The purposes of this study were to investigate whether twins and multiple births have a higher incidence of Developmental Dysplasia of the Hip (DDH), and whether universal ultrasound scanning would be beneficial in this population.

We often regard patient satisfaction as the best clinical indicator of outcome in the clinic situation. The aim of this study was to determine which wrist scoring system (Gartland and Verley, Sarmiento, Cooney, Patient-Rated Wrist Evaluation, Hand Function Score, and Disability of Arm Shoulder and Hand Score) best correlates with patient satisfaction and functional outcome and which individual variables predict a good outcome. Forty-five females and 5 males with a mean age of 66 years (range 19 to 93 years) were included in the study. Multivariate regression analysis was carried out using SPSS 13.

Patient satisfaction correlated best with the MacDermid, Watts and DASH scores. The variables in these scoring systems that best accounted for hand function were pain, ability to perform household chores, open packets, cut meat and perform the usual occupation.

The most important questions to ask in the clinic following wrist fractures are about pain, ability to perform household chores, open packets, cut meat and perform the usual occupation. The McDermid, Watts and DASH scores provide a better measure of patient satisfaction than the Gartland and Verley, Sarmiento and Cooney scores, however they are time consuming, complicated and may indeed not be necessary.

Hip resurfacing arthroplasty (HRA) in patients with a varus deformity of the femoral neck-shaft angle (NSA) is associated with poorer outcomes. Our experience has not reflected this. We examined the Oxford Hip Scores (OHS), Harris Hip Scores (HHS) and outcomes of patients with varus hips against a normal cohort to ascertain any significant difference.

We identified 179 patients. Measurement of the femoral neck-shaft angle was undertaken from antero-posterior radiographs pre-operatively. The mean NSA was 128.5 degrees (SD 6.3). Patients with a NSA of less than 122.2 were deemed varus and those above 134.8 valgus. These parameters were consistent with published anatomical studies.

The varus cohort consisted of 23 patients, mean NSA 118.7 (range 113.6-121.5), mean follow-up 49 months (range 13-74). Mean OHS and HHS were 16 and 93.5 respectively. Complications included 2 cases of trochanteric non-union; no femoral neck fractures, early failures or revisions. Normal cohort consisted of 125 patients, mean NSA 128 degrees, mean follow-up 41 months (range 6-76). The OHS and HSS were 18.8, 88.9 respectively. Complications included 5 trochanteric non-unions and 1 revision due to an acetabular fracture following a fall. Statistical analysis demonstrated no statistical difference between the cohorts OHS (p=0.583) or HHS (p=0.139).

Our experience in patients with a varus femoral neck has been positive. Our analysis has demonstrated no statistical difference in hip scores between the cohorts. We have not yet experienced any femoral neck fractures, which we believe is due to the use of the Ganz trochanteric flip and preservation of blood supply.

Choice of implant for patients aged sixty-five years or younger requiring hip arthroplasty is a topic of current debate, those in favor of resurfacing maintain it offers a greater range of motion and activity. We examined the Oxford Hip Score's (OHS) and Duke Activity Status Index (DASI) of patients undergoing either total hip replacement (THR) using an Elite Plus Stem, or hip resurfacing using a Birmingham Hip Resurfacing (BHR).

The THR cohort comprised 34 implants (4 bilateral), 17 men, 17 women, mean age 56.08 years. The resurfacing cohort comprised 27 implants (3 bilateral), 18 men, 9 women, mean age 50.51 years. The mean difference calculated between pre- and post-operative OHS was 22.08 and 25.33 for the THR and resurfacing cohorts respectively. The mean Duke score was 42.3 and 53 for the cohorts respectively.

Using the pre-operative and post-operative change in Oxford Hip Scores, no statistically significant difference was found between the THR and resurfacing cohorts (p = 0.2891). There was a statistically difference found between the THR and resurfacing cohorts with regards to activity using post-operative Duke scores, (p = 0.0047).

This study has emphasized the use of the DASI, a pure activity score, in hip research. In terms of reducing pain, both prostheses appear equally effective. With regards to activity, as evidenced by utilizing a pure activity score, the resurfacing cohort faired better. Our study suggests at one year post-op, young patients with a resurfacing have a greater activity level than those with a THR.

The role of magnetic resonance arthrography (MRA) in the evaluation of patients with femeroacetabular impingement (FAI) to assess femoral head-neck junction asphericity and labral pathology is well established. However, in our experience the presence of acetabular cysts on MRA, which may signify underlying full thickness articular cartilage delamination and progression towards arthropathy, is also an important feature.

We retrospectively reviewed 142 hips (mean age 32 years, 47 men, 95 women), correlating the findings on MRA with those found at the time of open surgical hip debridement to ascertain the prevalence of acetabular cysts and the association with underlying acetabular changes. Fifteen MRA's demonstrated features consistent with underlying acetabular cystic change. At the time of surgery, this was confirmed in eleven cases that demonstrated a full thickness articular chondral flap (carpet lesion) and an underlying acetabular cyst. The sensitivity, specificity, positive predictive value and negative predictive value of MRA in relation to acetabular cysts was 55%, 96.7%, 73.3% and 92.9% respectively.

We believe acetabular cysts on MRA to be a significant finding. Such patients are likely to have an associated full thickness chondral lesion and features of early degenerative change, influencing outcome and prognosis. Our clinical practise has changed to reflect this finding. For those patients with cysts on MRA, we are less likely to offer open debridement and favour arthroscopic intervention followed by arthroplasty when symptoms dictate. We believe hip preservation surgeons should be aware of the significance of acetabular cysts and be prepared to adjust treatment options accordingly.

