Ganz peri-acetabular osteotomy is commonly used to treat symptomatic hip dysplasia. It aims to increase the load bearing contact area of the hip to reduce the risk of subsequent osteoarthritis. In this study we assess the radiographic and clinical results of the procedure since its introduction to our unit. All patients undergoing Ganz osteotomies at our unit were followed up prospectively. Data collected included patient demographics and pre- and post-operative functional scores (Harris and Non-arthritic hip scores). In addition, acetabular correction was evaluated on pre-and post-operative radiographs (using Centre-Edge angle and Tonnis angle). Complications were also noted. Overall 50 procedures were performed between 2007 and 2013 with median follow-up of 3 years (1–7 years). The majority of patients (90%) were female. Average age at time of surgery was 32 years (17–39). There were significant improvements in pre- and post-operative median functional scores (Modified Harris Hip Score = 52 versus 63, p=0.001), Non-arthritic Hip Score = 49 versus 60, p=0.01). Median Centre Edge Angle improved from 15 degrees pre-operatively (range = 8–19 degrees) to 29 degrees post-operatively (22–36 degrees), p=0.02. Similarly, pre-operative Tonnis angle improved from 19 degrees (16–38) to 7 degrees (2–14), p=0.01. Four patients developed post-operative complications: 1 superficial wound infection, 1deep infection requiring hip washout and antibiotic treatment and 2 patients subsequently requiring total hip replacements. We have shown that the Ganz peri-acetabular osteotomy can be effective for the treatment of painful hip dysplasia improving both functional and radiographic outcomes. However, patient selection is a key factor

This study compared the quality of reduction and complication rate when using a standard ilioinguinal approach and the new pararectus approach when treating acetabular fractures surgically. All acetabular fractures that underwent fixation using either approach between February 2005 and September 2014 were retrospectively reviewed and the demographics of the patients, the surgical details and complications were recorded.

A total of 100 patients (69 men, 31 women; mean age 57 years, 18 to 93) who were consecutively treated were included for analysis. The quality of reduction was assessed using standardised measurement of the gaps and steps in the articular surface on pre- and post-operative CT-scans.

There were no significant differences in the demographics of the patients, the surgical details or the complications between the two approaches. A significantly better reduction of the gap, however, was achieved with the pararectus approach (axial: p = 0.025, coronal: p = 0.013, sagittal: p = 0.001).

These data suggest that the pararectus approach is at least equal to, or in the case of reduction of the articular gap, superior to the ilioinguinal approach.

This approach allows direct buttressing of the dome of the acetabulum and the quadrilateral plate, which is particularly favourable in geriatric fracture patterns.

Cite this article: Bone Joint J 2015;97-B:1271-8.

Specific radiological features identified by Brandser and Marsh were selected for the analysis of acetabular fractures according to the classification of Letournel and Judet. The method employs a binary approach that requires the observer to allocate each radiological feature to one of two groups. The inter- and intra-observer variances were assessed. The presence of articular displacement, marginal impaction, incongruity, intra-articular fragments and osteochondral injuries to the femoral head were analysed by a similar method. These factors were termed ‘modifiers’ and are generally considered when planning operative intervention and, critically, they may influence prognosis.

Six observers independently assessed 30 sets of plain radiographs and CT scans on two separate occasions, 12 weeks apart. They were asked to determine the presence or absence of specific radiological features. This simple binary approach to classification yields an inter- and intra-observer agreement which ranges from moderate to near-perfect (κ = 0.49 to 0.88 and κ = 0.57 to 0.88, respectively). A similar approach to the modifiers yields only slight to fair inter-observer agreement (κ = 0.20 to 0.34) and slight to moderate intra-observer agreement (κ = 0 to 0.55).