Aim: To assess the effectiveness and need for X-rays undertaken at 9 to 12 months of age in cases were children have a strong family history of DDH and have had a normal ultra-sound scan at 6 weeks of age.

Materials and Methods: A retrospective study was undertaken over a five-year period. 122 children were identified as having a positive family history of DDH with a normal ultra-sound scan at 6 weeks. 56% were female and 44% were male. 6 were breech (4.9%). The mean ultra-sound was undertaken at 8.9 weeks. The mean X-ray was undertaken at 11.6 months. Acetabular dysplasia was diagnosed if the acetabular index was over 30 degrees. All X-rays were reviewed by one specialist.

Results: 3 children were noted to have late acetabular dysplasia (2.5%). One case was bilateral and 2 cases were unilateral.

Conclusion: The study showed a sub-group of cases where there was an incidence of acetabular dysplasia where the ultra-sound was normal at 6 weeks in those with a strong family history of DDH. It was felt that the finding of this dysplasia supports the policy to X-ray these cases at one year because of the significantly increased risk of acetabular dysplasia in this group.

We assessed factors which may affect union in 32 patients with nonunion of a fracture of the diaphysis of the femur and 67 comparable patients whose fracture had united. These included gender, age, smoking habit, the use of non-steroidal anti-inflammatory drugs (NSAIDs) the type of fracture (AO classification), soft-tissue injury (open or closed), the type of nail, the mode of locking, reaming v non-reaming, infection, failure of the implant, distraction at the fracture site, and the time to full weight-bearing. Patients with severe head injuries were excluded. Both groups were comparable with regard to gender, Injury Severity Score and soft-tissue injury.

There was no relationship between the rate of union and the type of implant, mode of locking, reaming, distraction or smoking. There were fewer cases of nonunion in more comminuted fractures (type C) and in patients who were able to bear weight early. There was a marked association between nonunion and the use of NSAIDs after injury (p = 0.000001) and delayed healing was noted in patients who took NSAIDs and whose fractures had united.