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.
We have used dual-energy X-ray absorptiometry to measure bone mineral density (BMD) in patients with ankylosing spondylitis comparing 41 healthy control subjects and 33 patients with either mild or advanced ankylosing spondylitis. A Norland XR.28 bone densitometer was used to measure the BMD of the lumbar spine and that of the head, trunk, arms, femoral neck, Ward's triangle, legs, pelvis, and total body. Mild ankylosing spondylitis was defined as that showing no or incipient syndesmophytes between Li and LS vertebrae: we studied 16 men of mean age 37 years and six women of mean age 37 years. Advanced ankylosing spondylitis, in ii men of mean age 42 years, showed a bamboo spine with bridging syndesmophytes across all disc spaces between Li and L5. The mean BMD of the lumbar spine was significantly different in the patients and control subjects of the same sex (0.01 < p < 0.05, analysis of variance), being significantly reduced compared with control subjects in mild disease (0.001 < p < 0.01, t-test) and significantly increasedin advanced disease over control subjects (0.01 < p < 0.05; t-test) and over patients with mild disease (0.001 < p < 0.01; t-test). The relevance of these findings to the aetiology and pathogenesis of spinal deformities and other complications in ankylosing spondylitis is discussed.
Out of a total of 91 patients with traumatic posterior dislocation of the hip treated between 1936 and 1974 in the Mansfield area, 81 patients were reviewed. The average follow-up period was 12.5 years, although there was a large number of cases with a follow-up of more than 15 years and a smaller number with a follow-up of 30 years. The overall results were surprisingly poor despite early reduction of the dislocation in the majority of cases. We found that 15 years after simple dislocation 24 per cent of the cases had a poor result by both clinical and radiological criteria, but in the more severe grades of initial injury the results became worse, with 73.3 per cent of the patients graded as fair and poor, and only 26.7 per cent graded excellent or good.
The measurements of the angle of anteversion of the femoral neck by ultrasound scanning is described.The method was compared with direct measurement in 30 dried femora, and was then used in 18 normal volunteers and eight patients. The method is non-invasive, accurate and easily applicable.
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