114 research outputs found
Juvenile Tillaux fracture of the ankle associated with a tibial shaft fracture: A unique combination
No full text
Bilateral 'Jones' fractures of the fifth metatarsal following relapse of talipes equinovarus
No full textThe management of slipped capital femoral epiphysis
No full textThe treatment for most patients with slipped capital femoral epiphysis (SCFE) is well established but controversy remains as to how to manage the more difficult cases. The advent of
fixation by a single cannulated screw has made this the operation of choice. The morbidity is considerably less than that with any of its predecessors, but the optimum timing for treatment remains uncertain, particularly in the management of unstable and severe slipped epiphyses. Delay in diagnosis continues to be the single most important factor associated
with a poor outcome
Physiological cell death of chondrocytes in vivo is not confined to apoptosis: new observations on the mammalian growth plate
No full textChondrocytes at the lower zone of the growth plate must be eliminated to facilitate longitudinal growth; this is generally assumed to involve apoptosis. We attempted to provide definitive electron-microscopic evidence of apoptosis in chondrocytes of physes and chondroepiphyses in the rabbit. We were, however, unable to find a single chondrocyte with the ultrastructure of ‘classical’ apoptosis in vivo, although such a cell was found in vitro. Instead, condensed chondrocytes had a convoluted nucleus with patchy chromatin condensations while the cytoplasm was dark with excessive amounts of endoplasmic reticulum. These cells were termed ‘dark chondrocytes’. A detailed study of their ultrastructure combined with localisation methods in situ suggested a different mechanism of programmed cell death. In addition, another type of death was identified among the immature chondrocytes of the chondroepiphysis. These cells had the same nucleus as dark chondrocytes, but the lumen of the endoplasmic reticulum had expanded to fill the entire non-nuclear space, and all cytoplasm and organelles had been reduced to dark, worm-like inclusions. Since these cells appeared to be ‘in limbo’, they were termed ‘paralysed’ cells. It is proposed that ‘dark chondrocytes’ and ‘paralysed cells’ are examples of physiological cell death which does not involve apoptosis. It is possible that the confinement of chondrocytes within their lacunae, which would prevent phagocytosis of apoptotic bodies, necessitates different mechanisms of eliminatio
Slipped capital femoral epiphysis
No full textSlipped capital (or upper) femoral epiphysis occurs during periods of rapid growth in adolescence, when shear forces, particularly in obese children, increase across the proximal femoral growth plate, leading to displacement of the epiphysis. The typical patient is obese. In a recent case study of 54 patients with this condition, all had body mass indexes in the overweight or obese ranges.1 In boys, accompanying hypogonadism implicates possible endocrine causes.2 A chronic slip is the most common presentation, with symptoms present for weeks or months as the slip progresses. An acute slip occurs after a traumatic event and prevents weight bearing, whereas in an acute on chronic slip, prodromal symptoms are followed by a sudden exacerbation of pain. The last two types of slip usually present to the emergency department rather than the general practitioner
Familial congenital pseudarthrosis of the ulna
No full textA mother and daughter, both presented with congenital pseudarthrosis of the ulna due to neuro-fibromatosis. The daughter is one of identical twins, the second twin not having a pseudarthrosis. The mother's uncle also had pseudarthrosis of the tibia. This suggests a complex variable genetic inheritance pattern for pseudarthrosis in neurofibromatosis. Despite having had no treatment, the mother had minimal symptoms, minimal deformity, and no radial head dislocation.<br/
Improving the outcome of paediatric orthopaedic trauma: an audit of inpatient management in Southampton
No full textThe diagnosis and management of congenital dislocation of the hip
No full textCongenital dislocation of the hip (CDH) or developmental dysplasia of the hip (DDH) is a common condition that encompasses a spectrum of pathology affecting the neonatal hip. Clinical signs of instability may be difficult to detect at birth using the Barlow Ortolani test. A clear imperative is to make an early diagnosis since delay after 3 months is synonymous with the necessity for surgery and also leads to a compromised prognosis. There is considerable controversy about clinical screening for DDH or ultrasound screening, either comprehensive or selective. Risk factors – such as breech presentation, oligohydramnios and talipes – are well known and there is some evidence that selective screening for these babies with ultrasound may assist diagnosis. The incidence of neonatal hip instability is around 15–20 per 1000 live births but that of established dislocation 1–2 per 1000 live births in unscreened cohorts. The usual early treatment is with the Pavlik harness but after 3 months, surgery – either an open or closed reduction – is necessary and in some surgically untreated children, secondary procedures such as pelvic osteotomy are necessary
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