Orthopaedic Sequelae Research Articles

Outcome after acute osteomyelitis in preterm infants.

Eight cases of skeletal infection in preterm infants were studied. All the infants were systemically unwell, with polymorpholeucocytosis. Diagnosis was by blood culture, and any radiographic changes were apparent at the time of presentation. Infection was often multifocal, with sites around the knee being most commonly affected. Staphylococcus aureus was the pathogen isolated in six of the eight cases; in these treatment with fusidic acid was effective and well tolerated, even at doses that were less than the recommended therapeutic minimum. Even with prompt diagnosis and aggressive treatment orthopaedic sequelae are common.

Farm Accidents

In Reply.— We appreciate the interest and comments by Dr Paulson relative to our paper (Pediatrics 1985;76:562-566). In our series of 105 children injured in farm accidents, we reported one mortality (1%) and one child (1%) with major long-term disability. Follow-up ranged from 2 to 80 months based upon review of complete outpatient records in this stable rural population. Serious neurologic and physiologic sequelae were accurately recorded. We agree with Dr Paulson that a retrospective chart review will underestimate the number of minor disabilities including subtle neurologic, orthopedic, and pulmonary sequelae.

EPIEERMOIYSIS BULLOSA

Epidermolysis bullosa (EB) is a rare, hereditary, dermatologic disease with onset at birth or early infancy. Pathologically, the disease is characterized by blister formation resembling that of second-degree burns following slight, sometimes innocuous trauma(l). Immediate and long-term complications of epidermolysis bullosa include infectious, nutritional, orthopedic, gastrointestinal, hemolytic, and psychiatric sequelae. EB is heterogeneous, with varying patterns of inheritance and severity, ranging from mild inconvenience to severe debilitating disease, with death at an early age(2). The lesions ooze large amounts of proteinaceous substance rich in electrolyte content that predisposes the skin to local infections. The underlying defect appears to be a lack of the cellular "glue" in squamous epithelium, which is responsible for maintenance of cellular integrity. This lack of "glue" can be from destruction of the skin layers due to release of either a necrotizing agent or a collagen-lytic substance in the dermis(3). Epidemiologically, the disease is worldwide and rare, occurring in between 1:50,000 for the dominant types and 1:300,000 for the recessive dystrophic forms. There does not seem to be any predilection for a particular ethnic group. No relationship has been found to other genetic markers, such as ABO blood type, RH type, or sex(4). Classification is made by histologic location of the level of defect in the skin, biochemical markers, and by hereditary patterns(2). Clinically, the disease can be divided into three groups: Epidermolysis bullosa simplex (EBS). This is the mildest form of the disease and the one most compatible with life. Lesions occur t the basal layer of the epidermis and do not lead to scarring or to hyperkeratosis(l). It usually in-

Symphysiotomy or Transpubic Approach to Traumatic Strictures of the Posterior Urethra

The trans-symphyseal or transpubic approach is a useful technique which gives a very good exposure of the prostatic and membraneous urethra. We have used it on seven patients, for repair of post-traumatic strictures of the posterior urethra, complementary to the transperineal route in most difficult cases. This technique has allowed a correct anastomosis between the distal and the prostatic urethra in all these cases. The short-term results are good and no lasting orthopaedic sequelae have been observed.