Aim: Assessment of the management of painful paediatric snapping hips by a novel alternative, ie. proximal TFL release.

Materials and Methods: A retrospective study was undertaken between 1989 – 2002, reviewing 15 patients (21 hips) who had had proximal tensor fascia lata release. Diagnosis was made on the basis of history and physical examination. All hips were X-rayed and other causes of an audible snap were excluded. Physiotherapy had been attempted in all cases and most had failed to improve pre-operatively. All cases were followed up for a minimum period of 6 months.

Results: There were 2 males and 13 females. The mean age of operation was 15 years. 2 hips required a revision procedure. 81% had a pain-free, non-snapping hip at the time of discharge. There was 1 case of numbness in the thigh secondary to damage to the lateral cutaneous nerve of the thigh. No cases had a long-term Trendelenberg limp.

Conclusion: It was felt that proximal release of the tensor fascia lata from the pelvis is a good operation for painful, snapping hips with an excellent result in 81%. This has a similar success rate to the Brignall & Stainsby procedure, ie. Z-plasty of the tensor fascialata.

Aim: To assess the effectiveness and need for X-rays undertaken at 9 to 12 months of age in cases were children have a strong family history of DDH and have had a normal ultra-sound scan at 6 weeks of age.

Materials and Methods: A retrospective study was undertaken over a five-year period. 122 children were identified as having a positive family history of DDH with a normal ultra-sound scan at 6 weeks. 56% were female and 44% were male. 6 were breech (4.9%). The mean ultra-sound was undertaken at 8.9 weeks. The mean X-ray was undertaken at 11.6 months. Acetabular dysplasia was diagnosed if the acetabular index was over 30 degrees. All X-rays were reviewed by one specialist.

Results: 3 children were noted to have late acetabular dysplasia (2.5%). One case was bilateral and 2 cases were unilateral.

Conclusion: The study showed a sub-group of cases where there was an incidence of acetabular dysplasia where the ultra-sound was normal at 6 weeks in those with a strong family history of DDH. It was felt that the finding of this dysplasia supports the policy to X-ray these cases at one year because of the significantly increased risk of acetabular dysplasia in this group.