Arthrography in the assessment of septic hip joints in children

Acute septic arthritis of the hip joint in the pediatric patient is an emergency in which a satisfactory outcome hinges on an early and accurate diagnosis. The diagnosis is made primarily on clinical grounds and confirmed by finding pus on aspiration of the hip joint. Failure to obtain fluid on aspiration does not rule out the presence of pus in the joint, as in a small child it is difficult to be certain that the needle is indeed within the joint. In recognition of this difficulty, arthrograms were utilized at the Aga Khan University Hospital to obtain confirmatory evidence of the intra-articular position of the aspiration needle. From February 1989 to October 1990, ten children age range from 2 weeks to 10 years, presented to the Aga Khan University Hospital with symptoms suggestive of a septic hip. Five of these had a positive tap and underwent arthrotomy and drainage. In the other five, following a negative tap, an arthrogram was performed with the aspirating needle in situ. In three of these patients the arthrogram confirmed correct position of the needle within the joint and the diagnosis of septic hip was ruled out in these patients. In the remaining two, dye injection revealed the needle tip to be outside the joint cavity. The needle was successfully repositioned in one, pus aspirated and an arthrotomy and drainage performed. In the last patient, the needle was not repositioned and the surgeon proceeded with the arthrotomy. No pus was found in the joint. If arthrography had been pursued according to the protocol this negative arthrotomy could have been avoided. Our experience indicates that arthrography is a simple technique which improves the accuracy of hip aspiration in the diagnosis of septic hip disease in the child

Supracondylar fractures of the humerus in children-an analysis of different treatment modalities at the age khan University Hospital

From October 1986 to September 1990, 50 pediatric patients aged 2 to 13 years with supracondylar fractures of the humerus were admitted to the Aga Khan University Hospital for treatment. Three patients had open fractures. Forty Seven had closed fractures. Of the latter 45 were reviewed retrospectively. Four different treatment modalities were used in this group of patients. Five patients with undisplaced or minimally displaced fractures [Gartland's type I] had satisfactory end results with plaster splint immobilization without manipulation. Twenty patients with displaced fractures [14 Gartland's type II and 6 type III] were treated with closed manipulative reduction and immobilization with a plaster splint under general anaesthesia. Of these, nine [45%] had an initial anatomical reduction but healing of the fracture in that position occurred only in 5 patients [25%]. The remaining 13 patients [55%] had some radiological deformity at the conclusion of healing, but a significant cosmetic defect [a change of the carrying angle leading to cubitus varus of 5 - 15 degrees] was noted in only 5 patients [25%]. Ten patients with severely displaced fractures [Gartland's type III] required open reduction and internal fixation because of failure of closed reduction under general anaesthesia. Two patients [20%] had a significant change of the carrying angle of the upper extremity - a loss of nine degrees of carrying angle in one and cubitus varus of 4 degrees in the other. From January 1990 ten consecutive patients with severely displaced supracondylar fractures [one Gartland's type II and 9 type III] were treated by closed reduction with percutaneous pin fixation. An anatomical reduction was obtained and maintained in all patients without any complications. This method has been adopted as the method of choice at the Aga Khan University Hospital and a protocol has been established for its use. A detailed description of the operative technique is provided