Purpose: Some patients with Cerebral Palsy who had a de-rotation osteotomy performed for correction of excessive anteversion had persistence of internal foot progression even after the surgery. The aim of this study was to see if there is any relationship between significant abductor weakness [less than Grade III: MRC] and persistence of internal foot progression.

Methods: We included all ambulatory patients with cerebral palsy who had had a de-rotation osteotomy between the periods of 2000 – 2005, who had also had a pre and post operative gait analysis, assessment of ante-version, muscle charting and hip range of movements.

There were 12 patients [17 hips, 5 bilateral] 5 male 7 female with an average age of 13. Seven were diplegic, two hemiplegic and three had asymmetric diplegia. Data was assessed using SPSS 13.0. As the data was found to be normally distributed the Fisher exact test and the Spearman’s Co-relation Coefficient was used.

Results: Of the 17 limbs operated, preoperative femoral anteversion was 20–60 degrees [mean: 45] and post op femoral anteversion was 0–35[mean: 15]. Of these 7 hips had persistent internal rotation gait on gait analysis. None of these patients with persistent internal rotation had any hip capsular contractures, and there was no significant change in abductor power after surgery.

On testing the hypothesis it was found that there is no relationship between weak hip abductors and persistent internal rotation. [Fisher exact test: p value: 0.8, r = -0.07]

Conclusion: Weak abductors may not be a cause of persistent internal rotation following de-rotation osteotomy. Weak abductor power is not a contraindication to de-rotation osteotomies and do not affect outcome of surgery.

This aim of this study is to evaluate the efficacy of the Plant Tan plate, a new implant introduced for comminuted proximal humerus fractures. This paper presents the results of 10 patients who underwent the procedure over a two year period.

Methods : Two and three part proximal humeral fractures continue to be a difficult problem and accurate fixation is necessary for optimum functional outcome.

Ten patient had plant Tan plate fixation for proximal humerus fractures from January 2002 till January 2004. Details including patient demographics, the type of fracture, the bone quality, significant co morbid factors, the surgical approach union rate and complications were noted. Outcome was assessed using the Constant score and comparing with the opposite side and the Oxford shoulder questionnaire.

Results : After an average follow up of 6 months, 80% of the patients were satisfied with the result of surgery at the time of the most recent examination. The union rate was 85 %. The significant complications were infection ( 20 % ) and the development of avascular necrosis (1/10). The screw penetration into the shoulder joint was found to be as high as 50 % though it was not associated with poor result.

Conclusion : The early results of the Plant Tan plate are encouraging with good functional results in most patients. Careful case selection with proper indication, accurate reduction, and subchondral screw placement with purchase in the inferior portion of the humeral head along with early mobilisation should be considered as key factors for better outcome.

This paper presents the results of forearm fractures in twenty children treated with flexible intramedullary nailing, over a period of 3 yrs.

Forearm fractures in children are an extremely common injury and excellent results are obtained in the majority of cases by closed reduction and plaster immobilisation. If adequate reduction cannot be achieved or maintained by conservative means or if it fails, some form of internal fixation will be required. Flexible nails are an extremely effective way for addressing this problem.

Twenty children had flexible intramedullary nailing done following forearm fractures over a 3-year period from 1997–2000 [failed reduction (10), unstable post MUA(3), slipped in plaster(6) and open fractures(1)]. There were 15 male and 5 female patients, the mean age being 10. 9. The nature of the injury were radial neck (3); proximal radius (1), galeazzi (1) and both bone fractures (15). Nine patients had closed nailing, while 11 required a mini open approach of which, 5 needed exposure only on one side. Patients were protected post surgery until signs of union were seen. The patients had regular clinical and radiological assessment and nails were removed on an average of 6–8 months, though in patients with radial neck fractures it was removed much earlier [4–5 weeks].

All patients went on to full bony union in excellent position, the average time to union being 5. 8 weeks. All but one patient regained full prono-supination, elbow and wrist motion, though none had any functional disability. There were a few minor complications especially following implant removal, including superficial wound infections (3), transient hypoasthesia in the distribution of the superficial radial nerve (2) and one patient in whom one nail had to be left behind as it could not be removed. There were no long-term sequelae.

Several methods of internal fixation are available, and the very diversity of choice demonstrates the lack of an ideal solution. K-wires are not applicable at all levels and plates have the disadvantage that they require extensive exposure of the fracture site. Removal of the plates is just as, if not more, fraught with complications.

Flexible nails can often be inserted closed, leave cosmetically more acceptable scars, provide excellent alignment of the fracture and can be removed easily without requiring any postoperative immobilisation. In our opinion it should be considered as the method of choice in treating forearm fractures in children, when some form of internal fixation is required.