I have attempted to call attention briefly to an operation that has proved to be of use in many patients with non-union of the neck of the femur and have tried to point out not only the indications but also the contra-indications, and to stress some of the precautions in the technique and after-care of the operation. This trochanteric reconstruction operation may help to solve some of the problems related to the ununited hip fracture

1. Dislocation and subluxation of the hip has been produced in young rats by application of splints reaching from the hip to the foot, bringing the hip into extension. 2. Progressive acetabular dysplasia and anatomical abnormalities of the head and neck of the femur occurred. 3. Results of the experiments suggest that post-natal extension of the hip is of importance in the pathogenesis of congenital dislocation of the hip in man

The intensity of scattered radiation in both a forward and a backward direction from a portable fluoroscope during pinning of the neck of the femur was measured by experiments on a cadaver. The intensity decreased rapidly with increasing distance from the flare of the greater trochanter. Hazard to the surgeon's hands from scattered radiation can be greatly reduced by positioning the C-arm of the fluoroscope so that the x-ray beam is directed laterally

Aims

Asphericity of the femoral head-neck junction is common in cam-type femoroacetabular impingement (FAI) and usually quantified using the alpha angle on radiographs or MRI. The aim of this study was to determine the natural alpha angle in a large cohort of patients by continuous circumferential analysis with CT.

Aims

A variety of surgical approaches are used for total hip arthroplasty (THA), all with reported advantages and disadvantages. A number of common complications can occur following THA regardless of the approach used. The purpose of this study was to compare five commonly used surgical approaches with respect to the incidence of surgery-related complications.

Aims

Instability continues to be a troublesome complication after total hip arthroplasty (THA). Patient-related risk factors associated with a higher dislocation risk include the preoperative diagnosis, an age of 75 years or older, high body mass index (BMI), a history of alcohol abuse, and neurodegenerative diseases. The goal of this study was to assess the dislocation rate, radiographic outcomes, and complications of patients stratified as high-risk for dislocation who received a dual mobility (DM) bearing in a primary THA at a minimum follow-up of two years.

Serum 1.25 dihydroxyvitamin D concentrations were reduced in elderly patients with femoral neck fractures, irrespective of the presence of osteomalacia. This reduction was not attributable to a decrease in vitamin D binding protein. The low rate of bone turnover in these elderly patients might reduce the requirement for vitamin D and protect against the development of osteomalacia. Serum vitamin D metabolite concentration cannot be used as a screening test for osteomalacia in these patients

We performed transoesophageal echocardiography on 20 patients with femoral neck fractures randomly treated with an uncemented Austin-Moore or cemented Hastings hemiarthroplasty. Cemented arthroplasty caused greater and more prolonged embolic cascades than did uncemented arthroplasty. Some emboli were more than 3 cm in length. In some patients the cascades were associated with pulmonary hypertension, diminished oxygen tension and saturation, and the presence of fat and marrow in aspirates from the right atrium

Aims

We studied the impact of direct anterior (DA) versus non-anterior (NA) surgical approaches on prosthetic joint infection (PJI), and examined the impact of new perioperative protocols on PJI rates following all surgical approaches at a single institution.

The measurements of the angle of anteversion of the femoral neck by ultrasound scanning is described. The method was compared with direct measurement in 30 dried femora, and was then used in 18 normal volunteers and eight patients. The method is non-invasive, accurate and easily applicable. Findings in normal subjects included variation of the angle of anteversion from 10 to 34 degrees with a maximal difference between sides of six degrees. The expected rotational deformity of the femur was found in patients with unilateral intoeing

There is no firm published evidence to support the use of closed suction drains. Over 20 years ago, large studies by the Public Health Laboratory Service and the National Research Council found that drains were risk factors for wound infection. A prospective randomised study of the use of closed suction drains after surgery for fractured neck of femur in 70 patients failed to show that drains improved wound healing. Drained cases had more complications

Of 693 elderly patients admitted with suspected hip fractures, 43 had normal radiographs and were investigated by isotope bone scan. The 30 patients (70%) with normal scans were mobilised and none developed a fracture. All 13 of the patients with specific bone scan abnormalities were subsequently proved to have fractures, five of which became displaced. Clearly conventional radiography does not exclude fracture of the femoral neck in elderly patients; bone scanning is advisable in doubtful cases

Twenty patients each with a fractured femoral neck had a prosthesis with a built-in ball-and-socket joint inserted. Movements at the built-in joint were compared with total hip movement immediately after operation, one month later and three months later. It was found that the built-in joint soon lost mobility and at three months was almost completely stiff. Consequently such joints cannot be expected to prevent the acetabular erosion which is liable to follow femoral head replacement for fracture

Internal fixation with a trifin nail after displacement osteotomy of the femur permits reduction of external splintage to a degree that any patient can tolerate with ease; it also eliminates the problem of the stiff knee. The method has been used successfully for recent and old fractures of the femoral neck, for post-irradiation fractures, for failed nailing operations or arthroplastics, for osteoarthritis, for rheumatoid arthritis, for old congenital dislocations and subluxations, and to stabilise the hip after excision of the head and neck to create a pseudarthrosis

Aims

The aim of this study was to report the implant survival and patient-reported outcome measures (PROMs) in a consecutive series of patients aged less than 50 years at the time of arthroplasty using the Birmingham Hip Resurfacing system (BHR), with a minimum follow-up of ten years.

1. The femoral head has been examined in specimens taken from cadavers, patients suffering subcapital fracture of the femoral neck and patients undergoing total replacement arthroplasty for osteoarthrosis and rheumatoid arthritis. 2. Lesions have been seen, some of which appear to be uniting fatigue fractures of individual trabeculae. 3. It is suggested that excessive cyclical loading, sometimes leading to fatigue fractures, may represent a fundamental pathological process of general importance in the evolution of certain skeletal and articular diseases

CT scans of 18 hips with typical congenital dislocation have been studied in 16 children. These show that the common position of dislocation is lateral, superior and slightly anterior, and that a "false acetabulum" can be distinguished even in young children. A defect in the posterior ischium causing distortion of the acetabulum was also present in most cases. The cartilage and the acetabular contents were well shown. Positions of reduction and the anteversion of the acetabulum and the femoral neck were studied. Hypotheses are presented on the mode of dislocation and on the cause of the pathological changes

1. Congenital coxa vara and infantile coxa vara must be separated as distinct entities. 2. Infantile coxa vara is likely to be due to distal movement of the head fragment relative to the shaft and neck. This can result either from severe trauma in normal bone or from shearing stress on an abnormal femoral neck. 3. There is no justification for considering infantile coxa vara as congenital, developmental or due to interruption of ossification. The nature of the pathological lesion at the epiphysial line in some children is unknown

1. A review of 195 patients with displaced intracapsular fractures of the femoral neck treated by a sliding nail-plate appliance has been presented. 2. The highest failure rate was evident in fractures in women over seventy-five with Grade 4 displacement. 3. The effect of various concomitant factors has been analysed in relation to the end results. 4. Observations have been made on avascular necrosis, its incidence amongst the failures and its association with late segmental collapse after fracture union

1. A lateral intermuscular approach to the hip joint is described for replacement of the head of the femur by a prosthesis. 2. Advantages claimed for it are that it is attended by little or no shock, because the operation is rapid and relatively bloodless; that adequate exposure can be gained without dividing muscle or tendon; and that muscle function is unimpaired and so walking can be allowed early. The exposure is easily extended if unexpected difficulty is encountered. 3. Prosthetic replacement of the femoral head through this incision is advocated as a primary measure for elderly or unfit patients with fractured femoral neck