This study looks at the long-term outcome and morbidity following non-operative management of both-columns fractures (BCF) with secondary congruence.

A retrospective review was carried out of all both-columns acetabular fractures managed non-operatively from 1984 to 2004. Patients were clinically assessed using a modified Merle d’Aubigne (Matta’s modification) score and quality of life assessed using the SF-36 health survey. The results of the SF-36 scores for this group of patients were compared with the UK normative values and the student t-test was applied to compare the respective means. All these patients were managed according to the senior consultant’s protocol. Original acetabular radiographs were examined to confirm the classification had been correct. Late radiographs were inspected for the presence of union, avascular necrosis, non-union, secondary osteoarthritis (OA) and heterotopic ossification.

In the last 20 years, 57 patients have been managed non-operatively. 10 had died from unrelated causes and 16 were lost to, or declined follow-up. This left 31 patients available for assessment with at least 12 months following injury. The age at the time of injury ranged from 14 – 89 years. The majority of injuries were sustained in road traffic accidents.

The mean hip score was 15.5. 72% of the clinical scores were in excellent or good categories at the time of review. The SF-36 scores were not statistically significantly different from the normal population (P< 0.05). All fractures had clinically and radiologically united at follow-up. Surprisingly, there were no cases of heterotopic ossification or avascular necrosis. 4 patients developed secondary OA of the hip.

Most of the BCF demonstrate ‘secondary congruence’ after the injury assessed on Judet and pelvic radiographs. Good clinical outcomes with minimal complications can be achieved with conservative management of such fractures with secondary congruence, particularly in the older patients.

The radiographs of 153 children suffering from Perthes' disease of one hip were studied to examine the bony outline of the femoral capital epiphysis in the unaffected hip. In 48.4 per cent of patients irregularity of the surface, flattening or dimpling, were noted; in the majority of instances (37.2 per cent) these changes were present in the initial anteroposterior radiograph. By contrast, these changes were present in only 10.4 per cent of a control series of 153 children in whom intravenous urography was being performed, these children being matched for age and sex with the children with Perthes' disease. A second unmatched control series of 49 children whose pelves were being radiographed after injury showed a 6.1 per cent incidence of contour irregularities in 98 femoral capital epiphyses. In the patients with Perthes' disease and in the control series obtained at urography the incidence of changes was inversely related to age. The possible cause and significance of contour irregularities in normal children and in those with Perthes' disease is disscussed.

Twenty-four hips in twenty children affected by Group 1 Perthes' disease have been reviewed to assess the radiographic result after a minimum follow-up of four years. The children were allocated to Group 1 prospectively after examination of the early radiographs and no specific treatment of the affected hip was provided. The radiographic end results assessed by three methods were good even in those cases in which the additional stress of containment splintage of the contralateral hip was applied.