Aims

A borderline dysplastic hip can behave as either stable or unstable and this makes surgical decision making challenging. While an unstable hip may be best treated by acetabular reorientation, stable hips can be treated arthroscopically. Several imaging parameters can help to identify the appropriate treatment, including the Femoro-Epiphyseal Acetabular Roof (FEAR) index, measured on plain radiographs. The aim of this study was to assess the reliability and the sensitivity of FEAR index on MRI compared with its radiological measurement.

Contracture of the iliotibial band leading to flexion and abduction deformity at the hip is common in residual paralysis after polio. Ober’s test has been used to detect this, but it is unreliable and cannot determine the degree of contracture. We describe a new test which quantifies this contracture and can be used for comparative purposes

Over-zealous release of the first dorsal compartment of the wrist for de Quervain’s disease or other lesions such as ganglia, may result in volar subluxation of the tendons of abductor pollicis longus and extensor pollicis brevis. This is usually asymptomatic, but may occasionally become disabling. We describe an operation using part of the extensor retinaculum to stabilise such a subluxation

1. Three cases of abduction contracture of the shoulder caused by fibrosis of the intermediate part of the deltoid muscle are described. 2. Treatment by removal of the affected part of the muscle was successful in each case. 3. Histological findings are described and the nature of the condition is discussed

We describe a modified lateral approach to the hip which exploits the functional continuity of gluteus medius and vastus lateralis and their dense crescentic attachment to the greater trochanter. The gluteus medius is not incised or split, but is detached and mobilised with gluteus minimus as one unit. This facilitates reattachment of the glutei and helps to preserve abductor function

There remains confusion in the literature with regard to the spinopelvic relationship, and its contribution to ideal acetabular component position. Critical assessment of the literature has been limited by use of conflicting terminology and definitions of new concepts that further confuse the topic. In 2017, the concept of a Hip-Spine Workgroup was created with the first meeting held at the American Academy of Orthopedic Surgeons Annual Meeting in 2018. The goal of this workgroup was to first help standardize terminology across the literature so that as a topic, multiple groups could produce literature that is immediately understandable and applicable. This consensus review from the Hip-Spine Workgroup aims to simplify the spinopelvic relationship, offer hip surgeons a concise summary of available literature, and select common terminology approved by both hip surgeons and spine surgeons for future research.

Cite this article: Bone Joint J 2019;101-B:808–816.

Aims

The aim of this study was to examine the recent trend in delivery of arthroscopic subacromial decompression (ASD) in Scotland and to determine if this varies by geographical location.

With the identification of literature shortfalls on the techniques employed in intraoperative navigated (ION) spinal surgery, we outline a number of measures which have been synthesised into a coherent operative technique. These include positioning, dissection, management of the reference frame, the grip, the angle of attack, the drill, the template, the pedicle screw, the wire, and navigated intrathecal analgesia. Optimizing techniques to improve accuracy allow an overall reduction of the repetition of the surgical steps with its associated productivity benefits including time, cost, radiation, and safety.

Cite this article: Bone Joint J 2020;102-B(3):371–375.

Aims

The hip’s capsular ligaments passively restrain extreme range of movement (ROM) by wrapping around the native femoral head/neck. We determined the effect of hip resurfacing arthroplasty (HRA), dual-mobility total hip arthroplasty (DM-THA), conventional THA, and surgical approach on ligament function.

Aims

Abnormal femoral torsion (FT) is increasingly recognized as an additional cause for femoroacetabular impingement (FAI). It is unknown if in-toeing of the foot is a specific diagnostic sign for increased FT in patients with symptomatic FAI. The aims of this study were to determine: 1) the prevalence and diagnostic accuracy of in-toeing to detect increased FT; 2) if foot progression angle (FPA) and tibial torsion (TT) are different among patients with abnormal FT; and 3) if FPA correlates with FT.

Premature closure of the growth plate of the femoral capital epiphysis associated with limitation of abduction and gluteal insufficiency is described. The indications for trochanteric advancement and the results obtained in the late treatment of Perthes' disease and of congenital dislocation are discussed. Nine hips treated after Perthes' disease had satisfactory results, in that all were improved; but in eight hips with deformity arising from congenital dislocation the outcome was less favourable

1. Sixteen cases of thenar paralysis are reviewed in which a bone graft was inserted between the first and second metacarpals to maintain fixed abduction and opposition of the thumb. 2. The technique of the operation is described and the causes of failure are discussed. 3. The operation is intended for those cases in which tendon transplantation to restore active opposition of the thumb is unsuitable. Rotation of the first metacarpal into full opposition is the most important feature of the operation

A new approach to the hip is described that allows better exposure for difficult revision surgery without the need for trochanteric osteotomy. A V-shaped myofascial flap consisting of the proximal part of vastus lateralis and its fascia with gluteus medius and minimus, is reflected off the greater trochanter and proximal femur giving access to the entire capsule of the hip. If the leg has been significantly lengthened by the revision procedure, abductor tension can be adjusted at closure by altering the reattachment of the flap, analogous to a V-Y-plasty

Ultrasound was used to observe the entire course of spontaneous reduction of CDH in the Pavlik harness in nine infants. In six infants with Suzuki type-A dislocations, the femoral head settled slowly into the bottom of the acetabulum by gliding on its posterior wall. In type-B dislocations, passive abduction of the legs during sleep caused it to approach the entrance to the socket and then suddenly to slip in. Reduction with the Pavlik harness is due to passive mechanical factors, and occurs only during muscle relaxation in deep sleep: no active movement is involved

1. A case of compression of the deep palmar branch of the ulnar nerve by an accessory abductor minimi digiti muscle is described. 2. The morphology of abnormal muscles in the hypothenar region is discussed. 3. Five previously reported cases of ulnar nerve compression at the wrist by an anomalous muscle are reviewed. 4. When symptoms are produced by an anomalous hypothenar muscle, they seem to be related to the anatomical site of the muscle and the presence of muscle hypertrophy. Occupational factors may be important in producing this hypertrophy

1. In ten healthy young men an experimental paralysis of the supraspinatus muscle was induced with the aid of Xylocaine injected in or near the suprascapular nerve. 2. The completeness of the paralysis was checked by electromyography. 3. With the supraspinatus muscle completely eliminated, all subjects could move the arm against gravity through its full range in the shoulder joint, though the force and the power of endurance during abduction were diminished. 4. It is concluded that the role of the supraspinatus muscle is of a quantitative nature only