To assess healing pattern of Achilles tendons across the gap created by a percutaneous tenotomy and maintained by cast in club feet.

Twenty-one tenotomies in 16 patients (Age range 12 weeks-36 months) were monitored with dynamic and static ultrasonographic studies. Ultrasounds were performed before and immediately after tenotomy and at approximately 3, 6 and 12 weeks post tenotomy. Cast removal was done at three weeks. Two patients above age of two were casted for 6 weeks.

The healing pattern went through different phases although they were not distinctively exclusive from each other and did show considerable overlap. First phase showed formation of a bulbous mass with some continuity of scar tissue across tendon gap. The transition zone between new fibre and the original tend quite distinct. However dynamic ultrasound showed the Achilles tendon moved as a single unit. Second phase showed fibres resembling normal tendon crossing the gap and reduction of bulbous mass. The transition zone was still discernible. Final stage demonstrated more homogenous fibres of Achilles tendon with an indistinct transition zone.

Two older children showed a distinctly longer process of healing.

One child showed an irregular mass of fluid and soft tissue structures in the gap at six weeks.

The other child demonstrated a relative reduction in the proportion of tendon fibres across the gap.

At 12 weeks there was evidence of continuation of tendon fibres, but transition zone partly visible.

Aim: Assess healing pattern of Achilles tendons across gap created by percutaneous tenotomy and maintained by cast in club feet.

Methods and Results: 21 tenotomies in 16 patients (Age range 12 weeks–36 months) were monitored with dynamic and static ultrasonographic studies. Ultrasounds performed before, immediately after and at approximately 3, 6, 12 weeks post tenotomy. Cast removal was done at 3 weeks. Two patients above age of two were casted for 6 weeks.

The healing pattern went through different phases although they were not distinctively exclusive from each other and did show considerable overlap. First phase showed formation of bulbous mass with some continuity of scar tissue across tendon gap. The transition zone between new fibre and the original tend quite distinct. However dynamic ultrasound showed the Achilles tendon moved as a single unit. Second phase showed fibres resembling normal tendon crossing the gap and reduction of bulbous mass. The transition zone was still discernible. Final stage demonstrated more homogenous fibres of Achilles tendon with an indistinct transition zone. Two older children showed a distinctly longer process of healing.

At 3 weeks there was no evidence of healing.

Conclusion: Young Child (< 1 Year): When cast immobilisation is discontinued, the tendon is in mid phase of healing. There may be a positive effect on continued improvement in dorsiflexion while using boots and bars.

Older Child-Safe to consider percutaneous tenotomy in children up to 3 years of ages provided the period of immobilisation is extended.

Aim: To audit the impact of emergency hip ultrasound in the management of suspected hip septic arthritis.

Methods and Results: Case series – Review of 13 consecutive patients who presented with acute hip pain, where clinical examination and inflammatory markers, highly suspicious of Septic arthritis.

Emergency ultrasound was only available in 9 patients.

Septic arthritis group.

– Emergency ultrasound unavailable in 2 patents. They proceeded straight to arthrotomy yielding pus.

“Non Septic Arthritis of Hip” (8 patients).

– In 2 patients emergency ultrasound unavailable. They underwent emergency arthrotomy with negative findings of pus.

If ultrasound was available in all cases, then 8 (63%) patients would have avoided an unnecessary arthrotomy.

Out of hours urgent hip ultrasound may be difficult to request. However our recent experience leads us to propose that if available ultrasound should be performed in all suspected case of hip septic arthritis prior to surgical drainage.

Pathology in the vicinity of the hip can often masquerade convincingly as a septic hip joint.

Aim: To assess the healing pattern of Achilles tendons across the gap created by a percutaneous tenotomy and maintained by cast in club feet.

Methods and Results: 21 tenotomies in 16 patients (Age range 12 weeks-36 months) were monitored with dynamic and static ultrasonographic studies Ultrasounds were performed before and immediately after tenotomy and at approximately 3, 6 and 12 weeks post tenotomy. Cast removal was done at three weeks. Two patients above age of two were casted for 6 weeks.

The healing pattern went through different phases although they were not distinctively exclusive from each other and did show considerable overlap. First phase showed formation of a bulbous mass with some continuity of scar tissue across tendon gap. The transition zone between new fibre and the original tend quite distinct. However dynamic ultrasound showed the Achilles tendon moved as a single unit. Second phase showed fibres resembling normal tendon crossing the gap and reduction of bulbous mass The transition zone was still discernible. Final stage demonstrated more homogenous fibres of Achilles tendon with an indistinct transition zone.

