Arthrographically defined subchondral defects in Perthes' disease.

Since the original 1910 description of Perthes' disease, the aetiology and pathophysiology of this condition have remained elusive, and the treatment controversial. We found during arthrography that it has been possible to demonstrate a fluid-filled space between the ossified epiphysis of the femoral head and its overlying articular cartilage. This finding has not previously been documented in the literature, and we believe this mechanically vulnerable region may be subject to mechanical distortion, acting as a significant contributor to the evolving femoral head deformity seen in Perthes' disease.

Children with acute Perthes' disease have asymmetrical lower leg growth and abnormal collagen turnover.

Background: Abnormalities in distal growth and low levels of insulin-like growth factor (IGF)-I have been reported in children with Perthes' disease. Our aim was to establish whether the acute phase of Perthes' disease is associated with abnormalities of growth, of bone or of collagen turnover.

Methods: We performed a cross-sectional study of 15 children (3-11 years of age, 13 boys) at acute presentation and a longitudinal cohort study of 9 children.

The Salter innominate osteotomy: should it be combined with concurrent open reduction?

The timing of surgical realignment of the acetabulum after reduction of the dysplastic hip is controversial since a delay in correction may allow the joint to sublux again. The radiographic outcome after 188 Salter osteotomies was reviewed 5-25 years postoperatively using a comprehensive rating scale; 139 hips (69%) developed satisfactorily, 49 hips (26%) remained dysplastic but stable and nine hips (5%) were unsatisfactory. The best results occurred in children under the age of 30 months treated by combined open reduction and Salter osteotomy, when no further operation was required.

The transition from learner to provider/teacher: the learning needs of new orthopaedic consultants.

Background: Given the relatively sudden change from learner to teacher-provider that new consultants experience and the likely clinical and managerial challenges this may pose, there is a relative dearth of research into the problems they may have in relation to their new roles, or how supported they feel by senior colleagues acting in a mentoring role. This research sought to determine new consultants views on the quality and relevance of their training, its relationship to their confidence in clinical and managerial skills and their views on mentorship by senior colleagues.

Methods: Detailed postal questionnaire to new consultants using open and closed questions.

Infantile skeletal skew: the use of ultrasound in management.

The term 'infantile skeletal skew' recognizes the prenatal or postnatal moulding of a small proportion of babies who develop characteristic changes including plagiocephaly, wry neck, scoliosis, pelvic obliquity and postural foot deformities. Pelvic obliquity may cause an abduction contracture of the hip on one side and an adduction contracture on the other, and radiographs may suggest a 'dysplasia' of the acetabulum on the adducted side, giving rise to concern that the hip is unstable. In these cases we have found that early ultrasound assessment of the adducted side will reassure the clinician that the hip is 'in joint' and the condition should be allowed to resolve itself over several months without any treatment.

Guidewire damage during cannulated screw fixation for slipped capital femoral epiphysis.

Cannulated screw fixation of slipped capital femoral epiphysis is a standard procedure for the mild to moderately displaced slip. We report six cases in which the guidewire was damaged by a cannulated drill. In five the wire broke off within the femur.

Seasonal distribution of idiopathic congenital talipes equinovarus in Scotland.

Idiopathic congenital talipes equinovarus has a reported prevalence of between 0.64 and 2.5 per thousand live births in the Scottish population.