Twins are often considered to be at an increased risk of developmental dysplasia of the hip (DDH); we therefore investigated whether multiple births have a higher incidence of DDH, and if selective ultrasound scanning should be considered for these infants. We reviewed our records of all live births between 1 January 2004 and 31 December 2008 and included 25 246 single and 990 multiple births. Multiple births did not have a significantly higher incidence of DDH compared with single births (0.0030 vs 0.0023, p = 0.8939). Of the 990 multiple births, 267 had neonatal ultrasound scans and one case of DDH was diagnosed and treated successfully with a Pavlik harness. There were two late-presenting cases at eight and 14 months of age, neither of whom had risk factors for DDH and consequently had not had a neonatal scan. Whereas selective ultrasound scanning of multiple births would have led to earlier detection and treatment of the late-presenting cases, they did not have a significantly higher incidence of DDH compared with single births. We conclude that being a twin or triplet in itself is not a risk factor for DDH and that selective ultrasound scanning is not indicated for this population. Cite this article: Bone Joint J 2013;95-B:132–4

Tibial hemimelia is a rare congenital anomaly, occurring approximately in 1 per 1million live birth and consisting of aplastic/hypoplastic tibia with relatively intact fibula. The widely used classification was proposed by Jones and based on radiological description: type I: tibia absent, type II distal tibia not seen, type III proximal tibia not seen, type IV tibio-fibular diastases. This congenital deformity can be unilateral or bilateral and isolated, or unilateral or bilateral and associated with other malformation witch raise its genetic cause.

We are reporting the cases of two monozigotic twins reflecting the “intragenotic” expression variability of the syndrome of tibial aplasia and ectrodactyly. The two monozigotic female twins are born after an unremarkable first pregnancy and delivery. Family history was positive for malformations.(syndactily, split hand, phocomelia(elbow) and hip dyspasia)

Twin 1: Left leg: tibial aplasia type Ia, short femur, absent patella. Right leg: tibial aplasia type IV, clubfoot, hypoplasia of the internal ray. Left hand: split hand.

Twin 2: Left leg: nornal. Right leg: tibial aplasia type II, clubfoot. Left hand: split hand.

Most of the cases are unilateral and sporadic. 4 autosomal dominant tibial hemimelia syndromes are described

tibial hemimelia-foot polydactyly-triphangeal thumbs syndrome,

This is the first documennted case of monozigotic twins affected by the Tibial hemimelia-split-hand foot syndrome. Their clinical presentation demonstrates that the phenotypic manifestations are highly variable.

1. Congenital dislocation of the hip in identical twins is reported.

2. The heredity of congenital dislocation of hip is discussed. Studies in twins show that congenital dislocation of hip is probably a hereditary dysplasia of the acetabulum and upper end of the femur, and that external factors play a less important role.

Between 1964 and 2002, 26 pairs of conjoint twins were recorded at the Red Cross Hospital. The available radiographs and notes were reviewed, with specific attention to the incidence of spinal anomalies that result in scoliosis. Structural scoliosis was noted to occur only in the ischiopagus and pygopagus subsets, namely those joined by the pelvic outlet and the rump respectively. The abnormalities were largely those of failure of formation, with early onset of severe deformity. The hemi-vertebrae were often remote to the area of conjunction, mostly in the thoracic area. All six ischiopagi had vertebral abnormalities, with two of the four pygopagi demonstrating abnormalities. There were associated lower limb neurological abnormalities in the ischiopagi.

The association of conjoint twinning and vertebral anomaly is currently thought to be due to non-specific teratogenic insult with hypoxia. The fact that the ischiopagus and pygopagus are involved is important: these groups constitute up to 45% of survivors and are reported to have a longer life expectancy. Because they will later develop severe deformities, they need early active management.

The purposes of this study were to investigate whether twins and multiple births have a higher incidence of Developmental Dysplasia of the Hip (DDH), and whether universal ultrasound scanning would be beneficial in this population.

