The presentation of rickets to orthopaedic clinics: return of the English disease.

Rickets is a potentially treatable disease of the bone that is most commonly due to deficiency of vitamin D and is increasing in incidence in developed countries. Risk factors include dietary factors, the practice of covering up and darker skin pigmentation. This small retrospective case study set out to examine all cases of rickets presenting to the Paediatric Orthopaedic clinic over a 15-month period. Rickets presented in a bimodal fashion in the 6 cases identified: in males and females aged 3 or less and female adolescents aged 10 and above. This is in keeping with what is known regarding the rapid phases of growth during development. Five cases were from ethnic minority groups. Both female adolescents presented with genu valgum. Rickets can present primarily to Orthopaedic clinics with vague musculoskeletal symptoms. We recommend that biochemical screening be performed on patients from ethnic minorities who may be 'at risk'.

The statistical relationship between varus deformity, surgeon's experience, BMI and tourniquet time for computer assisted total knee replacements.

The outcome of total knee arthroplasty (TKA) with severe pre-operative varus deformity is significantly worse than in well aligned knees. Computer navigated TKA has addressed some of the problems by ensuring accurate post-operative alignment. Our aims were to see if navigation could reproducibly correct a varus deformity to 3 degrees of the mechanical axis and to investigate the relationships between the tourniquet time and severity of the preoperative deformity, BMI and a surgeon's experience. The 172 e.motion floating platform TKA's were implanted using the OrthoPilot Navigation system (B Braun-Aesculap, Tuttlingen, Germany). Pre-operative deformity and post-operative alignment were measured by the software. Tourniquet times were recorded automatically. All knees were corrected to within 3 degrees of the neutral axis (mean 0.48 degrees ). Statistically significant relationships between tourniquet time (TT) and degree of pre-operative varus (p<0.001), total number of previous e.motion TKA's performed (p<0.001), and body mass index (p=0.013) were found. A linear relationship between the variables can be expressed as a statistical formula: TT=49.5+PreOp Varus+0.6(BMI)-0.1(total previous). Tourniquet time is measured in minutes and preoperative varus is measured in degrees from the mechanical axis. Total previous is the total number of navigated TKA's implanted by the surgeon. Tourniquet time is increased with larger pre-operative deformities and high BMI and decreased with surgical experience. The formula may give us a method of predicting the length of a procedure for a particular surgical team and may allow us to plan operating lists more accurately.

Bone and joint tuberculosis in children in the Blackburn area since 2006: a case series.

This report describes a series of four cases of children between the ages 5 and 14 years with bone or joint infection with Mycobacterium tuberculosis diagnosed between June 2006 and March 2008 in the Blackburn area of England. All of the cases were of South Asian descent. The diagnosis was confirmed by the presence of M. tuberculosis on the culture of bone, synovium or joint fluid, or by the presence of the typical histology of tuberculosis (TB). The sites of tuberculous disease were the hip joint, the sacro-iliac joint and the talus. A recent paper by Sandher et al. (J Bone Joint Surg Br 89:1379-1381, 2007) illustrated only two cases of childhood bone and joint TB in the same geographical area in the preceding 17 years.