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Objective: The aim of the study is to investigate the long-term outcome of patients who received Lambrinudi arthrodesis for severe equinovarus deformities. Methods: This is a single-center, retrospective study of patients who received Lambrinudi triple arthrodesis of the foot. Both clinical and radiological information were analyzed. Results: We were able to review 10 patients suffering from severe equinus deformities mostly as a result of or in association with poliomyelitis (8 of 10) who received Lambrinudi arthrodesis. The majority (7 of 10) of our patients had fair to good outcome at an average follow-up of 37 years. Specifically, six of eight polio patients had fair to good outcome. Of the X-rays available for assessment, the majority of patients showed radiological signs of adjacent joint arthritis; however, the presence of such did not invariably lead to poor clinical outcome. Conclusion: Lambrinudi arthrodesis is a treatment option with favorable long-term outcome for patients with severe, fixed equinus deformities.

Background: Atypical triplane fractures are defined as triplane fractures that are intra-articular but affect the non-weight-bearing area of the tibia plafond or extra-articular triplane fractures where the epiphyseal fracture line exits outside the articulating cortex of the medial malleolus. These fractures are scarcely reported in the literature. Here, we study the fracture pattern, mechanisms, and recommendations for management. Methods: This is a retrospective study of all triplane fractures identified from 2012 to 2016 in a tertiary referral center. There were 10 atypical triplane fracture patterns identified in this cohort. All patients were followed up with an average of 19 months. A modified atypical triplane fracture classification was devised and compared with previously reported classification systems. Clinical outcomes measured included treatment complications, ankle range of motion, and time needed to return to sports. Results: We identified a new extra-articular triplane fracture variant with an anteromedial epiphyseal sleeve fragment (fracture variant). There were no long-term complications from operative closed reduction and percutaneous screw fixation. Operative cases had earlier ankle mobilization and regained full range of motion (12.8 weeks vs 13.3 weeks) earlier. The average time to return to sports was 5.2 months. Conclusions: We propose a modified classification for atypical triplane fractures and recommend closed reduction and percutaneous screw fixation for displaced atypical triplane fractures. Level of Evidence: IV (Case Series).

Nonbacterial osteitis (NBO) is an underdiagnosed and poorly understood condition caused by sterile inflammation. It can mimic the presentation of many other orthopaedic conditions, for example, osteomyelitis, septic arthritis, or malignancy, in particular for those patients who have unifocal presentation. Because NBO is a diagnosis by exclusion, it poses much difficulty and confusion to many orthopaedic surgeons in treating such disease. Clavicular involvement is common but it is typically present at the medial aspect of the clavicle. We report a case of NBO with atypical clavicular involvement who presented to our orthopaedic clinic with painful swelling in the left shoulder. Appropriate investigations and management are discussed together with literature review.

Purpose. To review records of children referred to ousr hospital for developmental dysplasia of the hip (DDH) and evaluate the effectiveness of hip screening in Hong Kong. Methods. Records of children suspected of DDH and referred to our hospital between 1 January 2005 and 31 March 2010 were reviewed. The diagnosis was based on static and dynamic ultrasonography of the hips and/or radiographic features of hip subluxation, dislocation, and pelvic dysplasia. The age of the children at presentation was recorded. Late diagnoses were those presenting after the age of 6 months. Late presentations were those presenting after the walking age. Results. Of 213 referred children, 33 were diagnosed to have DDH. Their mean age at presentation was 90.8 (range, 9–559) days. The female-to-male ratio was 2.9:1, and the mean follow-up duration was 25.1 (range, 4.2–50.3) months. 30 of the DDH infants were diagnosed before the age of 6 months, one at 8 months, and 2 were late presenters. Hence, the failure rate of the hip screening was 0.09 per 1000 live births. The remaining 180 were confirmed to be normal and followed up until the walking age. The point prevalence of DDH on Hong Kong Island was 0.87/1000 live births. Conclusion. In light of the low point prevalence of DDH in Hong Kong born children, the protocol of universal clinical assessment and selective ultrasonographic screening of suspected cases is justified.

Purpose. To assess the radiographic features of 36 hips with hereditary multiple exostoses (HME). Methods. Hip parameters of 12 males and 6 females (36 hips) aged 2 to 28 years with HME were assessed using anteroposterior radiographs. The recorded features included the sites of osteochondromas, the femoral head/neck ratio, the Reimer's migration percentage, Sharp's acetabular angle, the centre edge angle, the femoral neck-shaft angle, and degenerative changes. Results. 15 of the 18 patients were asymptomatic; 3 complained of pain (2 underwent excision or bone biopsy); no lesion was malignant. Osteochondromas were most commonly located in the femur followed by the ilium; only one was intra-articular. 32 hips had coxa valga; 26 had an abnormal Reimer's migration percentage; 17 had an abnormal Sharp's acetabular angle; 12 had an abnormal centre edge angle; 32 had an abnormal femoral neck-shaft angle; and 6 had degenerative changes. Acetabular and femoral dysplasia as well as subluxation are common in patients with HME. Conclusion. Borderline subluxated hips and those with marked coxa valga and/or acetabular dysplasia should be closely monitored to determine the need for surgery in the future. Subluxated hips should be operated on early, particularly in children and symptomatic adults.

A girl with known proximal femoral focal deficiency presented with Perthes' disease at 5 years of age. Her treatment involved a Salter osteotomy. This in conjunction with articular incongruence, due to deformity of the femoral head, resulted in mixed type femoroacetabular impingement when she was 10 years old. Surgical hip dislocation and femoral neck osteochondroplasty successfully relieved her symptoms of impingement. This is the first reported case of Perthes' disease in a patient with proximal femoral focal deficiency. The case highlights the importance of thoroughly investigating pain in patients with proximal femoral focal deficiency, a condition which is normally painless. Timely diagnosis of Perthes' disease and containment procedures can prevent collapse of the femoral head and the resultant sequelae. Acetabular over-coverage should be avoided in pelvic osteotomy to prevent the development of femoroacetabular impingement. [ABSTRACT FROM AUTHOR]