Osteomyelitis can be difficult to diagnose. Unlike septic arthritis no defined diagnostic criteria exist as a guide. Inflammatory markers are frequently utilized at initial presentation, (in addition to white cell count). All radiologically confirmed cases of long bone osteomyelitis without septic arthritis, joint effusion or abscess, in paediatric patients, presenting to one hospital over an eighteen-month period were included. These patients were compared with all culture positive septic arthrides presenting to the same hospital within the same time period. Inflammatory markers taken on the day of admission were studied.Background
Methods
To assess the initial rise in inflammatory markers in paediatric patients presenting with long bone osteomyelitis and whether this is comparable with that in septic arthritis, and diagnostic. All radiologically confirmed cases of long bone osteomyelitis without septic arthritis, joint effusion or abscess, in paediatric patients, presenting to one hospital over an eighteen-month period were included. These patients were compared with all culture positive septic arthritides presenting to the same hospital within the same period. Inflammatory markers taken on the day of admission were studied.Purpose
Methods
Patients overestimate pain following hip and knee replacement. Ninety two patients awaiting hip or knee replacement were asked at their pre-operative assessment to estimate the level of pain they expected following their surgery on a 10cm visual analogue scale. Note was made of their age, gender, previous surgeries, Amsterdam anxiety score as regards the anaesthetic and surgery and an information score relating to their anaesthetic and surgery. Seventy nine patients had pain scores collected on a daily basis post surgery. Mean (std dev) age of the group was 68 (11) years and with a female to male ratio of 1.57. Females were significantly more anxious about the surgery than males (t-test, p<
0.007). Patients were more anxious about the anaesthetic and the surgery with hip replacement compared to knee replacement although this did not reach significance (t-test p=0.07). The mean (std dev) pain score pre-operatively was 7.5 (1.6). The mean (std dev) pain score expected was 7.0 (2.2) on the first post operative day and 4.3 (2.2) on the sixth post operative day. Forty four per cent of patients expected to have pain greater than their arthritis pain on the day following surgery. The level of pain experienced post-operatively was significantly lower than expected. Mean (std dev) pain score was 5.1 (2.7) on day 1 post op and 3.3 (2.4) on day 6 (t-test, p<
0.05 for both). There was no correlation between age, gender, number of previous surgeries, anxiety or information scores and the expected level of pain. The majority of patients, whatever their age, gender or level of anxiety over estimate their level of post-operative pain after joint replacement. Studies are needed to assess whether educating patients about pain post surgery will be of benefit, particularly in their early rehabilitation.
We present our results with a modified Mann-Thompson procedure in 47 patients (86 feet). Minimum follow up was 24 months. All patients had moderate to advanced forefoot deformities.
M:F=12:35 43/47 bilateral Simultaneous procedures in bilateral cases. Popliteal block analgesia used routinely.
Medial incision centered on MTP1 joint. Minimal bony and soft tissue resection. Fixation carried out with staples (78 feet),K-wires (8 feet) Transverse incision centered on the lesser MTP joints made. Combination of soft tissue release, lesser MT head resection in cascade fashion from dorsal distal to proximal plantar performed. Lesser toe deformities treated by a combination of closed osteoclasis, soft tissue release and bony resection. Transarticular K-wire fixation then performed for all lesser toes. Bulky postop dressing and post op shoes used. Immediate FWB permitted. Transarticular K-wires removed at 4/52.
AOFAS Forefoot Scores assessed at preop,6/12,12/ 12,and24/12. Subjective patient assessment of procedure requested. Average AOFAS scores improved from 37to72(67 – 84) 40 patients extremely pleased with the results. 5 patients pleased with reservations and 2 patients disappointed with the outcome.
3 superficial wound infections 2 metal work related problems 2 early loss of lesser toe correction 3 late deformities of lesser metatarsals requiring surgery
