The incidence of joint involvement with adjacent osteomyelitis in pediatric patients.

Sixty-six patients admitted to our institution over an 8-year period with the diagnosis of osteomyelitis were analyzed to determine the incidence of adjacent joint involvement. Patients with osteomyelitis of the hand, foot, spine, and extraarticular pelvis were excluded from this study. The average age was 5.8 years (range, 1 month to 17 years). Forty-two percent of our patients who had osteomyelitis had evidence of adjacent joint involvement (either septic or nonseptic). One third of our patients had evidence of septic joint involvement. The most commonly involved joint was the knee. There was no difference in the incidence of adjacent joint involvement in those patients who were younger than 18 months compared with the incidence in older children. Our study suggests that the incidence of adjacent joint involvement in children who have osteomyelitis is higher than that suggested in the literature. We believe that careful evaluation of the adjacent joint should be an important part of the evaluation of any child who has osteomyelitis.

Ankle fusion in a high risk population: an assessment of nonunion risk factors.

Between July 1992 and April 1996, 88 ankle fusions were performed at our institution. Sixty-seven of these had adequate follow-up for evaluation for union of the fusion, including adequate records and/or radiographs. The average age of patients was 43 years. There were 37 men and 24 women. The charts were reviewed to determine what level of trauma had resulted in posttraumatic arthritis (low energy, high energy, or open fracture). Alcohol use, drug abuse, diabetes, peripheral vascular disease, psychiatric history, smoking, or technical problems were also assessed. A chi-square analysis was used to evaluate the statistical significance. Nineteen of sixty-seven ankle fusions progressed to nonunion (28%). Eighty-five percent of the patients had posttraumatic arthritis. Among 17 patients with a history of open trauma, nine patients developed a nonunion (P < 0.03). A trend toward significance was noted for patients who were smokers, drank alcohol, had diabetes, had a psychiatric disorder, or used illegal drugs. Even with current techniques, this study demonstrates that a high risk population in a trauma center is at risk for nonunion after an ankle fusion caused by multiple risk factors, including a history of open trauma, tobacco use, alcohol use, illegal drug use, a history of psychiatric disorders, or diabetes.

The mushroom femoral head. A radiographic investigation.

RATIONALE AND OBJECTIVES: In 1913, anthropologist Ales Hrdlicka described a number of femora as having "mushroom heads," a deformity he attributed to arthritis deformans. The authors have attempted to define the cause of this condition. METHODS: Forty of 41 femora with "mushroom" femoral heads collected by Hrdlicka were grossly inspected and examined with plain radiographs and with computed tomography. Femoral neck angulation and degree of anteversion were determined. RESULTS: Three distinct categories were established: group I, those specimens with normal angulation and short femoral necks; group II, those with varus angulation and short femoral necks; and group III, those with normal-sized femoral necks and normal femoral neck angulation. No correlation was found between degree of anteversion and the categories. Additionally, most of the mushroom deformities were related to osteophyte formation. CONCLUSIONS: Most of the changes in the femora were the result of osteoarthritis. Two groups showed evidence of growth disturbances that occurred early in life. The changes in the second group were similar to those seen in Legg-Calvé-Perthes disease.

Incidence of stress ulcer formation associated with steroid therapy in various shock states.

The use of pharmacologic doses of steroids early in the shock state, within the first hour when possible, for periods of less than forty-eight hours seems to reduce the incidence of gastric ulceration and hemorrhage in low flow states associated with septic, cardiogenic, and hemorrhagic shock.

Surgery and acupuncture analgesia.

In this paper are presented three case reports on the use of acupuncture as the sole means of intraoperative analgesia. The authors also discuss the present status of the possible indications, contraindications, advantages, disadvantages and future indications for its use. It also shows that the term anesthesia is a misnomer for this modality, and that it should be called acupuncture analgesia.