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101
APPENDIX F.
REPORT ON THE WORK OF THE ORTHOPÆDIC CENTRE FOR THE YEAR ENDED
31st December, 1934.
by
H. J. SEDDON, F.R.C.S., Orthopaedic Surgeon to the Council.
During the past year there has been an encouraging absence of severe deformities due to
rickets. No case came to operation, and only a few cases of bow-legs were sufficiently marked to require
splinting. My impression of rickets in Willesden during the past four years is that it is becoming
less frequent, and certainly less severe. Now it can hardly be considered a crippling disease.
Knock knee, appearing between the ages of two and six years, is the commonest complaint
that we deal with. In the vast majority of cases alterations to the shoes and splinting will correct
the deformity, but it has been necessary to admit two children for operative treatment. The cause
of this troublesome condition is still obscure. Rickets and muscular weakness following acute illnesses
undoubtedly account for a few cases, but in the greater number no obvious cause can be found. Recent
work in Germany suggests that knock knee may be a type of congenital deformity (though not
necessarily apparent at birth), and if this proves to be the case, preventive treatment becomes almost
impossible. Our present efforts are being directed to early recognition and prompt corrective treatment.
The loyal co-operation of Child Welfare and School Medical Officers contributes very largely
to our success in controlling this deformity.
Twenty cases of old infantile paralysis continue to absorb much of our time and energies.
It is most unfortunate that we have no certain means of combating this most damaging disease.
During the past year three children have been admitted for " stabilising " operations on the feet.
This form of treatment makes it possible for the patient to walk moderately well without
instruments, but the function of the lower limbs is never restored to normal.
Birth injuries have been few in number, which speaks well for the efficiency of the Maternity
Service. There has been only one case of obstetrical nerve injury during the year. The affected limb
was splinted immediately; recovery commenced after twelve days, and was complete within three
months.
The attendance of patients at the Clinic has been regular, and I have no suggestions to make
for the better running of the department.
The following are the particulars of 19 cases transferred to the Royal National Orthoptedic
Hospital, Stanmore, during the year :—
A.T.—Age 13 ; was admitted on 6.12.33 with old tuberculous disease of the right hip, which
had become partially fixed in a position of considerable deformity. The deformity was first corrected
by an operation on the joint, and the hip was fixed in a good position in plaster. At a later date a bone
grafting operation was done to ensure that the correction already obtained would be permanent.
The boy was discharged wearing plaster on 22.6.34. In November the plaster was removed and an
X-ray showed that the graft had united perfectly. It is fairly certain that this boy will be entirely
free from trouble in his hip for the rest of his life.
K.L.—Age 8 ; was admitted on 14.5.34 with stiffness of both hips, the result of acute arthritis
following scarlet fever. As the child was too young for any extensive operation on the hips we
endeavoured to restore some degree of movement by powerful traction. This was continued for five
months, but unfortunately the original damage was so great that no movement could be produced in
either hip. We have taught her to walk in spite of having stiff joints, and she was able to leave
Hospital on 4.1.35. It will be necessary to readmit her in five or six years' time for a radical operation
on one hip.
H.C.—Age 2; was sent to the Orthopaedic Clinic on account of difficulty in walking. It was
found that both hips were dislocated (a congenital condition) and she was admitted for treatment on
22.2.33. Reduction of the dislocations by manipulation was accomplished without great difficulty.
She has been discharged and readmitted five times for X-ray examination and a change of plaster.
In May, 1934, the plaster was finally removed and she has been walking since. It is almost certain
that the ultimate result will be perfect, and due in no small measure to early recognition of her
disability at the Infant Welfare Centre.
R.C.—Age 11 ; was admitted on 28.3.34 with old osteomyelitis of the left tibia. There were
two discharging sinuses above the ankle. At operation a cavity was found a few inches above the
ankle joint; it was obviously the cause of the persistent discharge. All diseased bone was removed
and the cavity was obliterated. From this time on the wound slowly healed, and the boy was
discharged on 22.8.34, walking well and with a very sound leg.