"Paws off our spurs": the calcaneal heel spur syndrome in Barbados - abstract

This retrospective study of 84 patients with pain under the heel, with or without a spur (the calcaneal heel spur syndrome) seen from October, 1989 in Barbados. The purpose was to assess the short and long-term results of conservative treatment. Follow-up ranged from 6 months to 8 years (mean = 4 years), and information was obtained by questionnaire (64/84 patients) and telephone. Most patients were middle-aged females, and duration of symptoms ranged from 2 weeks to 5 years. Calcaneal spurs were seen on X-rays in 64 (76 per cent) patients. Treatment was by infiltration of synthetic hydrocortisone preparation and local anaesthetic, surgery was not performed on any patient. Of 64 patients on whom follow-up data were availabe, 57 (89 per cent) were cured of their symptoms, and 7 admitted to having pain of varying severity. It is concluded that this syndrome is a self-limiting condition which usually responds to conservative treatment. Cases of chronic, persistent pain not responding to conservative treatment should be investigated for other causes (AU)

Nursing mothers' wrist - stenosing tenovaginitis of De Quervain - abstract

Fifty-two patients treated for painful wrists during a seven-year period at a referral clinic were studied. Forty-seven were women, and of these, twenty-seven were nursing mothers. This presentation shows the results of an investigation into some of the factors in the aetiology of this condition. Handling of the baby, especially those of higher birth weight, may be a contributing factor in the production of the disease. Conservative treatment by injection of local anaesthetic and hydrocortisone mixture into the tendon sheath is successful in early cases. Late cases benefit from operative relief of the stenosis (AU)

Diagnosis of foot deformities in babies and infants: birth to walking age - abstract

Cyrus, in his paper on 'congenital deformities' in 1985, observed that foot deformities form the largest part, 51 percent, of serious congenital defects. Deformities of the feet feature prominently in paediatric orthopaedic practice. Three deformities are commonly seen in the age group from birth to walking age. These are congenital talipes equino varus, metatarsus adductus, and talipes calcaneovalgus. These are often referred to as "golf club foot", "football foot" and "heel foot" respectively. It has been our experience here that the first two, which are more common, are usually confused; the diagnosis is uncertain, and treatment which should start very soon after birth is thus delayed. The results of subsequent mangement become compromised with recurrent deformity and disability for the children, even after the use of surgery. The purpose of this poster is to alert practitioners to the essential features of these deformities and what can be achieved in their management. The essentials of good management remain early recognition and prompt treatment (AU)

When a wrist injury is not a Colles' Fracture - abstract

Fractures of the lower radius with anterior displacement of the distal fragment are very uncommon injuries. These injuries, designated Smiths' and Barton's Fractures, tend to be readily confused with and misdiagnosed as the commoner Colles' fracture in which the distal fragment is displaced posteriorly, producing the well-known clinical "Dinner Fork Deformity". Between January 1977 and October 1984, 12 fractures of the distal radius with anterior displacement were seen and treated at the Queen Elizabeth Hospital. The case notes and radiographs of these 12 patients were studied, and nine were available for interview and examination. The injuries arose from falls (5), cycle accidents (6), and blows to the back of the hand (1). Two fractures were in children. In ten of the 12 cases the initial diagnosis was incorrect. On average presentation was late, 3 to 4 days, with one patient presenting one month after injury. Most fractures were treated by open reduction and fixation; three, including two children, were treated by manipulation and Plaster-of-Paris (AU)

Femoral shaft fractures in children: when bone shortening is desirable in healing - abstract

Fractures of the femoral shaft are common injuries in growing children. Road traffic accidents, falls from furniture at home and falls from trees account for the majority of cases. Apart from cases of child abuse which should be suspected in toddlers with multiple injuries to the body, pathological fractures are uncommon in this age group. Open fractures are also uncommon. Whereas in the conservative treatment of adult femoral fractures, every attempt must be made to reduce the fragments as accurately as possible and, in particular, restore normal length, in growing children such degree of accuracy in reduction is not necessary. In fact, some degree of bone shortening is desirable in displaced fractures. Accurate reduction of the fragments end to end will result in an overgrowth of the affected limbs amounting to 1" in the femur and this is permanent. This poster presents our experience based on 80 cases treated over an eight-year period. The ages of the children ranged from 3 months to 12 years. All cases were treated conservatively except one eleven-year old who had to be operated on. The only complication observed was a refracture, but this proceeded to proper healing. We believe treatment of fractures of the femoral shaft in growing children, based on certain well deformed principles, should be within the reach of every practitioner. In children approaching adolescence, the potential for growth is limited. Therefore, in these children, the fracture should be managed as for adults (AU)

Traumatic hip dislocations in Barbados (1976-1983) - abstract

Thirty-three cases of traumatic dislocations of the hip joint treated at the Queen Elizabeth Hospital between January 1976 and December 1983 were studied. Thirty-one were posterior dislocations, one anterior and one central. There were 27 men and 6 women. Road traffic accidents accounted for over 2/3 of the cases. Five resulted from falls and four from other less severe trauma. The sole case of anterior dislocation resulted from an alleged assault. Twenty-one of the 33 cases were available for review. Ten had required open operation to reduce and fix the acetabular fragment or reduce the dislocation. Two patients died. Follow-up of these 19 remaining patients (1-6 years) showed 85 percent good or excellent clinical results. Complications encountered included sciatic nerve palsy, (2 patients), extra capsular calcification (2 patients) and avascular necrosis of the femoral head in one case, leading to osteroarthritis. Prognosis of these injuries seems to depend on the severity of the injury, the age of the patient, and the timing of the reduction, especially open reduction (AU)