Assessment of acetabular retroversion following long term review of Salter's osteotomy.

Salter's innominate osteotomy may predispose to anterior over-coverage of the acetabulum. Over cover or retroversion has been demonstrated to be a cause of hip pain, impingement and subsequent osteoarthritis. We reviewed the long-term follow up of seventeen skeletally mature hips in sixteen patients who had previously undergone a Salter's osteotomy in childhood. The Salter pelvic osteotomy was performed at a mean average age of 5 years and follow up at a mean average age of 20 years. Patients were assessed by clinical examination for signs of impingement, Harris Hip Score and pelvic radiograph. Acetabular version was evaluated by the relationship between anterior and posterior walls of the acetabulum using templates applied to the pelvic radiograph as described by Hefti. The median acetabular cover averaged 17 degrees of anteversion with 2 patients (12%) demonstrating retroversion, neither of whom, had signs of impingement on examination. The mean average Harris Hip Score was 85 indicating a good outcome at long-term follow-up. We believe acetabular remodelling may occur with age after Salter's innominate osteotomy and have found good results in patients after skeletal maturation. Fears of long-term anterior over-coverage and retroversion with this operation may be unfounded.

Gap index: a good predictor of failure of plaster cast in distal third radius fractures.

The aim of this study was to assess the usefulness of the cast index and an indigenously developed gap index as measures of poor moulding of plaster. Twenty cases of re-manipulation of distal third radius fractures in children excluding growth plate injuries were compared with a control of 80 patients. A significant difference (<0.001) was observed in the cast index and the gap index of both the groups. The gap index was more sensitive than the cast index in predicting failure. At a level of cast index of more than 0.8 the relative risk of failure is 6.8 as compared with 35 when the sum of the gap index is more than 0.15. The gap index is a better predictor of failure than the cast index. A quick assessment of these indices is a good practice before accepting any plaster following a manipulation of distal radial fractures.

Orthopaedic sequelae of meningococcal septicemia.

The records of 143 patients admitted with a diagnosis of meningococcal septicemia were reviewed to identify vascular, cutaneous, and osseous sequelae. During the acute phase of the disease there were 21 deaths and 17 patients lost tissue. Thirty-six digits were allowed to autoamputate and six surgical amputations were performed. Each of the latter developed physeal growth arrests proximal to the level of amputation. Four patients underwent fasciotomies for compartment syndrome. Two of these patients had absent distal pulses and at surgery were found to have nonviable limb segments; the authors conclude that fasciotomy is rarely indicated. Sixteen patients were identified with a total of 41 growth arrests. Twenty-three of these occurred under areas of cutaneous scarring and were diagnosed 2 to 9 years after the index admission. The authors believe that patients requiring débridement and/or skin grafting of areas of skin necrosis should be reviewed regularly during the growth period to identify physeal damage at a stage when less complex surgery may be indicated.

Risk factors for developmental dysplasia of the hip: ultrasonographic findings in the neonatal period.

The relationship between ultrasonographic findings at birth and risk factors for developmental dysplasia of the hip have not been prospectively evaluated. Since implementing a routine screening programme for all new-born babies in 1989 we have collected 48 000 sets of data, including family history, birth presentation, mode of delivery and birth weight. Of the 92 babies (three per 1000 live births) with persistent ultrasonographic abnormality at 6 weeks only 20% displayed evidence of clinical instability at the original examination. Female babies without the additional risks of breech birth or positive family history were quantitatively the most significant group, accounting for 75% of cases treated. The majority of babies requiring intervention would not have been identified utilizing present criteria for selective ultrasound screening.