Two older children showed a distinctly longer process of healing. One child showed an irregular mass of fluid and soft tissue structures in the gap at six weeks The other child demonstrated a relative reduction in the proportion of tendon fibres across the gap At 12 weeks there was evidence of continuation of tendon fibres, but transition zone partly visible.

Conclusion: Ours study demonstrates when cast immobilisation is discontinued, the tendon is in mid phase of healing. This may have positive effect on continued improvement in dorsiflexion while using boots and bars. It is safe to consider percutaneous tenotomy in children up to 3 years of ages provided the period of immobilisation extended

Aim: Septic Arthrits & osteomylelitis has traditionally been managed by intravenous antibiotics for 4 to 6 weeks. This requires a prolonged in patient stay, inconvience to parents, morbidity and unnecessary cost. A number of authors have suggested that shortened course of intravenous antibiotics 7–10 days are effective.

Methods: In 2001 we started to prospectively evaluate a shortened 3 day of intravenous antibiotic regime. We prospectively treated 36 cases of acute osteomyelitis and 30 cases of acute septic arthritis in children. These were confirmed by positive blood culture, positive aspirate culture, raised WCC in joint aspirate for septic arthritis or positive bone scan/culture for osteomyelitis. These patients were treated with a shortened course (3 days) of intravenous antibiotics following surgical drainage when required. Serial measurements of inflammatory markers and clinical status were recorded. On Day 4 of admission if clinical and biochemical parameters improved patients commenced high dose oral antibiotics. If no improvement they continued IV abx and consideration for repeat washout given. Patients discharged with three week course of antibiotics. Endpoint analysis of duration of IV administration, inpatient stay, readmission/reoccurrence was undertaken.

Results: 43 of the 66 (66%) patients received were discharged by Day 5 after receiving 3 full days of intravenous antibiotics. Mean in-pt stay was 5.5 days. There was one readmission for intolerance of high dose antibiotics. 6 septic patients required a repeat washout (Day 4–7 of admission). At 3 months there were no patients with ongoing infection.

Conclusion: We suggest the vast majority of acute suppurative skeletal infection can be managed safely with shortened course of intravenous and oral antibiotics following surgical drainage (in the case of intra articular infection). About 25% of patients will need longer courses of antibiotics and possibly repeat washout. This subgroup can be identified by careful clinical evaluation and measurement of inflammatory markers.

Septic Arthrits & osteomylelitis has traditionally been managed by intravenous antibiotics for 4 to 6 weeks. This requires a prolonged in patient stay, inconvenience to parents, morbidity and unnecessary cost. A number of authors have suggested that shortened course of intravenous antibiotics 7–10 days are effective.

In 2001 we started to prospectively evaluate a shortened 3 day of intravenous antibiotic regime. We prospectively treated 36 cases of acute osteomyelitis and 30 cases of acute septic arthritis in children. These were confirmed by positive blood culture, positive aspirate culture, raised WCC in joint aspirate for septic arthritis or positive bone scan/culture for osteomyelitis. These patients were treated with a shortened course (3 days) of intravenous antibiotics following surgical drainage when required. Serial measurements of inflammatory markers and clinical status were recorded. On Day 4 of admission if clinical and biochemical parameters improved patients commenced high dose oral antibiotics. If no improvement they continued IV abx and consideration for repeat washout given. Patients discharged with three week course of antibiotics. Endpoint analysis of duration of IV administration, inpatient stay, readmission/ reoccurrence was undertaken.

Results: 43 of the 66 (66%) patients received were discharged by Day 5 after receiving 3 full days of intravenous antibiotics. Mean in-pt stay was 5.5 days. There was one re-admission for intolerance of high dose antibiotics. 6 septic patients required a repeat washout (Day 4–7 of admission). At 3 months there were no patients with ongoing infection.

Conclusion: We suggest the vast majority of acute suppurative skeletal infection can be managed safely with shortened course of intravenous and oral antibiotics following surgical drainage (in the case of intra articular infection). About 25% of patients will need longer courses of antibiotics and possibly repeat washout. This subgroup can be identified by careful clinical evaluation and measure

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.