis was made within two weeks of the onset of symptoms and the activities of the patients were matched to the clinical and radiographic progress of fracture healing. None of the fractures displaced and union occurred uneventfully. Our experience suggests that prophylactic internal fixation of these fractures is not necessary

1. Six patients are reported in whom ischaemic muscle contractures followed prolonged external pressure. 2. Systemic hypoxaemia may be a predisposing factor in patients with overdoses of central nervous system depressants. 3. If treatment is to be successful, early diagnosis is required, and the most important factor is an awareness of the condition. 4. The treatment of the late case is discussed

1. Attention is drawn to the importance of taking tangential radiographs of the patella in all cases of injury to the knee, especially when there is difficulty in distinguishing between recurrent dislocation of the patella and tear of a meniscus. 2. New bone formation along the medial side of the patella confirms a diagnosis of recurrent dislocation. 3. The importance of Coleman's original observations is stressed

1. The clinical and radiological features of thirty-two feet with congenital vertical talus are described and subdivided into groups determined by the presence or absence of associated abnormalities. 2. The differential diagnosis of congenital vertical talus from flat foot, talipes calcaneus and uncorrected club foot is discussed. 3. No benefit came from either non-operative treatment or tenotomy of the tibialis anterior

1) A case is reported of paraplegia with normal radiographic appearances in which cervical cord damage was shown at autopsy to have been due to hyperextension injury. 2) The mechanism of such injuries is discussed, together with the differential diagnosis from acute prolapse of an intervertebral disc. 3) The grave dangers of using the fully extended position of the cervical spine in the management of these cases is noted

1. A series of patients with recent ligamentous injuries of the ankle is presented. Stress radiography and arthrography were carried out in all cases, with surgical exploration where indicated. The findings are correlated. 2. Both stress radiography and arthrography are unreliable in the diagnosis of injuries to the "lateral ligament" of the ankle. 3. Arthrography may be useful in the demonstration of injury of the inferior tibio-fibular joint and of the medial ligament

1. Three cases of osteomyelitis of a metatarsal sesamoid bone are described. 2. The diagnosis should be considered in patients with acute pain under the first metatarsophalangeal joint, particularly if the temperature is elevated. 3. Failure ofdiagnosis may lead to persistent disability until sinus formation and sequestration dictate operative intervention. 4. Early antibiotic therapy may lead to resolution of the infection

1. Septic arthritis of the hip in adults is not common and the diagnosis can be difficult. The value of diagnostic aspiration is emphasised. 2. Predisposing causes in fifty patients are analysed and the possible relationship to pelvic infection is discussed. 3. Loss of joint space is occasionally seen within one week of the onset of the infection. 4. A method of treatment is suggested and the value of decompression by arthrotomy is discussed

1. Two cases are reported in which reappearance of an osteochondroma after excision was shown to represent a second independent lesion and not a true recurrence. 2. The significance of this observation is discussed in relation to the pathogenesis and prognosis of this lesion. 3. A plea is made for greater discrimination in using the ominous description "recurrence," because the rare true recurrence must strongly favour a diagnosis of malignancy

Needle biopsies, performed on 208 consecutive patients and interpreted at the London Bone Tumour Service over a two-year period, were reviewed. A correct diagnosis was reached in 97% (133 out of 137) using this technique alone. Needle biopsy is safe and accurate when undertaken in consultation within a bone tumour service; it offers considerable advantages to both patient and surgeon over conventional open biopsy

1. Two new cases of obstetrical separation of the upper femoral epiphysis are described. 2. Diagnosis in the first instance must be largely clinical, because radiological confirmation of the injury may be delayed. 3. The simple method of longitudinal traction is the treatment recommended. 4. It is notable that in our first case the ossification centre of the femoral head appeared at the exceptionally early age of fifteen days

1. Twenty-five cases of benign giant-cell tumour of bone, treated at Westminster Hospital, London, are reported. 2. The diagnosis can often be made on clinical and radiographic grounds alone but biopsy is sometimes necessary and seldom, if ever, contra-indicated. 3. Some cases may best be treated by excision, but in general irradiation is the treatment of choice. 4. Details of treatment by irradiation are given

Melioidosis is an uncommon infection caused by a Gram-negative bacillus, Pseudomonas pseudomallei. Only a few case reports of orthopaedic infection have been published in English, and most were of isolated septic arthritis or secondary to melioidosis of another organ. We have reviewed ten patients with localised melioidotic osteomyelitis; six had underlying conditions. We discuss the importance of obtaining a bacteriological diagnosis, and of surgical debridement as well as appropriate antibiotic therapy

We describe three patients with a compartment syndrome of the thigh, two after total hip replacement and one after total knee replacement. Two of the patients were fully anticoagulated. A compartment syndrome of the thigh is a rare, but important complication of joint replacement surgery if patients are receiving anticoagulants. Close observation is needed and when indicated monitoring of the intracompartmental pressure should be done. Early recognition of the signs and symptoms of an acute compartment syndrome and knowledge of the anatomy of the compartments of the thigh will help in the diagnosis and treatment of this potentially devastating complication

Isolated traumatic dislocation of the radial head in children is not as rare as sometimes supposed. Attention to detail in radiographic interpretation is the key to diagnosis. Early closed reduction and immobilisation in an above-elbow plaster in 90 degrees of flexion and full supination for three to six weeks is recommended. Seven cases are presented, two of which were treated operatively and had unsatisfactory results. The applied anatomy, management and complications are discussed