We present a single surgeon series of 20 modified Dunn osteotomies without surgical dislocation of the femoral head for slipped upper femoral epiphysis (SUFE). All patients from 2007 to 2011 who had a Dunn osteotomy for SUFE had their notes reviewed and we obtained an updated Non Arthritic Hip Score.Introduction
Method
Paediatric hip fracture accounts for less than one percent of paediatric fractures. Previous studies report complication rates between 20 and 92%. We retrospectively identified patients with fixation for neck of femur fractures at Birmingham Children's Hospital. All patients were under age sixteen. Data were reviewed over a 10 year period (1997-2006). Fractures were classified by Delbet's classification and Ratliff's system to grade avascular necrosis (AVN). Function was assessed using Ratcliff's criteria, incorporating clinical examination and radiographic findings.Introduction
Method
In 6 of 8 primarily explored brachial arteries the vessel was observed to be tethered to the fracture site. Following release, in 6 of 8 cases the radial pulse had returned within 24hrs. Satisfactory radiological reduction of the fracture does not preclude vessel entrapment. In 8 cases there was an associated median nerve palsy. All of these cases were found to have an anatomical obstruction to the brachial artery.
Two patients had re operation because of poor intra operative reduction which were performed by junior grade surgeon without supervision during out of hours. No fracture had displaced at follow up when compared with the intra operative X-ray when properly reduced and wired. One child had ulnar neuropraxia post operatively One child had superficial infection, which settled with oral antibiotics.
Two patients had re operation due to poor intra operative reduction which were performed by junior grade surgeon without supervision during out of hours. No fracture had displaced at follow up when compared with the intra operative X-ray when properly reduced and wired. One child had ulnar neuropraxia post operatively One child had superficial infection, which settled with oral antibiotics.
New guidelines proposed:
Patients with no N-V complications can wait till the morning trauma list. All intraoperative X-rays to be reviewed by consultants before discharging home. 3 weeks appointment for wire removal can be set at one week clinic follow up with out X-ray.
A retrospective study of 71 children in which we investigated the duration of both intravenous and oral antimicrobial therapy in relation to recurrent disease and side effects. A prospective study, now underway investigating the efficacy of a combined short IV (three days)/short oral (three weeks) combination of antibiotics in children with acute osteomyelitis and acute septic arthritis.
In the prospective study the duration of intravenous and oral antibiotics has been successfully reduced in the majority of patients, without any increase in the need for surgical procedures, re-admission or evidence of chronic osteomyelitis. However, in 26% of patients, the duration of the IV phase of antibiotic therapy was electively increased, because of clinical signs, suggestive of inadequate response. To date recurrent/chronic disease has only been seen in patients judged clinically to have an inadequate response to short-term therapy and who received a longer course of IV antibiotics.