Hip fractures accounts to about 86000 cases per annum in UK. AP and Lateral radiographs form an essential investigation in planning the management of these fractures. Recently it has been suggested that lateral view doesn't provide any additional information in majority of the cases. We looked retrospectively at 25 consecutive radiographs with intracapsular and extracapsular fracture neck of femur each presenting to our department between May 2010 and January 2011. These radiographs were put on the CD in 2 folders as AP and Lateral. It was reviewed by 2 Observers who suggested their preferred treatment. The results were compared for the intra observer agreement to assess the necessity of the lateral view of the radiographs. We also compared the treatment options with the gold standard and looked at the interobserver agreement. Of the 50 set of radiographs that were reviewed, Observer 1 had disagreed with himself on one occasion (98%agreement) compared to the Observer 2 who had two disagreements (96% agreement). When analyzing the intracapsular fractures, we found 100% agreement of OBSERVER 1 with himself when proposing treatment on AP and Lateral View. Whereas, OBSERVER 2 had only one disagreement. It gave us a Free marginal kappa value of more than 0.70 indicating excellent agreement. One difference doesn't have any statistical significance. In the extracapsular fractures, Kappa values ranged from 0.413 to 0.88. OBSERVER 1 did change his opinion after reviewing the lateral view but generally had good outcome (K=0.88). Whereas, the opinion of OBSERVER 2 was unaffected by the Lateral view. The X-ray diagnoses by OBSERVER 1 and OBSERVER 2 had only moderate agreement (K=0.52 (AP) and 0.57 (Lat). Comparing the observer opinion to the gold standard (operation performed) showed moderate agreement both on AP and Lateral view (OBSERVER 1 AP and Lat both K=0.64, OBSERVER 2 AP and Lat both K=0.41). The Lateral view failed to change the opinion of the observers (K > 0.7) but there was moderate to excellent agreement between the observers and observer vs operation (The Gold Standard) with kappa value of more than 0.52. We feel that the Lateral view doesn't make any difference in most of the cases as shown by a good intra-observer agreement. However, we cannot completely rule out their importance and they should be performed in occult fractures, pathological fractures, fractures extending into the shaft, young patients, and on the request of physician.

Introduction: Recurrent Instability of the hip remains a difficult problem to treat successfully. The Posterior Lip Augmentation Device (PLAD) is a useful option where there is no gross mal-orientation of the components.

Methods: A retrospective single surgeon review was performed to identify patients who had undergone application of a PLAD to treat recurrent instability. Patients with less than 12 months follow up were excluded.

Results: 14 patients were identified with an average age of 75.5 years (Range 59 – 90 years). There were 7 cases of trochanteric non-union as a result of previous surgery. The mean follow up was 26 months (Range 13 – 41 months). In 13 patients there have been no further instances of dislocation. 1 patient went on to dislocate again and has now undergone a socket revision.

Conclusion: Application of the Posterior Lip Augmentation Device is a well tolerated procedure with very favourable success rates (93%). Given the limited morbidity and short operating time associated with this surgical option it provides a predictable outcome in cases where the original components are well orientated and securely fixed.

Background: Unfortunately ACL injuries are not uncommon in the young: the majority however occurring after skeletal maturity.

Aim: To perform an internal audit of the demand, methods and results of ACL reconstruction in young patients at a tertiary referral centre.

Methods: Patients were identified through electronic patient records, and all operation notes and follow up records were scrutinised.

Results: 84 cases under 20 years of age (range 14–19) were reviewed from 2000–2004 with a minimum follow-up of 6 months. Over 10% had undergone previous surgery or had documented articular injury. 42 cases required further meniscal surgery at the time of reconstruction: 12% repairs (20/168 menisci), 18% partial menisectomy (30/168). The median time to reconstruction from injury was 9 months (range 1–72). No case was delayed for growth plate maturation. Reconstruction methods were partly surgeon dependent, following adult themes. Occasionally tibial fixation was away from the growth plate with low profile screws and washers. We are only aware of 1 failure during this short follow-up.

Conclusion: We believe that the use of techniques similar to those used on adults is appropriate for adolescents. However the high comorbidity is of some concern, demonstrating that this age range is as challenging as their older counterparts.