One hundred and twenty-nine unselected club feet were classified at birth into three grades of severity; 123 were followed up. The results of primary treatment were analysed and it is shown that the bad feet did worst. Serial splinting in plasters achieved lasting correction in nine in ten mild club feet, in half of the moderately deformed, but in only one in ten of the severely affected. Surgical correction succeeded in two out of three of the resistant feet, but had to be repeated in the others.
Clinical and experimental observations are described that indicate that intra-articular fibrinogenolysis is a cause of the defect of coagulation seen when blood is extravasated into a synovial joint.
SummaryTwenty-four cases of birth injury to the brachial plexus were seen in 21 infants over 15 years. Obstetric complications were common, and in 11 cases traction was needed to deliver the shoulders. Three out of every four arms fully recovered after exercises. Splints were not needed. Reconstructive procedures were performed on three permanently paralysed arms when the children were aged about 4. There was no way of predicting which patients would recover. The muscles supplied by the suprascapular nerve were paralysed in all patients, and this paralysis persisted in those whose arms failed to recover fully.
1. Eight cases of congenital vertical talus in infancy are reported. The principal differential diagnosis at this age is from talipes calcaneo-valgus. 2. The deformity is primarily a dorsal dislocation of the talo-navicular joint. 3. Closed reduction can be achieved if treatment begins at birth. Open reduction is indicated for the deformity uncorrected by the age of three months.
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