Septic Osteomyelitis Research Articles

Toxic Synovitis of the Hip in Children

Toxic synovitis, an acute inflammatory condition of the hip, is the most common cause of limp and acute pain of the hip in children under 10 years of age. Usually, the synovitis and joint effusion are present unilaterally. The etiology of the condition is unknown, although in a few cases a recent history of an upper respiratory tract infection may be present. The child with toxic synovitis may complain of a limp and pain in the hip, the anteromedial aspect of the thigh, and the knee. The white cell count and erythrocyte sedimentation rate may be slightly elevated, as is the body temperature. Ultrasound is recommended as the primary imaging tool in the diagnosis and treatment of toxic synovitis. Septic arthritis, Perthes disease, and osteomyelitis are a few of the differential diagnoses that the practitioner should consider. Most cases can be managed with bed rest at home and administration of a nonsteroidal anti-inflammatory medication. Follow-up care should occur 2 weeks after diagnosis to ensure there is no recurrence of the joint effusion or progression to avascular necrosis. Radiographs of the hip should be repeated at 1 month and 3 months to complete the patient follow-up.

Desepiphysiodesis--elimination of partial premature epiphyseal closure. Experience of 17 cases.

Between 1975 and 1990, 17 growth plates have been operated on by epiphyseal bridge resection. The children were from 4 years and 10 months to 13 years and 10 months old. The etiology of partial closure was traumatic (10 times), caused by therapeutic mistakes (3 times), septic osteomyelitis (1 case), purpura fulminans (1 case), unknown (2 cases). There was always length discrepancy or deformity of bone. The regions that have been subjected to treatment were distal femur, proximal tibia, distal tibia, distal radius. Evaluation of the bone bridge was made by tomoscintigraphies and recently by MR imaging and computed tomoscintigraphy. The bone bridge size was from 2.5% to 60% of the growth plate surface; surgical technique consists of resection of bone bridge connecting epiphysis and metaphysis which is replaced by methyl metacrylate. In 16 cases simultaneous corrective osteotomy was performed. Results are poor, there were only two good results and 8 failures; seven results were medium. The failures can all be explained by mistakes in technique or indication, except one. Indications are post-traumatic narrow bridges in young children. It would be useful to know the vitality of the residual growth plate.

Intramedullary pinning of femoral diaphyseal fractures in neonatal calves: 12 cases (1980-1990)

Summary Medical records of 12 calves ≤1 month old, with fracture of the femoral diaphysis, were reviewed. Ten calves were within 1 week of birth at the time of diagnosis. Open reduction was accomplished by use of a lateral approach. Retrograde intramedullary pinning was accomplished in all calves, using 2 (n = 4 calves) or 3 (n = 8 calves) pins. Cerclage wire was used to supplement fixation in 7 calves. A closed continuous suction drain was placed along the lateral aspect of the femur in every calf. Postsurgical complications included seroma formation over the middle gluteal musculature (n = 5 calves), pin migration (n = 6 calves), and osteomyelitis (n = 1 calf). Pin migration was observed in 4 calves that had been treated with nonthreaded trochar point pins. Fractures in 10 of 12 calves (83%) were considered to have healed satisfactorily. One calf was euthanatized because of septic osteomyelitis of the femur. One calf was euthanatized because of persistent lameness and pin migration. Pins were removed in 8 of 12 calves (67%) between the 13th and 90th postoperative days. Results of this study indicate that application of intramedullary pins may be a useful solution for management of femoral diaphyseal fracture in young calves.

Limb Pain in Childhood

Limb pain during childhood is common, and its causes range from the benign, such as joint hypermobility, to the potentially fatal, such as infection or tumor. Clues to the diagnosis are usually evident in the history, which can then give direction to the physical examination and, if necessary, laboratory investigations. Children with limb pain may be either ill or well (Table 1). ILL CHILDREN WITH LIMB PAIN Severe Joint Pain The majority of ill children with severe limb pain experience an acute onset and may have associated symptoms, such as rash, fever, previous infection (especially skin infection, sore throat, or diarrhea), conjunctivitis, dysuria, or weakness (frequently interpreted by the family as tiredness). The severe nature of the pain usually renders the limb immobile or prevents even light weight-bearing. Erythema over the joint is an important sign because it is rare in chronic arthritic conditions (Table 2). The most important possible diagnoses include: infection, neoplasia, gastrointestinal disorders, rheumatic diseases, and cardiopulmonary disease. Infection: Septic arthritis (with or without osteomyelitis) is the most common cause of severe monarticular pain. The absence of fever does not exclude a bacterial process. This is particularly true of septic sacroilitis and osteomyelitis of the pelvic and vertebral bones. Sudden onset of severe joint pain with marked swelling (and frequently erythema) is characteristic and typically involves the knee, hip, and ankle.

Limb Pain in Childhood

Limb pain during childhood is common, and its causes range from the benign, such as joint hypermobility, to the potentially fatal, such as infection or tumor. Clues to the diagnosis are usually evident in the history, which can then give direction to the physical examination and, if necessary, laboratory investigations. Children with limb pain may be either ill or well (Table 1). ILL CHILDREN WITH LIMB PAIN Severe Joint Pain The majority of ill children with severe limb pain experience an acute onset and may have associated symptoms, such as rash, fever, previous infection (especially skin infection, sore throat, or diarrhea), conjunctivitis, dysuria, or weakness (frequently interpreted by the family as tiredness). The severe nature of the pain usually renders the limb immobile or prevents even light weight-bearing. Erythema over the joint is an important sign because it is rare in chronic arthritic conditions (Table 2). The most important possible diagnoses include: infection, neoplasia, gastrointestinal disorders, rheumatic diseases, and cardiopulmonary disease. Infection: Septic arthritis (with or without osteomyelitis) is the most common cause of severe monarticular pain. The absence of fever does not exclude a bacterial process. This is particularly true of septic sacroilitis and osteomyelitis of the pelvic and vertebral bones. Sudden onset of severe joint pain with marked swelling (and frequently erythema) is characteristic and typically involves the knee, hip, and ankle.

