Transfer of flexor carpi ulnaris combined with selective release of the flexor pronator origin was undertaken in 35 patients with hemiplegic cerebral palsy for a pronation flexion deformity of the forearm, hand and wrist. The patients were divided into four groups depending on the severity of the deformity, the surgical procedure recommended, potential hand function and prognosis. The procedure reduces the power of wrist and finger flexion by release of the flexor pronator origin, and reinforces the strength of extension and supination of the wrist by transfer of flexor carpi ulnaris. After a mean follow-up of four years the appearance of the hand and forearm improved in all patients. None lost movement and all gained improved mobility of the forearm, wrist and hand. There was no overcorrection

Symptoms due to a supracondylar spur of the humerus, although rare, are common enough to make it the subject of routine examination of a patient with pain and disturbance of sensibility of the hand. It can mimic the carpal tunnel syndrome; it may produce ulnar nerve symptoms. Irritation or compression of either the brachial artery or, if there is a high division of it, the ulnar artery, may cause episodes of ischaemic pain in the forearm. The clinical features of a supracondylar spur causing symptoms are: symptoms of median nerve compression; forearm claudication; a palpable spur about two inches above the medial epicondyle; and disappearance of the radial or ulnar pulse on full extension and supination of the forearm

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To study the associations of lumbar developmental spinal stenosis (DSS) with low back pain (LBP), radicular leg pain, and disability.

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To report the surgical outcome of patients with severe Scheuermann’s kyphosis treated using a consistent technique and perioperative management.

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The aim of this study was to analyze the association between the shape of the distal radius sigmoid notch and triangular fibrocartilage complex (TFCC) foveal tear.

The axis of the talo-crural joint was analysed by roentgen stereophotogrammetry in eight healthy volunteers. Examinations were performed at 10 degrees increments of flexion and pronation/supination of the foot as well as medial and lateral rotation of the leg. Results indicate that the talo-crural joint axis changes continuously throughout the range of movement. In dorsiflexion it tended to be oblique downward and laterally. In rotation of the leg, the axis took varying inclinations between horizontal and vertical. All axes in each subject lay close to the midpoint of a line between the tips of the malleoli. Our study indicates that the talo-crural joint axis may alter considerably during the arc of motion and differ significantly between individuals. This prompts caution in the use of hinge axes in orthoses and prostheses for the ankle

The management of an anterior supracondylar fracture by closed reduction, traction, percutaneous pinning or open reduction is seldom satisfactory, especially for adults and the aged with a lesser ability to remodel and a slower functional recovery. A new, safe, and simple technique is described in which the condylar mass is pushed posteriorly along the axis of the forearm and the hand is rotated to full supination while the elbow is held in flexion to correct deformities. Fixation is divided into two parts: the circular cast around the upper arm provides a firm buttress onto which the lower fragment is reduced and then the arm is immobilised in a plaster which includes the wrist. Four cases of delayed, comminuted, compound fractures have been fully evaluated clinically and radiologically and the results assessed as good or excellent

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We aimed to address the question on whether there is a place for shoulder stabilization surgery in patients who had voluntary posterior instability starting in childhood and adolescence, and later becoming involuntary and uncontrollable.

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Preoperative talar valgus deformity ≥ 15° is considered a contraindication for total ankle arthroplasty (TAA). We compared operative procedures and clinical outcomes of TAA in patients with talar valgus deformity ≥ 15° and < 15°.

Between 1996 and 2000, we treated ten patients with severely comminuted fractures of the radial head using low-profile mini-plates. Their mean age was 42 years (24 to 71). Three fractures were Mason type III and seven were Mason-Johnston type IV. At a mean follow-up of 28.5 months (15 to 44), all fractures had united. The plates were removed in nine patients. No patient had difficulty with daily activities or symptoms of instability of the elbow. The mean range of flexion of the elbow was from 7° to 135°, with 74° of supination and 85° of pronation. According to the Broberg and Morrey functional elbow index, the mean score was 90.7 points (73 to 100), and the outcome was excellent in three patients, good in six and fair in one. These results compare favourably with those reported previously. The technique is applicable to severely comminuted fractures of the radial head which otherwise would require excision

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The aims of this study were to determine the change in the sagittal alignment of the pelvis and the associated impact on acetabular component position at one-year follow-up after total hip arthroplasty (THA).

