Aims

The paediatric trigger thumb is a distinct clinical entity with unique anatomical abnormalities. The aim of this study was to present the long-term outcomes of A1 pulley release in idiopathic paediatric trigger thumbs based on established patient-reported outcome measures.

Purpose. To determine whether radiographically demonstrated femoral neck irregularities (pistolgrip-deformity, focal prominences or lytic defects) are associated with positive clinical impingement tests. Methods. The 1989 Bergen birth cohort (n=4004) was invited to a population-based follow-up including clinical examination and two pelvic radiographs. 2081 (52%) were enrolled. Associations between clinical and radiographic findings were examined using chi-squared or Fischer's exact test. Results. Radiographs from 1193, 18-19 year olds, (42% males) have been analysed. For males, irregularities were seen in 128/501 (15.5%) right and 149/501 (19.7%) left hips, of which 13 (10.2%) and 12 (8.1%) had a positive impingement-test respectively (p-values 0.06 and 0.04). The pistolgrip-deformity was seen in 15.8% of right and 19.4% of left hips, of which 6.3% and 7.2% had a positive impingement-test, respectively (p-values 0.6 and 0.3); the focal prominence in 9.2% right and 10% left hips, of which 15.2% and 4% had a positive impingement-test (p-values 0.008 and 0.74) and the lytic defect in 7% right and 8.8% left hips, of which 14.3% and 9.1% had a positive impingement-test (p-values 0.053 and 0.19). For females, irregularities were seen in 34/692 (4.9%) right hips and 46/692 (6.6%) left hips, of which 0 and 2 (4.3%) had a positive impingement-test (p-values 1 and 0.65). Each irregularity was seen in 2-3% of both right and left hips, with no positive impingement tests on the right side and one positive test for each left side, yielding p-values from 0.45 to 1. Conclusion. Femoral neck irregularities are common and symmetrical findings in young males, and are associated with a positive impingement-test. A focal right-sided prominence is associated with a positive test. These radiological findings seem to be less common, but symmetrical, in young females, but without any association with a positive impingement-test

Children presenting with Perthes’ disease before their sixth birthday are considered to have a good prognosis. We describe 166 hips in children in this age group. The mean age at onset of the disease was 44 months (22 to 72). Mild forms (Catterall I and II) were treated conservatively and severe forms (Catterall III and IV) either conservatively or operatively. The aim of the former treatment was to restrict weight-bearing. Operative treatment consisted of innominate osteotomy and was indicated by a Conway type-B appearance on the bone scan. All the patients were followed to skeletal maturity with a mean follow-up of 11 years (8 to 15).

The end results were evaluated radiologically using the classifications of Stulberg and Mose. A total of 50 hips were Catterall grade-I or grade-II, 65 Catterall grade-III and 51 Catterall grade-IV. All hips with mild disease had a good result at skeletal maturity. Of the hips with severe disease 78 (67.3%) had good (Stulberg I and II), 26 (22.4%) fair (Stulberg III) and 12 (10.3%) poor results (Stulberg IV and V). Of the Catterall grade-III hips 38 were treated conservatively of which 31 (81.6%) had a good result, six (15.8%) a fair and one (2.6%) a poor result. Operative treatment was carried out on 27 Catterall grade-III hips, of which 21 (77.8%) had a good, four (14.8%) a fair and two (7.4%) a poor result. By comparison conservative treatment of 19 Catterall grade-IV hips led to ten (52.7%) good, seven (36.8%) fair and two (10.5%) poor results. Operative treatment was carried out on 32 Catterall grade-IV hips, of which 16 (50.0%) had a good, nine (28.1%) a fair and seven (21.9%) a poor result.

We confirm that the prognosis in Perthes’ disease is generally good when the age at onset is less than six years. In severe disease there is no significant difference in outcome after conservative or operative treatment (p > 0.05). Catterall grade-III hips had a better outcome according to the Stulberg and Mose criteria than Catterall grade-IV hips, regardless of the method of treatment.