Osteomyelitis continues to be a common problem amongst the paediatric population. Osteomyelitis of the calcaneus is an uncommon problem that still poses a problem to the treating physician. The purpose of this paper is to retrospectively review a large series of paediatric patients with calcaneal osteomyelitis. We compare our experience with that in the literature to determine any factors that may aid earlier diagnosis and or improve treatment outcomes.

A 10-year retrospective review was performed of clinical records of all cases of Paediatric calcaneal osteomyelitis managed at the two children’s orthopaedic departments in the Auckland region. The Osteomyelitis Database was used to identify all cases between 1997 and 2007, at Starship Children’s Hospital, and 1998 and 2008 at Middlemore’s Kids First Hospital.

Sixty patients fulfilled the inclusion criteria. The average duration of symptoms was 6.8 days. 40% of patients had a recent episode of trauma. 82% of patients could not weight bear on admission. Only 22% of patients had a temperature above 38 C. 27% of patients had positive blood cultures with Staph aureus being the most commonly cultured organism. X Rays, bone scans and MRI were all used to aid the diagnosis. ESR was elevated in 81% and the CRP was elevated in 77% of patients. 20% of patients had surgery with an average of 1.3 surgeries for those who progressed to surgery. Treatment length was an average of 2 weeks 6 days of oral antibiotics and 3 weeks 2 days of oral treatment. There was no post surgical complications and 10 readmissions, 3 for relapse, 3 for PICC line problems and 4 for antibiotic associated complications.

Although a sometimes more difficult diagnosis to make, calcaneal osteomyelitis can be diagnosed with an appropriate history, clinical examination and investigations. Treatment with intravenous and oral antibiotics and surgical debridement if indicated can lead to a good clinical outcome with minimal complications

The aim of this study is to prepare for the introduction of the world’s first nationwide registry of all rotator cuff tears proceeding to operative management.

Patient’s are scored pre-operatively and again at six and 12 months post-op using the Flex SF functional scale, pain scales and work and activity levels. A questionnaire is filled out by the operating surgeon on the day of surgery detailing pathology and the operative methods used.

This study is a New Zealand Shoulder and Elbow Society initiative begun in 2007. New Zealand is ideally suited with a small, cohesive group of orthopaedic surgeons. Rotator cuff surgery is advancing rapidly with changes in surgical approach from open to arthroscopic, and repair methods from bone tunnels to various choices of anchors. A wide range of surgical methods are used within New Zealand, presenting an opportunity to use the large numbers generated by a registry to give valuable information guiding future treatment.

The operation day questionnaire includes information on tear size, surgical approach, repair methods, biceps and AC joint pathology and rehabilitation.

More than 100 patients have already been registered in the pilot study and a number have completed the six month questionnaire. These early results will be presented, along with important information for the large number of surgeons who will become involved when the nationwide registry commences.

Dislocation of the elbow with associated fractures of the radial head and the coronoid process of the ulna have been referred to as the “terrible triad of the elbow” because of the difficulties in treating this injury and the poor outcomes.

The orthopaedic database, Orthoscope, was used to identify all patients with dislocation of the ulnohumeral joint and fracture of both the head of the radius and the coronoid process of the ulna, seen and treated at Auckland City Hospital since 1998.

All patients were invited to follow up appointments to evaluate the outcomes achieved. The research protocol was approved by the local research committee. Follow up appointments consisted of clinic al examination, assessing the range of elbow motion, an elbow radiograph and a functional assessment, using the DASH score and the American Shoulder and Elbow Society scoring systems.

There were 32 patients identified, from Orthoscope, and invited for follow up. Six patients, who had moved overseas, were lost to follow up and two others declined follow up. 23 patients (24 elbows) remained for evaluation. All patients returned for the described assessment protocol. There were 10 male patients and 13 female patients, with a mean age of 46.9 (range, 29 to 67 years). The average arc of ulnohumeral motion was 122 degrees (range; 110 degrees to 140 degrees) and that of forearm rotation was 138 degrees (range, 35 degrees to 170 degrees).

