Coxa valga may sometimes occur as a complication of varus osteotomy for congenital
We have reviewed the serial radiographs of 63 hips in 53 children treated by closed reduction for congenital
We describe a 15-year-old boy with a posterior
1. Three cases of premature epiphysial closure at the knee complicating prolonged immobilisation for congenital
Thirty-two neglected congenital
1. The case history of a seven and a half-year-old boy who developed increased radiographic density of the femoral capital epiphysis after traumatic
Opinion varies as to the incidence of nerve lesions in anterior
1. A small personal consecutive series of children with congenital
Forty-four patients who had undergone 50 capsular arthroplasties for congenital
Augmentation of the acetabular component of total hip replacements is a method of increasing stability and preventing recurrent
Thirty hips affected by congenital
The ideal treatment for traumatic anterior dislocation
of the shoulder in the skeletally immature patient is controversial.
The aim of this study is to evaluate the outcomes after either conservative
and/or surgical treatment using the Latarjet technique. A retrospective
series of 49 out of 80 patients were reviewed. We found no significant differences
between either treatment method regarding functional scores and
pain levels. Although not statistically significant, post-surgical
patients showed better signs of shoulder stability than others who
have a higher rate of recurrence. Further, 92% of the post-surgical
group had returned to the same level of activity
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1. Five cases of greenstick fracture of the upper end of the ulna with
The incidence of nerve injuries in primary shoulder
We studied the pathogenesis, incidence and consequences of avascular necrosis in 184 children treated for congenital
The sternoclavicular joint (SCJ) is a pivotal articulation in the linked system of the upper limb girdle, providing load-bearing in compression while resisting displacement in tension or distraction at the manubrium sterni. The SCJ and acromioclavicular joint (ACJ) both have a small surface area of contact protected by an intra-articular fibrocartilaginous disc and are supported by strong extrinsic and intrinsic capsular ligaments. The function of load-sharing in the upper limb by bulky periscapular and thoracobrachial muscles is extremely important to the longevity of both joints. Ligamentous and capsular laxity changes with age, exposing both joints to greater strain, which may explain the rising incidence of arthritis in both with age. The incidence of arthritis in the SCJ is less than that in the ACJ, suggesting that the extrinsic ligaments of the SCJ provide greater stability than the coracoclavicular ligaments of the ACJ.
Instability of the SCJ is rare and can be difficult to distinguish from medial clavicular physeal or metaphyseal fracture-separation: cross-sectional imaging is often required. The distinction is important because the treatment options and outcomes of treatment are dissimilar, whereas the treatment and outcomes of ACJ separation and fracture of the lateral clavicle can be similar. Proper recognition and treatment of traumatic instability is vital as these injuries may be life-threatening. Instability of the SCJ does not always require surgical intervention. An accurate diagnosis is required before surgery can be considered, and we recommend the use of the Stanmore instability triangle. Most poor outcomes result from a failure to recognise the underlying pathology.
There is a natural reluctance for orthopaedic surgeons to operate in this area owing to unfamiliarity with, and the close proximity of, the related vascular structures, but the interposed sternohyoid and sternothyroid muscles are rarely injured and provide a clear boundary to the medial retroclavicular space, as well as an anatomical barrier to unsafe intervention.
This review presents current concepts of instability of the SCJ, describes the relevant surgical anatomy, provides a framework for diagnosis and management, including physiotherapy, and discusses the technical challenges of operative intervention.
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We reviewed 236 of the 388 Chiari pelvic osteotomies performed between 1953 and 1967 at the Orthopaedic University Clinic of Vienna for the treatment of congenital
Two boys with entrapment of the median nerve in the elbow joint after closed reduction of a posterior
Fifteen patients who limped and had early fatigue on walking caused by ischaemic necrosis after treatment for congenital