Awareness that minimising tip apex distance (TAD) when inserting a sliding hip screw reduces the risk of screw cut out is important for orthopaedic trainees. The advent of the Picture Archive and Communication System (PACS) has made the accurate measurement of TAD from x-rays and image intensifier films much easier. This study was to determine whether TAD would be reduced if a surgeon knew that his performance was being continually monitored.

31 consecutive cases of sliding hip screw insertion by a single group of surgeons were identified and the TAD measured. The mean TAD was 16.11mm (8.87mm-25.47mm). The same surgeons were then re-educated as to the importance of the TAD and informed that their results would be monitored and discussed. The next 34 consecutive cases were collected prospectively. The mean TAD in these cases was 13.83mm (6.72mm-21.51mm). There was a significant difference between the TAD for the two groups using the two-tailed t-test (p=0.034). There was one implant failure in the pre education group and none in the post education group.

These results suggest that awareness of surveillance improves surgical performance even if the importance of the variable being assessed is already known.

The time at which patients should drive following total hip replacement (THR) is dependant upon recovery and the advice they are given. The Driver Vehicle and Licensing Agency (DVLA) in the United Kingdom does not publish recommendations following THR and insurance companies usually rely on medical instruction. Few studies have been performed previously and have reached different conclusions.

Brake reaction times for patients undergoing primary THR were measured pre-operatively and at four, six and eight weeks after surgery using a vehicle driving simulator at a dedicated testing centre. Patients were prospectively recruited. Ethical approval was granted. Participants included eleven males and nine females, mean age 69 years. Side of surgery, frequency of driving and type of car (automatic or manual) were documented. Patients with postoperative complications were excluded. No adverse events occurred during the study.

Statistical analysis using Friedman's test demonstrated a statistically significant difference (P=0.015) in reaction times across the four time periods. Wilcoxon test demonstrated a highly significant difference between initial and six week mean results (P=0.003), and between four and six week results (P=0.001). No significant difference was found between six and eight weeks.

Our data suggests reaction times improve until week six and significantly between week four to six. Patients making an uncomplicated recovery following primary THR may be considered safe to return to driving from week six onwards. We recommend this is clearly documented in the medical notes, and patients should check with their insurance company prior to recommencement.

Sledging related minor and major injuries represent a significant workload at ski-area medical centers across the world. Although safety rules exist, they are seldom obeyed or enforced. We set out to determine the incidence of sledging related injuries, identifying trends and causative factors at a busy New Zealand Ski resort.

All sledging related injuries presenting during a 70-day period were prospectively reviewed. Patient demographics, mechanism, diagnosis, and treatment were recorded. Sixty patients were identified, mean age 10 years, range 4-30 years. Injuries comprised; collisions with sledgers (21), collision with wall (14) and falling from sledge (14). Site of injury included head (36), lower limb (18), spine (9), upper limb (7), and abdomen (2). Fractures included; femur (1), tibia (1), fibula (1), ankle (2), cuboid (1), clavicle (2), scaphoid (1). One 9-year-old patient sustained a serious intracranial haemorrhage, with subsequent permanent neurological sequelae.

Sledging related injuries are mostly minor, however significant major injuries do occur requiring intervention at a secondary center. The potential for serious morbidity is evident. Recommendations supporting safety improvement measures does exist, however most were not implemented by the study cohort examined. The use of basic cycling helmets would seem an appropriate minimum level of protection, and greater sledging safety awareness should be encouraged.

Knee dislocation is a rare injury in high energy trauma, but it is even rarer in low energy injuries. We present, to our knowledge, the only case in the world literature of knee dislocation following a cricketing injury. The patient was a 46 year old recreational fast bowler who, whilst bowling, slipped on the pitch on the follow through. He sustained an anteromedial knee dislocation which was reduced under intravenous sedation. He also sustained a neuropraxia of the common peroneal nerve with grade 2 weakness of ankle and toe dorsiflexion. Magnetic Resonance Imaging (MRI) confirmed a complete rupture of anterior cruciate ligament (ACL), lateral collateral ligament (LCL) and postero-lateral corner (PLC). Patient underwent surgical reconstruction and repair of his PLC along with repair of LCL with combination of anchor sutures and metal staple within 72 hours of the injury. He was treated in a cast brace. The ACL insufficiency was treated conservatively. Patient made an uneventful recovery and follow up at 3 months revealed a full range of knee movements with asymptomatic ACL laxity

An 83-year-old woman presented with acute weakness in her right hand and wrist extensors and swelling in the proximal right forearm. Nerve conduction studies confirmed compression of posterior introsseous nerve at the level of proximal forearm. MR imaging demonstrated the characteristics of lipoma which extended on the atero-lateral aspect of the right radius neck. The lesion was parosteal lipoma of the proximal radius causing paralysis of the posterior interosseous nerve without sensory deficit. In this case report, posterior inretosseous nerve palsy due to compression of a parostel lipoma was recovered after excision of the lipoma followed by intensive rehabilitation for six month. Surgical excision should be promptly performed to ensure optimal recovery from the nerve paralysis.

Queen Elizabeth the Queen Mother Hospital, Margate, East Kent Hospitals NHS University Trust, UK.

Implant related hypersensitivity is an infrequent complication after total knee replacement. It remains a relatively unpredictable and poorly understood cause of failure of an implant.

We present a report of five patients who presented with persistent hypertrophic synovitis after total knee replacement using a cobalt chrome component. Extensive preoperative and intraoperative attempts ruled out infection as a cause of symptoms. The knees had good ligamentous balance and were well aligned and fixed.

The clinical condition improved after revision to a zirconium femoral and titanium metal backed tibial components. Intraoperative histopathology revealed thickened synovium with a predominantly monocellular (lymphocytic or histiocytic) response.

Where infection has been excluded as a cause of persistent pain and swelling, consideration should be given to metal allergy as a cause of failure in primary knee replacement surgery.