The National Institute for Health and Care Excellence (NICE) currently recommends the use of total hip replacement (THR) for displaced intracapsular hip fractures in cognitively competent patients and who were independently mobile with the maximum use of one stick prior to the injury. We conducted a prospective cross sectional study of the management of hip fractures within a defined geographic region in the North East of England to assess current practice and variation in provision of THR for displaced intracapsular hip fracture.Introduction
Method
To assess the role of pelvic osteotomy during the closure of bladder and cloacal exstrophy, we retrospectively reviewed 10 patients treated from 1990 to 1999. Six patients had cloacal exstrophy and four had bladder exstrophy. Two patients had no primary osteotomy. Two had posterior, two anterior pubic and two midiliac oblique osteotomies. Osteotomies were performed at a median age of 5.3 weeks. The mean follow-up time was five years (2 to 11). We assessed facilitation of closure, reconstitution of pelvic anatomy, maintenance of interpubic distance (IPD), urinary continence and gait. All osteotomies facilitated soft tissue closure at the time of surgery. Subjectively, the best restoration of pelvic anatomy was with a midiliac oblique osteotomy. In all patients, IPD increased progressively with increasing age (mean pre-operatively 3.3 cm, postoperatively 1.9 cm and 5.0 cm at follow-up). The results of soft tissue surgery to provide continence and maintain abdominal wall closure were poor. All procedures to address incontinence failed and there was a 100% dehiscence/sepsis rate. Although half the children had increased external rotation of the hip at review, only one child had an externally rotated joint. .
