Aim: To compare outcomes in patients who suffered a severe slipped upper femoral epiphysis (SUFE) treated by either a modified Dunn or Imhauser Osteotomy.

Method: A consecutive group of patients were identified retrospectively from the operative records of a single surgeon at two hospitals since 2003. Patient Notes were used to extract age at presentation, duration of symptoms, stability, and time to surgery. Radiographs were examined to determine: the slip angle; and the degree of correction achieved. Patients were assessed using the Harris and Oxford Hip Scores.

Results: Seven patients had a modified Dunn osteotomy and 11 patients an Imhauser osteotomy. Of those only 6 of the Dunn patients and 7 of the Imhauser patients could be recalled for clinical assessment. The average time to clinical assessment from osteotomy was 13.5 months for the Dunn group and 32 months for the Imhauser group. Post-operative lateral radiographs showed a mean angle of deformity correction of 63 degrees in the Dunn and 36 degrees in the Imhauser groups. There were no postoperative complications in either group, specifically no avascular necrosis.

In the Dunn group the Harris Hip Score ranged from 78 to 100, mean 92 (excellent) and the Oxford Hip scores from 12 to 21, mean 17. The Harris Hip Score for the Imhauser group ranged from 50 to 98, mean 76 (fair), and the Oxford scores from 13 to 34, mean 25. Range of motion was similar for both groups in all directions.

Conclusions: The Dunn and Imhauser osteotomies both give good clinical results in the severe SUFE patient. However the Dunn Osteotomy group had better Harris and Oxford Hip Scores, reflecting improved functional outcome.

Purpose of study: Septic arthritis and osteomyelitis have traditionally been managed by intravenous antibiotics for 3 to 6 weeks. This requires a prolonged in patient stay, inconvenience to parents, morbidity and cost. A number of authors have suggested that a shortened course of intravenous antibiotics for 7–10 days may be as effective.

This studies reviews the outcomes of a short course regime started in 2001.

Methods: We prospectively reviewed 34 cases of acute osteomyelitis and 28 cases of acute septic arthritis in children. These were confirmed by a positive blood culture or a positive aspirate culture or raised WCC in joint aspirate for septic arthritis; or a positive bone scan/culture for osteomyelitis.

Patients were treated with a 3 day course of intravenous antibiotics, following surgical drainage of joints when required. Providing the clinical and biochemical parameters were improving patients then received 3 weeks oral antibiotics.

The duration of IV administration and of inpatient stay and any incidence of readmission/reoccurrence was noted. Serial measurements of inflammatory markers were recorded.

Results: 35 of the 62 patients received intravenous antibiotics for < 4 days. Mean in-patient stay was 5.5 days. There was one re-admission for recurrence of infection. One patient required a repeat joint washout at 7 days. At 3 months no patients had ongoing infection. There was a correlation between CRP levels and the severity of infection, and therefore the length of treatment required.

Conclusions: We suggest acute suppurative skeletal infection can be managed safely with a shortened course of intravenous and oral antibiotics (following surgical drainage in the case of intra articular infection). Patients must be observed closely by experienced practitioners.

The best method of femoral head containment in Legg-Calvé-Perthes’ disease (LCPD) is still controversial. Triple pelvic osteotomy allows desired rotation of acetabulum, reduces the relative stress, provides optimum femoral head cover and compensates for shortening. The iliac osteotomy was modified to interlock following acetabular rotation to provide extra stability and allow early mobilisation.

Material and methods: We reviewed 21 patients, who underwent interlocking triple pelvic osteotomy for severe Legg-Calvé-Perthes’ disease, to evaluate their clinical, radiological and functional results.

The mean patient age at presentation was 7 years and 7 months. Fourteen hips were in the fragmentation stage whereas 8 were in the early re-ossification stage. Seventeen hips were Herring group C and 5 were group B. Seventeen hips had 2 or more at risk radiological signs. The average period of follow-up was 51 months (range, 33 months to 80 months). The average gain in acetabular head index was 18% and that in centre-edge angle was 22 degrees, more than reported for any other single surgical procedure. According to the Harris hip rating system, there was an average gain of 35 points. Average gains in abduction, internal rotation and flexion were 17, 12 and 28 degrees respectively. The average gain in length of the limb was 6.4 mm.

Interlocking triple pelvic osteotomy in LCPD provides good cover of the femoral head, good symptom relief and markedly improved range of motion. Assessment of a few patients approaching maturity has shown a congruent hip joint with a spherical femoral head.