Aim. To determine if the instigation of Magnetic Resonance Extremity (MRE) scanning in our unit as part of the management of suspected paediatric scaphoid fractures has prevented overuse of splints or casts reduced unnecessary clinic appointments and saved our department financially. Methods. Children with traumatic anatomical snuffbox tenderness and negative radiographs are seen 10 days following injury having been given a Futura® splint. If repeat radiographs are negative with on-going positive clinical findings the child has an MRE scan, which is usually reported the same day. If negative, the splint is removed on that day, but if positive, a cast is applied and the child referred onto paediatric fracture clinic. Results. Over a one-year period, 65 acute injuries were referred for MRE scanning. Fourteen bony injuries (22%) were identified including 10 scaphoid, 1 capitate and 3 distal radius fractures. The delay until MRE scanning averaged 11 days from emergency department and 14 days from outpatient clinic. Of these positive cases, the average time to clinic was 15 days equating to an average of 5 weeks from injury to orthopaedic review. The saving of orthopaedic clinics offsets the cost of the MRE scan by £5000 per annum. Fractures were identified in 22% of patients referred for MRE scanning with normal radiographs. Conclusion. The practice of streamlined MRE scanning for suspected paediatric scaphoid fractures can tailor management more efficiently. It has reduced the length of immobilisation in those normal cases and eradicated the need for continuing orthopaedic clinic review without increasing costs

Purpose of study

To determine whether hemiplegia causes abnormal torsion of the radius of the affected compared with the unaffected limb as demonstrated by MRI measurements, and to assess whether this correlates with the passive range of movement as measured clinically.

Background

The association between idiopathic scoliosis and intrinsic abnormalities of the spinal cord are well known. MRI is the most sensitive imaging modality available to diagnose an intraspinal anomaly. The use of a routine ‘screening MRI’ prior to scoliosis correction is controversial.

Aim. Differentiation between bone infarction and bone infection in sickle cell disease has traditionally been difficult, even with modern imaging techniques, and widespread antibiotic use is common. Early differentiation between the two conditions would enable more appropriate targeting of radiological investigations, antibiotics and surgery, and avoid un-necessary antibiotic usage. Method. At our tertiary paediatric sickle cell centre, we have developed a sequencing protocol to be able to accurately differentiate between infection and infarction in sickle cell children using Magnetic Resonance (MR) Imaging. We have undertaken a preliminary retrospective study to analyse clinical and laboratory parameters in these children to see whether earlier differentiation prior to MR imaging is possible. Results. We identified 52 episodes in 27 patients of bony pain in sickle cell children between 2006 and 2012. In 30 episodes in 27 patients, the MR sequences used allowed accurate determination of pathology, diagnosing infarction in 19 episodes in 17 patients, and infection in 8 episodes in 7 patients. The remainder showed no evidence of acute infarction or infection despite pain. As a general trend, admission white cell counts were higher in the infection group, with a temperature on admission also being more likely. There was no significant difference in CRP or platelet count between the infarction and infection groups. Conclusion. From a small retrospective study it may be possible to identify factors making infection as a cause of bone pain in sickle cell disease more likely, enabling better targeting of urgent MR imaging and surgery and preventing un-necessary antibiotic usage. A larger, prospective study is required and is currently underway

Aims

The aim of this study was to compare the surgical and quality-of-life outcomes of children with skeletal dysplasia to those in children with idiopathic early-onset scoliosis (EOS) undergoing growth-friendly management.

We treated eight dysplastic acetabula in six skeletally mature patients with Down’s syndrome by a modified Bernese periacetabular osteotomy. The mean age at the time of surgery was 16.5 years (12.8 to 28.5). Mean length of follow-up was five years (2 to 10.4).

Pre-operatively the mean (Tönnis) acetabular angle was 28°, the centre-edge angle was −9°, and the extrusion index was 60%; post-operatively they were 3°, 37°, and 17%, respectively. Two patients with post-operative (Tönnis) acetabular angles > 10° developed subluxation post-operatively and required secondary varus derotation femoral osteotomies. Another patient developed a late labral tear which was treated arthroscopically. All eight hips remain clinically stable, and are either asymptomatic or symptomatically improved.

These results suggest that the modified Bernese periacetabular osteotomy can be used successfully in the treatment of acetabular dysplasia in patients with Down’s syndrome.