Congenital humeroradial synostosis can occur as an isolated clinical entity or as part of a syndrome. Bilateral elbow fixed flexion deformity is very incapacitating and challenging to treat. Here we present the case of a boy with fixed flexion deformity of both elbows due bilateral humeroradial synostosis. Other characteristic features of multiple synostoses syndrome were also present in this child, his elder brother and mother. We elected to improve the position of the right elbow by adapting the modified French osteotomy described by Bellemore et al.

Congenital talipes equinovarus (CTEV), also known as clubfoot is the most common lower limb congenital deformity among paediatric patients. The outcome of starting clubfoot treatment early is very promising. Patient retention throughout the treatment programme is challenging in Sarawak. In this study, we explored the barriers that parents/caregivers face when seeking clubfoot treatment in Sarawak, Northwest Borneo. A better understanding of the barriers will provide us with the information to formulate effective programmes for clubfoot treatment in this region.Methods: We conducted a questionnaire-based quantitative cross-sectional descriptive survey. We adapted a set of closed-ended questionnaires originally designed by Kazibwe and Struthers in a study done in Uganda in the year 2006.Results: A total of 53 parents/caregivers of children with idiopathic clubfoot were recruited in this study, with 16 defaulter cases and 37 non-defaulter cases. We found 2 statistically significant barriers to clubfoot treatment in Sarawak, with p-value < 0.05, namely the geographical factor (p = 0.019) and logistic factor (p = 0.017).Conclusion: Barriers to clubfoot treatment that influence the compliance to treatment identified in this study are long distance travel, logistics limitations, uncooperative patients during treatment, parents/caregivers having other commitments, unsupportive family members, lack of understanding regarding clubfoot and its treatment, inadequate specialists in clubfoot, traditional socio-cultural beliefs and practices and economic constraints. Enhanced understanding in this matter will guide us in devising culturally admissible ways to increase awareness in parents/caregivers regarding clubfoot and its treatment. A sustainable national clubfoot program will be very beneficial in providing a holistic approach to tackle barriers to treatment in our country