We describe a new technique for examining the infant hip using ultrasound. Both hips are imaged simultaneously via an anterior approach. The examination can be done with the hip either extended or flexed and abducted. The method has three advantages: 1) since both hips are imaged simultaneously, lines can be drawn to assist in determining the relationship between the femoral head and the pelvis; 2) proximal, anteroposterior and lateral displacement of the femoral head can all be demonstrated; 3) the method is applicable to the infant in a harness or a plaster cast to demonstrate maintenance of reduction of a dislocated hip. The usual direction of dislocation of the femoral head was anterior and lateral. Proximal migration was also observed in cases with more severe dislocation. In flexion, the dislocated head of the femur often moved posterior to the acetabulum. Of 1276 hips, in 638 infants aged from three weeks to one year, 49 showed congenital dislocation. The accuracy of our anterior method of sonography in diagnosing congenital dislocation of the hip compared well with the method of Graf and with radiography

We have studied the relationship between movements of the foot and ankle and venous blood flow from the lower limb using colourflow Duplex ultrasound to determine the optimum type of exercise for promoting venous return. Studies of both active and passive movements were carried out on 40 limbs in 20 subjects (18 men; 2 women), with a median age of 27 years (20 to 54). We assessed ankle dorsiflexion and plantar flexion, subtalar inversion and eversion, and a combination of all movements. There was no difference in venous flow when comparing opposite limbs in a single subject (p > 0.5), but active exercises produced higher peak and mean velocities of blood flow than passive ones. The active combined movement produced the highest velocities with an increase of 38% in mean and of 58% in peak flow velocities, which were significantly greater than the peak and mean flow rates produced by passive movements. The active combined exercise would therefore be the most effective in eliminating stasis and could contribute to the prevention of deep-vein thrombosis

The factors involved in the mechanism leading to traumatic posterior dislocation of the hip are examined. In 47 adult patients who had previously suffered such a dislocation, ultrasound scans were used to measure femoral anteversion on both the affected and the uninjured side. In 36 normal adult volunteers, used as controls, similar measurements were made. Femoral anteversion on both the injured and uninjured side was significantly reduced in the patients compared with the volunteers. These findings are discussed in the light of previous work which indicates that medial rotation is a factor in the mechanism of posterior dislocation of the hip. It is suggested that reduced anteversion acts like medial rotation to make the hip more susceptible to posterior dislocation, and that the less the anteversion the more likely is the injury to be a dislocation rather than a fracture-dislocation. It is concluded that patients who suffer such dislocated hips belong at one extreme of the normal population, having either reduced femoral anteversion or even retroversion, and that this anatomical feature selects towards hip dislocation rather than to injury of the femoral shaft, knee or tibia during the appropriate type of accident

The torsion of both femora was evaluated in 110 patients who had been treated by intramedullary nailing for unilateral femoral shaft fractures. The anteversion (AV) angle was measured by ultrasound, using a tilted-transducer technique. True torsional deformity, defined as an AV difference of 15 degrees or more between sides was found in 21 patients, but only eight had complaints related to the deformity. Three patients had reoperations for troublesome external torsional deformities. Of 26 patients with AV differences of 10 degrees to 14 degrees, defined as possible torsional deformity, three had complaints, but none had serious problems. AV differences of up to 29 degrees were observed in symptom-free patients, and no patients with AV differences below 10 degrees had complaints. Static and dynamic nailing showed almost equal tendencies to lead to torsional deformity. We conclude that torsional deformities are usually established during the operation. Many patients tolerate abnormal torsion, but efforts should be made to reduce and stabilise the femoral shaft fracture with an AV difference of less than 15 degrees

Deep gluteal syndrome is an increasingly recognized disease entity, caused by compression of the sciatic or pudendal nerve due to non-discogenic pelvic lesions. It includes the piriformis syndrome, the gemelli-obturator internus syndrome, the ischiofemoral impingement syndrome, and the proximal hamstring syndrome. The concept of the deep gluteal syndrome extends our understanding of posterior hip pain due to nerve entrapment beyond the traditional model of the piriformis syndrome. Nevertheless, there has been terminological confusion and the deep gluteal syndrome has often been undiagnosed or mistaken for other conditions. Careful history-taking, a physical examination including provocation tests, an electrodiagnostic study, and imaging are necessary for an accurate diagnosis.

