Failed operative treatment in two cases of pseudarthrosis of the clavicle using internal fixation and bovine cancellous xenograft (Tutobone).

The most commonly reported technique of reconstructive surgery for congenital pseudarthrosis of the clavicle involves resection of the pseudarthrosis, insertion of autologous iliac crest bone graft and internal fixation. In an attempt to avoid the potential complications of iliac crest bone graft harvest we used bovine cancellous xenograft (Tutobone). Two cases of pseudarthrosis of the clavicle treated with resection of the pseudarthrosis, Tutobone graft and internal fixation are presented. Both cases resulted in treatment failures, which were associated with significant osteolysis and failure of incorporation of the graft material. This required removal of the loose metal work and debridement of the failed graft material. We would caution surgeons against the use of Tutobone as a graft material in the surgical management of pseudarthrosis of the clavicle. The level of evidence was level IV case series.

Congenital unilateral absence of sternocleidomastoid and trapezius muscles: a case report and literature review.

Unilateral congenital agenesis of sternocleidomastoid and trapezius muscles is a rare occurrence. To date, there are only two case reports in the literature. We present a case of a 7-year-old Caucasian boy who was born with torticollis and a cosmetic defect in his neck. An MRI scan of the cervical spine and shoulder confirmed the absence of the right sternocleidomastoid and trapezius muscles. No other significant congenital anomalies were detected. The patient has been followed-up for 7 years with no functional disabilities.

Audit of elective paediatric clinic referrals from primary care February 2002-September 2006.

Our large district general hospital organized additional Waiting List Initiative clinics for paediatric orthopaedic referrals. A prospective audit examined pathology, investigations and disposal, and the implications of Waiting List Initiative clinics, particularly the increased workload for other specialties and disciplines. Variations of normal development were the most common presenting complaints, with the majority discharged following initial consultation. Local protocols, providing guidance to primary care physicians, covered common paediatric orthopaedic problems. We compared these guidelines with the referrals received to establish the referral quality and quantify the extra work generated. Few examples of inappropriate referrals were found, suggesting that referring physicians utilize the guidelines.

Supramalleolar osteotomy for unilateral tibial torsion.

Surgical correction of unilateral torsional deformity of the tibia is indicated in fewer than 1% of cases. Treatment is limited to those who have a progressive deformity, who are symptomatic and on whom conservative treatment has failed. We present the results of an osteotomy performed at the supramalleolar level leaving the fibula intact and held with staples. In 7 years, 13 children with a mean age of 13.4 years (range 10-16 years) underwent osteotomy. Six osteotomies were performed for internal tibial torsion (mean 25 degrees) and seven for external tibial torsion (mean 25 degrees). Seven participants were female and six male and all cases were idiopathic. One participant required antibiotics for a wound infection and five had the staples removed. All deformities were well corrected and symptoms improved. Numerous methods have been described to correct this deformity but all have been associated with major complications. We describe a supramalleolar osteotomy, leaving the fibula intact, that achieves good correction with minimal complications.