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Introduction: Infant developmental dysplasia of the hips arises when there is an interruption to normal joint development, usually present at birth but may be a later development. It has a wide spectrum of severity with potentially disastrous long-term complications if left untreated. Incidence is highly variable, often being attributed to differences of opinion in definition and diagnosis; however, there is consensus that ultrasound be used in screening and management. Topic Description: The anterior hip ultrasound technique is underutilised but is of value due to the additional confidence it provides regarding joint stability. Discussion: The ability to relate the acquired ultrasound image to hip anatomy and a technical appreciation of the technique are crucial to successful use. The method is described and its use within previous literature briefly outlined. Using pictorial ultrasound imaging examples to demonstrate the technique, we aim to highlight the anterior approach as a useful addition to ultrasound assessment of infant developmental dysplasia of the hips. Conclusion: Knowledge and understanding of different techniques is essential for practitioners involved in the diagnosis and management of this multifaceted and vigorously debated condition.

Background Notching of the anterior femoral cortex in distal femoral fractures following TKR has been observed clinically and studied biomechanically. It has been hypothesized that femoral notching...

Between July 1994 and June 2004, 60 patients with 76 slipped upper femoral epiphyses were managed within the adult trauma service of three hospitals. Treatment was by a single cannulated screw. Of these cases, 53 were unilateral, in 17 of which uncomplicated prophylactic fixation of the contralateral hip was performed. Of the other 36 cases, nine presented with a subsequent slip despite ongoing out-patient care. The subsequent slip was unpredictable in timing and unrelated to the age at the initial slip. It was more often unstable and in one case avascular necrosis developed. The overall rate of avascular necrosis, although in accordance with the literature, was 60% in acute unstable slips with a slip angle greater than 40°. In our experience, prophylactic fixation was safer than continued observation of the contralateral hip.

OBJECTIVE: To compare the cervical isometric strength, fatigue endurance and range of motion of adult and under-18 age-grade front-row rugby players to inform the development of a safe age group policy with particular reference to scrummaging.DESIGN: Cross-sectional cohort study.SETTING: 'Field testing' at Murrayfield stadium.PARTICIPANTS: 30 high-performance under-18 players and 22 adult front-row rugby players.OUTCOME MEASURES: Isometric neck strength, height, weight and grip strength.RESULTS: Youth players demonstrated the same height and grip strength as the adult players; however, the adults were significantly heavier and demonstrated substantially greater isometric strength (pCONCLUSIONS: Extreme forces are generated between opposing front rows in the scrum and avoidance of mismatch is important if the risk of injury is to be minimised. Although elite youth front-row rugby players demonstrate the same peripheral strength as their adult counterparts on grip testing, the adults demonstrate significantly greater cervical strength. If older youths and adults are to play together, such findings have to be noted in the development of age group policies with particular reference to the scrum.

Objectives To evaluate the neck strength of school-aged rugby players, and to define the relationship with proxy physical measures with a view to predicting neck strength. Methods Cross-sectional cohort study involving 382 rugby playing schoolchildren at three Scottish schools (all male, aged between 12 and 18 years). Outcome measures included maximal isometric neck extension, weight, height, grip strength, cervical range of movement and neck circumference. Results Mean neck extension strength increased with age (p = 0.001), although a wide inter-age range variation was evident, with the result that some of the oldest children presented with the same neck strength as the mean of the youngest group. Grip strength explained the most variation in neck strength (R2 = 0.53), while cervical range of movement and neck girth demonstrated no relationship. Multivariable analysis demonstrated the independent effects of age, weight and grip strength, and the resultant model explained 62.1% of the variance in neck strength. This model predicted actual neck strength well for the majority of players, although there was a tendency towards overestimation at the lowest range and underestimation at the highest. Conclusion A wide variation was evident in neck strength across the range of the schoolchild-playing population, with a surprisingly large number of senior players demonstrating the same mean strength as the 12-year-old mean value. This may suggest that current training regimes address limb strength but not neck strength, which may be significant for future neck injury prevention strategies. Age, weight and grip strength can predict around two thirds of the variation in neck strength, however specific assessment is required if precise data is sought.

