Purpose. Our understanding of the spectrum of pathological lesions of the shoulder anterior capsular-labral complex in anterior instability continues to evolve. In a previous study using magnetic resonance arthrography we have showed three variants of the essential lesion of the anterior capsular-labral complex. This is the first large arthroscopic study to finely evaluate the nature and relative proportions of these three lesions in anterior instability. Methods. We studied 122 patients, 101 male and 21 female patients with an average age of 28 (17 to 47 years old), undergoing primary arthroscopic stabilization for anterior instability between 2004 and 2008. The pathoanatomy of the anterior capsule-labral complex was documented. Based on our previous MRI arthrography experience we were able to categorize the lesions seen arthroscopically in three subgroups: the Bankart lesion, the Perthes lesion and the ALPSA (anterior periosteal sleeve avulsion). Results. Arthroscopic findings confirmed the presence of the triad of essential lesion. The relative proportions of the subcategories of the essential lesion were as follows: 71 (58%) Bankart lesions, 18 (15%) Perthes lesions and 33 (27%) ALPSA lesions. Each lesion has unique characteristics, which affect treatment and prognosis. We describe the three types of labral injury and the surgical implications. Conclusion. The literature on the essential anterior capsular-labral lesion has historically focused on the Bankart lesion. There are in fact three variants of the essential lesion: the triad of Bankart, ALPSA and Perthes. This study evaluates these lesions and quantifies their relative proportions in a large series. We believe that awareness of this sub classification of the essential lesion is important as it affects the management of this condition

The lateral pillar classification (LPC) is a widely used tool in determining prognosis and planning treatment in patients who are in the fragmentation stage of Perthes disease. The original classification has been modified to help increase the accuracy of the classification system by the Herring group. The purpose of our study was to independently assess this modified Herring classification. 35 standardized true antero-posterior radiographs of children in various stages of fragmentation were independently assessed by 6 senior observers on 2 separate occasions (6 weeks apart). Kappa analysis was used to assess the inter and intraobserver agreement between observations made. The degrees of agreement were as follows: poor, fair, moderate, good and very good. Intraobserver analysis revealed at best only moderate agreement for two observers. 3 observers showed fair consistency, whilst 1 remaining observer showed poor consistency between repeated observations (p<0.01). The highest scores for interobserver agreement varying between moderate to good could only be established between 2 observers. For the remaining observers results were just fair (p<0.01). This study highlights the lack of agreement between senior clinicians when applying the modified LPC. This has clinical implications when applying the classification to the decision making process in treating patients at risk of developing adverse outcomes from the disease. To our knowledge, this is the first time the modified LPC has been independently tested for its reproducibility by another specialist paediatric orthopaedic unit

Aims

To evaluate the outcomes of cemented total hip arthroplasty (THA) following a fracture of the acetabulum, with evaluation of risk factors and comparison with a patient group with no history of fracture.