Aim: To study the epidemiology, diagnostic criteria and outcome of Septic Arthritis (SA) of hip in infancy and childhood

Method: Retrospective case notes review of 43 cases of Primary SA of hip. Diagnostic criteria used: 1. Confirmed SA: positive joint fluid culture/positive blood culture and elevated WCC in joint fluid / radiological changes. 2. Presumed SA: Negative cultures but elevated WCC in joint fluid. The outcome was rated as A. Satisfactory: clinically and radiology normal hip. B. Unpredictable: clinically normal hip with radiological changes. C. Unsatisfactory: clinically abnormal hip.

Results: We had 37 cases of confirmed SA and 6 cases of presumed SA. Mean age of presentation was 4 years with male to female ratio of 3:2. All cases had either joint aspiration or arthrotomy. The 25% of cases with negative joint fluid cultures had a history of recent antibiotic use. Radiological changes were found in 40% cases. Mean duration of follow up was 33 months. Outcome was rated as satisfactory in 61%, unsatisfactory in 7% and unpredictable in 31%. Of confirmed SA cases 57% had a satisfactory outcome. The delay in the initial presentation was more than a week in all cases with unsatisfactory results.

Conclusions: Our study outlines the demographic and microbiological profile of SA of the hip in children. Diagnosis in culture negative cases can be challenging, especially with a history of recent antibiotic use. Prolonged initial delay in presentation was associated with unsatisfactory outcomes.

Effectiveness of Surgery for Acromio-clavicular joint dislocation is a controversy. Multitude of highly variable techniques and equally variable results make the choice of surgical procedure difficult. Open Reduction and Internal Fixation (ORIF) (Intra-articular) with Tension Band Wiring(TBW)and K-wire fixation and Modified Weaver Dunn(WD) Procedure (extra-articular) were the two procedures analysed in this study.

Retrospective review of case notes of patients admitted for ACJ stabilization procedure. For each patient pro-forma filled in Conducted Telephone review of the cases and obtained the long term functional out come using Oxford shoulder Scoring System. Compared the functional outcome of various surgical procedures for ACJ Stabilization with the standards

We had eighteen cases of ACJ stabilization over a period of ten years. Eleven WD reconstruction and seven ORIF with TBW. Mean age of the group: thirty-one years. 70% were males. Mechanism of injury was fall in 60%. 77% had Grade three Rockwood ACJ dislocation and rest were grade four. Reason for operative management in majority of them were pain and weakness of shoulder. Most of them had the surgery done between one month and two years from the date of injury. Four out of seven ORIFs had post op complications like wire breakage, impingement and pain. Only two out of eleven Weaver Dunn had pain post operatively. All the four ORIFs which developed post op complications had the metal work removed. Long term functional results by Oxford shoulder score has shown good result in all the patients who had telephone review irrespective of the type of procedure.

WD Reconstruction has got less post operative complications and better short term functional out come compared to ORIF. Four out of seven ORIF patients needed a second surgery for metal work removal. WD Reconstruction, being a soft tissue procedure using biodegradable materials, never required a second surgery. Long term functional results were same for both types of procedures We recommend modified WD for the following reasons: 1. Better short term functional outcome and hence faster recovery. 2. No need for a second surgery. Hence they imposes less financial burden for the hospital as well as the patient Summary: Choice of surgical procedure for Grade three and above Acromio-clavicular joint dislocation is controversial. The extra-articular soft tissue procedures have a faster recovery but long term functional results are similar to that of intra-articular ORIF procedures.