After excluding spinal lesions, MRI scans of the pelvis are helpful in diagnosing deep gluteal syndrome and identifying pathological conditions entrapping the nerves. It can be conservatively treated with multidisciplinary treatment including rest, the avoidance of provoking activities, medication, injections, and physiotherapy.

Endoscopic or open surgical decompression is recommended in patients with persistent or recurrent symptoms after conservative treatment or in those who may have masses compressing the sciatic nerve.

Many physicians remain unfamiliar with this syndrome and there is a lack of relevant literature. This comprehensive review aims to provide the latest information about the epidemiology, aetiology, pathology, clinical features, diagnosis, and treatment.

Cite this article: Bone Joint J 2020;102-B(5):556–567.

We performed open acromioplasty for intractable impingement syndrome on 96 shoulders (93 patients) with an intact rotator cuff. All the shoulders were examined by ultrasound after a mean interval of nine years. Those showing pathological findings, a poor or fair subjective result, or deterioration of the primary excellent outcome had MRI and/or arthrography. The mean Constant score for the affected shoulders was 70 points and that for 48 non-involved, symptom-free shoulders, 84 points. The subjective outcome was excellent in 45, good in 24, fair in 18 and poor in 9 shoulders. Complete tears were found in 12 shoulders and partial tears in seven. A total of 14 shoulders was symptom-free after acromioplasty, but after an average of five years became painful again and showed deterioration. Of these, six had complete tears and four partial tears of the cuff. The tear rate was 4% in shoulders initially judged to be excellent, 25% in good, 33% in fair and 55% in poor shoulders. The tear rate was 71% in shoulders which subsequently deteriorated. The incidence was higher in men (25%) than in women (11%). We conclude that a tear of the rotator cuff may appear after acromioplasty, although there was no evidence of a tear at the time of operation. This is usually the reason for deterioration in a shoulder with an initially good operative outcome

Between January 1987 and December 1988 there were 7575 births in the Swansea maternity unit. Of these 823 (10.9%) were considered to be at ‘high risk’ for developmental dysplasia of the hip (DDH). Static ultrasound examination was performed in each case and the results classified on the basis of the method of Graf. A total of 117 type III–IV hips in 83 infants was splinted using the Aberdeen splint. Radiographs of these hips were taken at six and 12 months. Hilgenreiner’s measurements of the acetabular angle were made in all cases and the development of the femoral capital epiphysis was assessed by measuring the epiphyseal area. The effect of splintage on the acetabular angle and the epiphyseal area between the normal and abnormal splinted hips was compared. Radiographs of 16 normal infants (32 normal unsplinted hips) were used as a control group. This cohort has now been followed up for a minimum of nine years. There have been no complications as a result of splintage. The failure rate was 1.7% or 0.25 per 1000 live births. No statistical difference was found when comparing the effect of splintage on the acetabular angle and epiphyseal area between normal and abnormal splinted hips and normal unsplinted hips. Our study has shown that while the Aberdeen splint had a definite but small failure rate, it was safe in that it did not produce avascular necrosis. The current conventional view that a low rate of splintage is always best is therefore brought into question if the Aberdeen splint is chosen for the management of neonatal DDH

Aims

The primary aim of this study was to determine if delayed clavicular fixation results in a greater risk of operative complications and revision surgery.

Aims

The purpose of this study was to compare the effectiveness of surgical repair to conservative treatment and subacromial decompression for the treatment of chronic/degenerative tears of the rotator cuff.

Aims

Adductor canal block (ACB) has emerged as an alternative to femoral nerve block (FNB) for analgesia after total knee arthroplasty (TKA). The optimal duration of maintenance of the ACB is still questionable. The purpose of this study was to compare the analgesic benefits and physiotherapy (PT) outcomes of single-shot ACB to two different regimens of infusion of the continuous ACB, 24-hour and 48-hour infusion.

Aims

We report the natural course of Baker’s cysts following total knee arthroplasty (TKA) at short- and mid-term follow-up.