Musculoskeletal manifestations of Lyme disease in children.

Lyme disease, caused by a tick-transmitted spirochete, has significant musculoskeletal manifestations in children as well as in adults. A series of 23 children with Lyme disease is examined. Acute arthritis was present in five cases, with the knee being involved in three of these cases. Twelve cases (52%) presented with arthralgias, and 10 cases (43%) presented with myalgias. Neurological manifestations were present in 39% of the cases. Five cases have demonstrated recurrent polyarthralgias. Lyme disease should be considered in the differential diagnosis of arthralgias and arthritis in children.

Bilateral habitual hip dislocation in a child with Down's syndrome: a case report.

Habitual dislocation of the hips occurred in a 3-year-old girl with Down's syndrome. Dislocations were bilateral and recurrent. This condition seems not to have been reported previously. No treatment was permitted by the family. Capsular plication, femoral or pelvic osteotomy could become necessary in the future.

Source of Pseudomonas in osteomyelitis of heels.

Pseudomonas aeruginosa is the most common cause of osteomyelitis following puncture wounds of the feet of children. The source of the initial inoculum is unknown. Only one strain of P. aeruginosa was cultured from paired samples of the heel or corresponding shoe's surface or both obtained from 100 children. Neither the skin of the heel nor the shoe appears to be the source of the initial inoculum.

Dynamic gait electromyography study in Duchenne muscular dystrophy (DMD) patients.

Preoperative and postoperative dynamic gait electromyography (EMG) weas performed on 15 patients 8 to 13 year of age with Duchenne's muscular dystrophy who underwent Achilles tendon lengthening and posterior tibial tendon transfer anteriorly through the interosseous ligament for correction of equinus and equinovarus foot deformities. The muscles tested preoperatively (anterior tibial, soleus, gastrocnemius, posterior tibial, peroneal longus, and peroneal brevis) showed phase changes. It is believed that patients with weakened leg muscles fire multiple muscle groups out of phase in an attempt to overcome the action of the stronger muscles, thus stabilizing the limb for ambulation. Postoperative EMGs, performed with the patients walking in long leg braces after the deformity had been corrected, showed little activity in the muscles tested. As the patients became dependent on the brace, the need for the muscles to be active out of phase was eliminated. The transferred posterior tibial muscle appeared to be active both clinically and electromyographically.

Operative treatment of spine deformity in osteogenesis imperfecta.

There has been little mention in the literature of scoliosis associated with osteogenesis imperfecta. The purpose of this study was to investigate the problem of spine deformity in a series of osteogenesis imperfecta patients and to review the operative treatment of 8 patients. A series of 49 patients (ranging in age from 8 months to 57 years, average 12 years) with osteogenesis imperfecta were studied. Thirty-five (71%) of these patients had scoliosis ranging from 7 degrees to 105 degrees (average 42 degrees). The more severely involved patients (OIC and OITI groups) demenostrated a higher incidence (80%) of scoliosis and a greater average degree of curvature (42 degrees) as compared to the mildly involved (OITII) group with a 50% incidence of scoliosis with an average curvature of 26 degrees. Attempts to control these curves by bracing have been difficult and usually had to be abandoned. Eight of these patients underwent spine stabilization in an attempt to control curve progression. All 8 patients had posterior spine fusions. One of these patients had an anterior fusion preceding the posterior fusion because of a significant kyphotic deformity. Harrington instrumentation was used in 5 patients. One patient could not be instrumented secondary to severe osteoporosis while the remaining 2 patients were treated by the Risser technique. Postoperatively, either cast or brace protection was used. Only minimal improvement in the curves was achieved. Spine stabilization rather than curve correction is the goal of spine fusion in osteogenesis imperfecta. An important finding was that there was no change in the pre- and postoperative activity and ambulatory status in these patients. Preliminary follow-up (9-12 months) in all 8

Hypercalcemia of immobilization in neurologically injured children: a prospective study.

Seven of 20 consecutive admissions to the Children's Head Injury and Spinal Injury Services of the Rancho Los Amigos Hospital demonstrated hypercalcemia ranging from 10.7 mg % to 13.2 mg %, with an average of 11.4 mg % (normal range 8.5 mg-10.5 mg %). Return to normocalcemia coincided with mobilization in five of the seven patients. Four patients in the series developed heterotopic ossification; two of these demonstrated concurrent hypercalcemia. This association has not been previously reported. This study has helped to clarify the clinical suspicion that hypercalcemia of immobilization occurs more frequently than is suggested in the literature. Elevated alkaline phosphatase levels are associated with heterotopic ossification. The role of hypercalcemia in the development of heterotopic ossification remains speculative.