Orthopedic Emergency Research Articles

Traumatic Hip Dislocation: Pediatric and Adult Evaluation and Management.

Traumatic hip dislocation of a native hip joint represents an orthopaedic emergency that should be treated promptly. Dislocations can be classified based on the associated injuries and the direction of dislocation. Expeditious evaluation, reduction, and management of associated injuries are required to optimize short and long-term function of the hip. There are several important differences between the blood supply and ossification of the pediatric hip that necessitate different strategies for the evaluation and management of traumatic hip dislocations in pediatric patients. Appropriate treatment is dictated by the direction and type of dislocation as well as associated injuries. In addition to closed reduction, arthroscopy, open reduction (potentially with fracture fixation and/or soft-tissue repair), osteotomy, and total hip arthroplasty all have roles in treatment. Consensus on optimal postreduction activity protocols after simple hip dislocation remain unestablished. Short and long-term outcomes are largely driven by the amount of time from injury to reduction and associated injuries.

DORIS study: domestic violence in orthopaedics, a prospective cohort study at a Swedish hospital on the annual prevalence of domestic violence in orthopaedic emergency care

BackgroundDomestic violence (DV) is a major problem which despite many efforts persists globally. Victims of DV can present with various injuries, whereof musculoskeletal presentation is common.ObjectivesThe DORIS study (Domestic violence...

A prospective review of Cauda Equina Syndrome referrals received by an on-call orthopaedic department at a major trauma unit.

Cauda Equina Syndrome (CES) is one of the genuine orthopaedic emergencies. Diagnosis of acute CES is challenging and may be missed, resulting in considerable medicolegal claims. In Ireland, nearly €21 million in compensation has been paid out over a 10-year period due to the diagnosis being missed. As a result, defensive practices have resulted in an increased number of referrals for CES to the on-call orthopaedic service in a major trauma unit. A prospective data-capturing exercise was carried out of all referrals for acute CES to the orthopaedic on-call department in a tertiary-level university-affiliated teaching hospital between August and November 2023. Qualitative data was captured including referral source, referring clinician grade, in-hours or out-of-hours referral, MRI on referral, red flags as identified by the referring team, red flags as identified by the orthopaedic team, and outcome. Forty referrals for CES were made over the duration of this audit. Seventeen (42.5%) referrals were made in-hours, and 23 (57.5%) were referred out-of-hours. Only five (12.5%) of these referrals had an MRI done at the time of the referral. No patients were transferred for an out-of-hours MRI to another hospital. Only five (12.5%) patients required surgical decompression-none of these patients required an out-of-hours emergent decompression. There is a lack of understanding as to what exactly is being referred-resulting in a referral volume which is over ten times the expected number of CES cases being made to our unit. The lack of out-of-hours MRI access poses a significant concern for patient outcomes.

Are radiographs overutilized in pediatric orthopaedic emergency room care?

BackgroundIt is estimated that $12.8 billion to $28.6 billion is wasted annually on unnecessary imaging studies and treatment in the United States. This is especially important to the pediatric population, which is unable to make decisions for themselves and vulnerable to radiation exposure. We hypothesized that a significant number of unnecessary radiographs are performed in the pediatric emergency department, leading to excessive time, cost, and radiation exposure to pediatric patients. MethodsWe retrospectively reviewed 406 patients who were evaluated in a pediatric emergency department (ED) for possible fracture at a single institution during the 2020 calendar year. Records were reviewed for demographics, history and physical exams, as well as the sequential order that radiographs were performed. All radiographs were evaluated by the senior author to determine if they resulted in a change in management. All data was recorded and analyzed by the senior author and our statistician using Student’s t-test. Results406 patient encounters were included. 2807 radiographs were deemed unnecessary, with an average of 6.9 radiographs per patient. $454,734 were spent on radiographs that ultimately did not change management. A total of 216 hours and 43 minutes were spent in the x-ray suite alone, for an average of 32 minutes per patient. The estimated amount of radiation exposure that did not change management was potentially as high as 69 millirem per patient. ConclusionsThere is an excessive amount of monetary waste, radiation exposure, and encounter time spent in pediatric orthopedic patients in the ED. There are several potential strategies to alleviate this problem, which we hope can be taken into consideration to help address this widespread healthcare issue.

