The aim of this study was to determine the inter and intra observer reliability of ultrasound measurements in treated unstable neonatal hips and whether ultrasound measurements correlate with radiological outcome at 6 months.

Sixty-four babies treated from birth with a Pavlik harness for neonatal hip instability were scanned at 2 and 6 weeks. The α and β angles of Graf, the combined (H) angle of Hosny and the femoral head coverage (FHC) were measured by 3 observers and inter-observer and intra-observer repeatability co-efficients calculated using 95% confidence limits. Hips were categorized as normal, abnormal or borderline for each parameter and Kappa values calculated. A stepwise linear regression analysis was performed to assess any relationship between ultrasound measurements at 2 or 6 weeks and outcome as determined by acetabular index at 6 months.

Seven hundred and ninety two sets of measurements were made from 248 scans. The α angle had the smallest interobserver range (17°), the H angle range was 21°and the β angle 28°. Kappa values showed good agreement for FHC and β angle. The mean acetabular index of all hips at 6 months was 26° (sd 4.9). The acetabular index was 30° or greater in 24 hips (18 babies) despite prolonged splintage in 9 hips (6 babies). The FHC at 6 weeks was predictive of acetabular index at 6 months (regression coefficient −0.27, 95% CI −0.42 to −0.12, p< 0.001)

We recommend the FHC as being reproducible, useful and predictive of outcome in neonatal hips treated for instability.

We assessed the functional and health outcomes of patients treated for a hip fracture ,6–12 months following the injury.

One hundred and ninety six patients over 60 years of age ,admitted with a subcapital or intertrochanteric fracture were sent two questionnaires, an EQ-5D, and a Hip specific outcome questionnaire based on the WOMAC .Patients with pre-existing dementia were excluded.108 (55%) returned completed questionnaires.

There were 36 males and 72 females with an average age of 81. The average time since fracture was 8.44 months. There were 46 intertrochanteric and 62 sub-capital fractures.WOMAC scores averaged 35 for intertrochanteric fractures and 25 for subcapital fractures. Males scored higher than females (31 v’s 24)Age had no influence on WOMAC scores.EQ 5D results were compared with the general population, and showed significant problems with mobility, pain, performance of usual activities, and self care.

This study shows that despite seemingly successful treatment of the fracture, patients suffer very significant reductions in function and quality of life. Greater effort needs to be made to address these issues rather than concentrating on the development of new fixation devices, if we are to improve the results of treatment of these increasingly common fractures.

We assessed the functional outcome of fractures of the os calcis a minimum of twenty- four months following injury.

Eighty-three patients with 85 fractures were assessed a minimum of two years following fracture of the os calcis, using a validated functional outcome measure designed specifically for fractures of the os calcis, and an EQ5D. Radiographic analysis of all fractures was performed to attempt to correlate outcome scores with the fracture pattern.

Sixty per cent of the questionnaires were returned completed. Forty percent of the fractures were treated surgically, the remainder with a period of weight relief, followed by physiotherapy and graded weight-bearing. The majority of patients reported a mild hind foot pain (8/10 on a VAS), and all reported some difficulties with walking on uneven terrain. There was no appreciable difference in the outcomes comparing patients treated by open reduction and internal fixation and those treated non-operatively.

This study demonstrates a surprisingly high patient satisfaction rate following fractures of the os calcis whether they are treated operatively or non-operatively. Patients seemed to have compensated for any altered function very well. We were not able to identify specific fracture patterns that were associated with poorer outcomes.