Femoral neck abnormalities in spina bifida.

Femoral neck abnormalities in spina bifida can be of two types: Type A, consisting of widening of the physis and often associated with varus deformity, and Type B, characterized by marked narrowing of the femoral neck, resulting in a typical mushroom appearance. The Type A deformity is usually associated with an abduction contracture of the hip. This physeal lysis seems to be secondary to microtrauma sustained during persistent exercise done by the parents and therapist to overcome the abduction contracture. No treatment is required, even when varus deformity is present. These patients require an orthosis with a pelvic band for ambulation, and their mobility will not be affected by the deformity.

Fractures of the tibial plateau. Treatment by closed reduction and spica cast.

A retrospective study of sixty-one displaced fractures of the tibial plateau treated by closed manipulative reduction and immobilization for six weeks in a molded single hip-spica cast revealed that there was bone union in all cases. Weight-bearing was carefully avoided for twelve to sixteen weeks while motion of the knee was regained. Fifty-three patients were followed for six months to twenty-two years, an average of 3.8 years. Objectively, 85 per cent of the patients' results were rated good or excellent while subjectively 94 per cent of the patients were satisfied with their results.