ABSTRACT
Bilateral hip involvement in Legg-Calvé-Perthes disease occurs in approximately 10-13% of cases. Although both synchronous and metachronous involvement of the two hips have been described, metachronous involvement is rare and generally occurs within 6 months to 4 years of initial diagnosis. We report the cases of two patients diagnosed with late metachronous involvement of the contralateral hip 8.5 and 9.8 years after initial presentation. This is later than previously reported metachronous involvement in Legg-Calvé-Perthes disease and emphasizes that patients with Legg-Calvé-Perthes disease may be at prolonged risk for recurrent disease.
Subject(s)
Legg-Calve-Perthes Disease/pathology , Child, Preschool , Female , Hip Joint/diagnostic imaging , Humans , Legg-Calve-Perthes Disease/diagnostic imaging , Male , Radiography , Recurrence , Time FactorsABSTRACT
Sixty children younger than 3 years with culture-positive hematogenous septic arthritis and acute/subacute osteomyelitis treated between 1990 and 1995 were reviewed to identify the infecting organism. Gram-positive bacteria were identified in 47 (78.3%) patients, and gram-negative organisms were identified in 13 (21.7%) patients. Haemophilus influenzae was cultured in none of the cases of septic arthritis and in only one (1.6%) case of acute osteomyelitis. Kingella kingae was cultured in 10 (16.7%) cases, with all of these patients between the ages of 10.5 and 23.5 months. Routine immunization of infants against H. influenzae has caused a change in the historically reported bacteria of bone and joint infections in children younger than 3 years. Haemophilus influenzae has lost its predominance as the most commonly identified gram-negative pathogen, and in this study, has been replaced by K. kingae.
Subject(s)
Arthritis, Infectious/epidemiology , Arthritis, Infectious/microbiology , Kingella kingae/isolation & purification , Neisseriaceae Infections/epidemiology , Age Factors , Anti-Bacterial Agents/therapeutic use , Arthritis, Infectious/diagnostic imaging , Arthritis, Infectious/drug therapy , Child, Preschool , Escherichia coli Infections/epidemiology , Female , Gram-Negative Bacteria/isolation & purification , Haemophilus Infections/epidemiology , Haemophilus influenzae/isolation & purification , Humans , Infant , Male , Neisseriaceae Infections/diagnosis , Prevalence , Radiography , Retrospective Studies , United States/epidemiologyABSTRACT
Correct guidelines for the initiation and evaluation of brace treatment in adolescent idiopathic scoliosis are dependent on a thorough knowledge of the condition's natural history. Recently acquired data from school children screening programs and long-term follow-up studies of idiopathic scoliosis have added new insight to the natural history of the condition. This new information has raised questions concerning the validity of previous treatment guidelines and has led to changes concerning patient selection and indications for brace initiation, type of spinal orthotic used, duration of brace treatment, brace-wear programs, and anticipated results from bracing. Proper application of this new knowledge allows the physician to avoid overdiagnosis and overtreatment and to become more efficient in the use of spinal orthoses.