Costoplasty can reduce the important cosmetic deformity of rib prominence in scoliosis but there are few objective reports of correction. We recorded the results of three objective methods of assessing back shape before and after short-segment costoplasty in 55 patients. We showed that significant improvement was maintained over a two-year follow-up period. Primary costoplasty at the time of scoliosis surgery (n = 35) achieved greater proportional correction than secondary costoplasty performed after fusion of the spine (n = 20). The rib segments removed at primary surgery provided enough bone for the autogenous graft; harvesting from the pelvis was unnecessary. We report a new classification of rib morphology which helps in planning the site and extent of costoplasty, and in predicting the possible correction.

Objectives This study set out to pursue means of reducing mismatch in schoolboy rugby players. The primary objective was to determine whether application of previously reported thresholds of height and grip strength could be used to distinguish those 15-year-old boys appropriate to play under-18 school rugby from their peers. A secondary objective was to obtain normative data for height, weight and grip strength and to assess the variation within that data of current schoolboy rugby players. Design Cross-sectional cohort study. Setting 3 Scottish schools and ‘Regional Assessment Centres’ organised by the Scottish Rugby Union. Participants 472 rugby playing youths aged 15 years (Regional Assessment Centres) and 382 schoolboys aged between 12 and 18 years (three schools). Outcome measures Height, weight and grip strength. Results 97% of 15-year-olds achieved the height and grip strength thresholds based on previous reported values. Larger mean values and wide variation of height, weight and grip strength were recorded in the schoolboy cohort. However, using the mean values of the cohort of 17-year-olds as a new threshold, only 7.7% of 15-year-olds would pass these thresholds. Conclusions Large morphological variation was observed in schoolboy rugby players of the same age. Physical maturity tests described in earlier literature as pre-participation screening for contact sports were not applicable to current day 15-year-old rugby players. New criteria were measured and found to be better at identifying those 15-year-old players who had sufficient physical development to play senior school rugby., Article summary Article focus Potential for physical mismatch between schoolboy rugby players and assessment of established maturity testing methods to try to reduce this mismatch, and modifications based on new population data. Key messages Large morphological variation was observed in schoolboy rugby players of the same age. Previously reported parameters of physical maturity were not suitable to assess the current schoolboy rugby playing population. New criteria, based on current players, were found to better differentiate 15-year-old players as to their suitability to play senior school rugby, with the aim of reducing physical mismatch. Strengths and limitations of this study Evidence that current screening parameters are inadequately sensitive. Current population data collected to describe cohorts of schoolboy rugby players. Application of current data allows better assessment of physical maturity to inform the decision of whether an individual could play senior school rugby. There is an urgent need to establish a robust system for recording injuries in order to substantiate the screening system.

The pre-operative lumbar spine radiographs of 200 consecutive patients who had undergone discectomy for prolapsed intervertebral disc were reviewed. Prolapse was recognized as bulging or sequestration of the disc with consequent root compromise. Measurement of the lumbar level of the interiliac line was shown to correlate with the level of disc prolapse and the incidence of transitional vertebrae at the lumbosacral junction was significantly higher than normal. A pathological value for the lumbosacral angle could not be identified.

This study evaluated the efficacy and safety of three doses of botulinum toxin A (BTX-A; Dysport®) in 125 patients (mean\ud age 5.2 years, SD 2; 54% male)with dynamic equinus\ud spasticity during walking. Participants were randomized to\ud receive Dysport (10, 20, or 30 units/kg) or placebo to the\ud gastrocnemius muscle of both legs. Muscle length was\ud calculated from electrogoniometric measurements and the\ud change in the dynamic component of gastrocnemius\ud shortening at four weeks was prospectively identified as the\ud primary outcome measure. All treatment groups showed\ud statistically significant decreases in dynamic component\ud compared with placebo at 4 weeks. Mean improvement in\ud dynamic component was most pronounced in the 20 units/kg\ud group, being equivalent to an increase in dorsiflexion with the knee extended at 19°, and was still present at 16 weeks. The safety profile of the toxin appears satisfactory.