Reaching consensus on factors impacting optimal use of an orthopaedic emergency theatre in a public hospital.

The operating theatre (OT) complex of hospitals represents areas of considerable expenditure with regard to costs and requires maximum use to ensure optimum cost benefit for both patients and the hospital. Inefficient use of an operating theatre room (OTR) may result in hospital wasteful expenditure and frustrations for patients owing to surgery delays, cancellations and prolonged hospitalisation while waiting. The aim of the study was to explore and describe using a consensus method, factors impacting the use of an emergency orthopaedic theatre that can be optimised in a selected public hospital in Gauteng province. The study was conducted by a professional nurse and orthopaedic surgeon working in the theatre of a selected public hospital in Gauteng province. A qualitative, explorative and descriptive design was adopted. Data were collected using a nominal group technique (NGT) among professional nurses and orthopaedic surgeons. Data analysis was done through cross-analysis where participants reached a consensus on the voted ideas from the group. Consensus was reached and three main themes emerged: (1) inadequate resources; (2) poor organisation and (3) communication. The optimal use of an emergency orthopaedic theatre is influenced by the availability of resources being human and material, good organisation and clear communication. The study has demonstrated that a variety of factors needs to be considered to optimise the use of an orthopaedic emergency theatre. The management of an OT requires a concerted effort from the nurses and doctors.

Incidence of Secondary Osteoarthritis after Primary Shoulder and Knee Empyema and Its Risk Factors.

Empyema of the joint is an orthopedic emergency that is associated with a prolonged healing process despite adequate surgical and medical therapy. The risk of developing postinfectious osteoarthritis (OA) after successfully treated joint empyema is unknown. Both incidence and risk factors are important for prognostication and would therefore be clinically relevant for the selection of an adequate infectious therapy as well as for the individual follow-up of patients. The aim of this retrospective clinical study was to describe the risk of secondary OA after empyema based on knee and shoulder joint infections after successful primary infection treatment and its risk factors. Thirty-two patients were examined clinically and radiographically after completion of treatment for primary empyema of the knee or shoulder joint. Patients with previous surgery or injections in the affected joint were excluded from the study. The cumulative incidence of new-onset radiographic OA was 28.6%, representing a 5.5-fold increased risk of developing OA compared to the normal population. A figure of 25% of patients underwent total knee arthroplasty after knee empyema. Identified risk factors for primary empyema were obesity, hyperuricemia, and rheumatoid arthritis. Only about 60% of the patients tested positive for bacteria. Staphylococcus aureus, the most common pathogen causing joint empyema, was present in approximately 40% of cases. Secondary osteoarthritis, as a possible secondary disease after joint empyema, could be demonstrated and several risk factors for the primary empyema were identified.

Predictors of Acute Compartment Syndrome in Patients With Forearm Fractures: A Systematic Review.

Acute compartment syndrome (ACS) is a critical orthopedic and traumatology emergency arising from elevated pressure within a confined osteofascial compartment, leading to compromised blood circulation and tissue ischemia. This systematic review aims to comprehensively identify and analyze the most predictable risk factors associated with ACS development in patients with forearm fractures. Published articles on ACS were meticulously searched and evaluated on reputable medical databases such as PubMed. The keywords "risk factors associated with the ACS in patients who have sustained forearm fractures"were used to create the search syntax on various databases. Data were gathered on raw prevalence, population under study, and methodology. A total of 10 articles that met the search criteria were identified and included in this review with a total of more than 300,000 patients across the studies. Fracture-related ACS was the most common, followed by soft tissue damage among patients with forearm fractures. This review underscores fractures as primary ACS catalysts, along with the role of soft tissue trauma. Meticulous consideration of these risk factors can enhance clinical decision-making, early detection, and intervention, improving patient outcomes and care quality.

Advanced imaging shows extra-articular abscesses in two out of three adult patients with septic arthritis of the native hip joint.

