Clinical and radiological outcome of combined femoral and Chiari osteotomies for subluxed or dislocated hips secondary to neuromuscular conditions: a minimum of 10-year follow-up.

We evaluated the medium-term results of combined Chiari pelvic and femoral osteotomies performed at the Manchester Children's Hospitals between the years 1985 and 1994. The indications for these osteotomies were either hip dislocation or subluxation in children with neuromuscular disease. We clinically and radiologically evaluated 20 hips in 18 patients treated for hip subluxation and dislocation with Chiari osteotomy.

Hunter's legacy and surgical training and competence in the 21st century.

John Hunter's many contributions to surgery include the development of the scientific approach and possibly the first use of evidence-based medicine. This oration, concentrates on two other areas ? first, some of his contributions to orthopaedics and secondly past, present and future surgical training and competence.

Operative treatment for hip subluxation in spinal muscular atrophy.

Subluxation of the hip is common in patients with intermediate spinal muscular atrophy. This retrospective study aimed to investigate the influence of surgery on pain and function, as well as the natural history of subluxed hips which were treated conservatively. Thirty patients were assessed clinically and radiologically.

Effect of a bisphosphonate, disodium pamidronate, on the quasi-static flexural properties of Palacos R acrylic bone cement.

Aseptic loosening is a major complication of joint replacements and is thought to be associated with a heavy macrophage infiltrate in response to wear particles. Bisphosphonates are compounds known to inhibit osteoclastic activity and are used to reduce osteolysis in Paget's disease, osteoporosis, and metastatic bone disease. Oral bisphosphonates have also been used to decrease osteolysis and therefore prevent aseptic loosening of joint replacements.

Progression of scoliosis after spinal fusion in Duchenne's muscular dystrophy.

A consecutive series of 85 patients with Duchenne's muscular dystrophy who underwent spinal fusion over a period of 16 years was followed up with regard to the progression of the scoliosis and pelvic obliquity. Of 74 patients with adequate radiographic follow-up, 55 were instrumented with the Luque single-unit rod system and 19 with the Isola pedicle screw system; seven were instrumented to L3/4, 42 to L5, 15 to S1 and 10 to the pelvis with intrailiac rods. The mean period of follow-up was 49 months (SD 22) before and 47 months (SD 24) after operation.

Radiological evaluation of surgical treatment in Perthes' disease.

We compared the late radiographic results of femoral head coverage in two unselected groups of patients with Perthes' disease, one treated conservatively and one with surgical containment. Forty-eight hips were treated surgically and 28 hips were managed conservatively. The preoperative radiographs were classified using both the Salter and Herring classifications.

Hip subluxation and dislocation in Duchenne muscular dystrophy.

Although hip subluxation and dislocation occur commonly in neuromuscular diseases such as cerebral palsy, spinal muscular atrophy and myelomeningocele, they are not known to commonly affect patients with Duchenne Muscular Dystrophy. In this study, 15 out of 54 patients whose hip radiographs were reviewed showed unilateral subluxation, one had bilateral subluxation and three had unilateral dislocation. Having established that hip subluxation and dislocation develop frequently in patients with Duchenne Muscular Dystrophy, serial hip radiographs should be taken as has been advocated for cerebral palsy.

The effect of selective ultrasound screening on late presenting DDH.

We examined the impact of selective ultrasound screening on late presenting Developmental Dysplasia of the Hip (DDH) in the Salford area. In the years 1991-1995, babies with suspected clinical hip instability and a number of babies with known risk factors for DDH were referred to a designated Baby Hip clinic for sonographic hip examination. The decision for treatment was based solely on ultrasound findings.

Calcium mobilization is required for spreading in human osteoblasts.

Adhesion-induced changes in intracellular calcium concentration ([Ca2+]i) were measured in populations of human osteoblasts spreading on bone matrix proteins. In cells spreading on collagen type I, fibronectin, or laminin, average values for [Ca2+]i were found to increase approximately 2x over baseline and then decline. The speed with which [Ca2+]i increased and declined was dependent upon the matrix protein on which the cells were plated but was generally complete within 1 hour from the time of plating.

Whiplash injury--are current head restraints doing their job?

It is generally accepted that the incidence of whiplash associated disorders is increasing in all industrialised countries, despite the almost universal fitment of head restraints in at least the front seats of cars. This is usually attributed to the fact that few people can be observed to follow the standard recommendations as regards head restraint positioning, that is, level with the head vertically and as close to the head as possible horizontally. This study set out to determine whether any other factors, in addition to head restraint adjustment, could be found which would influence the severity of whiplash injury.

Ratio of basic surgical trainees to type 1 specialist registrar programmes 1999/2000/2001/2002.

It is recently becoming increasingly apparent that there is a significant discrepancy between the number of basic surgical trainees seeking Type 1 higher surgical training programmes and the number of those programmes available for appointment.

Removal of orthopedic implants in children: morbidity and postoperative radiologic changes.

One hundred twenty-one procedures for the removal of metalwork performed on 110 children aged 1-15 years is reported, with a focus on postoperative morbidity and radiographic skeletal changes. The removals were for a variety of acute and chronic pediatric orthopedic conditions. The level of postoperative morbidity was lower than in adult study groups with only one refracture (0.