The conservative management of primary pyomyositis abscess in children: case series and review of the literature.

Pyomyositis is a primary pyogenic infection in skeletal muscle, often progressing to abscess formation. It is rare in temperate climates and generally deep-seated within the pelvis with non-specific clinical features, making diagnosis difficult. Magnetic resonance imaging (MRI) is highly sensitive for muscle inflammation and fluid collection, and with its increasing availability is now the investigation of choice. Treatment of pyomyositis abscess has traditionally been with incision and drainage or guided aspiration followed by a prolonged course of antibiotics, although there are sporadic reports of cases treated successfully with antibiotics alone. Our aim was to describe our own experience with the treatment of pyomyositis abscess in children. From our 20-year database of over 16,000 paediatric orthopaedic admissions, we identified only three cases with MRI-confirmed pyomyositis abscess. These were all in boys (aged 2-12 years) and affected the gluteal, piriformis and adductor muscles. Despite the organisms not being identified, each patient was treated successfully with a short (4-7 days) course of intravenous antibiotics followed by 2-6 weeks of oral therapy. There were no recurrences or complications and all made a full recovery. In conclusion, we propose that uncomplicated pyomyositis abscess in children may usually be managed conservatively without the need for open or percutaneous drainage.

Metacarpophalangeal joint dislocation of the thumb in children.

There are few reports describing dislocation of the metacarpophalangeal joint of the thumb in children. This study describes the clinical features and outcome of 37 such dislocations and correlates the radiological pattern with the type of dislocation. The mean age at injury was 7.3 years (3 to 13). A total of 33 children underwent closed reduction (11 under general anaesthesia). Four needed open reduction in two of which there was soft-tissue interposition. All cases obtained a good result. There was no infection, recurrent dislocation or significant stiffness. So-called 'simple complete' dislocations that present with the classic radiological finding of the joint at 90 degrees dorsal angulation may be 'complex complete' injuries and require open reduction.

Open tibial fractures in children under 13 years of age--10 years experience.

OBJECTIVE: To evaluate the results of treatment in children with open tibial fractures. DESIGN: Retrospective review. SUBJECTS: Eighty three children under 13 years of age treated for an open tibial fracture between 1989 and 1999. MAIN OUTCOME MEASURES: Patient demographics, mechanism of injury, fracture classification, treatment method, clinical outcome and complications. RESULTS: Eighty one percent of children had an open tibial fracture as their only injury. According to the level of contamination, soft tissue injury and size of wound 46% were Gustilo grade I injuries, 30% grade II, and 22% (18) grade III (6 IIIa, 5 IIIb, 3 IIIc and 4 not otherwise specified). Sixteen fractures (19%) were treated using an external fixator and 65 (78%) using a cast. The average time to union was 15.5 weeks (range 9-31 weeks) for those treated with a frame and 10.4 weeks (range 5-40 weeks) for those treated with a cast. No deep infections, one delayed union and one non-union were recorded. CONCLUSIONS: Ninety four percent of these injuries were a result of a motor vehicle accident and involved a significant trauma-related energy transfer. Despite this the associated morbidity was low lending support to the literature, which suggests that open fractures of the tibia in younger children heal more predictably and with less complications than those occurring in adolescents or adults.

The Art of Reason versus the Exactness of Science in Elite Refereeing: Comments on Plessner and Betsch (2001).

Plessner and Betsch's (2001) investigation into officiating behavior may be representative of a shift from stress-oriented research (Anshel & Weinberg, 1995; Rainey & Winterich, 1995; Stewart & Ellery. 1996) to consideration of decision-making (Craven, 1998; Ford. Gallagher, Lacy, et al., 1999; Oudejans. Verheijen, Bakker, et al., 2000), the primary function of referees in any sport. Commendably, Plessner and Betsch have investigated the most important focus of referee performance, the application of the rules (Anshel, 1995). However, methodological weaknesses, together with a fundamental error in the attribution of causation to the findings, significantly dilute the paper's contribution to extending knowledge in this important area.

Comparison of conduct-disordered behavior in crack-dealing versus nondealing juvenile offenders.

Currently, little research has investigated psychosocial functioning among juvenile crack dealers, and there appear to be few studies comparing dealers to nondealing juvenile offenders. The current study examined whether juvenile crack dealers display more severe conduct-disordered behavior than their nondealing delinquent peers. The records of 130 adolescent males committed to a residential training school were studied. Analyses indicated that crack dealers were younger when first arrested, had more arrests and commitments, and met more DSM-III-R conduct-disorder criteria than their nondealing delinquent peers. In addition, the DSM-III-R conduct-disorder criteria met by dealers were more severe, and dealers were more likely to be rearrested within six months following release. Overall, significant differences between crack dealers and nondealing juvenile offenders were found; dealers displayed a more delinquent history and a more serious and violent conduct disorder than their nondealing yet delinquent peers.

Congenital convex pes valgus.

Congenital convex pes valgus (congenital vertical talus) is a rare condition. We reviewed ten feet in seven patients who had had surgical correction. All had been operated on by the senior author (JF) and the same surgical technique was used throughout, incorporating transfer of the tibialis anterior to the neck of the talus. The mean age at surgery was 31 months and the mean follow-up was nine years (6 to 14). All patients completed a questionnaire and had clinical, radiological and photographic evaluation performed by an independent examiner. None had required further surgery. All but one were satisfied with the result, and had no functional limitations. They all wore normal shoes. The mean ankle dorsiflexion was 17 degrees and plantar flexion 21 degrees. The mean arc of subtalar motion was 27 degrees. All radiological parameters measured were within the normal range, although irregularity of the talonavicular joint was common. No avascular necrosis of the body of the talus was seen. We conclude that the medium-term results of this procedure are very satisfactory.

The measurement of three dimensional scapulohumeral kinematics--a study of reliability.

OBJECTIVE: To validate a system, using electromagnetic movement sensors, for the simultaneous measurement of scapular and humeral positions. DESIGN: The study was designed to analyse the repeatability and to quantify the inherent measurement errors, using two observers to measure the movements of five normal subjects. BACKGROUND: Following an earlier study of a system to measure three dimensional scapula motion, the method has been developed to incorporate simultaneous measurement of humeral and scapular position using a new design of scapula locator and a two-channel measurement system. METHODS: The system was used to measure the scapula movements accompanying abduction of the shoulder. The scapula locator was applied at 10 degrees intervals of abduction. This was measured initially using a fluid filled goniometer, but, in a second part of the study, using an additional motion sensor. RESULTS: In the single channel study, the 95% confidence intervals were less than 4 degrees and 10 mm. When simultaneous measurement of arm position was performed the confidence intervals were little changed. CONCLUSIONS: A new system for the measurement of scapulohumeral relationships has been shown to have good inter-and intraobserver reliability. This study opens the way for a full investigation of the scapula motion accompanying three dimensional shoulder motion in both normal subjects and in patients having shoulder pathology.

Childhood physical assault as a risk factor for PTSD, depression, and substance abuse: findings from a national survey.

A national sample of adult women was screened for a history of serious physical assault in childhood, major depressive episode, post-traumatic stress disorder, and substance abuse. Approximately 2.6% reported having experienced serious assaults in childhood, with fathers and stepfathers identified as having been the most frequent offenders. Compared to women reporting no such victimization, these women experienced more lifetime and current episodes of depression, post-traumatic stress, and substance abuse.