Acute hand infections in children are usually trauma-related or of spontaneous origin. This paper describes the spectrum of hand infections, highlights the underlying causes and identifies the common organisms. Over two years 64 children, aged 6 months to 12 years, were seen. The duration of infection before presentation ranged from 2 to 38 days. The infection was palmar in 59 children and dorsal in five. It had developed spontaneously in 27 children, eight of whom had scabies. In 21 it was due to accidental injury (blunt trauma and penetration of needles, thorns and glass) and in 16 to inflicted injury (child abuse, animal bites, drip infiltrations and stabs). Associated medical infections were seen in four children. Seven were HIV positive. All children underwent debridement and assessment in theatre. Surgery was repeated in nine (two to five times). Organisms cultured were Staphylococcus aureus (24), Pseudomonas (two) and Streptococcus pyogenes (one). Most healed well but 10 had contractures of the hand. Thirty-eight per cent of cases of pyogenic infection admitted to our ward are acute. The majority present late, resulting in long hospitalisation. Cloxacillin is the first line of treatment. In children who are suspected to be HIV positive, the use of wide spectrum antibiotics is advisable.
Fractures of the femoral neck in the elderly are associated with significant morbidity and mortality. In the UK, patients with these fractures occupy 20% of orthopaedic beds. Between September 1999 and August 2000 a prospective study was conducted to evaluate the outcome in 36 patients, 24 of them women, with femoral neck fractures treated by uncemented Thompson’s hemi-arthroplasty. The mean age of patients was 71.6 years. All patients had sustained a Garden type-III or IV fracture, and 89% were due to low velocity trauma. Associated conditions were hypertension (66%), diabetes mellitus (27%), dementia (22%), ischaemic heart diseases (16%), cerebrovascular accident (16%), asthma (16%), alcoholism, epilepsy and malignancies (5% each). Before the injury, 55% of patients walked normally, while 19% had a limp and 28% were using a walking aid. At the time of injury 67% were living with family, 22% independently and 11% in a nursing home. Surgery was performed under spinal anaesthetic at a mean of 12.5 days (3 to 30) after injury. None of the patients received prophylactic treatment for deep vein thrombosis. Postoperative mobilisation was commenced at 48 hours, and patients were discharged a mean of 5.5 days (2 to 28) postoperatively to nursing homes (27.5%), family (27.5%) or independent living (16.5%). In the first month after surgery 27.5% of patients died. At six months 14% of patients had normal mobility, while 25% had a limp, 30% used a walking aid and 3% were wheelchair-bound. The overall results in this study are comparable with those in the literature. The delay in surgery did not affect morbidity or mortality.
