We carried out a retrospective review of 47 intra-articular fractures of the calcaneum treated by open reduction and internal fixation in 45 patients by a single surgeon between 1993 and 2001. The fractures were evaluated before operation by plain radiographs and a CT scan using Sanders' classification. Osteosynthesis involved a lateral approach and the use of the AO calcaneal plate. The mean follow-up was for ten years (7 to 15). Clinical assessment included the American Orthopaedic Foot and Ankle Society Score (AOFAS), the Creighton-Nebraska Score, the Kerr, Prothero, Atkins Score and the SF-36 Health Questionnaire. The radiological evaluation consisted of lateral and axial views of the os calcis. Arthritic changes in the subtalar joint were assessed with an internal oblique view and were graded using the Morrey and Wiedeman scale. There were 18 excellent (38.3%), 17 good (36.2%), three fair (6.3%) and nine poor (19.2%) results. Five patients had a superficial wound infection and five others eventually had a subtalar arthrodesis because of continuing pain. Restoration of Böhler's angle was associated with a better outcome. The degree of arthritic change in the subtalar joint did not correlate with the outcome scores or Sanders' classification. Prompt osteosynthesis should be considered for intra-articular fractures of the calcaneum in order to restore the shape of the hindfoot and Böhler's angle.

PurposeThe aim of this study was to determine the prevalence and pattern of upper limb involvement in children with cerebral palsy (CP), how this relates to function and how well these problems are recognised and treated.MethodsOne hundred consecutive patients with CP attending non-hand-related clinics were assessed. Function was assessed according to the Gross Motor Functional Classification System (GMFCS), the Manual Ability Classification System (MACS) and the ABILHAND-Kids system, and correlated to age and pattern of upper limb involvement. Patients were examined for contractures in the shoulder, elbow, wrist and hand. Concerns about the appearance of the hand were also assessed in older children.ResultsOverall, 83 % of patients had upper limb involvement, 36 % had a demonstrable contracture and 69 % had reduced hand control. The most common contracture patterns were the thumb in palm with clasp hand, shoulder adduction with internal rotation and wrist flexion with pronation. The thumb in palm with clasp hand pattern was associated with the greatest functional disability, followed by wrist flexion with pronation. Single contractures such as elbow flexion caused significant disability, whereas swan-neck contractures were, by far, less debilitating. Children aged 12 years and older had more concerns about the appearance of their hand. The ABILHAND score was strongly correlated to both the GMFCS and the MACS score.ConclusionDifferent patterns of upper limb involvement exist in CP and some have a significant impact on function and cause cosmetic concerns that should not be underestimated, particularly in older children.

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We assessed the risk for refractures following removal of elastic nails and plates from paediatric forearms. Out of 82 children who had 112 plates removed, seven patients (8.5%) had refractures when removals were within 12 months of implantation. Those aged 12 years or older were at risk. Out of 24 patients who had 38 nails removed, four patients (16.7%) had refractures and the risk was high when nails were removed within 6 months of insertion. Children aged 9 years or older were at risk. We do not recommend removal of forearm plates within 12 months and nails within 6 months of implantation.

A single ultrasound-guided corticosteroid injection resulted in generally short-term pain relief for symptomatic Morton's neuromas. The effectiveness of the injection appears to be more significant and long-lasting for lesions smaller than 5 mm.

Laying a patient on the side of their leg pain after a caudal epidural injection has a beneficial effect on the degree of pain relief. We recommend that this simple and safe maneuver be introduced routinely after administering a caudal epidural injection, to aid in the eventual outcome of a potentially difficult clinical problem.

Irreparable massive cuff tears in young patients pose a difficult problem for shoulder surgeons. Arthroscopic superior capsular reconstruction has shown promise in recent years in the treatment of this challenging patient population. The majority of the literature is limited to surgical techniques. The authors present the 2-year clinical outcomes of 25 patients undergoing arthroscopic superior capsular reconstruction with dermal allograft from a single center. The Oxford Shoulder Score and range of motion were assessed preoperatively and then at 3 to 6 months, 1 year, and 2 years following surgery. Patient satisfaction was recorded at final follow-up. Magnetic resonance imaging was performed at 3 months postoperatively to assess graft integrity. All patients were available at 1-year follow-up, and 23 were available at 2 years. The mean Oxford Shoulder Score improved by a minimum of 10 points at all time points compared with preoperatively. The mean forward flexion and abduction improved by 20° and external rotation by 7°. Revision to reverse shoulder arthroplasty was seen in 3 patients (12%). Graft failure was seen in 4 patients (16%). Overall, 20 patients had successful outcomes at 1 year (80%) and 18 patients had successful outcomes at 2 years (72%). Superior capsular reconstruction offers a safe and effective short-term bridging option for young patients with irreparable supraspinatus tears in the absence of glenohumeral arthritis. However, long-term outcome studies are required to evaluate the true clinical effectiveness and failure rates. [ Orthopedics . 2020;43(4):215–220.]

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