Morbidity associated with anterior iliac crest bone graft harvesting in children undergoing orthopaedic surgery: a prospective review.

PURPOSE: Autologous iliac crest bone grafting is an integral part of many orthopaedic surgical procedures. Several studies have documented morbidity and prolonged pain following iliac crest bone graft harvesting in adults; however, in children there is a paucity of information. The purpose of the present study was to quantify the degree of pain and morbidity associated with anterior iliac crest graft harvesting in children undergoing non-spinal orthopaedic surgery. METHODS: Patients were prospectively enrolled prior to orthopaedic surgery. A patient self-reported visual analogue score was used to record pain at specified time points following surgery. In addition, the patients were reviewed at 2 and 6 weeks, 3 months and 1 year after surgery to record any complications. RESULTS: Data was collected on 33 patients (34 graft sites). Only one patient (2.94 %) had a complication, namely an injury to the lateral femoral cutaneous nerve. This resolved 3 months after surgery. 89 % of patients had no pain at the iliac crest graft harvest site 3 months after surgery. The three patients who had pain at 3 months had visual analogue scores of 1.0, 1.1 and 1.3, respectively. CONCLUSION: This series reveals a very low complication rate and minimal iliac crest graft harvest site pain in children undergoing non-spinal orthopaedic surgery. In addition, the pain experienced is short-lived.

Scarf osteotomy for hallux valgus. A prospective clinical and pedobarographic study.

We prospectively reviewed 24 patients (35 feet) who had been treated by a Scarf osteotomy and Akin closing-wedge osteotomy for hallux valgus between June 2000 and June 2002. There were three men and 21 women with a mean age of 46 years at the time of surgery. The mean follow-up time was 20 months. Our results showed that 50% of the patients were very satisfied, 42% were satisfied, and 8% were not satisfied. The mean American Orthopaedic Foot and Ankle Society score improved significantly from 52 points pre-operatively to 89 at follow-up (p < 0.001). The intermetatarsal and hallux valgus angles improved from the mean pre-operative values of 15 degrees and 33 degrees to 9 degrees and 14 degrees, respectively. These improvements were significant (p < 0.0001). The change in the distal metatarsal articular angle was not significant (p = 0.18). There was no significant change in the mean pedobarographic measurements of the first and second metatarsals after surgery (p = 0.2). The mean pedobarographic measurements of the first and second metatarsals at more than one year after surgery were within the normal range. Two patients had wound infections which settled after the administration of antibiotics. One patient had an intra-operative fracture of the first metatarsal and one required further surgery to remove a long distal screw which was irritating the medial sesamoids. We conclude that the Scarf osteotomy combined with the Akin closing-wedge osteotomy is safe and effective for the treatment of hallux valgus.

Triplane fractures of the distal tibia requiring open reduction and internal fixation. Pre-operative planning using computed tomography.

Computed tomography (CT) of triplane fractures provides useful information not available on conventional radiographs. Knowledge of the size and position of displaced fragments, the location of the intra-articular fracture and any associated articular incongruency is useful when undertaking pre-operative planning.A postal survey of surgeons revealed only 38% always requested CT scans before undertaking open reduction and internal fixation of displaced triplane fractures. Examples of the usefulness of CT scans in pre-operative planning is presented in two cases.

Acute carpal tunnel syndrome as a complication of oral anticoagulant therapy.

Acute carpal tunnel syndrome is well recognized in patients with haemophilia and conservative management with factor replacement and temporary splinting is recommended. There have, however, been very few reported cases of acute carpal tunnel syndrome as a complication of oral anticoagulant therapy. We describe such a case in a patient on long-term warfarin anticoagulation, drawing attention to particular features of the history and clinical findings. In contrast to previous reports, we recommend prompt decompression under local anaesthesia and continuation of the anticoagulant therapy.

Unilateral lower limb hypoplasia in arterial fibromuscular dysplasia.

