Recurrent giant-cell tumour after en bloc excision of the distal radius and fibular autograft replacement.

We report two patients, each with a giant-cell tumour of the distal radius treated by curettage and bone grafting. Local recurrence of the tumour occurred in the autograft and in the adjacent soft tissues in both patients, and was successfully treated by local excision; one patient also had radiation therapy. Both remain well 20 years and five years later.

Neonatal screening in Vancouver for congenital dislocation of the hip.

After 20 years' experience throughout the Western world the effectiveness of screening newborns for congenital dislocation of the hip remains controversial. Is the clinical test for hip instability (the Ortolani or "jump" sing) reliable? Are other equally important physical signs frequently missed by inexperienced examiners? Do some dislocations develop after the newborn period when no abnormality was identifiable during the first week of life? In Vancouver, screening for this condition was initiated in 1964. In the 5-year period 1967-1971 an orthopedic surgeon screened all the infants in the newborn nursery of one hospital, while orthopedic residents screened all those at another hospital. Their rates of neonatal and late (after the first month of lfe) diagnosis of congenital hip abnormalities were, respectively, 6 and 0.3/100 lives births for the surgeon and 5 and 0.8/1000 for the residents. In contrast, at 20 hospitals that did not have regular screenign the average rates were 1.2 and 1.4. Systematic screening the early treatment have great potential for reducing the need for immobilization and surgical treatment of infants who congenital dislocation of the hip is missed in the first month of life. it may also prevent the arthritic sequelae that in adult life afflict many patients whose treatment was begun after the newborn period.

Squamous cell carcinoma arising in chronic osteomyelitis.

Analysis of three cases and a review of the recent literature on squamous cell carcinoma arising in osteomyelitis confirm that this is an uncommon condition which may run a less benign course than was earlier believed. The disease affects chiefly middle-aged and older men, usually involves the lower extremity and most often occurs in the tibia. Development of a malignant tumour is heralded by increased pain and foul-smelling drainage in the presence of a fungating ulcer. Increased bone destruction is seen on the roentgenograms. A consistent finding is the long duration of infection but the authors stress that sinus drainage of long duration is not essential: the carcinoma can arise in scar overlying quiescent osteomyelitis as is occasionally seen in burn scars. Amputation is the treatment of choice.