Congenital dislocation of the patella in Rubinstein Taybi syndrome.

Two patients with Rubinstein Taybi Syndrome (RTS) were found to have congenital dislocation of the patella (CDP). The dislocation was bilateral in one patient. Both underwent surgical reduction and stabilisation. The dislocation recurred in one patient who had associated genu valgum and external tibial torsion at the time of stabilisation. We feel that early diagnosis of CDP in patients with RTS is important to help early mobilisation and avoid secondary degenerative knee changes occurring.

The correlation between clinical diagnosis of knee pathology and findings at arthroscopy.

175 patients referred for arthroscopy were studied prospectively to assess the accuracy of clinical examination supplemented by standard radiology in the evaluation of knee symptoms. Clinical diagnosis of medial meniscal tears was inaccurate while greater confidence could be placed in the diagnosis of anterior cruciate ligament and lateral meniscus tears. Clinical accuracy rates could be improved if patients with minimal symptoms were excluded from arthroscopy examination.

Accuracy of sonography in transient synovitis.

The presence of acute transient synovitis (TS, irritable hip) often warrants hospital admission not only to exclude underlying sepsis but also to aspirate when the intraarticular pressure might induce ischemia in the femoral head. Diagnostic doubt may affect this admission. We evaluated 68 patients in a prospective study comparing sonography with diagnostic aspiration and clinical examination. Sonography proved to be relatively accurate (81%) but was inferior to careful clinical evaluation in diagnosing hip effusions. Sonography may be helpful if diagnostic doubt exists. Aspiration under sonographic control will improve this accuracy.

Spontaneous rupture of the biceps femoris.

A case is reported of spontaneous rupture of the biceps femoris muscle, a hitherto undescribed condition. A characteristic history is discussed and a new clinical sign described.

The aetiology of degenerative disease of the hip. A review of 400 cases.

Four-hundred and forty patients who presented for Total Hip Replacement to the Orthopaedic Hospital, Cappagh were included in this study. Each case was classified into radiographic and aetiologic groups on the basis of the patients history, the results of special investigations, and the radiographic appearance of the hips. This classification allowed a further differentiation into primary and secondary osteoarthritis. Primary or idiopathic osteoarthritis was the single most common aetiologic group. A surprisingly high percentage of patients with secondary osteoarthritis had congenital dysplasia. It is suggested that this faulty biomechanical situation is the initiator of subsequent joint degeneration due to stress loading on the supero-lateral border of the hip. The reasons why such changes may be delayed until the 6th and 7th decades are unclear but degeneration once started progresses quickly. The possible place of surgical correction of the underlying biomechanical fault in delaying or preventing the onset of osteoarthritis is demonstrated and discussed.

Osteoarthritis of the hip and Heberden's nodes.

One hundred consecutive patients with proved osteoarthritis were assessed for the presence of terminal interphalangeal joint disease. There was a significant association found between the presence of Heberden's nodes and primary (axillary) arthritis. Secondary osteoarthritis was relatively free of nodal involvement. It is suggested that Heberden's nodes are a helpful clinical marker in differentiating between the two major groups of osteoarthritis.

Bilateral stress fractures of the ulna.

A previously undescribed case of bilateral stress fractures of the ulna is reported. The cause is attributed to inappropriate use of weight-bearing crutches. Biomechanical comparison is made with other known causes of stress fractures in the bones of the upper limb.