We reviewed 166 adult patients on long-term haemodialysis, dividing them into three groups according to the presence and type of shoulder pain. The 24 patients in group A, with spontaneous pain related to a supine posture, had been under haemodialysis for significantly longer than the others, and had a much higher incidence of carpal tunnel syndrome. Open or arthroscopic resection of the coracoacromial ligament in 21 shoulders relieved pain during haemodialysis and night pain, and histological examination showed amyloid deposits and inflammatory-cell infiltration in the subacromial bursa in almost all cases, and in the tenosynovium of the bicipital groove in some. We conclude that one type of shoulder pain experienced by patients on long-term haemodialysis is caused by the subacromial impingement of amyloid deposits. This should be distinguished from other types of shoulder pain, because it can be relieved by resection of the coracoacromial ligament

The pathogenesis of Perthes' disease has been related to increased intra-articular pressure secondary to a joint effusion. The pressure within the hip in different positions was measured in eight children with transient synovitis and four with the synovial stage of Perthes' disease. In the position of comfort for the hip this pressure was always less than the arteriolar blood pressure and in a supine position it did not exceed the systolic blood pressure. However, in extension with medial rotation the intra-articular pressure always became several times the systolic blood pressure. This high pressure was also recorded in the stable lateral position which occurs normally during sleep. It is concluded that in the presence of a synovial effusion in the hip, a position of extension and medial rotation causes an increase in intra-articular pressure which may compromise the blood supply to the capital epiphysis of the femur

We report the ulnar impingement syndrome, which is caused by a shortened ulna impinging on the distal radius and causing a painful, disabling pseudarthrosis. Of the 11 cases reported, 10 were due to excision of the distal ulna after injury to the wrist; the other was a result of a growth arrest after a fracture of the distal ulna in a child. The symptoms are a painful, clicking wrist and a weak grip; clinical examination reveals a narrow wrist with pain on compression of the radius and ulna and on forced supination. Radiographs in the majority of cases show scalloping of the distal radius corresponding to the site of impingement. The mechanism by which ulnar impingement occurs after radio-ulnar convergence is illustrated. The plan of management for the young patient with traumatic dysfunction of the distal radio-ulnar joint is discussed; excision of the lower end of the ulna is not advised in such patients

We present our experience with correction of Madelung’s deformity by the Ilizarov technique. Seven patients (eight deformities) were treated by osteotomy of the radius with subsequent lengthening and angular correction. They were reviewed at a mean of 30 months (1.5 to 5.5 years). At the time of operation their mean age was 19 years (9 to 44). At follow-up all were free from pain and supination had improved by a mean of 34° and pronation by 9°. Flexion had increased in most cases with a median increase of 15°, but only one patient gained further extension. Radial and ulnar deviation were increased by a mean of 6° and 9°, respectively. Radiographic measurements showed that the mean volar angulation had been reduced from 25° to 11°, ulnar inclination from 45° to 30° and carpal malalignment (volar translation) from 7 to 2 mm. The mean lengthening of the radius was 12 mm (6 to 25). All the patients were satisfied with the functional and cosmetic results

Between 1993 and 1999, we treated ten patients with comminuted fractures of the olecranon by multiple tension-band wiring and a graft from the iliac crest. Their mean age was 35 years (19 to 56). The mean follow-up was for 28.5 months (15 to 46) and the mean time to union of the fractures was four months (3 to 7). No patient reported difficulties with activities of daily living or symptoms of instability of the elbow. The mean flexion was to 135° (125 to 145) with a mean flexion contracture of 15° (10 to 30). The mean pronation was 70° (60 to 80) and mean supination 79° (70 to 90). Only three patients had mild pain and loss of strength. Five patients had excellent and five good results with a mean Broberg and Morrey index score of 94.5 points (84 to 100). Our results compare favourably with those previously reported and the technique is thought to be a practical alternative to plate fixation in fractures with extreme comminution

We report ten cases of rupture of the distal part of the tendon of biceps brachii in patients aged from 27 to 58 years. MRI allowed assessment of the degree of retraction of the tendon which was related to the integrity of the bicipital expansion. When the retraction exceeded 8 cm the expansion was always ruptured. When there was doubt, or in longstanding injury, MRI allowed the lesions to be defined. Surgical repair was by reinsertion on the radial tuberosity at one or two fixation points in eight patients and reinsertion on the anterior brachial muscle in one. The other patient refused surgery. The MRI findings were confirmed at operation. Use of fixation points allowed minimal intervention, thereby reducing the risk of damaging the radial nerve. One year after operation, dynamometric evaluation of the strength of flexion and supination confirmed that the best results were obtained by reinsertion to the radial tuberosity

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Appropriate acetabular component placement has been proposed for prevention of postoperative dislocation in total hip arthroplasty (THA). Manual placements often cause outliers in spite of attempts to insert the component within the intended safe zone; therefore, some surgeons routinely evaluate intraoperative pelvic radiographs to exclude excessive acetabular component malposition. However, their evaluation is often ambiguous in case of the tilted or rotated pelvic position. The purpose of this study was to develop the computational analysis to digitalize the acetabular component orientation regardless of the pelvic tilt or rotation.

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The diagnosis of developmental dysplasia of the hip (DDH) is challenging owing to extensive variation in paediatric pelvic anatomy. Artificial intelligence (AI) may represent an effective diagnostic tool for DDH. Here, we aimed to develop an anteroposterior pelvic radiograph deep learning system for diagnosing DDH in children and analyze the feasibility of its application.