The radial head component was fixed in a standard fashion with repair, or replacement, and no radial head excisions were undertaken. Coronoid fractures were treated with screw fixation or suturing, with drill holes or anchors. To augment stability, a lateral ligament repair was undertaken in most patients. All patients, except one, would undergo the procedure again if needed.

Elbow fracture-dislocations are historically very unstable and are prone to numerous complications. With operative treatment of the radial head, with repair or replacement, to restore stability through radiocapitellar contact, coronoid and lateral ligament repair, good range of movement and stability can be achieved.

Introduction Vertebroplasty (VP), where vertebral bodies are injected with polymethylmethacrylate (PMMA) cement, is used to treat various spinal lesions. More recently VP has been used for augmenting osteoporotic vertebral bodies that have fractured or are at risk of fracture. Although the complication rate for VP is low, thermal damage caused by the exothermic curing of PMMA has been implicated.

The aim of this series of experiments was to measure the temperatures reached during VP using a sheep model. The cement volume effect and inter cement differences were assessed. Spinal cord monitoring was undertaken to monitor spinal cord function during this procedure to validate this for clinical use.

Methods In the in vivo experiment each of the lumbar vertebral bodies of 10 sheep were injected with one of two cements (Simplex & Vertebroplastic) and one of two volumes (3.0ml or 6.0ml). This was undertaken through an open approach in the lumbar vertebrae. While performing the in vivo experimental studies 6 of the sheep were concurrently monitored using epidural Motor Evoked Potentials (MEP’s).

Results There was a significant increase in the temperature at the bone cement interface. The mean peak temperature at the bone-cement interface was 49.5 C (3.0ml Simplex); 61.47 C (6.0ml Simplex); 42.1 C (DePuy 3ml) and 47.2 (DePuy 6ml).

Spinal cord monitoring showed that when PMMA was injected into the correct location within the vertebral body there was no change in amplitude of the evoked potentials. When significant leakage of PMMA occurred, there was a decrease in amplitude of MEP’s.

Discussion In this sheep model, using cement volumes similar to those used in human clinical practice, we were able to monitor temperature changes within the vertebral body at the bone cement interface. The temperature of the bone cement interface reached temperatures that are known to cause tissue necrosis.

Using epidural monitoring we were able to show that when PMMA is injected into the correct location within the vertebral body there is no change in amplitude of MEP’s.

Percutaneous vertebroplasty (PVP), where vertebral bodies are injected with polymethylmethacrylate (PMMA) cement, is used to treat various spinal lesions. Although the complication rate for PVP is low, thermal damage caused by the exothermic curing of PMMA has been implicated.

This study was to measure the temperatures reached during PVP as PMMA cures as well as assessing the cement volume effect and inter cement differences. Validating spinal cord monitoring during PVP was also undertaken.

In the in vivo experiment each of the lumbar vertebral bodies of 10 sheep were injected with one of two cements and one of two volumes. Thermocouple monitoring was undertaken at the bone cement interface. While undertaking the in vivo experimental studies 6 sheep underwent epidural monitoring using Motor Evoked Potentials (MEPs).

The mean peak temperature at the bone-cement interface was 49.5 C (3.0ml Simplex); 61.47 C (6.0ml Simplex); 42.1 C (DePuy 3ml) and 47.2 (DePuy 6ml). Spinal cord monitoring showed that when cement was injected into the correct location within the trabeculae of the vertebral body no change in amplitude monitoring was noted. When leakage occurred, deliberate or unintended, amplitude changes were noted.

Using cement volumes similar to those used in human clinical practice in a sheep model we were able to monitor temperature changes. The temperature of the bone cement interface reached temperatures that are known to cause tissue necrosis. Using epidural monitoring we were able to detect leakage of cement during injection.