Early detection of Developmental Dysplasia of the Hip (DDH), and treatment, may prevent the need for surgical correction following late presentation. Neonatal examination, and ultrasound screening of at risk groups, does not detect all cases. Most neonates treated in the Intensive Care Unit (NICU) have abdominal radiographs performed during their stay. These include the hips but DDH is not routinely looked for.

50 neonatal abdominal films (five from patients who subsequently were found to have DDH, 45 from patients without this condition) were randomly shown to three paediatric orthopaedic surgeons and three paediatric radiologists on two separate occasions. Each was asked whether they would refer the patient for further investigation.

An overall sensitivity of 25.5% (Range 0–60%) and specificity of 93.2% (Range 87–97%) was found with a positive predictive value (PPV) of 14.0% (Range 0–37%) and negative predictive value (NPV)of 96.3% (Range 95–98%).

Although the low sensitivity and PPV make interpretation of these films a poor way to diagnose DDH, the high specificity and NPV suggest that they may be used as a prompt to further investigation. Therefore, we propose that DDH should be looked for on these films and, where there is radiological suspicion, ultrasound examination should be advised.

The use of scoring systems for surveillance of post-operative outcomes is increasing. However, the methodology of this follow-up is not universal. We set out to assess whether a postal Oxford Shoulder Score (OSS) was sufficient to identify patients who were dissatisfied and wanted further treatment.

Of 88 patients who had undergone GlobalCap resurfacing in the previous 5 years, we received a completed postal OSS (Median score 33, Range 5–48) from 80 patients. Those with a score <24 (an agreed threshold for surgery pre-operatively) were brought to clinic for review.

The 16 recalled patients (2 males, 14 females; age 58–85) had their OSS repeated, supervised by a clinic nurse, and had a Constant Score and an American Shoulder and Elbow Surgeons (ASES) Score performed. Satisfaction was also questioned.

OSS correlated well with the Constant Score (r=0.79) and ASES (r=0.86). However, supervision increased the OSS by an average of 6 points (Mean 13.9 to 19.9) and only three of the patients proved dissatisfied with the outcome of their surgery.

Used alone, an unobserved OSS may have limited value for this purpose and the use of comparative pre-operative scores or additional patient-reported outcome measures may be necessary to detect poor outcomes.

Background

Patients with fractured neck of femur have historically received less attention than they deserve and have high morbidity and mortality. Literature suggests that speed to theatre reduces length of in-patient stay and complications.

The Proximal Humeral Internal Locking System (PHILOS) is being used increasingly in the treatment of proximal humeral fractures. Improvements in operative technique since its first use may represent improved functional results. We analysed 28 cases performed in the two years following October 2006. There were 22 females and 6 males. Mean age was 65 years (Range 37–79 years). There were five 2-part, nineteen 3-part, and four 4-part fractures. Functional results were measured using the Oxford Shoulder Score, American Shoulder and Elbow Surgeons’ Score (ASES) and Constant Score (Age and sex matched). This provided objective and subjective scores of function after a mean follow-up period of 15 months (Range 3–27 months). These results were compared to the patient’s non-operated shoulder to determine loss in function.

Following PHILOS fixation, function of the operated arm was decreased both subjective and objective scoring. This change was significant for all three scores (p-values < 0.01). Sub-analysis comparing patients aged < 60 years with those > 60 years and 2-part fractures with 3- and 4-part fractures showed no significant difference.

We conclude that our results show that function in the operated arm is lost. Our data confirms previously published function scores and shows no impact of the patient’s age and fracture configuration on the results of this implant.

The Proximal Humeral Internal Locking System (PHILOS) is being used increasingly in the treatment of proximal humeral fractures. Improvements in operative technique since its first use may represent improved functional results.

We analysed 28 cases performed in the two years following October 2006. There were 22 females and 6 males. Mean age was 65 years (Range 37–79 years). There were five 2-part, nineteen 3-part, and four 4-part fractures. Functional results were measured using the Oxford Shoulder Score, American Shoulder and Elbow Surgeons’ Score (ASES) and Constant Score (Age and sex matched). These results were compared to the patient’s non-operated shoulder to determine loss in function.

Following PHILOS fixation, the Oxford Score increased by a mean of 11 points, the ASES decreased by a mean of 25 points, and the Constant Score decreased by a mean of 31. This change was significant for all three scores (p-values < 0.01). Sub-analysis comparing patients aged < 60 years with those > 60 years and 2-part fractures with 3- and 4-part fractures showed no significant difference.

We conclude that our results confirm previously published functional data and show the patient’s age, and fracture configuration, have no impact on the results of this implant.