Background

Partial humeral head resurfacing using a stemless implant is a bone-conserving option in treatment of focal chondral defects. We report our experience using the Arthrosurface HemiCAP® device.

Introduction: The limping child poses a diagnostic challenge. The purpose of this study was to create a clinically useful algorithm of presenting variables to allow the exclusion of ‘musculoskeletal sepsis’ as a differential diagnosis in the child presenting with a limp.

Materials & Methods: This study represents the data collected on all limping children admitted to our centre over a 3-year period. Analysis was based on 229 admissions. Comparison was made between the group with septic arthritis or osteomyelitis and the group without infection, using univariate analysis. With logistic regression analysis, a model consisting of three independent multivariate predictors was constructed, to exclude infection.

Results: Patients with septic arthritis or osteomyelitis differed significantly from patients without infection with regard to duration of symptoms, presence of constitutional symptoms, temperature, white cell count and erythrocyte sedimentation rate (ESR), (p-values < 0.05). Multivariate analysis demonstrated that the best model to describe our patient population was based on three variables: duration of symptoms between 1 and 5 days, temperature > 37.0°C and ESR > 35mm/hr. When all three variables were present, the predicted probability of musculoskeletal infection was 0.66. When none of the three were present, the predicted probability of infection was 0.01.

Discussion: Diagnosis of septic arthritis or osteomyelitis is especially difficult in the early phase and there is no single variable that can serve as a definitive test. The significance of constitutional symptoms and duration of symptoms on univariate analysis emphasises the importance of careful history taking. C-reactive protein, while considered for inclusion, was excluded due to its limited availability at our institution.

Conclusion: The multivariate model enables us to rule out musculoskeletal infection with 99% certainty in limping children with none of these three presenting variables.

Ulnar drift is a common deformity in the hands of patients with rheumatoid arthritis. There is little in the literature regarding the value of crossed intrinsic transfer with MCPJ arthroplasty (Hellum 1968, Stothard et al 1991). In addition the significance of recurrent ulnar drift on hand function is unknown. The aim of this study is to assess if the addition of crossed intrinsic transfer to metacarpophalangeal arthroplasty has an effect on the recurrence of ulnar drift and to overall hand function.

This is a retrospective comparative study. 73 hands in patients with rheumatoid arthritis undergoing primary 2nd to 5th metacarpophalangeal joint (MCPJ) replacements were studied. In 28 hands a crossed intrinsic transfer was performed and in 45 hands it was not . A similar splintage and rehabilitation programme was followed in each group. Mean follow up was 50 months.

Ulnar drift and active range range of motion, Sequential Occupational Dexterity Assessment (SODA) functional score, patient satisfaction , grip strength.

The two groups had similar preoperative ulnar drift (crossed intrinsic transfer group mean 27 degrees, comparative group 29 degrees, p=0.44). At follow up the crossed intrinsic transfer group had statistically less ulnar drift (crossed intrinsic transfer group mean 6 degrees, comparative group 14 degrees, p=0.01). There was no difference at follow up in active flexion, extensor lag, SODA score, grip strength and patient satisfaction (both groups had 70% improved function).