1. Three cases are reported of avascular necrosis of the head of the femur after undisplaced fractures of the neck of the femur in childhood. 2. It is suggested that the diaphysial vessels play a more important part in the supply of the epiphysis than has previously been recognised. 3. The prognosis for any fracture of the neck of the femur in a child given at the time of the injury should be guarded

In the neonate, Group B beta-haemolytic streptococcal osteomyelitis presents with few inflammatory signs, a mild clinical course, extensive bony destruction, and usually single bone involvement. Onset is late (10 to 60 days after birth) and obstetric trauma appears to predispose to infection. Serotype studies suggest transmission from mother to child at the time of delivery

Aims

The purpose of this study was to compare the prevalence of hip displacement and dislocation in a total population of children with cerebral palsy (CP) in Scotland before and after the initiation of a hip surveillance programme.

We describe the reconstruction of a defect of the medial malleolus which was the result of an accident in a ten-year-old child. A graft from the iliac crest, with the apophyseal cartilage and perichondrium, was used for reconstruction of the medial malleolus, the growth plate and the adjacent metaphyseal defect, respectively. The soft-tissue defect was covered with a free scapular flap with microvascular anastomosis. Three years after the injury stability of the ankle is excellent with adequate growth of the reconstructed epiphyseal plate

Aims

The reduction in mobility due to hip diseases in children is likely to affect their physical activity (PA) levels. Physical inactivity negatively influences quality of life and health. Our aim was to objectively measure PA in children with hip disease, and correlate it with the Patient-Reported Outcomes Measurement Information System (PROMIS) Mobility Score.

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

A white child with a long history of illness from the age of six was thought at first to have Hodgkin's disease. There followed an acute illness with lesions involving glands, lungs, bone and skin. Mycobacterium avium-intracellulare group (Battey) was isolated from various lesions at the age of thirteen. After six years of continuous treatment the patient, now eighteen, is living a normal life

We describe the results of a policy of highly selective splintage for CDH, using knee plasters. No child suffered because splintage was withheld. In those who were treated the results were satisfactory and the proportion who required a subsequent operation was extremely low. Avascular necrosis was not a significant problem. The method, although a little more time consuming, appears to offer significant advantages over current alternatives

Simultaneous dislocation of the elbow and the proximal radio-ulnar joint is rare. Two children with this uncommon injury are reported. One child had a transverse divergent dislocation that was treated successfully by closed reduction. The other had a convergent dislocation (or translocation of the radius and ulna) which needed open reduction. Convergent dislocation is even rarer than transverse divergent dislocation, and this is believed to be the first time it has been reported

A new technique of tibialis posterior transfer is described which has been used in a wide variety of conditions producing muscular imbalance in the foot. The results in eighty-five feet are reviewed in terms of range of motion, power and voluntary control of the transfer. The effect of the transfer on shoe wear, on the necessity for bracing and on the child's or his parents' assessment of the results are used to allocate an overall evaluation of the operation. Recommendations on the indications for the operation are given

1. Dissections of the newborn child revealed that the psoas muscle is a lateral rotator of the hip in all positions but that this secondary action is much stronger when the limb is abducted. 2. It has also been shown that the iliacus portion of the muscle can contribute towards the completion of abduction movement. 3. An attempt has been made to reconcile these facts with the accepted concept of the action of the muscle in the adult. 4. The clinical significance is discussed

1. A study of the average rate of growth of the legs and trunk of 202 normal average maturing children is presented. 2. The annual growth of the limbs and trunk was related to the skeletal age of each child, and the increments of growth per skeletal year subjected to statistical analysis. 3. Methods of growth prediction of leg length and mature height have been derived and the practical application of the investigation to orthopaedic surgery is discussed

Sixty-six deformities of the foot and ankle in forty-two patients with arthrogryposis multiplex congenita were reviewd. Pes equinovarus proved particularly difficult to treat as there was a tendency for the deformity to recur because of the thick and rigid capsule. Intracapsular procedures were more successful than those done adjacent to the joint. Wide capsulotomy or talectomy were the best procedures under the age of three years and triple arthordesis was most successful for the older child

1. A specially designed splint is described with which it is possible to maintain the reduction of a paralytic dislocation in a child with spina bifida cystica. The results of its use in a series of thirteen cases are recorded. 2. It is suggested that all such children presenting in the first year of life, in whom the power of the flexor and adductor muscle groups is preserved, should be treated initially in this way until the prognosis for the individual can be accurately assessed. 3. The theoretical implications of the findings are discussed

Paraplegia occurred in an adolescent girl with osteogenesis imperfecta after chiropractic manipulation. The child had been able to walk freely out of doors. Complete motor paralysis with sensory sparing resulted due to anterior compression of the cord by spondyloptotic cervical vertebrae. Reconstructed computerised tomography was very helpful in demonstrating the abnormality. Anterior and then posterior decompression relieved the tethered spinal cord and were supplemented with bone grafting. Early diagnosis and surgical treatment will prevent similar neurological accidents

The development of genu valgum in a child after a fracture of the upper metaphysis of the tibia with a medial gap is due to the interposition of a flap of fibrous tissue consisting of pes anserinus and periosteum avulsed from the lower fragment. The ensuing biomechanical disturbance induces bowing of the shaft and asymmetrical growth at both ends of the bone. Four cases of established deformity are reported, together with two cases of fresh fracture successfully treated by surgical clearance of the fibrous tissue from the gap

1. A child with so-called ischio-pubic osteochondritis is reported from whom the affected ramus was resected. The features observed in the resected specimen were those of a normal closing epiphysis. 2. The literature is reviewed with emphasis on other children who had biopsies and on large scale radiographic surveys of normal children. 3. The conclusions are that the changes in the ischio-pubic synchondrosis cannot justifiably be called osteochondritis, and that they require further investigation, which can most profitably be done at necropsy

1. The literature of dislocation of the hip in childhood from 1922 to 1954 is reviewed. A total of eighty-eight cases have been recorded. 2. A further case, in a child of one year and eleven months, is described. 3. Nine of the children whose cases have been recorded developed Perthes' disease of the hip after the dislocation, an incidence of 10 per cent. A similar incidence of avascular necrosis of the femoral head has been reported after dislocation of the hip in adults

Aims

Aneurysmal bone cysts (ABCs) are locally aggressive lesions typically found in the long bones of children and adolescents. A variety of management strategies have been reported to be effective in the treatment of these lesions. The purpose of this review was to assess the effectiveness of current strategies for the management of primary ABCs of the long bones.

The operative technique for combined fusion of the knee and rotationplasty of the limb in the management of congenital deficiency of the femur is presented. The technique described allows earlier definitive prosthetic fitting of a child with proximal femoral deficiency; it has reduced the number of operative procedures needed to obtain the optimal function from that deficient limb; and it has enabled these procedures to be performed at an earlier age. The technique differs from those previously described and represents a significant improvement in management of the patient with femoral deficiency