Background: Septic arthritis (SA) of the native adult hip is a rare orthopaedic emergency requiring prompt diagnosis and treatment. As clinical presentation and laboratory findings are frequently atypical, advanced imaging is often requested. This retrospective study aimed to investigate the prevalence and pattern of extra-articular infectious manifestations and their implications for pre-operative advanced imaging in patients with proven SA of the native hip joint. Methods: Out of 41 patients treated surgically for SA of the native hip during a 16-year period at our tertiary referral hospital, 25 received advanced imaging (computed tomography (CT), magnetic resonance imaging (MRI), or fluorodeoxyglucose positron emission tomography (FDG PET-CT)) prior to initial intervention. For each investigation, a specific set of variables was systematically interpreted, and the most suitable surgical approach was determined. The prognostic value was evaluated by comparing specific outcome measures and the extent of extra-articular involvement. Results: It was found that 32 % of patients had an abscess in one anatomical region, 32 % of patients had abscesses in multiple anatomical regions, and only 36 % of patients had no substantial abscess. Gluteal abscesses were especially common in patients with SA due to contiguous spread. Abscesses in the iliopsoas region were more common in patients with SA due to hematogenous seeding. A combination of several different surgical approaches was deemed necessary to adequately deal with the various presentations. No significant prognostic factors could be identified. Conclusion: We recommend performing advanced imaging in patients with suspected or proven septic arthritis of the native hip joint, as extra-articular abscesses are present in 64 % and might require varying anatomical approaches.

Inappropriate Pediatric Orthopaedic Emergency Department Transfers: A Burden on the Health Care System.

Though the importance of level 1 pediatric trauma has repeatedly been shown to lessen both morbidity and mortality in critically injured children, these same tertiary referral centers also receive numerous transfers of patients with less severe injuries. This not only leads to increased costs and use of limited facility resources but, oftentimes, frustration and unnecessary expense to those families for whom transfer was avoidable. Prior work has demonstrated that half of all inappropriate pediatric interfacility transfers are due to orthopedic injuries. This study aims to evaluate the incidence of inappropriate transfers of pediatric patients with isolated orthopedic injuries to a pediatric level 1 trauma center and identify factors associated with such transfers. All patients transferred to a large metropolitan level 1 pediatric trauma center for isolated orthopedic injuries over a 6-year period were retrospectively evaluated. Medical records were reviewed for demographic and injury data, including age, gender, race, social deprivation index, insurance status, location of transferring institution, timing of transfer, and availability of orthopedic on-call coverage at transferring institution. The transfer was deemed to be appropriate if the patient required a sedated reduction, was admitted to the hospital, or was taken to the operating room within 24 hours of transfer. Regression analysis was reviewed for each of the demographic, patient, and transfer characteristics in an attempt to isolate those associated with inappropriate transfer. In all, 437 transfers occurred during the study period. Of these, 112 (26%) were deemed inappropriate. 4% of patients transferred for orthopedic injuries did not receive an orthopedic consult following the transfer. Non-white patients were more likely than white patients to be transferred inappropriately (34.01% vs. 21.58%, P=0.009 ). No other demographic characteristic was predictive of inappropriate transfer. There was no difference in the rate of appropriate transfer between patients with private insurance versus government-funded, self-paying, or uninsured patients. The timing of transfer (night vs. day and weekday vs. weekend) did not affect the appropriateness of transfer. Facilities with orthopaedic on-call coverage were more likely to inappropriately transfer patients than those without (26.6% vs. 23.4%, P<0.001 ). A quarter of patients transferred for isolated orthopaedic injuries were inappropriately transferred. Unlike studies published in adult literature, the timing of transfer (overnight and weekend) and the insurance status of the patient did not appear to play a role in the appropriateness of transfer. Inappropriate and unnecessary trauma transfers create a significant burden on tertiary referral centers. Raising awareness of the high incidence of unnecessary transfers coupled with enhanced education of outside emergency medicine providers may result in better stewardship of health care resources, limit delays in patient care, and reduce strain on both the health care delivery system and the families of injured children. Level III-Therapeutic Study.

The locked knee.

