The aim of this study was to determine the inter and intra observer reliability of ultrasound measurements in treated unstable neonatal hips and whether ultrasound measurements correlate with radiological outcome at 6 months.

Sixty-four babies treated from birth with a Pavlik harness for neonatal hip instability were scanned at 2 and 6 weeks. The α and β angles of Graf, the combined (H) angle of Hosny and the femoral head coverage (FHC) were measured by 3 observers and inter-observer and intra-observer repeatability co-efficients calculated using 95% confidence limits. Hips were categorized as normal, abnormal or borderline for each parameter and Kappa values calculated. A stepwise linear regression analysis was performed to assess any relationship between ultrasound measurements at 2 or 6 weeks and outcome as determined by acetabular index at 6 months.

Seven hundred and ninety two sets of measurements were made from 248 scans. The α angle had the smallest interobserver range (17°), the H angle range was 21°and the β angle 28°. Kappa values showed good agreement for FHC and β angle. The mean acetabular index of all hips at 6 months was 26° (sd 4.9). The acetabular index was 30° or greater in 24 hips (18 babies) despite prolonged splintage in 9 hips (6 babies). The FHC at 6 weeks was predictive of acetabular index at 6 months (regression coefficient −0.27, 95% CI −0.42 to −0.12, p< 0.001)

We recommend the FHC as being reproducible, useful and predictive of outcome in neonatal hips treated for instability.

We describe a previously unreported technique of Z-lengthening for the treatment of refractory trochanteric bursitis and review the long-term outcomes for this procedure.

Fifteen patients (17 hips) were diagnosed with trochanteric bursitis based on clinical criteria. These patients were found to be unresponsive to conservative treatment including multiple corticosteroids injections. “Snapping Hips” were excluded. All went on to have bursectomy and Z- lengthening of the iliotibial band.

Harris Hip Scores were evaluated for before and after their operation as well as a standardised baseline questionnaire and examination.

At mean follow up of 47 months following Z-lengthening, eight patients reported excellent results with complete resolution of symptoms, eight had good results with symptoms improved and one had a poor result. One patient required secondary repair of a tear in the tendon of gluteus minimus with a subsequent excellent result. The mean Harris Hip Score improved from 46 to 82 (p< 0.05).

Bursectomy and Z-lengthening has been shown to be an effective and long-term operative solution for the treatment of refractory trochanteric bursitis when conservative measures have failed. Although the majority of patients had a successful outcome, not all respond well to this procedure and careful patient selection is recommended as well as a pre-operative MRI to rule out concomitant pathology such as a tear in the Gluteus medius or Gluteus minimus.

We report early major complications encountered following TEN fixation of femoral fractures in children.

A case series of four children aged 8– 16 years who had primary TEN fixation of isolated femoral diaphyseal fractures.

Three of the four patients had major complications. These were: significant knee stiffness requiring manipulation, haemarthrosis requiring washout and nail removal, loss of position and refracture. Two required revision to locked intramedullary nails without early complication.

In the skeletally immature child TEN fixation of femoral fractures has a significant major complication rate. This needs to be recognised when comparing TEN fixation with other treatment options.

The purpose of this study was to audit screening and treatment programmes for Developmental Dysplasia of the Hip (DDH) over a 12-year period from 1989 to 2000 with respect to late presentation and treatment rate and duration.

All babies born in Queen Mary Hospital are clinically screened for DDH by a consultant orthopaedic surgeon. Unstable hips are treated by Pavlik Harness and attend an ultrasound clinic run by an orthopaedic surgeon within 2 weeks. High-risk babies or those with suspected instability can also be referred for ultrasound. Serial ultrasound exams assisted with determining the duration of splintage. Radiographs are taken at 4 to 6 months. Late presenters were identified and analysed.

Over the 12-year period 13 cases of late presenting DDH were identified (0.6 per 1000). Half of these had not been screened. None had ultrasound screening. Our treatment rate was approximately 4 per 1000 live births.

Our screening programme can be improved by increased capture of patients for clinical screening. Ultrasound is a useful tool in managing neonatal hip instability allowing duration of splintage to be tailored to the individual and allows early detection of treatment failure.