The Ponseti method for the treatment of idiopathic club foot is the gold standard of treatment in South Africa. A study in New York reviewed attainment of gross motor milestones (GMM) in these children and found that independent ambulation was delayed on average by 2 months compared to unaffected children. A retrospective review of gross motor milestones was performed in patients treated at a South African clubfoot clinic. All patients were walking independently at review. Ages at attainment of motor milestones were recorded (sitting, crawling and walking independently). The World Health Organisation (WHO) published the normal range for achievement of these milestones in six regions across the world. We compared the results of our patients to the 50th percentile in that study.Introduction
Methods
Penetrating injuries of the hand and forearm may cause significant morbidity for a patient. Our aim was to evaluate the accuracy of initial examination of forearm lacerations and pre-operative examination and compare both to the actual findings on surgical exploration. We wanted to identify any factors which may influence the accuracy of the initial examination. Existing literature indicates that there are differences between initial and subsequent examination in terms of picking up injuries. 65 consecutive patients with penetrating injuries to the hand/forearm were studied. The admitting casualty doctor/s completed an admission form indicating their findings on examination. Factors which may have hampered history taking and examination were noted on the form. The same form was filled in prior to surgery by one of the hand registrars after re-examining the patient prior to surgery. A separate surgical form was filled in by the surgeon indicating the actual findings at surgery.Purpose
Methods
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
