Evolution of head-shaft angle and neck-shaft angle in childhood

The current retrospective study investigates the natural evolution of head-shaft angle (HSA) and neck-shaft angle (NSA) in childhood. It is not known if a high HSA in early childhood leads to a high HSA in adulthood. This study aims to characterize the evolution of HSA and compares it with the more commonly known NSA in healthy children. We measured radiographs of 84 different healthy hips of children between 3 and 14.5 years old who underwent at least 2 radiographs of the pelvis, corresponding to 286 measurements. We used a linear mixed model to determine the covariance between random intercept and slope while allowing each individual hip to change over time. The covariance for HSA between random intercept and random slope was -4.262 (p < 0.001), corresponding to a high negative correlation of -0.717, for NSA -2.754 (p = 0.031) or a high negative correlation of -0.779. HSA and NSA were strongly correlated, a value of 0.736 (p < 0.001) was measured. The high negative correlation for random intercept and random slope means that the higher the initial value (intercept), the steeper the decline (slope). Therefore HSA decreases faster in hips with high HSA at an early age. Hips with high HSA in early childhood do not necessarily lead to hips with high HSA in adulthood. Our results may aid in future clinical decision making in patients with developmental dysplasia of the hip (DDH) with high HSA in particular.

Decision making in the management of malunion and nonunion of intertrochanteric fractures of the hip

Aim: Intertrochanteric fractures account for almost 50% of hip fractures.Nonunion and malunion of these fractures are relatively uncommon. This study reviews the outcome of 31 cases of intertrochanteric fracture failures. An algorithm for the management of these injuries is also proposed. Methods: 19 patients with intertrochanteric malunion and 12 patients with non-union were included in this study. Treatment of these injuries was initiated according to the algorithm proposed in this study. Treatment outcomes were evaluated by assessing union, pre and postoperative shortening and HSA (head-shaft angle). Functional outcomes were assessed by the Parker mobility scale and presence or absence of pain. Results: All the patients with intertrochanteric malunion with follow-up had united. The postoperative shortening in all patients were ⩽2.5 cms. Patients having intertrochanteric nonunion with follow-up, who underwent internal fixation had united with an acceptable Parker mobility scale score, except in 1 patient who sustained an ipsilateral distal femur fracture. The average HSA correction obtained was 21° (range 3–60°). Conclusion: The algorithm proposed in this study helps streamline the treatment according to each case scenario.It helps in planning and managing patients with intertrochanteric fracture failures.