Three different types of congenital hip disease in adults have been distinguished based upon the position of the femoral head relative to the acetabulum and the underlying pathoanatomy of the joint: (1) dysplasia; (2) low dislocation; and (3) high dislocation. To facilitate classification of borderline or ambiguous cases, we studied the morphologic variations of low and high dislocation as observed on the radiographs of 101 hips with low and 74 hips with high dislocation. In low dislocation, 54 hips (53.5%) had extended coverage of the true acetabulum (Type B1) and 47 hips (46.5%) had limited coverage (Type B2). Among the cases with high dislocation, a false acetabulum with an adjacent femoral head occurred in 46 hips (62.2%) (Type C1), and the femoral head was floating within the gluteal muscles in 28 hips (37.8%) (Type C2). The kappa value for interobserver agreement between two raters who made radiographic measurements was 0.963, and for intraobserver agreement between the two evaluations of the same observer it was 0.946 and 0.971, respectively. The two types of low and high dislocation were associated with high intra- and interobserver agreement. Whether these distinctions have clinical utility requires further validation. Level of Evidence: Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Background: Closed femoral nailing is universally accepted as the treatment of choice in almost all diaphyseal femoral fractures in adults. Numerous authors reported favorable results applying the same surgical technique in the adolescent patient group. Nevertheless, reports of complications such as avascular necrosis and alteration of the proximal femoral anatomy have dampened the initial enthusiasm. The purpose of this paper was to evaluate the possible effect of closed intramedullary nailing through the greater trochanter on the proximal femoral anatomy. Methods: We report the results of intramedullary nailing in 20 skeletally immature patients (13 men and 7 women) with a mean age of 14.4 years (range, 11–16 years). All were treated with closed, reamed, percutaneously performed nailing, using the tip of the greater trochanter as the nail insertion point. The patients were followed for 29 months in average (range, 19–37 months). Results: No major complication (limb length discrepancy, avascular necrosis, coxa valga) occurred during the observation period. All fractures healed clinically and radiographically within 9 weeks in average (8–13 weeks) and all patients returned to the preinjury activity level. The mean ATD difference was 1.10 ± 3.51 (range, −5–7 mm, 95% CI −0,54/2,74, p = 0.177). The mean LTA distance difference was 0.3 mm (range, −6–5 mm, p = 0.158), the mean femoral length difference was 1.9 mm (−9–12 mm, p = 0.122) and the overall limb length difference was 1.4 mm (−25–20 mm, p = 0.178). The mean neck-shaft angle difference was 0.20 ± 1.74 (range, −3–4, p = 0.612) and the mean neck width was 0.60 ± 1.50 (range, −3–3, p = 0.09). Fourteen nails (70%) were removed within 13 months in average (range, 10–18 months) without any complications. Conclusion: This study showed that with strict adherence to a surgical technique that respects the growing proximal femur and its vascular anatomy, using the tip of the greater trochanter as an entry point to the femoral canal, the proven advantages of closed, intramedullary nailing can safely be offered to the adolescent patient population as well.

Background and Objectives: Superior capsular reconstruction (SCR) with the use of a fascia lata autograft or a dermal allograft is an established treatment in treating irreparable rotator cuff (RC) tears. The long head of the biceps tendon (LHBT) has been recently proposed as an alternative graft for SCR. The purpose of this study was to present the surgical techniques and clinical studies utilizing the LHBT for SCR. Material and Methods: Medline, Scopus, and the Cochrane library were searched for relevant studies up to December 2020. The primary outcomes were pain intensity improvement and the incidence of RC and LHBT graft retears. Secondary outcomes were functional scores and acromiohumeral distance (AHD) improvements. Results: Nine studies described surgical techniques of SCR using the LHBT, and four clinical studies reported the outcomes of the technique. The mean pain intensity improved from 4.9 ± 2.3 to 1.6 ± 1.5 in terms of the visual analog scale, exceeding the minimum clinically important difference for adequate pain relief. Significant improvements were also noted in functional scores and AHD. When compared with other repair techniques for massive RC tears, i.e., the double-row repair, the transosseous-equivalent technique with absorbable patch reinforcement, and the traditional SCR with a fascia lata autograft, there were no significant differences in pain and function improvements. Conclusion: SCR using the LHBT is a useful treatment option for massive RC tears; it is equally effective with the traditional SCR and other established techniques. It presents numerous advantages being a safe, easy, time-saving, and cost-effective method. The only precondition for the technique is the presence of an intact LHBT. Additional clinical trials are necessary to determine which treatment is superior for treating massive RC tears, as well as to evaluate the long-term results of the technique.

Our study evaluated the reliability of the Crowe and Hartofilakidis classification systems for developmental dysplasia of the hip in adults. The anteroposterior radiographs of the pelvis of 145 patients with 209 osteoarthritic hips were examined twice by three experienced hip surgeons from three European countries and the abnormal hips were rated using both classifications. The inter- and intra-observer agreement was calculated. Interobserver reliability was evaluated using weighted and unweighted kappa coefficients and for the Crowe classification, among the three pairs there was a minimum kappa coefficient with linear weighting of 0.90 for observers A and C and a maximum kappa coefficient of 0.92 for observers B and C. For the Hartofilakidis classification, the minimum kappa value was 0.85 for observers A and B, and the maximum value was 0.93 for observers B and C. With regard to intra-observer reliability, the kappa coefficients with linear weighting between the two evaluations of the same observer ranged between 0.86 and 0.95 for the Crowe classification and between 0.80 and 0.93 for the Hartofilakidis classification. The reliability of both systems was substantial to almost perfect both for serial measurements by individual readers and between different readers, although the information offered was dissimilar.