Purpose: Scarf osteotomies are commonly performed in adults with symptomatic bunions. We have reported the radiological and clinical outcome of this procedure in the treatment of moderate to severe hallux valgus among adolescent children.

Methods: Data was collected retrospectively from a tertiary referral children hospital between April 2001 and June 2006. The pre and postoperative intermetatarsal angle (IMA), hallux valgus angle (HVA) and distal metatarsal articular angle (DMAA) were determined. Patients were followed up for a mean of 8.6 months (3–18).

Results: 23 scarf osteotomies were performed in 16 patients with a mean age of 14.3 years (12–18). The mean pre operative IMA of 14.4 degrees was improved to a postoperative value of 9.3 degrees, p< 0.0001. The mean HVA angle was improved from 34.7 to 16.5 degrees, p< 0.0001. The DMAA was improved from 13.1 to 8 degrees, p< 0.0001. There were 2 cases of superficial wound infections successfully treated with oral antibiotics. One patient developed a complex regional pain syndrome that resolved with physiotherapy and analgesia.

Conclusion: We believe that scarf osteotomy is a safe and effective option for the management of the adolescent symptomatic bunions.

Significance: There are no published reports in the English literature of scarf osteotomy in the management of adolescent children with symptomatic hallux valgus. The aim of this paper is to report the radiological and clinical outcome of scarf osteotomy in the treatment of moderate to severe hallux valgus among adolescent children.

Purpose of Study: To present the clinical features, investigations, histopathology, differential diagnosis and treatment options for lipoblastoma, based on a series of six encountered in our paediatric orthopaedic practice.

Method: The records of six children with lipoblastoma who attended Alder Hey Hospital between 2000 and 2006 were reviewed. Mean age was 17 months and mean follow up was 26 months.

Results: The youngest was a six month old infant with a swelling on his right instep. The second patient, a three year old girl, presented with a limp and swelling in her foot. The third patient was an 18 month old boy with a swelling on the dorsum of his left forearm. The fourth patient had a swelling of his left thigh and two patients had swellings in their backs. Each was investigated by MRI (1), CT (1) or US (4) and surgical excision planned accordingly. There were no post operative complications. None has shown recurrence during follow-up.

Conclusions: All patients were originally thought to have simple lipomata or soft tissue swellings. This is primarily because lipoblastoma is a rare tumour, yet lipoblastoma is the most likely diagnosis of a fatty lump in a child aged less than two. Differential diagnoses include myxoid liposarcoma, well-differentiated liposarcoma, spindle cell lipoma, typical lipoma and soft tissue sarcoma.

Lipoblastomata need thorough imaging. Cytogenetic evaluation of tumour cells often reveals chromosomal anomalies, such as abnormalities of the long arm of chromosome 8 leading to rearrangement of the PLAG1 gene. Biopsy of the lesion is recommended for accurate diagnosis, as clinical and radiological diagnoses can be misleading.

Lipoblastomata tend to spread locally and may recur after incomplete resection; metastatic potential has not been reported. Complete surgical resection is mandatory to prevent recurrence.

Background: Tourniquet provides a blood less field for surgery, but it has few complications and contraindications. There are several studies identifying the tourniquet as a factor for increased risk of complications in knee arthroscopy, we reviewed 200 consecutive knee arthroscopies done in our hospital with out tourniquet to analyse the outcome.

Aim: To analyse the out come of 200 knee arthroscopies done with out use of tourniquet; with respect to visualisation, time of surgery, bleeding, analgesia and post operative complications.

Materials and methods: We retrospectively analysed 200 consecutive knee arthroscopies with out tourniquet done in our institute. Average age of these patients was 39 (21–81). All patients underwent soft tissue procedures under general anaesthesia, supine, with sole support, no antibiotics and were done by same surgeon as day case. Same arthroscopic kit (Dyonics) with pump was used for all patients, using 2 litre saline bag and pump set at 65 mm Hg pressure. First few cases had tourniquet applied but not inflated, but later even this was avoided. Procedures included were diagnostic arthroscopies, arthroscopic debridements, meniscal repairs and partial or complete meniscal resections. Procedures like arthroscopic ACL reconstruction and other bony procedures were excluded. We looked at any visualisation problems, time of surgery, bleeding, analgesia and post operative complications. We also looked weather any of these patients visited the consultant or GP for any wound related problem or pain before the usual review at 2 weeks.

Results: There was no problem with visualisation noted in any of the cases, or any incidence where arthroscopy was unduly prolonged. There was no incidence of bleeding, stiffness or increased need for analgesia in any of these patients. None of the patients had any wound problem or haemathrosis requiring intervention. There was no record of any patients reattending the clinic or their GP for pain or bleeding.

Conclusions: Many orthopaedic units continue to use a tourniquet routinely for soft tissue procedures in knee arthroscopy, probably in the belief that a clear operative view can only be achieved with one. However, the findings in our study indicate that knee arthroscopy for soft tissue procedures may be performed adequately without the use of a tourniquet provided a pump system is used and the pressure maintained above venous pressure. Therefore we recommend that its use for routine soft tissue arthroscopic procedures be discontinued.

Objectives: To evaluate and compare the imaging of lumbar spinal canal stenosis using plain radiographs, CT-Myelogram and MRI.

Patients and Methods: Prospective study at Medical College Calicut during 2002-2004. 25 patients of age from 25 to 69 years, with clinical features of lumbar spinal canal stenosis were evaluated. Inter pedicular distance, anteroposterior diameter and thecal sac cross sectional area (IPD, APD and TSCA) were measured using plain radiographs, CT-Myelogram and MRI, in all 25 patients.

Results: Soft tissue compression evaluated as disc protrusion and ligamentum flavum hypertrophy detected in 20 patients by CT-myelography and 22 patients by MRI. Thecal sac cross sectional area at stenosed level were assessed and compared with CT- Myelography and MRI, out of 25 patients 10 and 11 patients were detected with significant narrowing by CT-Myelogra-phy and MRI respectively in which 2 cases of severe thecal sac compromise (< 76 mm2) detected by CT-Myelography and 3 cases by MRI. CT–Myelography detected one case of single level absolute stenosis (AP diameter of < 10mm), but none of the cases were detected by MRI or Plain radiography. Relative stenosis (AP diameter of 10-12mm) at single level detected in 6 cases by CT–Myelography, in 4 cases by MRI and in 3 cases by plain radiography. Relative stenosis at multiple level detected in 3 cases by CT–Myelogra-phy, in 4 cases by MRI and in 6 cases by plain radi-ography.4 cases of multilevel absolute stenosis were detected by all 3 modalities.

Conclusions: CT- Myelographic measurement are well correlating with clinical symptoms and MRI findings. Bony Canal measurements obtained by CT- myelogra-phy are superior to same measurements obtained by MRI. Thecal-sac cross sectional area measurements obtained by CT-Myelography is comparable with that of MRI, even though soft tissue involvement in lumbar spinal canal stenosis is more clearly detected by MRI. In comparison of AP diameter taken by plain radiograph and CT- Myelography, X-ray measurements shows only 50-60% accuracy. AP diameter in CT- Myelography and MRI were comparable, when the thecal-sac cross sectional area measured by MRI taken as gold standard (using Karl pearsons correlation coefficients). CT-Myelography shows sensitivity of 92% and specificity of more than 96%.