Geoffrey Walker

MIXED SCLEROSING BONE DYSTROPHIES

1. A Nigerian patient with radiographic features of osteopathia striata, osteopoikilosis and melorheostosis is reported. Also radiographs of a patient from the Radiographic Museum of the Institute of Orthopaedics at the Royal National Orthopaedic Hospital are reproduced because they show a similar mixture of these conditions. 2. lt is probable that a common factor is present at some stage in the development of melorheostosis, osteopathia striata, osteopoikilosis and possibly osteopetrosis.

The hip in the moulded baby syndrome

The moulded baby syndrome comprises: head moulding (plagiocephaly); pelvic obliquity with unilateral loss of hip abduction in flexion; and occasionally scoliosis, torticollis and bat ears. The hips, however, are radiologically normal and do not require the treatment used in the management of congenital dislocation or dysplasia. A review of 67 hips confirms this finding.

THE EARLY MANAGEMENT OF VARUS FEET IN MYELOMENINGOCELE

1. A conservative approach to the varus deformity of anaesthetic feet in infants with myelomeningocele is advocated. Thirty-three of thirty-five varus feet treated by this method, supplemented when necessary by a minor operation to correct equinus, responded satisfactorily in this prospective study of twenty-four infants treated from birth. 2. A rotation flap incision has proved of considerable advantage in the rare instances when an extensive medial release is required.

BLINDNESS DURING STREPTOMYCIN AND CHLORAMPHENICOL THERAPY

ALTHOUGH the toxic effects of streptomycin on the eighth nerve are well known, it is perhaps not so widely appreciated that loss of vision may complicate the administration both of streptomycin and of chloramphenicol. A patient is described who became partially blind during combined streptomycin and chloramphenicol therapy and in whom streptomycin was at first considered to be the toxic agent. However, from a review of the world literature, it is evident that either drug may be incriminated.

TYPHOID SPINE IN A NIGERIAN WITH SICKLE HAEMOGLOBIN

1. A proven case of typhoid spine in a patient with sickle cell trait (AS) is recorded. It responded well to conservative treatment with chloramphenicol. 2. The literature on typhoid spine is briefly reviewed and the relationship between salmonella osteomyelitis and sickle cell disease is discussed.

POSTERIOR PSOAS TRANSFER AND HIP INSTABILITY IN LUMBAR MYELOMENINGOCELE

Seventy-two posterior psoas transfer operations performed in forty-four children with lumbar myelomeningocele were reviewed one to eight years after operation in an attempt to assess its value. Muscle charting, an objective recording of the childs walking ability, and radiographic examination of the hips were done. Hip stability was improved: 49 per cent were stable at the time of psoas transfer and 94 per cent at review. Functional results depend mainly on the level of neurological activity present: 57 per cent of the children had an acceptable functional result. Usually, posterior psoas transfer should be done as soon after the age of nine months as the childs condition will allow. Over the age of two years it should be restricted to children with activity in the third and fourth segments of the lumbar cord.

AN EVALUATION OF AN EXTERNAL SPLINT FOR IDIOPATHIC STRUCTURAL SCOLIOSIS IN INFANCY

1. The records of forty-nine patients with idiopathic structural scoliosis in infancy treated by a combination of splinting and physiotherapy have been reviewed. 2. Nine curves (18·3 per cent) failed to respond to treatment and five of these progressed. 3. The percentage of good results (81·7 per cent) shows no improvement on the natural course of the condition.