The genesis of Perthes' disease: does it lie in hips with reduced ranges of movement?

Noting that Perthes' disease is relatively common in Caucasian British children compared with black African children, this study was carried out to compare the range of hip movements in a series of 100 normal Ghanaian children and 182 normal British children, between 5 and 6 years of age. A significantly increased range of movement was found in the African group in all parameters, (P<0.001).

The epiphyseal tubercle in adolescent hips.

Background: It has already been shown in animals and using anatomical human specimens that chronic slippage of the adolescent upper (capital) femoral epiphysis is unlikely to take place by shearing due to the presence of an epiphyseal tubercle projecting down into the metaphysis.

Material, Results, And Interpretation: Plain radiographs of 20 adolescents and CT scans of 9 of them were analyzed for evidence of the size and presence of this tubercle in vivo. These cases showed that CT scanography is the investigation of choice to illustrate this largely undescribed anatomical feature.

Familial pseudarthrosis of the clavicle: does it need treatment?

The eighth family with multiple cases of congenital pseudarthrosis of the clavicle is described. This usually presents as a clavicular lump and is distinct from more common conditions such as birth fractures, craniocleidal dysostosis and neurofibromatosis. There has so far been no clear indication on whether familial pseudarthrosis of the clavicle should be treated operatively.

Splitting plaster with a scalpel blade: a safe way to allow easy splitting of a plaster.

Introduction: Splitting of a plaster cast is frequently required to accommodate post-operative limb swelling. Oscillating saws are often used but can cause injury and distress and cannot be used when the plaster is drying. At these times plaster shears are used.

Does the upper femoral epiphysis slip or rotate?

Although much has been published on the causes of slipped upper femoral epiphysis and the results of treatment, little attention has been given to the mechanism of the slip. This study presents the results of the analysis of 13 adolescent femora, and the attempts to reproduce the radiological appearances of a typical slip. The mean age of the skeletons was 13 years (11 to 15).

Bony lesions in BCG-vaccinated children: consider BCG osteitis.

This instructive case describes a 31-day-old female infant presenting with left elbow swelling. Radiographs were initially consistent with non-accidental injury, and she was investigated accordingly. After Paediatric Orthopaedic review, BCG osteitis was considered as a differential diagnosis.

Pelvic ramus fractures in the elderly: 50 patients studied with MRI.

Background: Whilst it is well known that fractures of the pelvic rami in the elderly are frequently associated with posterior ring injuries, the extent of this second injury is less well known. We evaluated this question by MRI scanning a group of elderly patients presenting at our unit with pelvic rami fractures.

Patients And Methods: We investigated 50 consecutive elderly patients (45 women) with fractures of the pelvic rami using an MRI scan of the pelvis in order to assess the competency of the pelvic ring.

Choice of dressing has a major impact on blistering and healing outcomes in orthopaedic patients.

Objective: To investigate the effect of three postoperative dressings on orthopaedic wound healing.

Method: Three hundred orthopaedic patients were divided into three treatment groups and allocated to management with one of three dressings: Primapore, Tegaderm with pad, and OpSite Post-Op. Staff completed a questionnaire to evaluate the wound progression.

Compartment syndrome caused by suction.

Compartment syndrome is probably underdiagnosed particularly when the mechanism of injury is indirect. This case is unusual in that the syndrome occurred as a consequence of suction injury and illustrates the benefits of early tissue pressure measurement and surgical decompression.

Maffucci lymphangioma syndrome: an unusual variant of Ollier's disease, a case report and a review of the literature.

A case of Maffucci's syndrome in an 18-month old boy is presented, in which the vascular malformation consists of lymphangioma. This is a rare variant of Maffucci's syndrome. So far only six other cases have been reported in which lymphangiomas featured.

Perthes' disease and the relevance of thrombophilia.

Recent work has suggested that thrombophilia may be an aetiological factor in up to 50% of children with Perthes' disease, and that up to 75% may have a coagulopathy. Our aim was to test these findings in the local population of children with Perthes' disease and attempt to correlate them with the severity of the condition. In 64 children there were only eight (12%) with low levels of clotting proteins, as defined by normal paediatric ranges.

Carbon-fibre reinforced plates for problem fractures.

We report our experience with carbon-fibre reinforced plastic (CFRP) plates in the management of 19 problem fractures complicated by either infection, nonunion, comminution or contamination. The combination offers secure fixation without inhibition of callus formation.

The response of human tissues to carbon reinforced epoxy resin.

The tissue surrounding carbon fibre reinforced epoxy resin plates applied to forearm and tibial fractures was biopsied in 32 patients at the time the plates were removed. The reaction was minimal and was compared with that in a control group of 16 similar patients in whom stainless steel plates were used. No significant histological differences were found.

Indication for weight relief and containment in the treatment of perthes' disease.

Fifty-four cases of Perthes' disease each suffering from total involvement of the femoral head were investigated to establish the relative merits of total weight relief and containment in management. It was found that using Catterall's criteria, once the femoral head is "at risk", containment is the only treatment of value; but when the head is "not at risk" a combination of containment and total weight relief produces a near perfect result in every case.

How stiff should semi-rigid fixation of the human tibia be? A clue to the answer.

Test results on carbon-fibre-reinforced plastic plates are presented, all of which had been used as semi-rigid fixation in a series of fractures of the middle third of the human tibia. Symptoms of pain experienced by the patients were found to be related to the stiffness of the plates and it is suggested that a stiffness of 2.0 newton-metres per degree is most suitable for this type of fixation of the tibia.

Corrosive effect of carbon-fibre reinforced plastic on stainless-steel screws during implantation into man.

The corrosion of stainless-steel screws used to fix carbon-fibre reinforced plastic (CFRP) plates to human fractures was compared with the corrosion on similar screws used to fix stainless-steel AO plates. Corrosive changes were noted in both sets of screws with similar frequency and severity; however, the stainless-steel plates were 'in situ' almost twice as long as the CFRP ones, showing that the corrosive changes occurred more rapidly on screws in contact with CFRP. Nevertheless, over the implantation time necessary for bone healing, corrosion was very mild and there is no clinical contra-indication to the use of stainless-steel and CFRP together in this particular application.