Hypoplasia or hyperplasia of limbs can be unilateral or bilateral and can involve the upper or lower extremities in any combination. The etiology is varied, and the presentation, clinical features, and investigative pathway differ to some extent among patients. Reported here is a child, referred for limb lengthening, with claudicating unilateral leg pain and unilateral hypoplasia of the same limb. Investigations revealed multiple arterial stenoses consistent with fibromuscular dysplasia. In such cases, early diagnosis and intervention with angioplasty may enhance subsequent growth of the limb, thus avoiding the need for limb lengthening procedures.

Comparative and multilaboratory studies of two immunodiffusion method enrichment protocols and the AOAC/Bacteriological Analytical Manual culture method for detection of Salmonella in all foods.

The single enrichment immunodiffusion (1-step), the preenrichment and selective enrichment immunodiffusion (2-step), and the AOAC/Bacteriological Analytical Manual culture methods for Salmonella were evaluated for equivalence in 2 separate studies, a comparative evaluation and a multilaboratory dilution study. In the comparative study, all 3 methods were performed on 10 food types. For 550 samples, analyses resulted in 99.3 and 99.6% agreement between the culture method and the 1-step and 2-step methods, respectively. False negative rates were 0.9 and 0.3% for 1-step and culture, and 0.0% and 0.6% for the 2-step and culture, respectively. Subsequently, 6 food types were included in a multilaboratory dilution-to-extinction study. A sequential dilution series of Salmonella in foods was analyzed by the 3 methods to determine their lower limits of detection for Salmonella. A total of 1185 samples analyzed resulted in 98.9% agreement between 1-step and culture, and 99.7% agreement between 2-step and culture. False negative rates were 1.8 and 0.1% for 1-step and culture, and 0.4 and 0.1% for 2-step and culture, respectively. During these evaluations, 1735 samples and controls representing 10 different naturally contaminated and inoculated foods were tested. The data indicate statistical equivalence of all 3 methods when analyzing all food types.

Tibial tuberosity excision for symptomatic Osgood-Schlatter disease.

A modified Ferciot procedure was used to excise the tibial tubercle in patients with persistently symptomatic Osgood-Schlatter disease. Forty-two knees in 35 patients were reviewed at a mean follow-up of 5 years to assess outcome. The results revealed relief of pain in 95% of patients and reduction of prominence in 85.5% with minimal complication, in particular no evidence of genu recurvatum. The pathogenesis of the condition is outlined, and some of the theories and treatment modalities discussed. Tibial tubercle excision is recommended as the treatment of choice in those few cases that fail with conservative treatment.

Brachial neuritis after human parvovirus B19 infection.

This case report presents the clinical picture of a patient with brachial neuritis who was investigated and found to have infection with human parvovirus B19. The clinical presentations and prevalence of human parvovirus infection are discussed, as is the prognosis for brachial neuritis. It is recommended that viral serologic testing, including that for human parvovirus, be carried out in cases of brachial neuritis. (J Shoulder Elbow Surg 1993;2:321-3).

A comparative study of the disease in cattle caused by Theileria parva or T. lawrencei: II. Hematology, clinical chemistry, coagulation studies and complement.

Theileria lawrencei tick-derived stabilate infection of 8 cattle resulted in the development of panleukopenia and hypoproteinemia. In addition to these changes, T. parva infection caused mild normocytic, normochromic, non-responsive anemia at either of two dose rates. Disseminated intravascular coagulation, as indicate by positive protamine paracoagulation tests, prolonged prothrombin and partial thromboplastin times, and thrombocytopenia, developed in cattle infected with either of the Theileria spp., and was probably an important intermediary mechanism leading to death. Infection of calves with a high dose of T. parva stabilate resulted in more rapid onset of clinico-pathologic changes than did the low dose infection. Theileria lawrencei infection produced a severe, acute syndrome, the clinico-pathologic alterations of which varied in time of onset and severity between those of the T. parva high dose and low dose groups.

The demonstration of maedi/visna virus in sheep in Great Britain.

A virus indistinguishable from that causing maedi/visna has been isolated from a sheep flock in Great Britain. The virus was identified in cell cultures using immunofluorescent and electron microscopical techniques. The complement fixation test and the agar gel immunodiffusion test were used to assess the proportion of serological reactors within the flock. There has been no evidence of clinical disease in the flock into which foreign imports were introduced in the years prior to 1976.