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Purpose of Study: Planovalgus deformity in cerebral palsy is disabling for the child in terms of increased energy expenditure during the gait cycle. The lever arm function of the foot is lost due to midfoot break and the achilles tendon is at a disadvantage being unable to lift the body weight during push-off. We evaluated the results of calcaneal lengthening osteotomy in such patients with clinical, radiological and gait parameters., Methods: 17 spastic feet in a sample of 10 children were included in our study. The children were classified according to the GMFCS classification system and clinical parameters such as heel valgus and heel rise tests, radiological angles such as Talo-calcaneal angle and Talo-navicular coverage angle on AP view and Calcaneal pitch angle, calcaneus-5th metatarsal angle and talus-1st metatarsal angle on lateral view were measured. Video gait analysis was performed to observe knee progression angle in mid stance and peak knee flexion angle in mid and terminal stance., Results: Improvement was noted clinically in the heel valgus angle (preop-12.06°, postop-5.12°) and radiological parameters showed an improved coverage of the talus by navicular with simultaneous lifting of the medial longitudinal arch. Gait analysis showed decreased knee flexion trend in mid and terminal stance phase with better restoration of the knee axis., Conclusion: Calcaneal lengthening osteotomy with peroneus brevis lengthening corrects almost all aspects of planovalgus deformity with an improved gait pattern without disturbing joint range of motion. It is a safe procedure for GMFCS grade 1 and 2 patients without much complications., Competing Interests: On behalf of all the authors, the corresponding author states that there is no conflict of interest., (© 2020 Delhi Orthopedic Association. All rights reserved.)

The incidence and risk factors of distal tibia/fibula fracture, an uncommon complication during Ponseti manipulation, are unknown. We evaluated 222 virgin clubfeet of patients aged less than 3 years for fractures of distal tibia/fibula. Incidence rate was found to be 1.3% per year. Associated risk factors were identified as neglected, syndromic clubfeet, feet requiring greater than 10 casts, post-tenotomy dorsiflexion less than 10° and casting by physician with less than 3 years of casting experience, with odds ratios of 14, 28, 4.9, 3.7 and 3.4, respectively. Most of these fractures healed without consequences; however, it is still advisable not to forcefully dorsiflex while casting, which may result in the fracture of distal tibia/fibula.

Femoral shortening has an advantage of gaining reduction in severe grades of congenital dislocation of the knee joint without release or lengthening of the quadriceps tendon, thereby reducing the incidence of extensor lag. We report our mid-term functional results in six patients (10 knees) with grade III congenital dislocation of the knee joint who were treated with femoral shortening. At an average follow-up of 4.1 years, the mean active range of motion was -0.5 to 107° and none of the patients had extensor lag. The results in arthrogryposis multiplex congenita were noteworthy for the absence of extensor weakness, postoperative deformity, or recurrence.

A cold abscess causing tracheo-oesophageal compression is quite unusual. A case of a 5-year-old boy with caries spine of D3-D4 vertebrea with respiratory distress due to mediastinal cold abscess pressing over trachea is being reported. Urgent costotransversectomy was done to decompress the cold abscess. There was immediate relief of airway compression which was evident from fall in airway pressure from 39 cm H2O to 29 cm H2O. The child was extubated on the 5th postoperative day and discharged on the 15th postoperative day in good condition.

Meningococcal outbreaks are a major health concern in Delhi and adjoining regions. Besides acute pyogenic meningitis, meningococcal disease can also manifest as vasculitis, dermatitis and arthritis. To study the frequency, characteristics and long-term outcome of joint involvement in May 2005 meningococcal outbreak in New Delhi, 24 patients with proven meningococcal disease admitted to the hospital from May, 2005 through August, 2005 were studied for occurrence and outcome of joint involvement, and were followed up and evaluated for any complications. The frequency of arthritis was found to be 20%, which is much higher than reported. Diplococci could be identified in the joint aspirate of all 5 patients who developed arthritis. All patients had features of acute septic arthritis which healed without residual deformity following arthrotomy. A significant percentage of patients can still be expected to develop acute septic arthritis in an outbreak of meningococcal meningitis, and a high index of suspicion should be kept for the same. Prompt diagnosis and management will lead to healing without complications in most cases.

The intra-articular fracture of radius has been an enigma for orthopaedic surgeons since time immemorial. It is a dilemma as to when to use the fixator, when to mobilise after fixator or simply treat it by conservative means. Numerous fixators are in vogue depending on the preference of the surgeon--in the present prospective study the results of dynamic external fixator--which, based on the principle of ligamentotaxis, were evaluated over a 3-year period and the results showed that although excellent radiological results were seen in 90% of the cases yet only 75% of the cases had a excellent functional result.

The aim of this study was to evaluate the conditions of the articular cartilage and other intra-articular structures in patients with refractory knee pain. A total of 50 patients were taken up for this study based on specific inclusion criteria. Arthroscopy was done using a 30 degrees scope and was introduced most commonly via anterolateral approach after a thorough clinical and radiological evaluation of the affected joint. It was observed that majority (76%) had grade I articular lesion and 10% had grade IV lesion. Arthroscopically 78% of the patients had a meniscal tear while 12% had cyst of lateral meniscus while clinically, meniscal tear was present in 22% of the cases and cyst in 2% cases only. Arthroscopy also detects other intra-articular lesions, which are missed clinically, thus modifying further management of the patient.