How not to miss infective causes of hip pain in children.

A referral from accident and emergency for a child with hip pain is a scenario commonly faced by orthopaedic juniors on call. The list of differentials is vast and can make assessment and diagnosis challenging, with severe consequences if diagnosis is delayed or missed. Three common causes of paediatric hip pain are septic arthritis, transient synovitis and osteomyelitis. These can all present as a child with atraumatic hip pain, irritability, fever and refusal to weight bear. Differentiating between them can be challenging. A thorough history and examination, combined with appropriate investigations and imaging, is essential. Early diagnosis and prompt treatment are key to reducing irreversible secondary sequelae of joint destruction and long-term functional impairment.

Educational e-Learning Tool to Improve Fascia Iliac Block Uptake for Neck of Femur Fracture Patients: A Multi-Disciplinary Approach.

BACKGROUND: There are 75,000 neck of femur (NOF) fractures that occur each year in England and Wales. Prompt, adequate analgesia is a major priority in hip fracture management to reduce the risk of delirium and facilitate earlier return to mobility and independence. NICE guidelines recommend the use of fascia iliaca block (FIB) for NOF fracture patients. Current literature suggests that FIB significantly improves pre-operative pain scores; however despite this, the uptake of FIB still varies between centers. OBJECTIVE: The study aimed to review pre-operative analgesia management of NOF patients in our center. The primary endpoint was to improve uptake of regional fascia iliaca block (FIB) in NOF patients by means of an educational e-learning tool. STUDY DESIGN AND METHODS: We performed a prospective review of all patients with NOF fractures admitted via the emergency department from September to October 2018 in a single district general hospital in the UK. We recorded patient demographics, time of admission, grade of physician performing block and pain scores and total FIB uptake. A multidisciplinary-led, short interventional training program of FIB administration was then developed and delivered to all relevant staff. Pain management and pain scores were recorded in a second prospective cycle along with uptake of FIB. RESULTS: There was a 53.2% reduction in pain score in the group that received FIB compared to 26.7% in patients who received oral analgesia only, consistent with current literature (p value = 0.0046). There was a significant increase (2.66x) in FIB administration by orthopedic doctors (27.3% in cycle 1 to 100% in cycle 2) after the educational session intervention. CONCLUSION: This study shows that with the use of an educational training tool, all members of the multidisciplinary team can successfully administer FIB without any complications. Our educational tool has enabled a significant increase in delivery of FIB.