In the litterature patients suffering Mb. Scheuermann (MS) have been reported to experience more back pain and other back related constrains compared to subjects matched for age and sex. We have been unable to find publications on health-related quality of life by SF-12 or SF-36 in MS. The aim of the present study was to compare health-related quality of life status in MS to the background population.

Materials and Methods: The present cohorts are derived from The Danish Twin Registry and consist of all Danish twins born from 1931 through 1982. This twin cohort has been shown to very closely resemble the general Danish population. A total of 46,418 twins received and 75% returned a questionnaire of which 34,007(97.3 %) answered the question ‘Have you been diagnosed with Scheuermann’s disease?’ Included in the questionnaire were the standardised questions for The Medical Outcome Study Short Form-12 (SF-12), from which we calculated the SF-12 Physical Component Summary scale (SF-12 PCS) and the SF-12 Mental Component Summary scale (SF-12 MCS) using the SF Health Outcomes Scoring Software. Nine-hundred-and-forty-three reported to have MS and the remaining 33,064 responders were used as controls.

Results: The mean(SD) age in the MS group was 43.7(11.9) years compared to 44.4(13.7) in the control group (NS). The overall self-reported prevalence of MS was 2.8% (95% c.i.l. 2.6–3.0), male : female prevalence was 3.6% (95% c.i.l. 3.2–4.1) : 2.1% (95% c.i.l. 1.9–2.3). In the controls male : female prevalence was 45.2% (n=14,953) : 54.8% (n=18,111).

Conclusion: The perceived health status from SF-12 PCS in self-reported MS was moderately though highly significantly worse than in controls in a big cohort of Danish twins. There was no difference in SF-12 MCS between the two groups.

Background and aims:. T2D is postulated to be an important aetiological factor for lumbar disc degeneration (LDD), which itself has a well documented relationship with low back pain. Obesity increases risk of both T2D, low back pain and LDD. Connective tissue modification has been reported in hyperglycaemia, but the epidemiology of LDD in T2D has not been described to date. Methods and results:. A population sample of unselected same-sex adult twin pairs was studied who had attended a spine MR study and completed general health questionnaires defining T2D by self-report. LDD had been coded as the sum of five lumbar discs coded (0–3) for each of height, signal intensity, disc bulge and anterior osteophytes. Risk factors for LDD included age, body-mass index (BMI), sex, alcohol consumption and smoking. Mean age of the 1011 participants = 54 years (sd=8), mean BMI=25 kg/m. 2. (sd=4), 95% female. The prevalence of T2D was 6%. Twins with T2D had increased BMI (27 vs 25 kg/m. 2. , p<0.001) and were older (59 vs 54 years, p<0.001). LDD score in T2D was significantly higher in diabetic cases than controls (14.9 vs 13.1, p=0.04) in univariable analysis. In multivariable analysis inclusion of age and BMI abrogated the effect of T2D. Conclusions:. We did not find evidence that T2D is an independent risk factor for LDD. This study had 0.8 power at 0.05 significance level to detect a difference of 2.1 LDD units. Age and BMI accounted for the increased LDD observed in T2D

Non-accidental injury (NAI) in children includes orthopaedic trauma throughout the skeleton. Fractures with soft-tissue injuries constitute the majority of manifestations of physical abuse in children. Fracture and injury patterns vary with age and development, and NAI is intrinsically related to the mobility of the child. No fracture in isolation is pathognomonic of NAI, but specific abuse-related injuries include multiple fractures, particularly at various stages of healing, metaphyseal corner and bucket-handle fractures and fractures of ribs. Isolated or multiple rib fractures, irrespective of location, have the highest specificity for NAI. Other fractures with a high specificity for abuse include those of the scapula, lateral end of the clavicle, vertebrae and complex skull fractures.

Injuries caused by NAI constitute a relatively small proportion of childhood fractures. They may be associated with significant physical and psychological morbidity, with wide- ranging effects from deviations in normal developmental progression to death.

Orthopaedic surgeons must systematically assess, recognise and act on the indicators for NAI in conjunction with the paediatric multidisciplinary team.