Surgical release of the 'snapping iliopsoas tendon'

We report 22 patients (19 women and three men) of mean age 20.8 years who had painful snapping sensations in the groin. Most were able to reproduce the click by extending the affected hip from a flexed, abducted and externally rotated position and most were tender in the adductor triangle. Plain radiographs and an arthrogram were normal. A clinical diagnosis of subluxation of the iliopsoas tendon was made. Conservative management failed in 14 patients, two of whom had bilateral pain. All 14 had surgical release of the iliopsoas tendon through a medial approach. At follow-up (mean 17 months) the click had resolved in ten hips, was occasional but painless in five and unchanged in one. The syndrome of a painful 'snapping' psoas may result in disproportionately disabling symptoms. It may be diagnosed on clinical grounds and effectively treated, when severe, by release of the iliopsoas tendon. <br/

lateral growth arrest of the proximal femoral physis – a new technique for serial radiological observation

Purpose: lateral growth arrest is recognised as the most common form of avascular necrosis (AVN) seen in the management of developmental dysplasia of the hip (DDH). The purpose of this report is to present a new technique that is of benefit in the early identification and subsequent radiological monitoring of lateral growth arrest and which may permit appropriate timely surgical intervention.Methods: we performed a retrospective review of the medical records and serial radiographs of 11 patients (three males and eight females) with lateral growth disturbance in the proximal femoral physis. We devised a new technique (named the ‘Tilt angle’) for serial radiographic observation of lateral growth arrest.Results: this study included 11 hips in 11 patients. Ten patients had screw epiphyseodesis performed after progression of lateral growth arrest was noted. One patient did not have screw epiphyseodesis but the results for this patient are included, as they provide an interesting ‘control’ case for comparison. The average age of screw epiphyseodesis was 12 years. Seven patients demonstrated improvement in their tilt angle following screw epiphyseodesis (i.e. less valgus), one showed no change and two continued to decline.Conclusions: using a new technique to monitor the progression of lateral growth arrest, we noted that screw epiphyseodesis can be used for guided growth of the proximal femoral physis. This technique can be employed for serial radiographic observation of lateral growth arrest and can guide the clinician on the optimal timing of screw epiphyseodesis. Further studies are needed in order to clarify the optimal timing of screw epiphyseodesi

Congenital dislocation of the hip in extrauterine pregnancy

Only two cases have been reported of congenital dislocation of the hip in infants born after extrauterine pregnancies. We report a further two and discuss the management and the variable outcome. These cases seem to confirm that congenital dislocation of the hip is associated with moulding forces rather than being a teratological abnormality. <br/

Recurrent irritable hip in childhood

Between 1989 and 1992 we admitted 426 children with an irritable hip, 363 (85.2%) once and 63 (14.8%) on 143 occasions. We assessed the records retrospectively to determine whether the groups differed and in particular whether recurrence was followed by pathological sequelae. We identified no feature which distinguished between them at either presentation. The use of bone isotope scans was greatly increased in recurrent cases, without clinical benefit. No relationship between recurrence and subsequent abnormality was identified, with 22 (42%) of the recurrences taking place in the opposite hip. The only difference was a higher incidence of 'psychosocial factors' recorded in the notes of children who presented on more than two occasions. The incidence of recurrent irritable hip is larger than previously indicated and in the presence of normal radiographs and low-grade clinical signs, more detailed investigation on subsequent admission is unlikely to be helpful. </jats:p

Improving the outcome of paediatric orthopaedic trauma: an audit of inpatient management in Southampton

The patterns, management and outcome of non-fatal orthopaedic injury in childhood was audited over a 1 year period in Southampton. A computer-based audit (1 September 1993 to 31 August 1994) was conducted of all children aged under 15 years who were admitted to the orthopaedic unit after accidental injury. Management was audited by studying the primary conservative and operative treatment methods employed. Treatment outcome was evaluated in terms of need for secondary operative treatment, salvage internal fixation, length of hospital stay and unplanned readmission. In all, 398 children, representing 50/10,000 of the local paediatric population, were admitted with a traumatic injury. There was a significant (P < 0.001, Kolmogorov-Smirnov) seasonal variation in admission rate. There were 87.3% admissions required for fractures, 8.5% after soft tissue injury and 2.2% after joint injury. The following areas were identified where management and outcome could be improved: 1 A 12.1% readmission rate (47/346) in children with fractures owing to a 16% incidence of loss of position after closed reduction of distal radial, forearm shaft and distal humeral fractures. 2 In all, 24% of internal fixation procedures were performed as 'salvage' after failure of conservative treatment, entailing either reoperation during the initial admission or a further unplanned readmission. 3 A prolonged inpatient stay for patients with femoral fractures owing to a wide variation in treatment method. The outcome of non-fatal orthopaedic injury can be improved through the selective use of primary internal fixation of distal radial and humeral fractures and the close adherence to a management algorithm in femoral fractures. There may be a role for more specialised supervision of primary treatment of these particular fractures