Human recombinant bone morphogenic protein type 7 (BMP 7) is now available commercially for clinical use. In our trauma unit it has been used since September 2001 for patients with established intractable non-unions. We present the early results.

All consecutive patients receiving BMP 7 were reviewed regularly following treatment. All patients had established non-unions previously treated with a variety of methods. The patients were assessed for clinical evidence of fracture union (using stability and pain). Treatment episodes will be categorised as failures if there is no evidence of fracture union at 1 year following BMP 7 treatment. Plain x-rays were assessed by 2 independent radiologists and categorised into: Radiological evidence of fracture union; encouraging progression towards union; little evidence of fracture healing; atrophic non-union, hypertrophic non-union.

A total of 12 separate non-union sites have been treated in 10 patients (all male) to date. The mean age of the patients at follow up was 45 years. The series included 5 tibial non-unions, 3 femoral non-unions, 3 ulna non-unions with a mean of 3.3 treatments (range 1–7 treatments) and had endured symptoms, from initial injury to treatment with BMP 7, with a mean of 8.3 years (range 2 months-10.4 years). To date, the mean follow-up is 18 weeks (range 6–48 weeks).

Currently, 2 fractures have clinical & radiological union, 2 treatments have failed (implant failure and patient opted for amputation), 3 fractures are below 3months follow up, 5 fractures have a radiological classification as “encouraging” progression towards of union ( 4 with clinical union).

In a very difficult treatment group, we have encouraging early clinical results. Radiological evidence to compare to initial clinical results will be available shortly.

Objective: To compare the results of MRI Gadolinium Arthrograms and hip arthroscopy in patients with hip pain.

Design: Retrospective analysis

Setting: St. James University Hospital, Leeds

Participants: 15 patients (10 females and 5males) underwent hip arthroscopy between 1999 and 2002.The procedure was performed by a single surgeon. The mean age of the patients was 39 (Range 24–74).

Outcome Measures: A review of the findings of both the MRI and arthroscopy were undertaken. Attention was paid to the both the specificity and sensitivity of the MRI diagnosis when compared to the findings at arthroscopy.

Results: All 15 patients underwent MRI Arthrograms with intra-articular gadolinium prior to arthroscopy. The time that elapsed between radiological evaluation and surgery was a mean of 10 months (Range 7–15).During this time there had been no significant change in any of the patients’ clinical symptoms.

Of the 15 scans performed only 10 were found to provide an accurate diagnosis confirmed at the time of surgery, The presence of osteochondral defects, loose bodies, synovitis and AVN were all correctly identified.

Of the remaining five cases, two labral injuries were identified radiologically, but arthroscopy proved to be normal. MRI was also found to be particularly inaccurate when assessing for articular cartilage defects, failing to demonstrate moderate to advanced changes in three cases, later confirmed at surgery.

Discussion: MRI is the non-invasive investigation of choice for the assessment of both intra and extra articular hip pathology. However our results show that limitations do exist with the sensitivity and specificity of this investigation. Previous studies (Edwards et al, Villar et al) have demonstrated similar findings .The interpretation of MRI Arthrograms should therefore be carefully considered when establishing a diagnosis for hip pain.