The acute locked knee is an orthopaedic emergency requiring prompt diagnosis and treatment. It can be classified as acute or chronic. The term 'locked knee' refers to a knee that demonstrates fixed flexion or which has a 'block' to complete extension. Some degree of active or passive extension may be achievable, but not full extension. The most frequent causes of a locked knee are a meniscal tear, rupture of the anterior cruciate ligament or loose bodies. Magnetic resonance imaging is the gold standard in diagnostic imaging. Knee arthroscopy is considered the gold standard in management. This article gives an overview of the presentation, assessment and management of the locked knee for core surgical, acute care common stem and emergency medicine trainees.

Microbiological Profile and Clinical Features of Septic Arthritis of the Shoulder: A 10-Year Cohort Single-Centre Study.

Introduction Septic arthritis (SA) constitutes a pressing orthopedic emergency characterized by acute, non-traumatic joint pain. Timely diagnosis and intervention are imperative to avert complications such as chondrolysis and systemic sepsis. The etiology is predominantly hematogenous, necessitating an integrated approach involving surgical and microbiological modalities. Shoulder aspiration and microbiological analysis play pivotal roles in guiding treatment, especially when positive findings prompt more aggressive therapeutic strategies. This study aims to elucidate the nuanced clinical and epidemiological characteristics of septic arthritis in both native and prosthetic joints within a singular institutional cohort over a decade. Methods This retrospective case series analysis spanned a 10-year period, focusing on non-prosthetic shoulder joints from January 2012 to July 2021. In this timeframe, only 183 aspirations were performed and sent to the microbiology department for analysis, including cultures, microscopy, and antibiotic sensitivity tests for positive cultures. The study delved into the microbiological profile of infections, encompassing gram stain, culture positivity rates, identification of microorganisms, and antibiotic susceptibility patterns. Additionally, the incidence of primary joint infections with resistant strains, particularly methicillin-resistant Staphylococcus aureus(MRSA), was scrutinized. Statistical analysis utilized the SPSS program version 20.0 (IBM Inc., Armonk, New York), with a significance level set at 5%. The project, registered with the trust's clinical audit department (Reg #5372), adhered to the Declaration of Helsinki and good clinical practice guidelines. Data collection involved extracting non-identifiable patient modifiers from the laboratory database bank into Excel spreadsheets. Results The study included 183 patients, with 108 (59%) females and 75 (41%) males. The average age was 76.2±16.5 years. Among them, 138 (75.4%) reported pain, and 15 (8.2%) had a body temperature over 37.8°C. Lab results showed a mean white blood cell count of 11.6±4.5 and an average C-reactive protein level of 121.7±102.1. Leucocytosis (>11,000 WBC) was seen in 82 (44.8%) cases. Elevated C-reactive protein (CRP; >10 mg/dl) was found in 136 (74.3%) patients. Synovial fluid analysis revealed no crystals in 91.3% of cases. Microbial resistance analysis showed 19 strains resistant to co-trimoxazole and 11 to erythromycin. Among co-trimoxazole-resistant strains, 73.7% were Staphylococcus aureus, a statistically significant association (p<0.001). Conclusion The evolving sensitivity patterns of microbes in septic arthritis underscore the necessity to reassess empirical antibiotic therapy. Subsequent joint damage resulting from infection can result in substantial disability.

Septic arthritis in the pediatric hip joint: a systematic review of diagnosis, management, and outcomes.

Septic arthritis of the pediatric hip joint (SAH) is a rare but serious orthopedic emergency requiring immediate diagnosis and management. Delayed recognition can lead to severe complications, emphasizing the need for timely intervention. This systematic review aims to provide a comprehensive analysis of SAH in the pediatric population, focusing on its diagnosis, management, and outcomes. The review included 11 studies involving 391 patients with SAH, aged between three months and 12 years. Staphylococcus aureus was identified as the most common causative pathogen, with increasing cases of methicillin-resistant strains. Diagnosis is challenging due to nonspecific clinical presentations, necessitating validated criteria and a multidisciplinary approach. Ultrasound emerged as a valuable tool for early detection, and MRI was used in challenging cases. Treatment options include hip aspiration, arthrotomy, and arthroscopy, often combined with appropriate antibiotic therapy. Success rates were comparable among different surgical procedures. Early intervention is vital for optimal outcomes. However, the review highlights the need for standardized protocols and further prospective studies to address limitations and improve understanding and management of SAH in the pediatric hip joint.

