Aim: To assess if routine x-ray can be avoided following normal ultrasound in high risk screening for developmental dysplasia of the hip.

Methods: All children who had ultrasound as part of screening programme for developmental dysplasia of the hip during the period August 2006 and March 2007 were included for the study. After excluding 16 children due to incomplete details, either lack of clinical details/x-ray/ultrasound of the hip, 121 children were finally included for the study.

Results: Out of 121 children (242 hips), six of the hips were found to be dysplastic by ultrasound, average alpha angle being 43°, 2 of the hips turned out to be normal in subsequent X-rays. However three of the hips were found to be dysplastic in follow-up x-ray which was initially normal in the ultrasound, average alpha angle being 58.6°.The sensitivity in diagnosing developmental dysplasia of the hip by using α angle is 57% and 99% specific. The sensitivity did not improve by combining the alpha angle with percentage of femoral head coverage. Grafs α angle and percentage of femoral head coverage did not have any direct correlation with that of future acetabular index and hence routine x-ray still needs to be done to rule out developmental dysplasia of the hip.

Conclusion: Though the number of children involved in this study is small, three hips would have been missed if not followed up with x-ray, despite their percentage of coverage of femoral head being more than 50% and normal grafs α angle. Hence we recommend routine x-ray in the screening programme for developmental dysplasia of the hip despite initial normal ultrasound of the hip.

Aim: To assess if routine x-ray can be avoided following normal ultrasound in high risk screening for developmental dysplasia of the hip.

Methods: All children who had ultrasound as part of screening programme for developmental dysplasia of the hip during the period August 2006 and March 2007 were included for the study. After excluding 16 children due to incomplete details, either lack of clinical details/x-ray/ultrasound of the hip, 121 children were finally included for the study.

Results: Out of 121 children (242 hips), six of the hips were found to be dysplastic by ultrasound, average alpha angle being 43°, 2 of the hips turned out to be normal in subsequent X-rays. However three of the hips were found to be dysplastic in follow-up x-ray which was initially normal in the ultrasound, average alpha angle being 58.6°. The sensitivity in diagnosing developmental dysplasia of the hip by using α angle is 57% and 99% specific. The sensitivity did not improve by combining the alpha angle with percentage of femoral head coverage. Grafs α angle and percentage of femoral head coverage did not have any direct correlation with that of future acetabular index and hence routine x-ray still needs to be done to rule out developmental dysplasia of the hip.

Conclusion: Though the number of children involved in this study is small, three hips would have been missed if not followed up with x-ray, despite their percentage of coverage of femoral head being more than 50% and normal grafs α angle. Hence we recommend routine x-ray in the screening programme for developmental dysplasia of the hip despite initial normal ultrasound of the hip

Background: Osteoporosis is a significant cause of morbidity and disability through an increase in bone fragility and susceptibility to fracture. In March 2001 guidelines were produced by The Clinical Resource Efficiency Support Team (CREST) on the Prevention and Treatment of Osteoporosis, which were distributed throughout the primary and secondary care groups.

Aim: The aim of this audit was to analyse the use of the CREST guidelines within the secondary care sector.

Methods: The audit was conducted from January 2002 until March 2003. The sample group was identified retrospectively from September 2001 to February 2002 from patients over 45 years of age with diagnosis of osteoporosis / osteopenia and an osteoporotic fracture. All patients sampled were admitted to the secondary care sector, and data was collected using the CREST audit tool data collection form, utilising the information on the central fracture database located at the Royal Victoria Hospital Belfast.

Results: 213 patients studied (165 female). Mean age 73 yrs (Range 41 to 100yrs). 5% had a risk factor for osteoporosis. 30 patients had previous fragility fracture, 9 male and 21 female, 21 of which were either wrist, hip or spine. Of these 30 patients, 4 (13%) had a diagnosis of osteoporosis considered. Regarding most recent fracture; in males (n=46); 24 (52% hip, 15 (33%) vertebra and 7 (15%) colles, in females (n=156); 66 (42%) hip, 62 (40%) colles, 18 (12%) and 10 (6%) hip and colles. 28 patients (13%) received lifestyle advice concerning osteoporosis. Pharmacological intervention; in males 1 (2%) calcium and vitamin D and 47 (98%) no treatment, in females 10 (6%) calcium, 18 (11%) calcium and vitamin D, 5 (3%) bisphosphonate, 4 (2%) SERM, 3 (2%) HRT and 125 (76%) no treatment. 91 patients underwent operation for hip fracture, 33% of operations were completed within 24 hour period, and 74% completed with 72 hour period. Grade of anaesthetist supervising operations: 80% Consultant, 12% Specialist Registrar, 7% Senior House Officer and 1% Staff Grade. 93% of patients received both prophylactic antibiotics and anti-coagulation prior to surgery. 83% of patients were identified at risk of falling, but only 17% had documented evidence that fall prevention advice had been given.

Summary: Only 5% of patients were identified as having a risk factor for osteoporosis; 14% of patients had a previous low trauma fracture – a strong independent risk factor – however in only 13% of these 30 patients had osteoporosis been considered at time of fracture; only 13% of patients received any form of lifestyle advice; only 17% had advice given regarding fall prevention. These low figures could be due to improper recording, or simply that advice was not given. The vast majority of patients received no form of pharmacological intervention. In regards to surgery; time to operation, grade of anaesthetist and prophylactic treatments were appropriate in the vast majority of cases.

Conclusion: The current cost of hip fractures in Northern Ireland is £21 million per year and with 90% of these fractures related to osteoporosis it is important that steps are taken to ensure early diagnosis, and that appropriate action is taken in the prevention and treatment. As can be seen, the CREST Guidelines are being adhered to in parts, however patients at risk are not being identified and appropriate pharmacological treatment and lifestyle advice is not being given.