Legg-Calvé-Perthes' disease (Perthes' disease) is a childhood osteonecrosis of the hip for which the disease determinants are poorly understood. In this review, the authors identify studies of Perthes' disease incidence published up to December 2010 and make denominator populations comparable in order to allow meaningful between-study evaluation. Incidence rates and confidence intervals were determined, and, where appropriate, denominator populations were obtained from national statistical offices. Poisson regression was used to determine the influence of race and geography. The review included 21 studies that described 27 populations in 16 countries, with 124 million person-years of observation. The annual incidence among children under age 15 years ranged from 0.2 per 100,000 to 19.1 per 100,000. Race was a key determinant, with East Asians being least affected and whites most affected, though data were insufficient to consider incidence among blacks (for South Asians vs. East Asians, incidence rate ratio = 2.9, 95% confidence interval (CI): 2.4, 3.5; for whites vs. East Asians, incidence rate ratio = 8.8, 95% CI: 8.2, 9.6). Latitude was a strong predictor of disease, even after adjustment for race. Each 10° increase in latitude was associated with an incidence increase of 1.44 (95% CI: 1.30, 1.58) times. While much of the international variation appears to be a function of race, latitude demonstrates a strong association. This observation may offer new epidemiologic insights into the determinants of Perthes' disease.

Tardive dyskinesia (TD) is a severe and potentially irreversible movement, and previous studies have suggested increased mortality among patients with TD, but most of these studies are limited by small sample sizes and short periods of follow-up. This study examined the mortality rate of a cohort of 608 Asian patients with schizophrenia during a 6-year period and used survival analyses on time from case ascertainment to outcome (death). Data on the survival status were collected and compared between those with and without TD, and cross-tabulation was performed to show the correlation between survival and mortality rates among patients with and without TD.Seventy-two patients died, 39 (54.2%) of whom had TD previously. Of the 536 surviving cases, 239 (44.6%) have TD. The mortality rates between those with TD and those without TD were statistically significant (hazard ratio, 2.62; 95% confidence interval, 1.58-4.33; P = 0.0006).The mortality rate was dependent on age; nevertheless, the adverse effect of TD on survival rate, although reduced, remains after controlling for age (hazard ratio, 1.90; 95% confidence interval, 1.12-3.20; P = 0.017). Our finding showed a robust association with increased mortality rate and TD, but we failed to find any significant association with any specific cause of death and TD.

This review seeks to draw attention to the existence of the 'slipping rib syndrome' as a not uncommon clinical entity. It is characterized by trunk pain in a radicular distribution, often related to certain movements or activity, but not associated with other visceral symptoms. The diagnosis is a clinical one, with surgical excision of the affected rib and costal cartilage a successful simple treatment for relieving those patients of a severe and persistent pain syndrome.

Ann R Coll Surg Engl 2011; 93: 57-60 57 Distal radius fractures are one of the most common fractures presenting to orthopaedic surgeons. Traditionally, such fractures have largely been treated by closed reduction and immobilisation in plaster, yet improvements in orthopaedic technology have changed the management of distal radius fractures. The use of volar plates for managing distal radius fracture is now almost universal to orthopaedic surgeons engaged in adult trauma care.The conventional means of internal fixation of dorsally displaced distal radius fractures was by dorsal plating to create a mechanically stable, dorsal buttress effect. The close proximity between plate and tendons, however, meant that extensor tendon irritation and rupture were common; hence, although it inferred improved fixation, it had unacceptable tendon complications.1-4 Improvements in plate design, in the form of locking plates, have allowed mechanical stability of the fracture to be achieved with plates on the volar surface of the radius, which has better tendon relationships. This mechanical advantage stability, even in osteoporotic bone, allows early active mobilisation and has resulted in a marked increase in the use of volar fixation of distal radius fractures. 5,6 Despite the improved tendon relationships, extensor tendon complications remain. Most commonly affected is the tendon of the extensor pollicis longus (EPL), owing to its confinement within the EPL groove. The cause of tendon irritation and rupture is thought to be due to attrition either by prominent screws or perforating the dorsal surface intraoperatively with a drill. 7-13We sought to investigate if it were possible to identify screw hole positions, within three of the most commonly used locking plates in the UK, through which a long screw may pose a risk of injury to the EPL tendon in the EPL groove. This knowledge combined with the understanding that the use of all screw holes is not always necessary to achieve fracture stability may reduce the risk of EPL tendon irritation and rupture. Subjects and MethodsEighteen preserved cadaveric forearms were examined. Each arm was from a different individual and had been preserved by freezing and was completely thawed before use. Cadavers were examined both visually and radiographical- (EPL) tendon is a recognised complication following volar plate fixation of distal radius fractures, usually from attrition caused by prominent screws. We sought to identify the screw holes in some of the most commonly used plates which may precipitate tendon injury. SUBJECTS AND METHODS Three fixed-angle volar locking plates were sequentially positioned into 18 cadaveric arms. A wire was passed through each of the holes in the plates using a locking guide and the dorsal relationships noted. RESULTS Each plate had specific 'high-risk' holes which directed the wire towards the EPL groove. The central screw holes appeared mostly implicated in EPL injury. CONCLUSIONS Awareness of 'high-risk' holes and appropriate minor alterations in surgical ...

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