Proportion of Hidden Vertebral Fractures Among Egyptian Males With Fragility Hip Fractures in the Emergency Room of Ain Shams University Hospitals.

Background Fragility fractures are linked to significant costs for society as well as significant pain and suffering, disability, and even death. It is well-recognized that osteoporosis-related fragility fractures raise the risk of subsequent fragility fractures. One of the most frequent osteoporotic fractures brought on by low bone mineral density and other risk factors is vertebral fractures. Considering that most vertebral fractures are asymptomatic and not clinically identified, proactive screening could stop additional impairment. Objective The current study aims to determine the prevalence and risk factors of hidden vertebral fractures in Egyptian males who have fragility hip fractures. Patients and methods A cross-sectional case-control study examining the correlation of risk factors between cases (fragility hip fracture and vertebral fractures) and a control group (fragility hip fracture without vertebral fracture) was carried out from September 2020 to September 2021 on patients visiting the orthopedic emergency department of a university hospital in Cairo, Egypt. Males who presented to the emergency room (ER) with fragility hip fractures and were 40 years of age or older met our inclusion criteria. For every patient who presented with a fragility hip fracture, standard lateral and anteroposterior radiographs of the dorso-lumbar spine were taken. Results A total of 43,935 patients visited the orthopedic emergency room (ER) throughout the study period; 13,034 of those patients were men, accounting for 29.7% of all orthopedic ER visits. Our inclusion criteria for fragility hip fractures were met by 132 male participants. The screening lumbosacral plain X-rays identified 27 (20.5%) of the 132 patients as having concomitant vertebral fractures in addition to the fragility hip fractures. Concomitant hidden vertebral fractures among Egyptian males with other fragility fractures, particularly fragility hip fractures, are predicted by the number of co-morbid diseases, hypertension, and continuous use of steroids and anti-epileptics. Conclusion Most fragility fractures are avoidable. Because one fragility fracture increases the likelihood of others, early detection is crucial. To prevent complications and mortality, it is important to identify and manage individuals who have a fragility hip fracture as they frequently have concurrent hidden vertebral fractures. Predictive risk factors for fragility vertebral fractures include hypertension, the number of concomitant illnesses, and chronic drugs (anti-epileptics and steroids).

Clinical and radiological risk factors associated with the occurrence of acute compartment syndrome in tibial fractures: a systematic review of the literature.

Acute compartment syndrome (ACS) is an orthopedic emergency that may lead to devastating sequelae. Diagnosis may be difficult. The aim of this systematic review is to identify clinical and radiological risk factors for ACS occurrence in tibial fractures. PubMed® database was searched in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Additional articles were found by a manual research of selected references and authors' known articles. The identification process individualized 2758 via database and 30 via other methods. After screening and eligibility assessment, 29 articles were included. Age, gender, occupation, comorbidities, medications, habits, polytrauma, multiple injuries, mechanism, sports, site, open vs closed, contiguous lesion, classification, and pattern were found to be related to ACS occurrence. Younger age and male gender are strong independent risk factors in tibial plateau and shaft fractures. High-energy fractures, polytrauma, more proximal fractures and fractures with contiguous skeletal lesions are aggravating risk factors; higher AO/OTA and Schatzker classification types, increased displacement of the tibia relative to the femur, and increased tibial joint surface width are associated risk factors in tibial plateau fractures; higher AO Foundation/Orthopaedic Trauma Association classification types and subgroups and more proximal fractures within the diaphysis are associated risk factors in tibial shaft fracture. Open fractures do not prevent ACS occurrence. Increased fracture length is the only factor suggesting a higher risk of ACS in tibial pilon fractures. The presence of each independent predictor may have a cumulative effect increasing the risk of ACS occurrence.

