Deep gluteal syndrome is an increasingly recognized disease entity, caused by compression of the sciatic or pudendal nerve due to non-discogenic pelvic lesions. It includes the piriformis syndrome, the gemelli-obturator internus syndrome, the ischiofemoral impingement syndrome, and the proximal hamstring syndrome. The concept of the deep gluteal syndrome extends our understanding of posterior hip pain due to nerve entrapment beyond the traditional model of the piriformis syndrome. Nevertheless, there has been terminological confusion and the deep gluteal syndrome has often been undiagnosed or mistaken for other conditions. Careful history-taking, a physical examination including provocation tests, an electrodiagnostic study, and imaging are necessary for an accurate diagnosis.

After excluding spinal lesions, MRI scans of the pelvis are helpful in diagnosing deep gluteal syndrome and identifying pathological conditions entrapping the nerves. It can be conservatively treated with multidisciplinary treatment including rest, the avoidance of provoking activities, medication, injections, and physiotherapy.

Endoscopic or open surgical decompression is recommended in patients with persistent or recurrent symptoms after conservative treatment or in those who may have masses compressing the sciatic nerve.

Many physicians remain unfamiliar with this syndrome and there is a lack of relevant literature. This comprehensive review aims to provide the latest information about the epidemiology, aetiology, pathology, clinical features, diagnosis, and treatment.

Cite this article: Bone Joint J 2020;102-B(5):556–567.

We examined the differences in post-operative functional disability and patient satisfaction between 56 patients who underwent a lumbar fusion at three or more levels for degenerative disease (group I) and 69 patients, matched by age and gender, who had undergone a one or two level fusion (group II). Their mean age was 66 years (49 to 84) and the mean follow-up was 43 months (24 to 65).

The mean pre-operative Oswestry Disability Index (ODI) and visual analogue scale (VAS) for back and leg pain, and the mean post-operative VAS were similar in both groups (p >  0.05), but post-operatively the improvement in ODI was significantly less in group I (40.6%) than in group II (49.5%) (p < 0.001). Of the ten ODI items, patients in group I showed significant problems with lifting, sitting, standing, and travelling (p < 0.05). The most significant differences in the post-operative ODI were observed between patients who had undergone fusion at four or more levels and those who had undergone fusion at less than four levels (p = 0.005). The proportion of patients who were satisfied with their operations was similar in groups I and II (72.7% and 77.0%, respectively) (p = 0.668). The mean number of fused levels was associated with the post-operative ODI (r = 0.266, p = 0.003), but not with the post-operative VAS or satisfaction grade (p > 0.05). Post-operative functional disability was more severe in those with a long-level lumbar fusion, particularly at four or more levels, but patient satisfaction remained similar for those with both long- and short-level fusions.

PURPOSE: To determine the capability of fellowship trained Orthopaedic Trauma surgeons to predict union or non-union of femoral and tibial shaft fractures.

METHODS: A series of 50 patients with femur or tibia shaft fractures were evaluated. Patients were prospectively followed at 2,6,12, and 18 weeks after surgical intervention. At each interval surgeons evaluated factors related to fracture healing on AP and lateral radiographs and predicted the probability of union on a visual analog scale. Union was defined as radiographic evidence of healing three of four cortices, no tenderness with palpation of the fracture site, and full weight bearing without the use of assistive devices.

RESULTS: Eight patients missed initial visits or were lost to follow-up, making for a total of 42 patients that were included in the results. Average patient age was 31 years. Eighty-one percent of the patients went onto union (N=34) and 19% went onto nonunion (N=8). Early clinical prediction for nonunion at 2 weeks had a sensitivity of 50%, a specificity of 91%, a positive predictive value (PPV) of 57%, and a negative predictive value (NPV) of 89%. At 6 weeks, there was a sensitivity of 75%, a specificity of 100%, a PPV of 100%, and a NPV of 94%. One patient treated with intramedullary nailing was 15 years old and despite minimal callous formation the physician incorrectly predicted future union given the young age. The other patient had a severely comminuted femur fracture and required a quad cane to ambulate and should perhaps have been predicted to go onto nonunion. At 12 and 18 weeks, sensitivity, specificity, PPV, and NPV were both 100%.

CONCLUSIONS: Fellowship trained orthopaedic trauma surgeons at 6-week follow-up can predict union with a sensitivity of 75% and specificity of 100% and a PPV of 100%. Early clinical prediction at 6 weeks can be used to provide the patient with a secondary intervention such as a bone graft or bone stimulator and avoid months of delay.

To determine the effectiveness of six-axis analysis deformity correction using the Taylor Spatial Frame for the treatment of post-traumatic tibial malunions and non-unions, the study design was a retrospectively reviewed, consecutive series. Mean duration of follow-up: 3.2 years (range 2–4.2 years). All patients had been referred to a tertiary referral centre for deformity correction. Eighteen patients were included in the study (11 mal-unions and 7 nonunions). All deformities were post-traumatic in nature. The mean number of operations prior to the application of the spatial frame was 2.6 (range 1–6 operations). All patients completed the study. Six-axis analysis deformity correction using the Taylor Spatial Frame (Smith & Nephew, Memphis, TN) was used for correction of post-traumatic tibial malunion or nonunion. Nine patients had bone grafting at the time of frame application. One patient with a tibial plafond fracture simultaneously had deformity correction and an ankle fusion for a mobile atrophic nonunion. Two patients had infected tibial nonunions that were treated with multiple debridements, antibiotic beads, and bone grafting at the time of spatial frame application. A rotational gastrocnemius flap was used to cover a proximal third tibial defect in one patient. The average length of time the spatial frame was worn, time to healing, was 18.5 weeks (range 12–32 weeks). The main outcome measurements involved assessment of deformity correction in six axes, knee and ankle range of motion, incidence of infection, and return to preinjury activities.

Results: Seventeen of the 18 patients treated with the Taylor Spatial Frame, with adjunctive bone graft as necessary, achieved union and significant correction of their deformities in six axes, i.e. coronal angulation and translation, sagittal angulation and translation, rotation, and shortening. Fifteen of the 18 patients returned to their pre-injury activities at last follow-up.

Conclusion: Six-axis analysis deformity correction using the Taylor Spatial Frame is an effective technique in treating post-traumatic malunions and nonunions of the tibia, with several advantages over previously used devices.

We reviewed 22 children with cubitus varus who had been treated by a reverse V osteotomy and fixation by cross-pinning and wiring. The mean pre-operative humeral-elbow-wrist angle was −16.9° (−25° to +9°) and at the latest follow-up it was +7.3° (−2° to +14°). No child had a lateral prominence greater than 5 mm after correction. An excellent result was achieved in 20 children and a good result in two. We believe that this osteotomy has the advantages of better inherent stability, the avoidance of a prominent lateral condyle after correction and firm fixation allowing early movement.