Background: Information on embryological hip development has been obtained from post mortem examination

. There is less information on normal foetal hip

. Magnetic resonance imaging (MRI) allows development to be followed in the healthy baby.

AIM: To assess the value of MRI of the foetus and neonate to provide information on normal and abnormal hip development.

To establish normal patterns of hip development.

To obtain charts that could be used to detect abnormality earlier.

There are three aspects to this study:

Validation – analysing MRI scans of babies hips prior to post mortem (the gold standard) would verify MRI as a valid tool for such studies.

Measurements will be gained for foetus in utero

Similarly for pre and term babies.

PATIENT SELECTION: 30 patients for each aspect of this pilot study, 90 in total (3).

For the initial validation process, parents who had consented to post mortem were asked to consider additionally an MR scan of their neonate’s hips, a total of 30 cases.

Method: MR images in axial and coronal planes were obtained using a high resolution T2 weighted sequences (4).

Measurements were made, by two independent observers, of the width and depth of the acetabulum and the radius & diameter of the femoral head, volume and area were calculated. Inter-observer variation was assessed.

Results: The babies ranged in gestation from 17 – 42 weeks

With the exception of the acetabular width each dimension showed little development until week 20 when the line of growth rose exponentially. The acetabular width showed only a slow rate of growth despite the changes seen in the femoral head. Levels of observer agreement were high (ICCs = 0.98) for all but depth (ICCs = 0.86). The measurements for all dimensions were in line with previous post mortem studies.

CONCLUSION: MRI is a valid and acceptable alternative to post mortem in the assessment of hip development eventually allowing early detection of abnormal hip development.

Aim: To determine the Inter & Intra-observer Agreement in Assessment & Classiþcation of Non-unions of fractures based on Radiological appearance. Methods: X-rays of 100 adult patients with established non-union (NU) were selected by random sampling, excluding cases with poor quality x-rays. Common denominators of various classiþcation/assessment systems were selected for study. Observers were selected in 3 categories (2 in each): Senior Limb Reconstruction specialist, Musculoskeletal Radiologists & senior trainees. 6 weeks were allowed between the 2 sets of observations.

Data was analysed by calculating kappa coefþcients (95% CI) Results: Radiologists were unable to comment on vascularity.

Conclusion: Agreement in common denominators except hypertrophic/atrophic NU is poor. Radiographic analysis of non-union remains poor indicating the need for further study to see whether identiþable diagnostic, therapeutic & prognostic features exist

To evaluate the effects of smoking on fracture healing in a non-union population.

A consecutive cohort of 104 patients with 107 non-unions managed by external fixation was reviewed. 75% were regular smokers compared to the regional average of 3 0%. 5 8 male and 20 female smokers, matched with the non-smoking group. Patients’ records and x-rays were evaluated; where information was missing patients were contacted by phone/post. Scoring was recorded from our own prospective database.

The smokers underwent 2. 6 procedures per segment with a mean treatment time of 17. 43 months (4–64) compared to 1. 9 and 10. 9 (2. 5–24) respectively in non-smoking group. The total hospital stay was 66% greater in the smoking group (41. 12 vs 27. 4 days).

102 non-unions healed, including seven who required revision surgery, six of whom were smokers. In smoking group five went on to amputation and three had residual infection. The entire non-smoking group healed after primary surgery except a 70 years old lady who was converted to intramedullary nailing.

The final assessment of the bony and functional results was performed by the method described by Paley and Catagni (JBJS 77A 1995).

When considered in the context of regional statistics for smoking there was a trend towards non-union in smokers [P< 0. 05].

When limb reconstruction treatment was compared between the two groups despite the low number of infected cases in the smoking group, the number of surgical procedures, duration of treatment and hospital stay were all increased.

Failure, revision rate and residual infection were high in the smoking groups.

We conclude that smoking adversely affects both primary fracture healing and non-union treatment.

To determine the Inter & Intra-observer Agreement in Assessment & Classification of Non-unions of fractures based on Radiological appearance.

Medical records and X-rays of patients who attended the Limb Reconstruction Clinic (1987 to 2000) in a University Hospital for fracture non-union were studied. X-rays of one hundred adult patients with established non-union were selected by random sampling.

Common denominators of various classification / assessment systems were selected for study. Observers were selected in 3 categories (2 in each): Senior Limb Reconstruction specialist, Consultant Musculoskeletal Radiologists, Senior trainees (Post-FRCS Orth).

Data was analysed by calculating kappa coefficients (95% confidence intervals). Kappa measures between observer agreements having been corrected for chance.

Radiologists were unable to comment on vascularity. (S= substantial, M= moderate, F= fair & P= poor)

It would appear that the agreement for classification of atrophic/hypertrophic non-union is good all round (both inter & intra). Within this classification, radiologists showed better agreement than trainees whose results were better than Orthopaedic specialists. Agreement of healing potential & infection was fair to poor only. Radiographic analysis of non-union remains poor indicating the need for further study to see whether identifiable features exist.