Acute osteomyelitis of the radius or ulna in children is rare and may be associated with complications including pathological fracture, growth disturbance and cosmetic problems. Purpose:. To highlight the outcome of acute pyogenic osteomyelitis of the forearm bones in children. Methods:. Eleven children were treated for osteomyelitis of the radius (6) and ulna (5) over 15 years. Staphylococcus aureus was cultured following initial incision and drainage. Two had signs of compartment syndrome. Late complications included gap defects of 2–6 cm (radius 1 and ulna 2). Larger defects with physeal involvement were seen in the distal ulna (4) proximal radius (1) and whole radius (1). The late clinical features included pseudarthrosis (9), distal radioulnar instability (3), radial head dislocation (3) and “radial clubhand” type deformity (1). Treatment:. Gap defects <2 cm were filled with autogenous grafts (3). Segmented iliac crest grafts threaded over a K wire were used in 1 patient with an 8 cm gap defect. Radio-ulnar synostosis was performed in 4 cases. The carpus was centralized onto the ulna in 1 child. Results:. Reconstructive grafts healed by 6–12 weeks. Residual elbow contracture <30° occurred in 3 children. Ten children had improved grip strength and stability of the wrist and elbow and forearm length was decreased by 2–5 cm. The child with a radial clubhand deformity had severe shortening and stiffness of the hand. Conclusion:. Osteomyelitis of the forearm bones can be missed and present late. Complications include disproportionate growth, proximal or distal radio-ulnar instability and radial clubhand type deformity. Treatment is challenging requiring reconstruction of gap defects. Radio-ulnar synostosis is a useful salvage procedure to improve function and cosmesis

Purpose. Pain and stiffness from elbow arthritides can be reliably improved with arthroscopic osteocapsular ulnohumeral arthroplasty (OUA) in selected patients. Post-operative continuous passive motion (CPM) may be helpful in reducing hemarthrosis, improving soft-tissue compliance and maintaining the range of motion (ROM) established intra-operatively. There is only one published series of arthroscopic OUA and CPM was used in a minority of those patients. We hypothesized that a standardized surgical and post-operative CPM protocol would lead to rapid recovery and sustained improvement in ROM. Method. Thirty patients with painful elbow contractures underwent limited open ulnar nerve decompression and arthroscopic OUA at our institution by a single fellowship trained upper limb reconstruction surgeon. All patients underwent CPM for three days in-hospital with a continuous peripheral nerve block, followed by gradual weaning of CPM at home over two weeks. ROM using a goniometer was assessed at discharge, cessation of CPM (2 weeks) and final follow-up. The main outcome was elbow flexion, extension and total arc of motion. Paired students t-test was used to compare pre and post-operative ROM. Results. The median age was 45 (14–68) years, 77% were male, 73% had the dominant side affected and the most common pre-operative diagnosis was arthritis (50% post-traumatic, 30% primary osteoarthritis). Mean last follow-up was 7 months (range 2 weeks to 2 years). The mean pre-operative range of motion was 119 flexion, −32 extension and a total arc of 8719. At cessation of CPM, the mean flexion was 135, extension −7 and total arc 12711. At last follow-up flexion was maintained at a mean of 134 (p=0.6) but some extension was lost (mean −15, p<0.05) and total arc of motion decreased to 11820 (p<0.05). However, only two patients failed to maintain a functional arc of >100 and the amount of pre-operative contracture was correlated (r=0.73) with final arc of motion. Complications included only two transient ulnar neuropraxias. Only three patients required post-CPM bracing or physiotherapy. Conclusion. We present excellent improvement in short-term ROM following arthroscopic OUA using a standardized post-operative CPM protocol. These results are equal or better than open and non-CPM results published in the literature and alleviate the need for lengthy post-operative physiotherapy and splinting protocols in the majority of patients. A comparative study of CPM and non-CPM post-operative regimens after arthroscopic OUA is warranted to determine the true influence of CPM

Lengthening of the humerus is now an established technique. We compared the complications of humeral lengthening with those of femoral lengthening and investigated whether or not the callus formation in the humerus proceeds at a higher rate than that in the femur. A total of 24 humeral and 24 femoral lengthenings were performed on 12 patients with achondroplasia. We measured the pixel value ratio (PVR) of the lengthened area on radiographs and each radiograph was analysed for the shape, type and density of the callus. The quality of life (QOL) of the patients after humeral lengthening was compared with that prior to surgery. The complication rate per segment of humerus and femur was 0.87% and 1.37%, respectively. In the humerus the PVR was significantly higher than that of the femur. Lower limbs were associated with an increased incidence of concave, lateral and central callus shapes. Humeral lengthening had a lower complication rate than lower-limb lengthening, and QOL increased significantly after humeral lengthening. Callus formation in the humerus during the distraction period proceeded at a significantly higher rate than that in the femur.

These findings indicate that humeral lengthening has an important role in the management of patients with achondroplasia.