ORTHOPAEDIC TRAUMA EMERGENCIES DONE AFTER HOURS

In 2019, the incidence of fractures were 178 million globally, South Africa accounting for close to 600 000 of these fractures, an 18.53% increase since 1990. South Africa does not have the public infrastructure to adequately facilitate the optimal surgical management of this burden. This forces intensive labour practices among orthopaedic surgeons, often performing complex surgeries throughout the night. There is a direct correlation between “after-hour”operations and the increase in morbidities.A retrospective review of the orthopaedic surgical cases and orthopaedic surgical emergencies done at a tertiary institution in Johannesburg between 8th of August 2021 to 12th December 2022. The nature of the orthopaedic interventions, the date of booking of the surgical procedures, date of surgical procedures, as well as start and end time of the orthopaedic interventions were analysed.“After-Hours” orthopaedic interventions were defined as interventions done between 16:00 and 07:00. Orthopaedic emergencies were defined as: Open fracture debridements, external Fixator insertion, arthrotomies, fasciotomies and the insertion of steinmann pins. 1483 (27.92%) of 5310 operative cases done on the emergency board were orthopaedic cases. 1098 (74.04%) hardware-related cases and 535 (36.08%) orthopaedic emergencies were done. 854 (57.58%) cases were done “After-Hours” of which 433 (29.20%) cases were done during “Dead-Hours” (23:00–07:00). Of these 433 cases, only 173 (39.95%) were true orthopaedic emergencies.Although the proportion of emergencies done after hours were greater than during working hours, there is still a large proportion of intricate orthopaedic cases done between 16:00– 07:00 that should not be prioritized, due to an associated higher morbidity. Enhanced strategic planning is advisable in future in order to prioritize complex hardware cases during working hours, and due to the burden, prioritize minor relooks and simple skin- grafts for the latter aspects of the night. A dedicated Orthopaedic Trauma theatre is recommended.

Factors associated with compartment syndrome after a tibial fracture in children

ObjectivesCompartment syndrome (CS) after a tibial fracture in children is one of the orthopedic emergencies. Identifying high-risk patients in a timely fashion minimizes morbidities. This study aimed to find the...

Fasted or Not: Anesthesia-Related Pulmonary Complications in Pediatric Orthopaedic Emergencies Are Rare: A Pilot Study

Background: The American Society of Anesthesiologists (ASA) recommends fasting before surgery: clear liquids (2 hrs), breast milk (4 hrs), light meal (6 hrs), and fried foods/fatty foods/meat (> 8 hrs). In emergencies, guidelines are bypassed for timely surgical intervention. Pediatric post-anesthesia complications caused by violating fasting guidelines remain controversial. The aim of this study was to compare the risk of post-anesthetic complications in patients who met and did not meet ASA fasting guidelines for pediatric orthopaedic emergency procedures.Methods: Patients were retrospectively identified who had emergent procedures at a level 1 pediatric trauma center from 2010 to 2020. Patients were divided into two groups: those meeting current ASA fasting criteria of fasting and those who did not. Charts were reviewed for complications of gastric content aspiration during or following anesthesia.Results: There were 321 patients who met inclusion criteria for emergency orthopaedic surgeries. Of these, 264 (82%) met fasting guidelines, and 57 (18%) did not. One patient who met preoperative fasting status needed postoperative supplemental oxygen and met criteria to be reported as an adverse event. Of the 57 patients not meeting fasting guidelines, there were no anesthesia-reported adverse events.Conclusions: No increased risk was found with anesthesia in nonfasted patients with orthopaedic emergencies undergoing general anesthesia during the perioperative period in this underpowered, pilot study. No respiratory complications (pulmonary aspiration, intraoperative or postoperative emesis, or postoperative respiratory support) were reported in patients who did not meet fasting guidelines. The authors believe this is a valuable starting point for further research into fasting criteria in pediatric trauma patients.Level of Evidence: IIIKey Concepts•No increased risk was found with anesthesia in nonfasted patients with orthopaedic emergencies undergoing general anesthesia during the perioperative period.•Modern anesthesia techniques are tailored to minimize risk of pulmonary aspiration in patients with unknown fasting status.•The rate of pulmonary complications following modern anesthesia in children remains so small as to suggest that additional research is needed to determine if fasting guidelines are truly necessary in the majority of cases or if other factors beyond the time since last oral intake should be more carefully considered.

