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In cases of established calcaneus after anterior poliomyelitis the deformity can be greatly reduced by combining an extensive plantar release with an oblique transverse osteotomy of the calcaneus that permits displacement upwards and backwards of the posterior weight-bearing part of the bone. The procedure greatly improves the mechanical advantage of subsequent tendon transplantations to the heel. Between 1956 and 1969 fifteen such osteotomies were carried out and the long-term results have been reviewed.

Over the 10-year period 1969 to 1978, 271 consecutive cases of congenital dislocation of the hip were diagnosed at birth. Standard anteroposterior radiographs ofthe pelvis were obtained routinely and were analysed retrospectively. The medial gap, a measure ofthe separation between the proximal femur and the pelvic wall, was found to be significantly increased in cases with unilateral or bilateral dislocation when compared to normal. A medial gap greater than five millimetres is indicative offemoral head displacement and is of value where the clinical diagnosis is uncertain. The rate of missed dislocation at birth was 0.6 cases per thousand. Treatment with the Malmo splint was the normal routine. The Pavlik harness was applied ifsplintage was poorly tolerated by the infant, or in the rare instance oflimited hip abduction. Failure to maintain reduction by splintage occurred in 3.3 per cent. The incidence of pressure deformities ofthe femoral head was 2.95 per cent and there was a residual deformity in later childhood of 1. 1 per cent. It is presumed that this lesion can be attributed to the effect of splintage and it was notably avoided in the latter period BSc. MChOrth. FRCSEd(Orth).

The work capacity of 26 women after a Chiari pelvic osteotomy for symptomatic unilateral subluxation of the hip was assessed using two simple exercise tests: the maximal walking speed during a 12-minute test and the time taken to climb stairs. A significant linear decline in walking speed occurred with increasing age, despite the operation, and only one patient over the age of 25 years was able to walk at a normal rate. Compared to the results in a control group of women of similar age the stair climbing time was increased in 54 per cent of the patients and showed a significant negative correlation with the maximal walking speed. Age-adjusted walking speed was closely associated with the degree of pain experienced but there was no relationship between observed function and conventional clinical assessment based on the range of movement and the radiographic appearances of the hip.