We have contrasted 161 patients with Down's syndrome admitted to three acute care centers with 107 patients in an institutional setting, outlining their major orthopedic problems and suggesting methods of management based on acute care experience. Severe hallux valgus, metatarsus primus varus, subluxation an dislocation of the patella, severe pes planus, atlantoaxial subluxation, femoral head epiphysiolysis, and dislocation or subluxation of the hips remain the most critical problems against a background of other less common orthopedic abnormalities.

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