Evaluation of distribution and susceptibility of microorganisms isolated from joint fluid cultures: five-year data

Aims: Septic arthritis is joint inflammation. It is an orthopedic emergency that requires prompt diagnosis and treatment. In this study, it was aimed to examine the distribution and antibiotic resistance profiles of microorganisms isolated from joint fluid samples taken from patients who applied to the orthopedic clinic of our hospital in the last five years. &#x0D; Methods: In our study, 1162 joint fluid samples were sent to the medical microbiology laboratory of our hospital from the orthopedics and traumatology clinic between January 01, 2018 and December 31, 2022. Joint fluid samples taken from clinically appropriate patients under sterile conditions were incubated in a BacT/Alert 3D (Biomerieux, France) culture device. Bacteria isolated from 164 specimens with growth detected, were identified by matrix-mediated laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS) based VITEK MS (Biomerieux, France). Antibiotic susceptibility tests were performed on the VITEK 2 Compact (Biomerieux, France) device.&#x0D; Results: Staphylococcus aureus (S. aureus) (29.3%) and coagulase negative Staphylococci (CNS) (29.3%) were the most commonly grown microorganisms. Other microorganisms grown were Streptococcus spp. (9.1%), Enterococcus spp. (6.1%), Pseudomonas aeruginosa (P. aeuruginosa) (7.3%), Escherichiae coli (E. coli) (4.3%) and Klebsiella pneumoniae (K. pneumoniae) (4.3%). When antibiotic susceptibility results were evaluated according to EUCAST restricted reporting criteria, linezolid in Gram-positive strains, amikacin in Enterobacterales, colistin and tigecycline in nonfermentative Gram-negative bacteria were found to be the most susceptible antibiotics. &#x0D; Conclusion: The continuous change in antibiotic susceptibility profiles in joint infections, the long duration of treatment and follow-up, and the increase in polymicrobial infections require regular monitoring of culture and antibiotic susceptibility tests. In our study, the distribution of microorganisms isolated from joint fluid samples of our hospital and the determination of antibiotic resistance profiles will contribute to the clinician in terms of guiding empirical treatment.

Case of left hip acute pediatric septic arthritis - polymicrobial etiology

Septic arthritis is a true orthopedic emergency, involving a severe bacterial, viral, or fungal joint infection that triggers inflammation and the degeneration of joint tissues. It typically affects joints such as the knee, hip, shoulder, or wrist. Early diagnosis and treatment are crucial to avoid long-term complications. Herein, we describe the case of an 8-year-old male patient who presented with complaints of spontaneous onset of hip pain and an abnormal gait. The patient was diagnosed with left hip septic arthritis and underwent a left hip arthrotomy under general anesthesia (GA). The patient was administered intravenous antibiotics for 21 days while being kept on non-weight-bearing mobilization. After 3 weeks, the patient's intravenous antibiotics were switched to oral antibiotics for the next 3 weeks. On the second follow-up visit, the patient showed significant improvement, with laboratory findings within normal limits.

Septic Arthritis of Neonates: A Rare Case Report

Neonatal septic arthritis is a rare condition which may present as an orthopedic emergency. The sequalae may be devastating in untreated cases. The presentation of neonatal septic arthritis could lead to multitude of differential diagnosis which consequentially delays the final diagnosis. It is very crucial to make an early diagnosis in such cases and commence prompt or timely appropriate management to prevent serious complications. Worldwide incidence in the neonatal age group is 0.3 per 1000 live births, although higher incidence of 0.6 per 1000 live birth has been reported in India, [1,2]. Older children are affected more than the younger age group and the hip joint is most commonly affected because of its unique anatomy and blood supply. The Pathogenic bacteria most commonly found to be responsible for septic arthritis are staphylococcus aureus, haemophilus influenza and streptococcus agalactiae (GBS). We are reporting a rare case of septic arthritis in the shoulder joint to a neonate caused by GBS bacteria, presenting as a late onset infection.