Of the 34,723 infants born between 1 June 1992 and 31 May 2002, the hips of 2578 with clinical instability or at-risk factors for developmental dysplasia of the hip were imaged by ultrasound. Instability of the hip was present in 77 patients, of whom only 24 (31.2%) had an associated risk factor. From the 'at-risk' groups, the overall risk of type-III dysplasia, instability and irreducibility was 1:15 when family history, 1:27 when breech delivery and 1:33 when foot deformity were considered as risk factors. Of those hips which were ultrasonographically stable, 88 had type-III dysplasia. A national programme of selective ultrasound screening of at-risk factors for the diagnosis of hip dislocation or instability alone cannot be recommended because of its low predictive value (1:88). However, the incidence of type-III dysplasia and hip dislocation or dislocatability in the groups with clinical instability, family history, breech position and possibly postural foot deformity as risk factors could justify a programme of selective ultrasound imaging.

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Introduction?Carpal tunnel surgery represents a significant source of litigation in hand surgery. The aim of this work was to evaluate the burden of successful litigation relating to this type of hand surgery in England. Secondary measures looked at identifying the most common causes of successful legal action. Material and Methods?A retrospective review was conducted on the National Health Service Litigation Authority (NHSLA) database. All successful carpal tunnel surgery-related claims over a 10-year period from 2002 to 2012 were identified. A total of 60 claims were retrieved and analyzed. Results?The total cost of successful claims to the NHS was ?3.9 million. This compromised ?2.4 million in damages, with ?1.5 million in legal costs (22% in NHS legal costs, the remainder the claimants costs). The mean cost of settling a claim was ?65,440 (range ?350??397,134). The commonest cause of the claim was nerve damage. The average damages paid in relation to this injury was ?55,460. Additional surgery and poor outcome were the next commonest cause of successful proceedings, with average damages of ?28,984. Conclusion?Legal action in relation to carpal tunnel surgery is a considerable source of cost to hand surgeons and the NHS. The complexity of resolving these cases is reflected in the associated legal costs, which represent a significant proportion of payouts. With improved understanding of factors instigating successful legal proceedings physicians can recognize areas, where practice and training can be improved, and steps can be taken to minimize injury.