Septic arthritis and osteomyelitis in children

Septic arthritis and osteomyelitis in children

External Fixation of Femoral Fractures

We report our experience with external fixation in 15 femoral fractures in 14 patients. Follow-up times ranged from 4 to 56 months. Thirteen patients had multiple injuries. All but two fractures healed. In one patient with a supracondylar fracture, a knee arthrodesis had to be performed. One septic osteomyelitis of the femur led to amputation. The range of active knee joint motion was greater than or equal to 90 degree in 13 knees. Only six knees, however, regained a flexion of greater than or equal to 120 degrees. Pin tract infection occurred in one case and resolved uneventfully after revision and systemic antibiotics. External fixation should not be routinely used for fixation of femoral fractures, but may be considered in multiply injured and critically ill patients or in case of extensive soft tissue injury.

Surgical treatment of partial closure of the growth plate.

During the period from 1965 to 1980, 43 operations for partial closure of a growth plate were performed on 35 patients. Five of the operations were for recurrent partial closure. At operation, the bone bridge connecting epiphysis to metaphysis was removed and replaced with a free fat transplant as described by the author in 1967 and 1975. Of the operations, 18 were on the distal end of the femur and 13 on either end of the tibia. Closure was due to fracture in 28 growth plates and septic osteomyelitis in 8. Benefit from the procedure was questionable after 7 operations. All other operations resulted in restoration of growth and correction or prevention of deformity. The operation prevents deformation of the joint surface, an effect that cannot be achieved by osteotomy or leg lengthening. Deformity present before operation is often reduced by growth to a normal condition after the procedure. Age, location of the bone bridge, and its size influence the indication for the operation and its results. Free fat, as an interposition material, has some advantages compared to solid materials, which may require a second procedure for removal.

Clinical Usefulness of Susceptibility Testing of Anaerobes

We have studied the clinical usefulness of antibiotic susceptibility testing of fresh clinical isolates of anaerobes (primarily from blood cultures). Analysis of 65 patients showed that susceptibility reports were used in only 13 instances (20%), representing mainly orothopedic and CNS infections. Of the 47 patients whose susceptibilities were not used, 20 received therapy (appropriate in each case) based on the culture report, and 27 were treated empirically. Only six patients in the empirically treated group received inappropriate treatment, but four of those six died, and patients in this group as a whole had a worse outcome than did patients in the other groups. However, these empirically treated patients also had a somewhat worse prognosis. We suggest that susceptibility testing of anaerobes be reserved for bacteremic patients and for managing severe, chronic anaerobic infections, such as septic arthritis, osteomyelitis, and brain abscesses.

The Early Diagnosis of Acute Septic Osteomyelitis, Periostitis and Arthritis and its Importance in the Treatment

The Early Diagnosis of Acute Septic Osteomyelitis, Periostitis and Arthritis and its Importance in the Treatment

The Early Diagnosis of Acute Septic Osteomyelitis, Periostitis and Arthritis and Its Importance in the Treatment

The Early Diagnosis of Acute Septic Osteomyelitis, Periostitis and Arthritis and Its Importance in the Treatment

A Further Case of Brodie's Abscess Simulating Tuberculosis or Chronic Septic Osteomyelitis

A Further Case of Brodie's Abscess Simulating Tuberculosis or Chronic Septic Osteomyelitis

On Septic Osteomyelitis in Infants

On Septic Osteomyelitis in Infants

Three Cases of Septic Osteomyelitis of the Spine

Three Cases of Septic Osteomyelitis of the Spine

Nerve injuries from electric shock

Most serious wound infections involve at least one, and usually a combination, of these factors: (1) extensive contamination or bacterial burden that overwhelms the patient's resources, (2) refugia which protect the bacteria from host defenses and antibiotic drugs, (3) immunocompromise, (4) poor perfusion, and (5) antibiotic resistance of the wound pathogen(s). In horses, wounds that involve bone, range in severity, complexity, and long-term impact from those containing a sequestrum, to septic osteomyelitis at the site of internal fixation. The principles of successful treatment are as follows: (1) debride the devitalized or irreparably damaged bone and soft tissue, (2) preserve and protect the vascular supply to bone and soft tissue, (3) maintain or restore structural integrity at the site, (4) control infection through appropriate local/regional and systemic antibiotic therapy and (5) protect the wound from further contamination, desiccation, maceration, and trauma.

Treatment of septic osteomyelitis of the cranial and facial hands. V. Blair in J. B. Brown (Ref. Journ. de chir., 1927, No. 4)

The authors are ardent supporters of the old conservative method of treatment of this disease. In their opinion, in this latter case it is necessary first of all to establish a good drainage of the focus as early as possible with a minimum of surgical trauma, then to wait until the virulence of the infection decreases and the dead bone separates spontaneously from the living one, and finally, at this favorable moment to remove all fragments of dead bone, affecting as little granulation as possible.

Removal of the Frontal Bone for Septic Osteomyelitis

Removal of the Frontal Bone for Septic Osteomyelitis